12/29 Webster AMPS=380 +2=198

Yesterday's condo

Last night was interesting. Webster went from 160 to 52 in 1.5 hours so I gave him 2 tbs of eight percent food. I laid on the couch and fell asleep for just over an hour. When I woke up and tested him he was at 37! This was by far the lowest that I have ever seen him go.

I of course panicked, gave him a generous serving of 20% with several drops of Karo. An hour later he jumped up to 87. Since he was at his nadir, I left out 2 tbs of 8% of "just in case" food and then hit the bed.

When it comes to earning a reduction I have some mixed feelings.

On the surface, him dropping low and earning a reductions may show that hes getting too much insulin and needs to be given less. With a goal of slowly step him down until he hopefully doesn't need insulin, earning a reduction is a good thing right?

However, I really have my doubts that Webster's dose really needs to be reduced. Comparatively speaking, he's doing better than ever on the 1.5U dose. My thoughts are that his drop last night was food related.

I've been noticing over the past several days that he's becoming more of a grazer. This was one of the reasons why I switched from 4 feeding to 2 feeding - 3 oz @ PS and 1oz sometime around +3.

Before, he was getting one serving every hour for the first 4 hours of his cycle. I recently started to notice that he wasn't eating all of his food prior to the timer going off and taking away his food. Okay, well the insulin is working and he's able to process his food properly so he's not inhaling everything that's put in front of him immediately. Let's give him most of his food and allow him to graze and save an ounce for backup. Makes sense..

Last night he only ate about 1.5- by +3. My theory is that by +3 his insulin was kicking in and he hadn't eaten enough to counteract the insulin and dropped like a rock.

Fortunately, he eventually ate all of his food and when he was at 37 he would eat whatever I put in front of him.

That being said, I'm thinking that with his reduction to 1.25U we are not going to see those nice greens and blues that we have been seeing. I foresee lots of pinks and reds coming. Unless of course he continues to slowly graze which means that he will not have enough food in time to counteract the insulin. In the scenario he might continue to crash again and earn more reductions.

While having to give him less insulin sounds like we are making progress, I'm really having my doubts about this reduction.

Am I looking at this correctly? What are you thoughts?

 

Wow, Webster! Who would've thunk! I know what you mean about being reluctant to take a reduction. I had a meltdown over Mikey's last one. I'll be interested to see what the experienced members think you should do. Meanwhile, I'm so glad to see that he's staying out of ketone-land.

 

Thank you Mary and yes its great to see the ketones gone! Now, the challenge is to keep these numbers down so that they don't return.

 

Hi there

I'm glad you reduced - Safety First!

From the TR protocol:

Reducing the dose:

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
  
  Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
  
  • If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
  • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
    Please ask for advice.

​

I'm pressed for time presently but will be back later with my thoughts.
In the mean time I've highlighted the statements from TR that apply to Webster today.

​

 

I agree Sandy. Safety first.

It's just difficult for me to drop him back down when he's been doing so well and we know that ketones can quickly become a threat with higher numbers. I suppose we will just wait and see how this new dose plays out.

 

Hello again

My $0.02-

The root cause of the drop last night was insulin related.
If his eating pattern/amount does not mesh safely with the onset of the dose, it could result in unexpected lows.

As stated in the TR protocol guidelines-

• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.

You have done well grasping a whole lot of information quickly however I don't feel you know Websters reactions well enough to step outside the very important safety guideline above. Having to go into crisis mode right from the get-go has not offered the best opportunity to "Know thy Cat" in a non-crisis way that allows you to best treat his FD and have a life.

The ketone situation required you temporarily employ an approach even more aggressive than the TR protocol (which in and of itself is aggressive) with the goal being to steer Webster to safer shores. Using food to keep a kitty from bottoming out while you attempt to get more insulin in him in order to derail the development of ketones is not a strategy to be used indefinitely.

Webster has made wonderful progress - nearly 11 days ketone free - most definitely safer shores but there is one more item to be addressed - underlying infection.
Think of a three legged stool-
As a result of getting more insulin into him energy from calories is being transported into his cells. These are legs one and two. The stool may be able to balance on two legs for a while however sustaining that balance requires an intensive effort that cannot be safely sustained for long.
Uncovering and addressing any source of infection is required since it may be feeding the development of ketones. It's the third leg of the stool and once it is in place the stool is sturdy.

Working to achieve regulation or remission is well worth the effort. However first things first - cut off all sources of fuels that feed the development of ketones.

Regarding reductions, if you reduce and it does not hold Webster in normal numbers after allowing for any depot action from the previous dose and the clearing of a bounce (should one occur) you go back up. Most all of us have experienced a failed reduction at some point in the journey. The road to healing is rarely without some ups and downs. Try to stay focused on the larger picture and all the progress made so far.

 

Thank you Sandy. While I would prefer to think of it as a "Food problem", you are right. His eating habits were not meshing with the insulin onset, therefore it's an insulin issue. Granted, there may be an underlying reason why he wasn't particularly hungry that night and ate extremely slowly which caused his drop.

Excellent analogy! I need to get moving on his dental. Just when I was ready to pull the trigger and call my vet for an appointment, this happened and now I'm concerned about his numbers sky-rocking and ketones developing. The last thing that I want is to deal with a kitty who won't eat, going hypo and on AB... This is where I started over a month ago when he came out of the hospital. I just don't know when the right time may be.