6/24 Henry's ongoing saga AMPS 317 +1.5 308 +2.25 313 +3 336

Wasn't sure what to put in the title since we have no AMPS yet. Here's the old thread for anyone following along.

Thank you everyone for all your help. Tagging people so they can find the new thread @Liz & Minnie @Sandy and Black Kitty @Lisa & Oberon @Wendy&Neko @FrostD @tiffmaxee @Bron and Sheba (GA)

I added the "R sheet" from Minnie's SS. We're 20 minutes to AMPS and need to figure out dosing for both R and Lantus. Wendy suggested 1.75U Lantus and .1U if over 300 and .25U if over 350. That sounds reasonable to me, but what do I know?? Love everyone thoughts

 

This is so weird. According to the Nova the BG is DECREASING! WHAT? It went from 350 to 294 to 287 just now? Could his bodys own insulin be causing this drop? Guess I'm really glad its not going higher. libre is showing 328. so at +11.75 we're at 287 (nova) 328 (libre)

 

8 minutes to shot time. 1.75U Lantus? .1U R? no R?

 

I just got home. I need to do a lot of reading. I’ll be back.

 

Awesome! Thank you!

 

So I read last night in lab tests on the Nova max was within 9.5%. The FDA allows up to 20%. But yeah, I'm really questioning the accuracy of the meter(s)

edit: and so did my vet in her most recent e-mail this morning. She'd like me to bring in my meter(s) next time I'm in so I can compare them to their lab meters. She was as confused with what happened last night as we are.

 

See what Elise says, she is so much more experienced...but, if it were me I would stick with Wendy's suggestion 1.75L and, if he's below 300 at shot time, so be it. No R. Try and get a blood ketone reading at shot time too. Then sit tight and monitor til midcycle/nadir, if it's over 300 at that point then top up with R.

I was going crazy with meters. I started with Freestyle lite because I liked the strips and the small drop of blood but was going crazy trying to get good prices on EBay so I finally switched fulltime to Novamax. I noticed that the Freestyle would give scary limes (30s!) and she had no symptoms other than hungry and Novamax would give 60s/70s on same blood drop. Similarly the Novamax would give pinks where the Freestyle give yellows. Also with both meters I can get "off" readings if I don't get enough blood in one go - enough to avoid error codes, but the BG would be weird. Re-check is the answer but all to often I get panicked by the reading (even though that's the first rule, 'don't panic') and forget the extra reading.

So....I feel the monitors are a useful tool but I 'try' to remember it's just that and not get too worked up. So much easier said than done, especially when you don't have months of data on your s/s to look back at!

 

That is actually very helpful information! Thank you. I had no idea the blood volume could throw it off, but it makes sense! The only "signs" of hypo I've seen in Henry is he'll occasionally twitch every once in awhile for a few seconds, but only while he's sleeping.

 

Did you get another test? I too think 1.75 should be safe. I should put should be in quotes.

 

For when you start using R - sorry my R tab is so complicated, I tend to overwork spreadsheets! The R scale is over on the right. columns S - U.
column 1 - BG range
column 2 - R dose at shot time
column 3 - R dose at midcycle

You'll want to put different numbers in for Henry based on Wendy's suggestion, so
>350 0.25u
300-349 0.1u
<300 0u

I'd probably start with the same doses for the midcycle. As you learn how he responds, you'll make new tables. I used black kitty's as a template.

We are looking for the right R dose that brings a BG drop of around 100.

You want to give R when you can be around to monitor for 4 hours afterwards (or perhaps even longer when you're first learning how Henry responds, especially given last night's shenanigans). This is how my R tab ended up so complicated, I wanted to track how she responded at different L dose, R dose, BG and ketones and hopefully find a pattern though as I said before, my conclusion was that it's R roulette. Could not find a pattern!

Eagerly awaiting his ( ? ) AMPS reading!

 

Just did one. 376 on the libre. 317 on the nova max and .4 ketones. 1.75 sounds good to me. we're over 300. should I try .1U R too?

edit: the libre number was off A LOT, just correct it from 2 something to 376

 

Alright 1.75U has been administered.

 

I’ve had cats twitch and it had nothing to do with fd.
I’m not in any way experienced with R unfortunately. @Liz & Minnie What do you think?

