? 2/13 - Wally - PMPS: 71 ....dose advice for uncommon low values in the last few days

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http://www.felinediabetes.com/FDMB/...w-70-in-a-row-maybe-too-much-insuline.210639/

hello all,
anyone experienced in similar scenarios?

We are experiencing low values even though we are reducing much more than TR would allow...

Is this a miracle on Wally health or a known situation?

Look at todays nadir moving toward +12

This is outside TR rules but I'm tempted to reduce dose even more than 5.5u

Any feedback is welcome

 

@Gill & George
@Wendy&Neko
@Sandy and Black Kitty

I see you already did 2 doses of 5.5u. If you are not seeing any ketones so far, I think you can do 5.5u again unless a more experienced member comes on and says otherwise.

I do have a concern that you may be seeing the 8.5u depot still talking.

 

I did shot 5.5u ...anyway i will now monitor often to see if he continues to drop

 

I read the Depot can release insulin for 3 days. A new dose should be held for 3 days to see what it will do.

You reduced by 3 units in just 2 days? Were you advised to do that by one of the people here?

 

I was not adviced by anyone, it was my own decision based on Wally inability to stay on the green and tendence to continuosly drop further. Also low PMPS influenced my decision

It was hard to keep him on the 70’s level even using MC, HC

I was lucky to have someone home when I was out for work that could take care of him.

Unfortunately tomorrow I not not have this kind of support...

 

Attention lurkers- my post below is based on the possibility that Wally may have an underlying high dose condition...

8.5u is a sizable dose for a kitty. Since you don’t know if he has Acromegaly or IAA, or both, caution is prudent.
Once I knew that my kitty had IAA and that it could resolve at any time I became extra cautious.

My opinion is that as long as ketones remain negative your decision to drop to 5.5u was fine.
Like others have said, the Depot draining may still be a factor.

Has anything changed (diet, medications etc.) recently?
How is Wally’s behavior overall?
All Ps (peeing, pooping, playing, purring, preening) in place?
Appetite normal?

 

Nothing changed in his diet (aside we had to bring out MC/HC a few times to keep him in the right direction). His regular food is 1,5% carbs.

Wally in general is doing great. He is full of energy during the day, but calm in the morning.
Last few months he was used to meow a lot every morning asking for food...
He's not doing that in the last 5 days... he sleeps calm with his sister until I wake them up doing some noise at 6.30AM

I see a lot of improvement
- He's eating much less than before ... for example on AM cycle he ate 60gr while he was used to 110gr
- I don't see anymore big clumps in litter
- His fur is amazingly beautiful like i've never seen before... really soft and silky
- he plays during the day a lot, he started climbing our cat tree that he never was able to climb
- he's doing a lot of grooming which he used not to do much recently
- His is putting on some weight.... even tho we are controlling the amount of food

All signs are positives in my opinion

 

It would be a good idea to tag one of the people helping you & have them advise you. That's why you you joined this Forum right? To get expert Advice!

I've been doing this a year now & I do NOT give dosing advice. I leave that to the people that have a LOT of Experience.
Insulin is a very powerful Hormone & I'd never want to be responsible hurting anyone cat! It's nothing to mess around with.

Wally's SS looked "BEAUTIFUL" for the last 4 days. It's what we're all trying to achieve! But I do understand your concern in him dropping too low.

My cats BG has dropped into the 40's many times & even the 30's. I'm alone & it's been many nights I'm up feeding him some carbs to bring his Glucose up.

Have you had a chance to read the Sticky notes about how the insulin works in his body? The more information you have the easier it will be.

Best of Luck to you & Wally

 

@Wendy&Neko is my advisor here, but I haven't been a very good student lately considering I didn't follow TR rules on dose decrease.

I confirm I've read all the sticky nots several times, but i think this is an uncommon situation - would like to hear from someone that has seen unexpected improvements before.

I think these next cycles and Wally feedback on the dose decrease will give us some more information on the amount of insuline he needs.

