? 5/19 MIMI AMPS 66 +16: 466 +2 394

MIMI was back in the black yesterday even after we gave her .25 shot. Now she is 66!
She is asking for food and her shot is not due until 8am.
I do not understand what is going on. We checked her overnight and she steadily dropped.
If she dropped so much with such a small amount, how safe is her AM shot?
Any advice with deciding what to do is appreciated.
She is all over the board and after 3 weeks surely she should be more stable by now..
We both have to work tomorrow. What can we do?

 

I know this is driving you crazy. You are looking at Mimi's FD as a sprint. It's a marathon. So, from that perspective, 3 weeks is a rather short period of time. If Lantus teaches you anything, it will be patience.

She bounced, hence the high numbers. The bounce broke, hence the low numbers.

If it's any consolation, look at @Marje and Gracie spreadsheet and look at mine. We would routinely shoot any number above 50. (We were following TR.) That said, I would not encourage you to shoot a 66 with only 3 weeks of experience at managing Mimi's FD.

Ideally, a Lantus curve is flat. Mimi is not well regulated so you won't see that yet.

Your choices are:

• Stall, but don't feed. This will throw you off schedule so it may not be a good option.
• Shoot a token dose and monitor carefully.
• Skip -- provided you are confident that ketones are well controlled.

 

I can't seem to understand the first option. Would you mind explaining? I thought that being sensitive to hypoglycemia, we should feed her..

 

Stalling without feeding means delaying the shot time, with no good given, so that you can test again to see if her sugar is going up. The negative to it is that since you want shots to be every 12 hours, any delay will shift your schedule.

 

Oh I see. Thanks. It makes sense now, but once again we did the wrong thing. We gave her food thinking we would shoot her dose, but her values are not going up much even with 1/4 can food. So we will stall and recheck in 4 hours and don't feed her again. At that point, we can give her her 0.25 and restart a 12 hours schedule?
Her ketones were negative last night.

 

This late in the cycle, it may be best to feed as normal, withhold for the 2 hours before preshot, and see where she is at preshot. You could grab a +11 if you'd like, so you can see how much she is going up, and you can ask for dosing advice early in case someone doesn't get to you right away. I would be nervous about giving insulin when the numbers aren't rising, and she has been hospitalized recently for hypoglycemia.
The possibility of a bounce is worrisome too with history of ketones- I hope someone with more experience chimes in.

 

So we stalled and her BG is now at 466 and she is not eating. We can force feed her and give her a shot? With those values, I am not sure we can wait anymore. With nobody here tomorrow to give her a dose at 1pm, what will happen?

 

@Sienne and Gabby (GA)
@MrWorfMen's Mom
@Bron and Sheba
@Wendy&Neko
@Marje and Gracie

Tagging everyone I can think of off the top of my head to help you here.

 

How long until her pm shot time?
Is there someone to shoot at regular times tomorrow?
She has earned a reduction- are you able to give her 0.1U tonight?

 

Her shot time would not be until 9pm. and there will be nobody here tomorrow to administer the dose as we have taken all our time off from work for the past three weeks and the only thing left to do is to quit the job. We struggle with understanding what 0.25 is so I doubt we could even know what a0.1 looks like. We keep getting bubbles and are so afraid to overdose her.
I am hoping that we can extend the cycle tomorrow morning and maybe stall enough? It seems every day is a different scenario with mimi, so I can't even imagine what her values might be tomorrow morning. I am so demoralized at this point.. i understand i have to be patient but she is so difficult that it is becoming hard to even handle her.

 

First, please link your thread from the previous day: Mimi 5/19 Doing so, allows us to go back and review what feedback you've gotten and it also allows you to do the same.

I commented in yesterday's thread about stalling. If you get a lower than expected pre-shot number, stall for 15 min. Do not feed. Re-test. Continue to repeat the process until numbers are rising on their own.

I also asked if you have decided on an approach to dosing. Deciding on whether you are following TR or SLGS also allows us to give you guidance that's relevant to how you are dosing. Please read the stickies and put a not in your signature. @majandra - we do not know if Mimi earned a dose reduction since I don't know which dosing method they are following.

There is information on how to handle low pre-shot numbers if you're following TR in one of the stickies at the top of the board. There is information on low pre-shot numbers if you're following SLGS in the dosing method sticky that I linked.

Since you skipped the shot (or at least that's what Mimi's SS indicates), you can shoot at whatever time you need to tonight to get back on schedule.

 

@Sienne and Gabby (GA)
I just saw that her sugar this morning was lime green- wouldn't that mean a dose decrease? Or is he using a pet meter spreadsheet while using a human meter?