 

Time to pick a meter and stick with it. The other meter can be a double-check.

If it were me, I would go with the guidance (hardest thing to do, not second guess!) - 0.1u R and make sure you're monitoring at least every hour. i.e. follow the Novamax. You can still read the Libre but base your dosing on the Novamax.

 

I've been using the Nova max as my main guide and the libre as a backup. I agree with the .1U R.. so scared of the ketones. OK, time to put my .1U measuring abilities to the test. (I've been practicing a lot last night with Gatorade)

 

Alright official AMPS is 317. 1.75U Lantus + .1U R given. Thank you @Liz & Minnie & @tiffmaxee & @Wendy&Neko

I'll be monitoring closely

 

Looks like you are in good hands here with Liz. She’s an experienced R user. I found that I didn’t always get a consistent response to the same R dose (Liz’s R Roulette). Hopefully Henry’s tiny dose will help and he will be consistent.

 

And you will post the hourly BGs here? I hope.

 

Meters can be confusing, especially in the early days when you’re short on data and putting so much stock into each reading. And with what you’ve been through already? Shaking head.

I did a couple of things to give me a “reality check.” First, I tested one of my non-diabetic cats just to verify that the meter was likely working properly (a non-diabetic should be in “normal” range, right?). I also had a backup meter(s) just in case I needed a second (or third) “opinion.” It’s not the exact value that matters, just a general feel for how the BG is trending and what constitutes “low” on your meter. Some meters run higher/lower than others. And yes, I’ve seen wonky readings with too much/too little blood, so if in doubt, re-test. I also ran double tests whenever switching batches of test strips (last strip from old vial vs a strip from the new vial).

The other thing to know is that anemia can cause glucometer readings to be “off” although I don’t see that as one of Henry’s issues so I won’t go into the weeds on that.

I was following along last night and am very glad you got Henry up out of those lower numbers. “R” is a powerful and potentially dangerous insulin (I used it on two of my three diabetics) so I’m very glad you were testing and on top of keeping him safe. I’m not thrilled with the vet giving a whopping 0.5u of R without previous data and then discharging Henry. I don’t get the sense the vet understood what risk that might present.

When do you expect the results from TAMU on the fPLI/fTLI/folate/cobalamin? That might be helpful information.

Oh, and you have a very powerful tool in your dog. She might be your early warning system going forward. (What’s her name?)

 

I will. My Laptop screen just picked the worst time to die. Getting my backup up and running.

 

This is so helpful. No he isn't anemic luckily. Vet did send me some results this morning but I don't think they included the fPLI/fTLI/folate/cobalamin. I'll post what she sent when I get my laptop back up. My GSDs name is Penny and she hasn't been doing the excessive sniffing that she had been when he had ketones so yeah, I think it's a very helpful metric. Thank you JL

 

Oh, something else I picked up - I mark in the s/s when I dose R (so in the cell where you have 317 I also would write 0.1 R, then manually change the color of the cell). As I said, I am a bit overkill with my s/s so I also put a lime green border around the cell to make it easy to spot. You don't have to do it, could just put it in the remarks and I know you're already tracking in the other R tab - I just found it easier to have the R's in the main s/s itself.

Crossing paws for the first reading! If you see he is dropping a lot in the first hour (say 100) I would give some higher carb food. You want to slow that drop and don't want him dropping more than 100 in the 4 hours. That's not just an R thing, others can probably chime in with tips on that too, but after last night you're already a pro.

 

How is he eating now/this afternoon? I'm happy the last ketone test was .3 -- any more since then?

 

I always did, too, write the R dose in the same cell indicating the hour that it was given. Sometimes it was at pre-shot, sometimes mid-cycle, as long as I was around to monitor for the next several hours. It's just too difficult to slide the SS all the way to the right and try to figure out when the R was given and at what BG level it was when it was given, etc. Also, I added a column specifically for ketones.

 

So for today, I would write 1.75 L and .10 R into the cell. Good idea Liz has for the border color.

 

Henry is famous, I went to check his spreadsheet and there's anonymous dingo, goose, otter, crow and wolverine looking too . Too early to tell how well the R is working but it's in the right direction at least and confirms the R was the right decision! I'm sure you're doing this already, but I'd make sure there's plenty of water mixed in with his food. Minnie only drinks water when her BG is high for a while, but she always takes whatever I mix in with her food.

