PMPS- 511

Hi, it's been a long time for me. Booby was diagnosed 12/2017 and after a rough first 5 months he has been on 2U Lantus for over 2 years. He got sick 4 days ago and seemed to be vomiting after each meal starting in the middle of the day. I took his reading preshot the next AM and he was at 28. Gave him honey water and small amount of carb food and got it, I thought back to normal. He's been up and down in his numbers since. Vet said yesterday that all organ function and blood work looks great. Even had x-rays and all ok. I'm starting him back to 1 unit 2X day and will continue to monitor. His food has been and still is FF chicken liver and Friskiest turkey giblets. Looking for guidance as we move forward. It's like starting over. Thanks so much.

 

Oh wow, how scary!

I'm glad you caught that low. It definitely sounds like he needs less insulin. Cats can go into remission, or just change insulin needs over time, plus they can be more sensitive to insulin after a deep hypo like the one he just had. He may need even less than 1U.

How often do you test? If you've been around a while, you know about the spreadsheet we use here . If you can set one up, even with just the last few weeks of data, we can be more helpful. Instructions:

FDMB SPREADSHEET INSTRUCTIONS

Your kitty is absolutely gorgeous, by the way!!!!

 

Thanks for your response, I see spreadsheet now has choices and am not sure if mine is calibrated for feline. I just started using ReliOn Prime the past 2 weeks. I was previously using Arkray Glucocard 01 but the strips are now only available online. In the meantime I attached his notes I took to his Vet and added last day and a half. As you can see I am now struggling the past 36 hrs when the best time to give him his shot and at which Glucose number is a go. Again, Booby and I thank you!!! I will enter what I have in spreadsheet as soon I know which one to use.

 

Sorry, here's the attachment

 

I posted his spreadsheet, his normal shots are between 10-10:30 am & pm. When entering the data when his numbers started going crazy- I entered the PM preshot in the correct +column he was tested at- and entered the dose a few spaces later(in its normal spot). Hope that makes sense. I am currently not on a 12 hour schedule with his shots as you can see but his AM test is always 12 hours after PM shot since his issues started, regardless of time, and random testing throughout the day. I typically don't get up in the middle of the night after PM test to give him some peace, but if need be I can start. I am a little nervous about backing down to one unit due to now seeing numbers in the 400's. He hasn't had numbers that high for a very long time but I know I have to start somewhere again. Thanks for any guidance.

 

Hi. Have just looked at your SS and vet notes.
Is Booby still vomiting pinkish vomit? What did the vet say about that?

For whatever reason, maybe the vomiting and lack of food , he is needing les insulin at the moment. Instead of skipping every second dose, I would reduce the dose to 0.75 unit and give it twice a day to see if you can get back on track. That way you won’t be skipping shots.
Has there ever been a history of any ketones? While he is like this and also getting less insulin I would be testing daily for ketones in the urine. They can appear when a cat is not eating well, is getting less insulin and maybe has an infection or an inflammation and Booby potentially has all three. If you don’t have any I would buy a bottle of Ketostix from Walmart or a pharmacy and test the urn be. It is a simple test.
Please keep us updated

 

He hasn't vomited since Friday and seems to be recovering from his 3 day bug after the injection of Cerenia on Saturday. He is a 14lbs big boy and typically eats 3- 4oz cans FF Pate a day. Currently he has been eating 1 and a half cans a day (FF Pate chicken/Liver), eating less but more frequently. Throughout this I have allowed the test number dictate the shot as I was always told when the number was low not to give any shot. Can you please elaborate to help me understand the change for this, and what .75 would do when his readings are under 50, much appreciated. I am afraid to give him any shot when his number is under 100. The vomit had a small streak of blood once and she thought maybe his esophagus may have been irritated. It didn't happen again after that. I do have Keto sticks but haven't been able to catch him at his box yet, any suggestions on that would be helpful as well. All information and advice is welcomed, thank you so much!!

 

With the urine catching, try putting a small container in his favourite spot to pee. Testing for those ketones is important.

The idea behind reducing the dose so you can give it each cycle is that Lantus works best when given every 12 hours and at a consistent dose. Then if you look at the SS the low numbers are after the insulin is given and the high numbers are after the skipped dose.
If you lower the dose to what I suggested ( I divided 1.5 units by 2 to get the 0.75 units) and give the first dose when the BG is higher (after the skipped dose) the following cycle should not drop too low and hopefully will allow you to shoot the next dose at the correct time.
If it doesn’t then we reduce to 0.5 each cycle. Does that make sense?