 

@majandra - I'm not sure. I can't get the SS to open and the information isn't in her signature.

 

Your cat feels your stress. At this point she's probably frightened when you grab her to test. Try to take a few deep breaths & try to be calm when you test her. She will get used to it eventually. The way her BG keeps dropping at this low dose she may get regulated sooner than expected. Just be patient.
I'm confused about the name you listed? Is the cats name Mimi & your name is "Velvet Mirth"? (you also misspelled Mimi)

We were all confused & frustrated in the beginning. It will get easier,really. There's a lot to learn. The more you read about the insulin & how to use it the easier it will become. And ask questions. We all want to help you!

I asked Marje to help you with your SS (spreadsheet) She responded yesterday.

Instructions for pasting the SS link in your FDMB Signature block:

1. Login to FDMB and click on your user name in the upper right corner.

2. Select "signature”. The signature block is limited to three lines. If you have a lot of other information in your signature block, please be sure you place the spreadsheet link so it is easily located by other members (i.e. please don’t stick it at the very end of a long, detailed description of medications).

3. Put your cursor in the text box, type in your kitty’s name with the word “Spreadsheet” (e.g. Furbaby’s Spreadsheet), highlight those words, and then click on the “hyperlink" icon above the text box:



4. A text box will open that states "link"; paste your link into the box next to “URL” and click on “insert”.



5. This should result in the highlighted text turning light blue which means it is now a hyperlink to the spreadsheet and anyone clicking on it can see the spreadsheet.

6. Click "save changes" and you're done!! Great job!!!! If you need any help at all, please send me a private message by clicking on “Marje and Gracie” (to the left under Gracie’s photo) and then “Start a Conversation”. I am more than happy to help you or do the Spreadsheet for you.


@Marje and Gracie

Thank you for your help.

 

We have tried both dosing ways and I have read everything and tried everything, but with a 0.25 dose, I don't have a lot of room. Her values are all over the place no matter what we try and she often refuses to eat wet food or any food.
We stalled today and as her values were not getting better so decided not to shoot and she had nothing to eat and yet she jumped to 466. We had no choice but not to shoot as her AMPS was 66 and she has a history of hypoglycemia. Because we have been testing her so much for the past two weeks, she is now becoming even more aggressive than usual. The hospital had to sedate her to give her insulin and she can be scary even to us.
We force fed and now she has her shot. We usually monitor her at +2 +4 +6 and depending on how she behaves more or less.
One of us is prepared to quit if need be. We love too much not to, but in the meantime we need to get through this week.
0.25 is such a small dose and yet she reacts in a disproportionate way, whether high or low.
Thank you for all your advice and I am very sorry if I keep asking for help and feel frazzled but I truly am lost

 

The sig link stopped working. Here is a direct link I grabbed from history:
https://docs.google.com/spreadsheet...kKgelcP7pnj1kTEMqxlYuszpAZo7XreK_myG5/pubhtml

 

I am using the AT2 so I was told 68 was the lowest she could go. Thanks for the instructions on the SS name. I will get it fixed when my anxiety subsides. Right now I am running on empty and I am not sure I have the capacity. As I have mentioned, I have never even being online so I am new to diabetes, forums, online, google spreadsheet etc.. Velvet Mirth is my other rescue cat. She is special needs with cerebellar hypoplasia and epilepsy. With her schedule being 7am and 7pm, we were hoping to get MIMI on the same meds schedule, but with all these lows and skipping shots, we are nowhere near that...

 

Some questions:


1) Are you just feeding two meals? just reading through your posts it seems like you are. It would be really helpful if you could tell us what your usual feeding schedule is with Mimi.
What she get's and when with respect to her insulin shots.

yesterday you said

Since you skipped this morning you could have shoot at 7pm tonight to get you back on schedule. But I see you shot at +16 when she hit 466. The SS needs to reflect that you stalled and shot at +16 (16hrs after the last insulin shot). Have a look at Georges SS you can see on the 15/12/2015 (sorry european date) I stalled, you can see how that is reflected in the ss.

I see she is getting Dr Elseys Dry, as she is on a dry food, in theory you are stuck with SLGS (though with DKA and ketones, you may need to get a little creative)
If I remember correctly you kinda went cold turkey with the wet food, It can take some cats a long time to transition fully to wet, it's frustrating, but if you need to, just take it slowly.