I have to run out to do some errands - will have my phone but not checking here as frequently. But, you are in many many good hands. There's nothing special for you to do about the R now, just wait and monitor. Crossing paws for you!

 

I want to be a dingo maybe? I am one of those anonymous animals looking at Henry's spreadsheet, I confess.

 

Finally got my other laptop dusted off and updated. Now I gotta get used to it again. I can't move as quickly with this keyboard, scroll speed, etc...
So we're at AMPS +1 we're reading 308 (nova) and 397 (libre) (I'm following the nova as my "guide")

Done, but the boarder isn't easy to see, even when bolded unfortunately.

Good idea, just did that. Thank you

Last ketone test was .4 at AMPS, I'll add it to the SS

He downed a whole can of FF about 3 hours ago, and he's always begging for more. I find that if I don't leave food out for him all the time, he's more likely to eat everything I give him.

 

Not too much movement in the first hour. I never did get much in the first hour (but my cat was unique) either. Waiting now for +2.... (cue Jeopardy music).

 

Ha!, I've been watching those little animals constantly. Henry's got his own exotic zoo! He hasn't been drinking much. The high BG/ketones definately make him want to drink constantly. We got some subQ fluids on deck for tonight tho. I'll try mixing in the water with the food and see how that goes.

Thank you Liz, really appreciate all your help!

Glad to hear that. I was hoping for a bigger move. Next check isn't too far away for fingers crossed.

 

Still very little movement in BG. Grrr. Frustrating. I'm sure you will start to see some downward movement soon.

 

Yes, was just coming to comment that. +2.25 313 (nova) 370 (libra) ... Looks like we should have given a bit more R. Henry just finished his second can of fancy feast (in about 5 minutes). His belly feels so full. I just wish he could migrated some of that to his bones. Hope we see some movement soon and the ketones are minimal being just over the 300 mark. +3 check in 30 minutes. Hopefully we see the Lantus work its magic. I gotta close my eyes for a minute. I'm not sure I even fell asleep last night, maybe got an hour or two. Got my alarm set for 30 minutes!

 

Oh I hope you wake up with your alarm. I wish there was a way we could prod you awake if we don’t hear from you

 

I just envisioned some sort of system where you can shock me over the internet lol.

So not looking good. Nova is 336 @ +3 and libre is reading HI. so too high to be read So we're not getting any help from the Lantus. This is like what happened right before he went in the hospital when 2U of Lantus did almost nothing. Frustrating. When can we use more R? Not til +6? I can feel the ketones building. I'd much rather deal with hypo which can be fixed with some corn syrup.

 

Right. Can’t do any more R yet. Sorry about the numbers. See you in an hour?

 

Yep. Thanks for the reply.

 

So interesting thing here. First test I did with the nova read 266 but the libre was still reading HI. So I opened a now box of strips and the second reading from the nova was 342! Quite the difference! stupid meter! So we're still getting outta control. The dog has sniffed his mouth atleast 3 times in the past few hours. My K9 ketone meter is lighting up. I feel we gotta do something soon!

edit: He's also not acting as "bright" as he has been since he's been back just in the last few hours. I wouldn't saw lethargic, maybe he's just being a typical cat (he went and got in my bed around 8am this morning, like "Enough with the pokes papa, its bed time already!"

 

Praying things level out and you get some rest. You're doing a great job by the way, as well as you're in the midst of good helpers!

 

Have you tested ketones

 

Did you say subQ fluids were on deck for tonight? Hydration is key and fluids can sometimes help lower BG a bit in some cats, so I might be looking at doing them sooner rather than later…

 

Just caught up. I am in no way experienced with R besides what I've read here and picked up from spreadsheets. Just a few comments -

I trust Wendy and Liz's advice re:R Insulin. Better to start a little conservative because we've seen some drastic reactions and karo isn't always the safety net we like it to be (not to completely scare you, but we had a cat seizing on and off for 9+ hours and stuck in the 30s/40s despite constant karo administration).