 

I think so, what does the SS mean?

 

Just tested and he is 332. I gave recommended dose of 0.75. He just ate another 1/2 can as well. His numbers have been low only in the AM test, hopefully it wont be so low tomorrow. What would the magical low number be then to not give insulin? I realize that Lantus is time release but he doesn't even get above 150 until after about 5 or 6 hours some days since this started. This has only been happening since last Thursday, it was truly like clockwork for the past 2 years with no insulin issues at all. Shot test numbers were always in high 200's to 350 or 360ish. He never showed any evidence of heading into remission but I was happy that he was pretty stable anyway. I did forget to mention that besides FF he nibbles on Dr. Elseys Clean Protein thru out the day and night. I so agree thatI have to figure something for the ketone tho. I have 5 kitties and 5 boxes that get cleaned morning and night and are pretty well shared by all, 2 are Breeze boxes and the other 3 are ScoopAway litter. Thanks again!

 

Spreadsheet

At first, if he's below 150 you should stall, DON'T feed and test again in 20-30 minutes. Use that time to post with a good clear subject line like "STALLING..NEED HELP!!" to get some eyes on it quickly (you can always go back and edit it once you have somebody's attention)

You could also start posting in the Lantus forum. You'd get the most experienced eyes there since everybody there uses a depot insulin like Lantus

 

SS means spreadsheet. can you fill out your signature please to give us info on Booby. Here is the link to how to go it.... look towards the bottom.
also read the test. Very good for new members.
I will answer the other things later. I have to go out for awhile now.
Can you test during the cycle
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

I see Chris has answered... thanks @Chris & China (GA)

 

Here's the information Bron wanted you to see....the info on how to fill out your Signature and what details to put in it is towards the bottom of the page but there's lots of good information there to read too.

ETA (Bron and I are two heads with the same fingers sometimes....LOL)

 

I updated signature, numbers got pretty high by PMPS. I haven't seen them that high since DKA issue 2 1/2 yrs ago. Still nervous about such small dose.

 

The dose is actually the same as when you were giving 1.5 once a day so it’s no less just twice a day instead of once. It can be increased if it’s not enough. Have you managed to get a ketone test yet.?That is the most pressing thing we need at the moment ... to ensure there are no ketones in the picture.

 

I'm so sorry, I must not of communicated effectively. Booby has been on 2 units twice a day for about 2 years, not 1.5 once a day. He had stomach issues last Thur and Fri and those are the days his numbers dropped in the AMPS. I cut him in the PMPS hoping to help the AMPS.

 

Yes I realise that.
If you think he is over whatever caused the problem and think he should be back on 2 units twice a day then go back to that. I was just trying to find a dose you could shoot twice a day not once a day until things settled back down.

 

He hasn't been vomiting at all and is still eating small amounts multiple times a day. I think he is ok as far as that incident goes. Thanks for clarifying the dosage. I will have to pick up plain clay litter tomorrow and close him into a room until he pees, with 5 it's impossible as we never even notice him in any box. 3 litter boxes are downstairs, 2 up and we even have one in the garage that occasionally gets used. Would that be anything that doesn't clump?

 

Don’t understand your question sorry .. .. ‘would that be anything that doesn’t clump’

 

Yes on the litter...sorry I went to bed. I wont be home for around 8.5 hours today and will check him as soon as I walk in the door.

 

I am wondering why you need non clumping litter and why you are putting him in a room alone. Are you trying to catch him peeing to read ketones? You would have to get ketones in fresh urine, not urine that touched litter. You would have to catch it in a cup. I personally find it easier to just use a ketone meter.

 

One option is to make a little temporary litter pan with something non-absorbant like acquarium gravel. Then you can collect a "clean" urine sample.

 

yes, true.... or i've heard of people putting some plastic wrap on top too.

 

Which type of ketone meter would that be, and how to use it. I like the fishgfish as an alternative too. with five cats I have to be sure I'm getting his urine so he will have to go into a separate room.Sorry I'm driving I'll check back in later. Thank you for all your help.

 

I picked up the aquarium gravel and placed a layer in a small litter box. Hopefully he uses it tonight. He was at 82 AMPS +8. Would that be the
KetoCoach Blood Ketone Meter that is sold at Walmart???

