? 9/29 Minner AMPS 220 PMPS 82 vomiting

MinnerPip

MinnerPip

Active Member
I did not give her insulin this PM given the 82. I was planning to skip until AM. I fed her normal regular food (some dry some wet). At +5 she vomited. All other behavior normal. I offered her more food after this, some hartz delectables bisque and some of the dry food she always eats. She was hungry and ate all I offered and drank a lot of water. But then within 45 minutes she vomited again. I took her BG via ear prick and it was 411. It has never been this high since very first being diagnosed 3 mtgs ago.

I don’t know what to do. The ONLY thing that is different is that I opened a new vial of Lantus today. The prior vial has been used since she started Lantus first week of July.

Could the new vial be more potent somehow or the old vial less effective? I have kept it refrigerated other than times I have taken it with me to vet.

Or is something else going on?? I am too afraid to dose her given she has vomited twice. But her BG is over 400. Is this some kind of bounce, might she had gotten really low after the PMPS of 82? Why would she be vomiting?

I’ve taken her to ER. Full bloodwork looks normal with exception of glucose now being 497. Ugh. No ketones. Tested urine and no infection there. No indication of infection on bloodwork, Temp a little high at 103.5 but I’m told that’s not unusual given her stress level.

They gave her cerenia and ondestan (?) injection for anti vomiting and anti nausea. But we don’t know what to do with insulin dose. Not knowing the cause of vomiting is concerning.

Does anyone have recommendation?
 
Im sorry she’s sick and im new so no advice but sending positive thoughts and hoping someone better at this comes on board. Did they test for pancreatitis?
 
Also if you opened the new vial today the 82 yesterday was from the old vial, correct? If so I asked a similar question about Glargine to the pharmacist and was told an old vial would only become less potent but it would look bad (precipitate in vial).
 
Since you are following SLGS for dosing, her new dose is 4.25 units.

Could you put that 411 on the spreadsheet? It's been a couple months since you've gotten any mid cycle tests or done a curve so I can only guess what might be happening.

If the old vial is clear and no floaties, and has been kept in the fridge and not frozen, it should be OK. Looks like you've had it less than 3 months. Lot of people here get 5-6 months from a vial.
 
Looking at the spreadsheet some more, I see a similar low PM preshot number on 9/17. The dose reduction should have happened then.

Can you tell me what the vomit looked like? Foamy, food, hairball?
 
Thank you. The new vial of Lantus was used 9/29 AM and the 82 happened 9/29 PM. I wasn’t sure how to show the 411 on the sheet since I gave no shot after the 82 PMPS. I guess I put 411 in the +5 column, I’ll do that now.

The old vial of Lantus has been refrigerated except for the periods of time when I have taken it with me to vet office and its been out of fridge for 3-4 hours on maybe 5 occasions. Plus once I left it on counter by accident for maybe 8 hours. I don’t *think* this adds up to enough time to affect it but I don’t know for sure.

Yes I want to get more readings beyond AM and PM but the ear prick hurts her. She yelps every time. I always do it on right ear b/c its hard to get positioned for inner ear prick on her left ear. Her poor ear is bruised all the time. I’d like to put the Libre on her again but that drives her crazy and then it takes a month for the glue to completely go away. Just venting. I think the ear prick is lesser of 2 evils for her, harder for me. So I’ll work on getting a +6 reading after AM dose as a start for maybe a week (?).

We ended up giving her 2U dose while at ER since by +10 after the 82 PMPS she was at 497. Then my regular vet talked to me this morning and had me check BG at +8 following the 2U and it was 283 so gave her 4U then per his direction. We’re all out of whack with timing/schedule now, so we’re waiting 14-15 hours after that 4U dose to check BG and dose again at the Oct 1st AMPS time. My vet shared with me that vomiting can be result of rapid swings in BG, that it can somehow affect gastric reflex. I guess we’ll never know if the 82 kept going lower, got too low and body responded with cortisol release, driving BG way up. Is this what the community here calls a bounce?

The anti vomiting injection she got at ER wears off after 24 hours, but it must have helped b/c she hasn’t vomited again. Crossing fingers that doesn’t return overnight. Does anyone else experience vomiting that can’t be attributed to anything other than a diabetic symptom from BG swings and if so, how do you manage it?
 
The reason I asked what the vomit looked like, is I saw the odd foamy vomit with lower numbers. The way to prevent it is to make sure you are on a dose that's not taking her too low, meaning upping the testing. Food or hairball vomits could mean something else.

The 411 was a combination both of the low numbers and the skipped dose which made it even more extreme. Here is the definition of a bounce:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

The above definition is the the New to the Group Sticky Note. I strongly recommend reading all the yellow starred Sticky Notes if you haven't already.

In the New to the Group Sticky Note is a link to a post on Feeding the Curve, which is a technique to slow down fast drops. Though it's hard to say if that's what you are seeing.
 
Thank you Wendy. Did more reading about feeding curve and bouncing. I am upping the testing today. Her vomit looked like partially digested food. Foamy did not come to mind. She has seemed more sluggish since returning from ER over past 24 hours. And she has urinated quite a bit more, 50-75% increase in volume.

I went back to old vial and gave her 4.25 for 10/1 AM dose. Her AMPS was 227. I don’t understand this. She was at 257 at +11 yesterday evening. I did not dose her at +12 yesterday evening but waited until +16 to get closer to her regular schedule time. +16 is today’s AMPS and it’s lower at 227 than it was at +11. This seems very odd to me. In fact I was worried that since she was 257 at +11 then she would likely be above 300 as a result of delaying AM shot to +16 to get back on schedule. Hmmmm. Instead a 30 point reduction. Yes, I need to do more ear pricks today.

I have been doing ‘feeding curve’ w/o knowing it was a technique. Since Minner is still at least 50% dry food and that has a delayed BG impact, I give her about half of her morning dry food meal at PS time with dried chicken too. Then I wait until +1.5 and give her the rest of her dry food meal along with LC wet (fancy feast oceanfish pate and gourmet naturals trout). She scarfs up dry and might graze on wet. At +3 and +4 I usually encourage more eating of wet by sprinkling some freeze dried chicken on top of each bowl and I might add small number of additional dry kibbles. She never finishes the wet dishes, but sometimes might get close to half. I throw out a lot of unfinished wet food with her. I am not always consistent with this approach given I am not always at home to do the +3 and +4 encouragement. But the wet stays out and available. I try to avoid food encouragement and definitely no more dry at +6 and later.

I will keep you posted today on ear prick results given these unusual numbers and what was potentially her first bounce that I am aware of yesterday. Thank you again for all your help.
 
BG numbers wobble around during a bounce - they don't necessarily look like a normal curvey cycle. You also have to consider that the factor of meter variance. Depending on what country you are in, manufacturers are allowed some variability in the test results.

A curve after a skipped dose isn't going to tell you as much information as one done after the depot is full with the new dose. However, looks like you have a rough idea when her nadir might typically be. That's a good time to test to try to catch the lowest numbers.
 
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