I'm not sure how quickly R scales can be adjusted but I would imagine you do have leeway up to 0.25U. Like everyone else mentioned, the corner is overlapping nadirs. On a normal cycle, his L nadir appears to be +6 to +8...but it is a bit muddied with the hospitalizations, etc. On a bounce breaking cycle, that nadir is often much later, often +8 to +12 - sometimes later. And they get extra downward momentum on the break - hence not giving R to add fuel to that fire.

He is absolutely bouncing, you can only fight the liver dump and counterregulatory hormones so much. I suspect the R may be helping keep him from higher numbers even though it seems like nothing.

Also about the meters... I'm a fairly vocal critic of the Libre. I think it is a fantastic tool in the chest in this exact situation, and in situations we need to at least have an idea what's happening. But the trouble is what you're seeing - anecdotally it tends to read artificially lower below about 70, and artificially HI on the upper end. It has messed quite a few people up in terms of dosing strategy, intervening with food when they didn't need to, etc. But it's one of the many tools we have, I always say use a handheld as your primary meter, use the Libre to help fill in the gaps.

Don't drive yourself crazy with the meters ...hard not to, I know. Everything you listed is pretty much within variance. Pick a meter and stick with it. If it's on the threshold of R vs no R vs different R dose...take 3 readings and do an average.

 

It can’t hurt to give fluids. I never noticed a huge change in ketones with sub-q fluids. But I gave them anyway - I just didn’t see a lot of change in the numbers. I logged it all on my spreadsheet. Did you say they said to give 60 mL?

 

Yeah, I've been thinking about that. My only concern is it may interfere if we were to give more R, but I really have no idea. I suppose the R could be given somewhere other than the shoulders. She prescribed 60ml of subQ fluids. Is that a standard amount?

 

I would feel very uncomfortable giving any more R before +6, and then still only .10 units at this point. And even this would be dependent upon a ketone meter test. I hope that, since @Wendy&Neko is in your time zone, she will be able to stop by and give us her recommendation.

 

She probably based that on his weight. Since you said he is down to 7 pounds some ounces? It’s normally based on the cat’s weight as you don’t want to overhydrate because it can be dangerous for the heart. I do not think 60 mL is too much right now.

 

Thank you, that's very helpful. I'm thinking of the pre-hospitalization numbers where he was in the 400s but the 2U of Lantus didn't touch it. Are you saying with the counter regulatory hormones I could give him a huge dose of R and it still wouldn't bring it down? I thought in the hospital they could always bring it down (granted they're using those continuous infusion IV pumps they can dial up and down as needed... maybe I should price those out... feel like I'm at my wits end here). It sounds awful to have seizures for 9 hours, but in such a situation I'm only 5 minutes from an ER that could set him up on dextrose. His ketones build quickly, and he was half way to DKA and very lethargic this last hospitalization in under 24 hours in the 400s. I just can't afford these repeated hospitalizations, I'm probably down over $15k at this point. If we get to the point of another hospitalization, I'm probably going to have to make a very hard decision I really don't want to make. I'm going to check ketones on next check. Praying they're not through the roof

Theres so many "what ifs" and I'm already seeing him acting tired. I feel like I gotta do something.

 

That's correct.

 

I have always done subQ in the flank. I think 60mL is fine

 

Just tested and they're at .6, so not through the roof. That makes me feel a bit better. They went up so fast last time tho.

 

Deep breaths…

a few questions-
Is there an underlying infection/inflammation?
Has he lost weight?

 

Yeah, I'm only using the libre as a back indicator. Making all decision with the nova (although that was the one that just had a faulty reading)

 

I hope you have a stash of the ketone strips! They're expensive but still cheaper than the ER... you have my sympathies, she was in/out 3 times in a row over about 3 weeks last year so my bill was similar to yours. I get ketone strips from adwdiabetes.com (discount SAVE12 has worked for me for months and if you spend enough you get free shipping) or amazon (I think occasionally have been marginally cheaper but the big bonus with them if you have prime is that they arrive quicker).

Right now, I'd also stick the ketone reading in your s/s in the same cells as the BG. It might get a bit crowded when you have BG, ketone and R dose in there but it's only for now.

Also (sorry if I'm repeating myself here) if he is eating well and especially if ketones increased, I'd put a lot of water in with his food and make it nice and soupy whenever I put food down right now. I have never successfully given subq fluids so I can't help with that but food, fluids and R are the magic combo for ketones.