 

I bought a keto MOJO off amazon. The ketosens meter got some good reviews on there too. It works just like a blood glucose meter. teh keto MOJO can be used as a BG meter as well, so I have it as a backup.

 

Any blood ketone meter will work. They do take bigger sample sizes than the blood glucose meters though and the strips are more expensive, but when you need a ketone test, they're a lot easier than collecting a urine sample in a multi-cat house!

 

82 is a lovely BG number, but I am really worried that 2.0U is too much. Not only did you have the deep hypo numbers on 7/9, it happened again on only 1.5U on 7/12. I am very very worried about dosing that much insulin twice a day.

You were doing 0.75U for a few cycles, but not really long enough to be able to evaluate the dose. What do you think about going back to that, or else possibly 1.0U twice a day? The thing about Lantus is that you really want to have a consistent dose for a while before changing it (unless you get one of those lime green numbers, which usually means an immediate reduction is needed).

 

I there one thing I noticed you are not doing any tests after his PM pre shot.
Cats usually drop lower at night. Please monitor him at night, god forbid he drops low and you don't catch it

 

Yes, I agree his dosage needs some adjusting. Unfortunately I am not a day shift worker and 10:30 AM/PM is the best for me in order to be consistent with my fluctuating schedule. I either work all night or middle of day to late evening. I just did PMPS and he is at 122. I will go back to .75 tonight, I just worry that if I do the same in the AM he will jump high again by tomorrow night. I hope to get him to use the gravel so I can get the Ketone #, I am anxious to do that. I will have to pick up a meter tomorrow as a backup, I didn't know about that and think that's the easiest and less stressful for him in a multi-cat home. Do you think I should just give him his shot now? I can wait and test at again at 11:30 if that's best.

 

I think you should be able to shoot 0.75U now-- the 122 is going up, so he should be safe.

He might be high tomorrow no matter what because of going low today-- he may be "bouncing". There is nothing to do about bounces other than wait them out-- we don't increase the dose because of them. You'll just have to give the 0.75U some time to work and then we'll see if it's enough insulin (or even too much-- it's hard to tell sometimes!).

 

Thanks, I gave him the 0.75 dose at 11pm, I also ordered the Keto meter from Amazon but it wont be here until Friday. Pick up locally was Saturday. I'm still hoping to get something from him tonight in the gravel box. I can not thank you all enough for guiding us through this, it really helps calm the panic and anxiety that goes with the number fluctuation of my fluffy love muffin.

 

Today when I got home he tested AMPS +7 at 118. Unfortunately when I opened my laptop the chart wasn't there and when I try to open it from my link it wont let me edit. I am logged into google but when I open the chart it says I am not logged in but also doesn't give me an option to login??? Has anyone had that happen???

 

Are you sure you're trying to open your personal copy in your Google Drive? Or are you clicking on the "shared" version in your signature?

118 is a great number . I suggest a "stall": don't feed, and test again in 20-30 minutes to see if he's moving up from there. Edit: whoops, I thought you were at pre-shot time, not +7. So you have time now to see where he's going before having to make the "shoot" decision. But, the stall technique is still good to know about, when you do find yourself with a low number at pre-shot!

 

Thank you I retrieved it from my google drive, yes I tried to open from my signature since I am logged into it and thought it would automatically know me. Another learning curve

 

He is at 178 now PS, gravel didn't work yet for Ketones when I was at work today, they were completely dry. I didn't want to keep him closed in a room stressed out any longer and let him out. Amazon delivery expected on time tomorrow for blood ketone meter. He is still only eating small quantities but he is hungry alot, he acts like I am not feeding him enough yet he is only eating about 1/5 of a can at a time (4oz) also no signs of vomiting. Its been 5 days since the Cerenia injection. Normal for him is 3 meals a day (4oz AM-2 to 4 oz midday and 4oz PM) I would be happy even if he ate a half can at this point. Also been adding homemade chicken broth to the remainder on his plate when he is done and he seems to lick a little more at it but still doesn't eat it all.

 

Have you tried getting different flavors of the ff? If I feed the same thing a few days in a row they don't want it. I always have a lot of flavors.

 

Yes, yesterday he was given a different one each time- FF Pate beef/liver,whitefish/tuna, ckn/liver. and I have both FF and Friskies turkey/gib and the homemade chicken broth. He loves loves loves the chicken broth but refuses to eat the cooked chicken no matter which part it is. His numbers seem a little better. (220 AMPS) Thank you

 

woohoo 220 progress!