 

MImi has never had a feeding schedule as she is only eating when she wants to and in very small quantities all day long. Prior to the past two weeks, she has never accepted wet foor, home cooked or any dry food other than the one she liked. Since being in hospital and Now that she has to eat before the shot, she is refusing food and we have to force feed her. We are using Dr Elseys to help with the transition. She likes that.
Mimi has always had behavioral issues, so she is not the typical happy kitty. We rescued her and accepted her aggressive personality, but now that we need to handle her, it is very hard.

 

So she's a grazer.
A question. Does she just have wet food down to graze on? dry? Or both?

 

14 months ago I was "Just Like YOU" ! I didn't know anything about diabetes,forum or spread sheet! (I'm 72 yrs old & alone.It was difficult going without sleep & reading & re reading the Yellow sticky notes over & over to understand what i was doing!)
It will get easier, it takes time for you to learn what's going on . As you fill in the blank spaces on the Spreadsheet think of it like a puzzle. The more spaces you fill in the more information you have about how the insulin is working in Mimi's little body.

If you look at my Ravan's SS from 2018 you'll see how he was always very high. It took time but he's finally doing a lot better. Ravan will be 17 years old in a few weeks. He also has Kidney disease & high blood pressure. I have 2 others the same age with different medical problems.

All of us here understand what you're feeling now. We've all been there,done that. Some of the people have been here for years. Their kitties have passed on & they come back to donate their time to help the new people. Never feel you can't do this. You have all these people here that want to help. You will get thru it, you CAN do this to help your kitty. It's wonderful that you are taking care of the other rescue kitty.

Keep reading & ask questions!

 

We leave the wet food for her to graze and use dry food to entice her to eat a bit pre shot.

 

Frankly, I don't know what I would have done without everyone here helping. Mimi is a difficult kitty (i have scars to prove it) but we adore her just the way she is. Seeing her in ICU for three days has made us so worried and the hospital doctors stated her lack of regulation is unusual but offered no real solution, other than the oral insulin which I will not do.
I am very grateful for eveyone's help. Truly am...

 

Do you find she looks for food when her numbers are dropping? My George did, but not all cats do.
If you test her and you find that her numbers are dropping fast, one thing that you can do to slow down the drop is to try and get her to eat, perhaps encouraging her with a sprinkling of Dr E on her wet food???

At the moment she seems caught in a cycle of dropping fast and low, and then that results in a bounce and numbers sky rocketing. If you were able to slow her down by enticing her with more food, even if it is Dr Elseys, it might help even her out a bit. It's not something that would happen overnight, but it might be worth trying.

could you please do me a favour, and add a few things to the signature.
1) AT2 that way if for anyreason we cant see your ss we can know easily without having to ask.
2) add Dr E to the food she's having in the sig
3) you perhaps want to indicate SLGS, since she is having dry food, this is the only dosing method that will support it, TR would require her to be on a solely LC wet diet.
thanks.

I've been thinking about you being really of schedule now, you shot at 1pm so next shot is due at 1am. and you said you wanted to get onto a 7am/7pm schedule. Clawing your way back 15min a cycle is going to take forever, I had to claw back 2 hours and it took me nearly 2 weeks to get back on track.
An alternative would be the following two options
1) skip tonights shot and shoot tomorrow morning at 7am (effectively this would be an 18hr cycle)
2) shoot on time tonight, and skip tomorrows am shot shooting at 7pm
Whichever suits you best, and as long as ketones are low and she's not sick.

Mimi did earn a reduction with that drop to 66, (in fact on SLGS dropping below 90 earns a reduction) so you do need to reduce to 0.1u

follow this link for more info on dosing http://www.felinediabetes.com/FDMB/...info-proper-handling-drawing-fine-dosing.151/

below is an extract from that sticky it shows you the 0.1u dose. (top right pic)
Fine dose gradations:

• 0.5U = exactly half a unit
• 0.4U = skinny 0.5 touching the line
• 0.3U = skinny 0.5 with daylight under the line
• 0.2U = fat zero with daylight over the line
• 0.1U = fat zero barely touching the line

Pictorial guide using a U-100 syringe marked with half units:

 

I understand you're trying to get her to eat but dry food is digested differently than wet food & is probably causing the high BG, If you have the time please read the yellow sticky note by Dr, Pierson about dry food.

It's really terrible stuff. It's not natural for any animal. I've seen cats here go into remission just by eliminating all dry food.
Have you tried "real" chicken? My 17 year old Ravan goes off his food sometimes. (he was raised all his life on a raw meat diet)

I picked up a Rotisserie Chicken from the Jewel & he will eat that! Or the Fortiflora dusted on his canned food. I recently bought "Halo" Turkey & Duck canned food at the Petco . I was happy that all 3 of my cats liked it. It's only 5% carbs

Right now I have about a dozen different canned foods I sometimes have 4 or 5 opened in the fridge trying to find something he'll eat. I think most of the cats here have gone thru this. They are hungry but just can't find what they want to eat.