I don't know what's going on but we are so happy of the improvement

 

Absolutely !! Everyone here will be excited to see that Wally's BG is better

 

You increased the dose on the 8th & you soon started to see his Bg coming down. Remember it takes about 3 days till you see what the new dose can do.
It's not unusual to see an improvement when you hit the correct dose.
Wendy will be able to tell you how to handle the dosing especially when you aren't always there to monitor his BG.

Has Wally ever been on Dry food? I've seen several kitties go into remission when they transitioned to all wet food. It's really amazing to see their bg keep dropping just from eliminating all dry food.

 

Ours was an uncommon situation:

BK going into remission was the ultimate unexpected improvement.

It sounds like Wally’s doing very well overall.
The next few cycles will reveal if 5.5u is enough...or too much.
Please check for ketones daily.

 

Exactly why I tagged you.

 

Very amazing chart!!! Love it!

I will monitor strictly and I hope it will never stop to improve!

 

Stefano I hope one day to see Bear's BG numbers which weren't steered with food look like Wally's BG numbers look today!
Such beautiful numbers.
Looking at Wally's SS it looks like you can't have worked much or gotten very much sleep.
Good job at keeping Wally safe!

 

I hope Bear will join us soon in the green!!! I still remember we started Lantus almost the same day... so our kitties have special bound !!!!

 

We transitioned to only wet food just after dx in late November!

 

I agree with Sandy. Let’s see what this dose does once the depot has drained. It’s likely Wally has broken through some glucose toxicity, and/or there is another underlying condition that has changed somehow. Either of those can change how much insulin he needs, sometimes quickly. Sorry I haven’t been able to help much lately, but I am at the other side of the continent from home.

 

Thank you Wendy for joining the conversation! ...Tell you the truth I felt a bit guilty reducing so much but I hope I did the right thing.... I also hope he's actually improving and not making jokes!!!

Right now he's slowly going down in his PM cycle.... I will keep monitored to understand his intentions!

 

I agree with Wendy and Sandy. Numbers can change in an instant even when there's not some underlying condition.

 

Wonderful wonderful, Stefano. Good job using your common sense with the dosing. Sometimes you need to go with your gut feeling about reducing to keep them safe. And so far it looks good. If he starts to rise, you will know to take him back up. But, I wouldn't take him up by any more than .50 unit.

As discussed in a previous condo, if you are constantly propping them with HC food , you could be preventing them from taking a reduction that they need.

I hope that he can hold this dose and continue to race down the dosing ladder.

 

OT I know, but I had to say it - YOU wake THEM up? Tell me all your secrets.
The alarm clock is set for 630 am but the cat clock wakes up at 5-530 . . . EVERY. SINGLE. MORNING.

 

Back when we were stumbling our way through the IAA unknown, I learned to rely on my instincts, instincts informed by the BG data I collected and BKs behavior.

Going down in dose is emotional in a very different way than going up, particularly when, all of a sudden, in spite of lower doses you find yourself in a constant struggle to keep your kitty in safe numbers.

There were periods where it seemed every shot involved a dose decision and being that BK was the first kitty to test for IAA the circumstances were unprecedented. There was no experience to learn from. We were ‘flying by the seat of our pants’.

From Jojo , who was one of the ‘gurus’ of Lantus back then, I learned that when downward momentum starts to build for a high dose kitty, in the absence of ketones the use of a significantly reduced dose is always an option. This type of dose decision we refer to as a ‘BCS’ (big chicken shot).

Higher doses make a larger depot. Safety first.

Better a day too high than an hour too low.

 

Wally has certainly decided to challenge you, Stefano. I agree with Wendy, Sandy, and Sienne. If he’s IAA and breaking through antibodies, if he’s acro and the tumor is waning, or if his liver has just decided to stop the bouncing, using those reduced dose shots helps. If you’ve never studied Sandy’s BK’s SS, it’s worthwhile to do so.

Just be sure you have lots of strips and HC foods in case he decides to continue to roll down the dosing scale.

Paws crossed!

 

Pasting this to Wally's current thread.