I didn't learn til today that 'mid-cycle' = after nadir, but if it were me I would be inclined to give 0.1u R again at +6 especially since his ketones have increased. Wendy had said 0.25u for you if BG>350 but I'm not sure if she meant that for mid-cycle as well as pre-shot. Hopefully Wendy will be back again before then to clarify. If not, post your BG and ketone reading at +6 and we'll figure out what to do.

 

Keep monitoring them. Check again in a few hours if you can. .6 still okay. But Henry can get high very quickly.

 

Well, they looked for those things in the hospital but couldn't find anything. Still waiting on some tests to come back. He's on 2 different antibiotics (clavamox & Marbofloxacin) and he's been on them for almost a week now? He normally runs about 9.5 and he's down to the lower end of 7. This was probably all caused my the underlying diabetes.

 

Exactly what I said in my previous post. I would try no more than .10 at +6 - unless Wendy advises an increase to .25 R

 

Looks like I got about 8 (thought I had more than that) guess I'll prime some more right now.

 

So the strength of Lantus isn't bringing down high numbers, it's strength is keeping BG relatively flat (compared to an in-and-out insulin like ProZinc). To head off the question I know is forming - no you do not want ProZinc at this point. Adds complexity while depot is draining, and often is pretty harsh and causes even steeper drops and then bounces again, etc. and it's a never ending cycle of swinging. In my opinion better to use the L+R combo.

So the 2U gave him pretty nice cycles, but no Lantus usually cannot quickly fight a bounce. Theoretically yes there is an R dose that can bring it down, but you don't have the luxury of compensating with IV dextrose at home if it's overdone. As you say, another hospitalization is not good. So you are walking an unfortunate fine line of being aggressive enough at home to hopefully keep him from DKA, but not so aggressive he ends up in the hospital from hypo.

Again with a huge disclaimer that I am not an R user - if he's above 350 at +6, I personally if it were my cat would be trying 0.25U R at about +6/+7 assuming you can monitor. Logic there is L nadir should be just about there or past, and he will either stay flat or head upwards. Liz and Suzanne have used R and said stick with 0.1U. Another disclaimer, I have always been slightly more aggressive in my dosing and not everyone is comfortable with that.

 

I am really glad to see @Sandy and Black Kitty is here. John, please listen to what she has to say as she is very experienced with R and DKA.
Please don’t go ahead with more R unless Sandy gives the go ahead.

 

I'm guessing some IV dextrose at the smaller local ER for a few hours would be much cheaper than where he has been going, getting constant blood gases, tests, fluids, etc. for days. But yeah, point taken. I appreciate your candor.

 

If his ketones are up quite a bit at +6 and his BG numbers are high, then it may be advisable to increase the R a little. Still a little more time to go before that time.

 

Just took +5 reading on the nova we're up to 372

 

Sandy is the person we are all referred to as an example when using R.

 

it’s important for him to consume 1.5-2 times the calories required to maintain his optimal weight.

you are in a period of intensive care. Try not to get strung out.

Lots of moving parts. Let’s see where he’s at come +6

 

I just checked on the Ketone strips from amazon and they won't make it til monday So I got 9 strips from now til monday

 

Wendy is not available today and I think everyone should wait and hear what Sandy has said.
I have no experience with R so I am not going to get involved with saying whether he needs a dose or not and I think that anyone else who has no experience with R should also not be giving an opinion,

 

Well, after I put QTY 2 in the cart, they said they could make it by Sunday. Anyway, they're ordered.

edit: Dope, I just checked my backstock and I had another box of ketone strips. yay 10 more.

 

Oh no. Do you at least have urine strips? I wish I had known. I have unopened boxes of Nova Max ketone strips her that I could have mailed. But at this point they would not make it until at least Monday either.

 

Have you checked Walmart by chance? They were always cheaper for me than amazon, but not usually in stock near me.

Do you have Ketostix? I know it's not as good as the blood meter, but perhaps use the urine ones when you can - and save the ketone strips for once a day + if you're trying to make an R decision.

Edit - glad you found more. Also, as everyone else has said, defer to Sandy. Glad to see she's around.

 

you can use the time honored ketostix. Back when we were in the thick of it that’s all there was.

 

8 strips should be fine through Sunday. Just don't be like me and waste them on too-small blood drops!