Have you ever trimmed Mimi's nails? Or had the vet tech do it? I've been trimming my cats nails since they were kittens.

 

Dr Elseys is LC dry I believe.

 

Mimi's lack of regulation is absolutely typical. Your vet is passing along unreasonable expectations which is adding to your anxiety. Take some time to look at people's spreadsheets. It's very rare to see a cat get regulated within a few weeks. I've been hanging out here for 10 years and there are only a handful of cats who were regulated or in remission within a month or two. Please understand, vets often have very limited experience with FD. If they get a few hours of training in vet school it's a lot and when they do get lectures, it covers more than just cats. And, cats are very different than dogs.

If Mimi is grazing during the day, that's good! It means if she's hungry, which often happens if numbers are dropping, she'll eat. Some cats like freeze dried chicken and you can crumble it over their food as a way to entice them. If you crush some of the Dr. Elsey's, that may also be a way to spread the dry a bit thinner and get her to eat. Another option is Stella & Chewy's. They have raw food that is freeze dried and crunchy and low in carbs.

Gil has made some good suggestions about how to manage Mimi's shot for either tonight or tomorrow.

 

Though I do agree that a low carb wet diet is much more preferable, i have seen cats go OTJ on LC dry.

Most dry food is too high in carbs and will play havoc with BG, but a low carb dry can also be effective in lowering/controlling BG, it's less healthy for other reasons, mainly in that a lot of kitties end up being chronically dehydrated when on a dry food diet and that's not good for the urinary tract or kidneys, so though I would not advocate it.
I do think that using a LC dry is a useful tool to use when transitioning a stubborn kibble addict, especially one where it is more important that they get enough calories (post DKA), or indeed using it if you need kitty to eat so that you can slow numbers down.

 

Maybe I got this wrong? I thought even low carb dry can cause problems with the BG?
Because she is trying to "slowly" get her onto wet food I see why she's tempting her with the dry. I'm very much against all dry food after reading what Dr pierson said about it.
My cats have never had any dry food.

 

i have never been able to trim her nails. My husband sometimes manages, but otherwise the tech will have to take care of that. Note that at the hospital they had to wear gloves and protective gear to handle her, and yet sometimes she is the sweetest thing. Unpredictable just like her BG!

 

mimi has only ever eaten one type of dry food her whole life. She will starve herself to death, rather than try anything else, so it is already a small miracle that she is eating FF and Dr Elseys

 

We will continue to test her and see if we can shoot tonight or tomorrow morning and leave some food out so she can graze in case she is getting low. I read a lot about hypoglycemia, but not so much about hyperglycemia. Is the latter less dangerous? When I see those black numbers I am scared as much as the lime colored ones!

 

Me too but even Dr P will feed dry to a kitty she is transitioning while she convinces them that a wet diet is best, she's had some stubborn kibble addicts over the years, . Right now with Mimi dropping fast and with recent DKA history she needs to have access to food that she will readily eat especially when her Beans are at work.

Nervous Pervis, was eating Young Again, low carb dry when he went of the juice second time. He stopped eating wet, CG gave him some dry, but it was HC this resulted in him loosing remission, then swapped onto YA started insulin again and went OTJ a second time
https://docs.google.com/spreadsheets/d/1xLeRZynrKjkPEDty9eHXVLZ2vXGLUYW3G424_pjGJTo/pubhtml
back on the juice
http://www.felinediabetes.com/FDMB/threads/8-30-nervous-pervis-otj-ambg-316-pmbg-337.164063/
OTJ
http://www.felinediabetes.com/FDMB/...rvis-otj-trial-day-14-ambg-77-pmbg-73.168534/

Prolonged hyperglycaemia is worrying especially in the presence of ketones. Prolonged high blood sugar levels are hard on the kidneys. But at least with Mimi you are seeing some movement into healthier range, we just need to convince her that she needs to spend some more time there, as Sienne said above, it's unlikely to happen quickly, George took 3 months to get regulated, almost 6weeks before he saw anything other than red, and in FD terms that was pretty quick. It then took a futher 3-4months before he went into remission.
Try not to worry

 

Thank you everyone. This has been the hardest day so far. I appreciate all your kindness and expertise. I hope one day to be seasoned enough to help newbies like me. Mimi is blissfully asleep.