@Sandy and Black Kitty @Marje and Gracie @Wendy&Neko @Sienne and Gabby (GA)

Sandy since at this point Wally's situation is very different and can not be held to normal protocol in a safe manner.
Did you ever have to skip a shot to drain the Depot?
I realize that Wally has had DKA and that needs to be kept in mind with constant testing for ketones while trying to maintain a safe dose of insulin .
On the other hand in this situation weighing the margins of safety for Wally do you feel draining the Depot is an option that could be considered when a safe dose is elusive.

The only reason I am broaching this is that Stefano has shared through PM's with me the struggle he has been dealing with and like you with BK, trying to keep Wally's head above water so to speak, along with the fear of uncertainty when he has to leave Wally for long stretches of time unmonitored.
The Depot while being a positive in the regulation of a feline by the continuation of insulin becomes somewhat problematic in this rare situation.

Everyone that has joined this forum has a deep, abiding love for a feline and I have much empathy for Stefano in what has become a difficult pursuit to keep Wally safe and am trying to find more options for Wally and Stefano with no offence intended.

 

@Bear & Lora - I'm not sure that I agree that a dosing method should be abandoned.

Skipping a shot is feasible if the depot needs to be drained a bit more quickly than usual. However, Wally's numbers are trending back into blues given that Stefano dropped the dose from 5.5u to 3.5u. I would not be surprised if the numbers keep trending up. That was a BIG dose reduction. With DKA-prone cats, the goal is to give as much insulin as possible and use food to prop up the numbers. One of the issues with DKA is not only insufficient insulin but an inadequate number of calories. I just don't think that skipping is a great option until we have some certainty regarding whether Wally is still vulnerable to ketones developing. A too high dose can be managed with close monitoring and high carb food. DKA is not something that any of us can adequately manage at home.

Sandy has been here longer than I. Unless she has a different perspective, Wally's situation is not rare. Often when cats are coming down the dose ladder, they are racing down at breakneck speed. The only thing that is a complication is the ketone history.

 

I was a bit worried of the lack of appetite... In my mind it was a good idea to keep 5.5u also this morning but wasn't able to convince him to eat

I hope the reduction is not too much by now

 

I couldn’t have said it better.

I will only add for Stefano that sometimes feeding a much higher low carb food can help you safely get more insulin in (assuming he’s eating). You list in your signature that his food is 1.5% carbs on a dry matter basis but that doesn’t really tell us what the % calories from carbs is and that’s what is needed. Once you know that, if it’s on the lower end, you might want to either get a food that is closer to 10% calories from carbs or mix some MC in with the LC you have to make a higher LC. This can be a helpful way to be sure he gets enough insulin but the other side, as Sienne said, is being sure you feed foods that have a good amount of calories.

 

I confirm he's eating 1,5% calories from cabs, my signature is not exact... but that is what i meant!

I will do the mix only when needed I suppose. Could those additionals carbs have any negative effect on Wally healing process?

 

Look at Wally's SS in remarks, he is logging his Carbs and times.
Stefano has been steering at times with 28% and the outcomes depending on where Wally is in his cycle have held his BG steady with little to no movement.

 

The real issue here is how long can a human being stay at home to test their Kitty when they have to leave home to work and are getting little sleep and are feeling a lot of anxiety when food is doing minimal steering of the BG.
This has continued for 6 days now with a decrease of 5 units.

 

Thank you! That’s probably too little. Unless a cat is really carb sensitive, we’ve found they tend to do better with calories from carbs more in the 4-6% range (and some even a bit higher). Of course, there’s the issue of what you can get and what he’ll eat

BTW, I LOVE Vicenza!!!! Lucky you!!!

 

Did you visit Vicenza recently? There's not much too see... but some nice Palladian Villas!

 

It’s been a seven years. We lived in Germany six years and would drive to Italy, base out of the army post at Vicenza, and hop trains all over Italy. Then several years ago, we had friends move there and we visited them. They loved living there and we just thought it was such a great place to be! Because they lived there, we got more of a local feel than tourist feel.