 

I do have the urine strips and that's what the vet insists I use anyway, apparently she doesn't like the blood ketone strips because she calls them just a "snap shot" and not an overall pictures (which is the same reason she gave me for ignoring his 5.7 reading 2 days before he went DKA for the second time)

 

Oh yeah, I've learned my lesson there!

 

Oh, he's eating like a champ. He's gone through 3 cans of FF since noon (it's 7pm here right now)

 

I did a quick edit but you were too fast - just reiterating to defer to Sandy. My intent is not to muddy the water here. Since I wasn't sure Sandy would be around, I was simply giving my thoughts as to what I personally would do. I'd rather someone have a straightforward opinion and explanation vs nothing at all to go from.

I will leave it to Sandy now as this thread is pretty busy.

 

For anyone interested here's the vet response to my email from this morning. I explained the those hypo situation and sent her the data:

 

Once the Lantus depot fills it will be easier.

excellent!!!

BK was down to 7lbs and some change after his 2nd DKA (10.5lbs was ideal). When he turned the corner he went through 15-16 oz every 24 hours!

 

I lied, I'm back.

...she's describing triaditis. I am not 100% sure on the treatment for that, but I *believe* you should have been able to use budesonide (which typically does not affect BG) to help with the inflammation (quick Google says yes). Other than that it's just managing any nausea, inappetence, pain, and fluids with various meds.

 

I regards to the message back from the vet.
In my experience with my meters v the vets meters I found they were always different. And it also depends on whether they are using a pet meter or a human meter or are measuring it on a machine. All give different results. Don’t let them talk to you into a pet meter. We are much more used to human meters here and a pet meter would only complicate things.
I’m glad Sandy is helping you

 

2 DKAs and went OTJ? That's awesome. I need that little bit of hope right now.

 

Does he have any cardiac issues? Most vets and specialists I’ve worked with go with at least 100ml at a time, assuming no heart problems. So 60ml sounds safe, though it probably won’t dent the BG.

I’ve administered subQ fluids a lot over the years, including in my diabetics. They can be a good tool in the arsenal. SubQ and oral water intake have the same net goal but work on different “pathways” to achieve that goal. I’d do the subQ soon to try to help flush the system. Even though 60 ml might not do much, it’s something.

You can use opposite sides for insulin shots/fluids or gave the fluids slightly farther back. As long as they’re not given in the same spot, you should be fine.

Also, has he been tested for hyperthyroidism?

 

Granted he was very low last night, and it was a bit of a battle since I'm such a noob at this, but we managed it with just 1.5ml of corn syrup. I'm not saying that .5U R is the answer (although his discharge instructions explicitly say "Give .5U regular insulin if BG >300 6 hours after Lantus dose"). I feel like .25U may not even be enough, but I won't give more than that. I really feel it's necessary. 15 minutes til +6 and reading

Thank you for that. I guess I'll give the subQ on the back where I normally give the insulin, and can put the insulin on his sides? The libre is near his rear end. She put it there in hopes the subQ wouldn't interfere with it.

edit: yes, he was tested for hyperthyroidism and he was fine

 

He also had IAA, an idiopathic condition where his body created antibodies that bound up circulating insulin making it unavailable.

He was the last cat anyone thought would get OTJ. It took 23 months but it happened

 

I’d give the insulin wherever you have been. No need to add another variable.

 

Yeah, the insulin seems more important right now. He can get the fluids later tonight.

 

Alright. +6 was bad. very bad. Ketones are up from .6 a little over an hour ago to .9 now. BG is 398. I'm giving the .25U R and praying its going to be enough.

 

Get a R+1,2,3 and 4

 

His ketones really are rising steadily. I understand this decision on R. I’m praying it’s going to bring the numbers (and ketones down too.)

 

SubQ fluid will help flush ketones. Hopefully you have done that, or are about to!
Energy to you — keep the faith.

 

I'm planning on doing it in about 3 or so hours from now. Hopefully after we see the R work some magic.

 

Ok. I was just trying to emphasize the importance of the tool you have. With ketones rising, I wouldn’t wait!

