7/20 - Macka AMPS 535 +5 522 - still so high :( IBD & Steroids soon, Increase?

Hi all,

Macka is still in very, very high numbers. I can see he's losing steam
He's getting 1.25 unit. The specialist vet asked me to stay on this dose for another week, so that we can start the steroids for his Inflammatory Bowel Disease (haven't received them yet), and the B12 shot (given this morning).

I understand we cannot make too many changes at the same time, or data will be harder to read. And it might also be risky for him. I am hopeful that the steroids will bring him down a little next week. How quick do they work?

What do you think? Thanks so much

 

Well, steroids typically increase numbers, but illness and pain will too, so you should treat his IBD. I don’t know enough to give advice about what to do next. If you search the forum for posts about IBD you’ll find more info.

 

Poor Macka maybe change your post title to include IBD / steroids so someone with knowledge about that is more likely to notice it. I hope you get some suggestions to help you think through this!

 

Steroids will increase insulin needs - usually. I don't see why you need to hold this dose if it's not working. I would increase. He would sooner go into ketoacidosis with that high of BG and not enough insulin. How is Macka with his food? Eating still? Have you done any ketone tests for his urine?

 

I believe @Wendy&Neko has some experience with IBD. She might be able to point you to some resources. I tried googling but can't remember what the website that everyone recommends to go to for IBD is.

 

It doesn't necessarily impact BG, which steroid are you getting? Most now use budesonide for IBD, and that doesn't seem to impact BG like a prednisolone/prednisone would..

Whispy had symptoms similar to IBD when we first adopted him so we gave him budesonide and saw almost no difference in his BG.

 

I have not used it so can't vouch for the quality of the Info, but I bet this is the one: https://www.ibdkitties.net

 

Yes I test every day for ketones and he is ok for now. He eats okay. But not like he used to, but ok, about 2 cans a day/ a little more sometimes. I want to increase the dose so bad tomorrow.

 

Yes! That's the one.

 

What's the reasoning the IM specialist doesn't want to change up his dose?

If I were you, I'd increase. And if the start of steroids helps bring down his numbers, it's what reductions are for. You test and are in control. If Macka goes low, you know what to do and we're here to help.

Maybe others will have more to say. You could change your title to ask for other's opinion on increase.

 

There is absolutely no reason you can't (and shouldn't) increase him at his next shot time

Your signature says you're doing SLGS, but you test more than enough to do Tight Regulation. TR would allow you to increase by .5 as often as every 3 days if his nadir is above 300.....and increase by .25 every 3 days if nadir is under 300. With that blip of blue recently, I'd go to 1.5 tomorrow

I'm glad he's still ketone free, but with numbers that high, you need to be more aggressive with his dosing (IMO)

 

I did not chose TR because I can't stay up all night fighting to bring him back up. I was sleep deprived for a month and lost my health. I am very anxious and worried about hypos, so if I am agressive with the dosing, I will lose my mind completely.
I am just too anxious, to the point that it eats me up (I already quit my job, and stopped having a life).

 

You're already testing enough to do TR.....as you learn more about how he reacts, the chances of you having to be up all night will lessen ...that's kind of the point of home testing.

With him running that high, I'm worried about him developing ketones and you really don't want that!

You have to do what you're comfortable with though so we'll support you any way we can.

 

Ye, I think i'll increase to 1.5 tomorrow, and will write an email to the vet to explain why.

 

Because I suspect she expects the numbers to go down with the treatment for IBD, and also she asked me to stop testing a home for my health and his well being. Which I can't. So we agreed on testing at +5, but I still test more than that, preshots included.

 

Treating IBD had no imoact on Neko’s Numbers, neither the addition of budesonide or helping the inflammation. Dose by the numbers you are seeing now, not by what you might sort of maybe see in the future. Leaving Macka in high numbers contributes to glucose toxicity.

 

Personally I think it is good that you test a bit more/earlier in Macka's cycles than your vet suggested. Macka usually responds very well to the insulin at night and I think you will be shocked many times (and go into panic and despair mode) if your first test in the evening was at +5.
Zorro often takes giant leaps from the +2 to +3 test (which I only realized when I started to do those very early tests) so I try to feed him 1 - 1.5oz at his PMPS, then another 1oz at +2 and about 0.5oz at +3. If you do try this then your quantities will depend on Mackas current feeding regime. Stick with low carb for those feedings because you're just trying to help him slide down gently, not bring him up. In general it has helped Zorro "surf" the good numbers better - much better than before anyway.

Something I also started doing recently when I saw that the snapping sound from the lancet device was starting to make Zorro flinch (don't know if you use one of those?): For ease of handling I still use the lancet in the device but I remove the front cap and don't use the auto-release function so there's no loud "click " in his ears. It took just a couple of times to get used to and now I can do it very gently on the outer tip of his ear (rotate ears and position) and many times he is sleeping while I test. It makes me feel more comfortable with testing often and is clearly much easier on him.

I agree with a dose increase looking to be necessary, Penelope

 

Do you mean that you just poke with the movement of your hand? When you say outer ear, are you saying on the external furry part of it?

 

Okay, I just increased to 1.5 units this morning

 

Good luck with the increase! It will get easier, I promise. We've all been there and have cried and worried lots about our kitties. I still do sometimes but it's a lot easier because I know what to do (most of the time). I know the stress of going against vet advice also adds on to everything but just remind yourself that you are in control and make the decisions too. Do what is best for Macka.

I also poke along the side of the outer ear with a needle - not lancet. I buy needles without the syringe at the vet (22 G) and just poke by hand. I put a tissue behind where I'm poking and then poke for blood. It's helps that Ming is short hair and not long hair.

 

Yes, I gently fold the tip of his ear along its natural lines and quickly do a light poke on the outer furry side, moving a bit up or a bit down each time.
I stopped using the inner side of his ear long ago - it seemed too vulnerable to me and I get much better droplets using the outer ear.
The first few times your hands will feel slow and clumsy but after a few tries it is so easy.

 

Don't know if you've ever gotten a very big droplet that kept forming because you've hit a little vein - don't be alarmed, it doesn't seem to bother Zorro any more than other pokes and normally he just shakes his head because he can feel the droplet on his fur. Just press gently with a tissue and the bleeding will stop.

Something that's happened to me twice over the past 3 weeks or so: I managed to only get a small amount of blood that barely covered the tip of the test strip properly. I expected an error message from the tester but it was enough blood to nót trigger the error message. However each of those times the reading shocked me and I though "Oh my gosh, he's dropped thát much by now?!" Then when I did a double-check with a new strip with the same tester the first time it happened and the second time with a new, back-up tester that I have, with sufficient blood, the readings were more in line with what I expected.
Just something to keep in mind if you get a surprise reading AND you got a very stingy amount of blood on the test strip.

 

Yes, it happened many times, and I did not want to risk having an incorrect reading so I did not even try to use the same stick again. I just throw them away.

 

Just to clarify, whether you need to stay up at night to test if your cat is in lower numbers has nothing to do with which dosing method you choose to follow. If you are using SLGS and Macka is in low numbers, you still need to stay up and make sure your kitty is in safe numbers before you go to sleep.

I'm glad you increased. Please explain to Macka that those are not pretty numbers!

 

Oh definitely never use the same test strip more than once; I don't even think that will work and the machine should immediately give you an error message if somehow a previously used strip is inserted.
My point was rather to do another test (with a new strip, of course) in the event that you only get a small amount of blood on the strip, even if the tester does not give you an error message

 

Yes, thank you, of course, if numbers are concerning, I am NOT going to bed