 

AMPS +10 332, Ketone 0.5, still trying to read the teeny teeny tiny instructions to see if the ketone number is a good one?? I did watch the video for instruction on the general meter use, I can say very impressed with the simplicity and getting both numbers with 1 poke!!

 

Blood ketone? That's good!

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter

 

Yes, Blood keytone. PMPS 391, thank you so much for the keytone range info.

 

Booby woke me up this morning throwing up, since it was in the carpet I really didn't see a color. We only leave Dr Elsey Clean Protein out at night as my other cats eat it as well. AMPS is 341. Hopefully just a hairball but will keep a close eye. How often do you do the keytones? Should I make this part of his daily routine and if so does it there a specific time of day that's best??? Thank you

 

Awww poor Booby
Poor you! Nothing like waking up to upchucking. I hope it was just a fur ball.
Not sure on how many times to test for keytones so hold on for more replies.
j

 

Maybe weekly on the ketone testing? More often if he shows any signs (lack of appetite, lethargy, etc.). The 2018 ketone episode in your signature was the most recent one, correct? I don't think you'd need to do daily testing unless he was just coming out of an episode and was in a delicate state.

I have all wood floors with just a few throw rugs here and there. Guess where my kitties always throw up?

 

Yep Zoe goes out of her way to throw up on anything but the tile floor.

 

Yes on the 2018 ketone. He actually has a little larger appetite this morning and ate about a half can, I offer half at this point because he has only been eating quarter can or less multiple times a day.
He ate at 10:45am and so good so far

 

fingers and paws crossed!

 

Don't like seeing him this high mid-day... AMPS +6 383.

 

@Aleluia Grugru & Minnie
@Deb & Wink

Lets see what they have to say.

 

PMPS 380... phew I was afraid it would of been higher. Is it still to early to tell if he needs a little increase??

 

PMPS 380... phew I was afraid it would of been higher. Is it still to early to tell if he needs a little increase?? OOOOOPS, thought it didn't post

 

That's been happening to a lot of us lately since we moved to a new server. My post just "sits and spins" (for lack of a better term) so after awhile, I hit "post reply" again (or again)....then when it seems my post has finally actually posted and I refresh the thread, there are 3 of them

I know you work some strange hours, but is there any way you can get some tests on the PM cycle? Even just one test at +2 or +3 each night?

Without having any idea what's going on in that cycle, it's really impossible to know what the best advice is. That PM cycle is responsible for at least 50% of what's going on

 

Yes, I can try and do a +3 tonight and tomorrow, if possible....anything else I can to get. I am home most of the day tomorrow and can do either the every two or four hours if it helps him. Appreciate the explanation as I didn't realize the +PM's were vital. I assumed that one curve told most of the story, what you said makes sense.

 

PSPM- +3 380 again, I don't think I ever had the same # two times in a row.

 

AMPS- 211 He's a happy cat but still a small appetite all day.

 

So I got a 211 @ AMPS +6 as well using Relion Prime . I thought it was strange so I did it again with his new MOJO meter and it was 187. Just got the Prime 2 weeks ago but I think I will continue using MOJO even though it requires a little more blood. The Prime was not giving any codes and was acting normal.

 

Youre doing great! 211 and 187 close enough to being the same number with variances.

 

PMPS 150, may on the lower side because he hasn't had much to eat today. I would say between half a can to three quarters. Should I hold off on his shot??

 

Good question. I cant give that kind of advice
@Nan & Amber (GA)
@Chris & China (GA)
OR... This post will bump you to the top of the list

 

Two nights in a row PMPS is above 500, tying hard to remember how long it took to before dose adjustments post-DKA. Any thoughts appreciated, his eating has improved today and yesterday and had about a can and a half today.

 

Is there any way you can get some tests between shots? Black pre-shots are not good, but we need to know if he needs more insulin, or if he's going low and bouncing up from there.

It is a good sign that his eating has improved!

 

Yes, I can start getting a few starting around +6ish today. Tomorrow will be a little harder to do but the weekend I can get several. What are the best intervals? Are at +3,+6,+9 ok?

 

That sounds great!

Probably a good idea to start a new thread on the day you'll be able to start getting these tests-- this one is getting long, and hard for folks to jump into.