 

I hear that. Will do it after the next BG check. Thank you

Good news! we're down over 50 points to 344 @ +7

 

A couple of observations:

• When the vet showed me how to draw the Lantus she pulled an amount of insulin from the pen with the syringe (past the target unit marking) and then adjust it to the proper marking (thus pushing insulin from the syringe back into the pen). I now know this is improper and can denature the insulin.
• My refrigerator is very cold (or well was, I turned it down last night). It is very rare that anything ever froze, but his clavamox had frozen when I went to use it yesterday. The insulin is stored in a seperate part of the fridge with a plastic divider door and I've never seen the insulin frozen, but it makes me wonder... Could it be too cold? could it have damaged the insulin?
• It's been a little over 30 days now since I first started using the Lantus pen. I know they're "supposed" to only be good for 30 days, but some people use them up to 6 months (my vet says 3)
• I've left it out of the fridge 3 times for 12 hours each time.

Considering all of the above, should I request a new bottle? With the little effect it has seemed to have lately it really makes me wonder if it may be bad?

 

This is same vial used on the 20th/21st? It was definitely working then. Also appeared to be working last night. When did you find the clavamox frozen, yesterday morning sometime? Was it also in the door? Door tends to be warmer.

Human diabetics store it at room temp (actually what the insert says too) so I wouldn't worry about the times you left it out. Ive been around here two years now and I've yet to see it lose efficacy before the 3 month mark (unless of course it froze or overheated, etc).

I've always liked to keep a spare pen for the "just in case" (aside from having a high dose cat anyway). Most of the time the expiration date is 1-2 years away.

 

Yes, same I've only had one vial ever (before getting the R yesterday that is), and yeah, i guess your right. It did seem to work last night even, so I guess it must be good. Not sure why I didn't realize that. I need sleep. lol. Thanks for pointing that out.

 

Good news is we're on the upswing! That .25U of R @+6 brought his BG down 106 points at +7 to 292! I just took the +8 and it moved up a bit to 309, but still better than pushing 400. Hopefully this will also help gauge his reaction to the R in the future as well.

I gave 60ml subQ fluids @ AMPS +8.75 This was my first time giving subQ fluids. I was scared he wasn't going to like the 18g needle they gave me. That thing scares the heck outta me! My first two attempts I shot through the skin and got myself all wet (didn't lose that much). I hope I haven't been doing that with the insulin! I think I figured out how to avoid that ever happening in the future now tho. He was great about it. It was the first time he ever even flinched accepting a needle. By my third attempt he thought, "Uh, I think I'm going to go now" but my wife was there to keep him put. He was still very good about it.

He just finished his 4th can of food for the day. Hasn't drank much at all.

edit: libre is still reading over 400

 

Hi @Wendy&Neko

I just noticed you were online. How do you think I did? More importantly how do you think I should handle the PMPS in 2 hours?

 

So a drop of 74 from 0.25u R mid-cycle, nice.

I'm heading to bed now, hopefully Wendy will check in on you. If not (and if @Sandy and Black Kitty are not around either) at PMPS I would check ketones again and stick with Wendy's R guidance from before i.e.
>350 0.25uR
300-349 0.1uR
<300 0uR
I would stick with the 1.75u L.

Same drill as before, monitor BG hourly - the R should last about 4 hours and we're looking for a drop of around 100 in those 4 hours. If he drops a lot in the first hour, I would give slightly higher carb food to slow it down. Hopefully you'll also see a drop in ketones thanks to the subq fluids - congrats on that, I haven't managed it myself yet!

At this time of night (you may know this) your best bets for online support are @Bron and Sheba (GA) and @Bandit's Mom. There may be people in Europe coming online soon, too though I'm blanking on any names at the moment.

Good luck and hope you get some naps. You're doing great, whatever your inside voice might be saying...don't listen to it.

 

A word of caution when working with a rapid onset and slow onset insulin at the same time-
Make certain that you are fully present when preparing syringes. develop some sort of cross check to verify which insulin is in which syringe and that the doses are correct. You do not want even a shadow of a doubt. I’ve seen it more than once over the years where a caregiver using both L and R (for example a kitty with a high dose condition) realizes that instead say 6u L and 0.25u R they shot, or may have shot 0.25u L and 6u R.

 

Thank you for all your help and advice today @Liz & Minnie

 

Yes, that would truly be awful. Point taken and I'll be installing a big billboard with flashing lights in my brain shortly. Thanks for the warning.