29/8 Jai Jai – AMPS: 493, +3: 445, +5: 466, +9: 454; PMPS: 464, +2: 407, +4: 454

Yesterday’s Condo: http://www.felinediabetes.com/FDMB/...4-2-254-possibly-an-error-3-382-4-367.143416/


My Active Thread on the Main Forum:http://www.felinediabetes.com/FDMB/threads/jai-jai-update-and-discussion.143333/#post-1485314
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The bald spot found on Jai Jai yesterday turned out an inflammation as Jai Jai kept licking the area. It is red and a bit hardened. I am not sure what it is right now, and there is some discussion going on here (http://www.felinediabetes.com/FDMB/threads/jai-jai-update-and-discussion.143333/#post-1486258)



I start planning for adjusting Jai Jai’s dose, but I will keep his dose of 0.5 units for at least 10 cycles, because rapid change may not quite suitable at the time. I also wonder how I determine whether his bounce was done after his hypo on 25/8.


See anyone here will give some advice, thanks.

 

His bounce is no doubt done, but I suspect he is a bouncy kitty, probably not staying very long in green numbers once he gets there. The reason I'm suggesting this as a possibility is because he was definitely overdosed to have gotten into the 20's like that, and while looking at the data you had before you'd increased his dose, I'd have thought he needed more as well. But I think there are hints on his ss that these highs are from hitting low numbers and bouncing.

Since you're at work during the day, you'll have to just grab tests in the pm cycle and on your days off to try to catch the low points. That's your goal - to see how low the dose is taking him before you increase his dose.

I saw Sienne's suggestion in your last post about shooting earlier in the day, so that you are testing, feeding and shooting all within a few minutes. Then if he needs to graze, he can graze over the hour or two after his shots, rather than before. I think that's a very good suggestion and would encourage you to try it. So according to the schedule you've got below, at 6:15-6:30 am you would test, feed & shoot. Let him graze until you leave for work. At 6:50 when you return from work, test feed and shoot the moment you walk in the door. See if that doesn't help things.

5:45am Get up
6:00am Test/Feed (40g)
6:30am Feed (50g)
7:00am Shoot
7:00am Feed (20g)
7:30am Go out for work
6:50pm Return home
7:00pm Test/Feed (40g)
7:15pm Feed (50g)
7:30pm Shoot
7:30pm Feed (20g)
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Some people with multiple cats will isolate the diabetic cat into a bedroom or bathroom while they are at work so the cat has access to food during the work day. It would be a good idea if you can work out a way to get food for him during the day.

Most people don't give subq fluids at the same time and place as they shoot insulin. It can cause blood sugar to plummet sometimes. We always gave punkin subq's at +3 to avoid that problem.

Like Sienne, I don't spend any time on Main Health except when people put out a 911 on LLL and ask for help for someone on Main Health. We encourage people to learn the basics there, but then to "move" to an insulin support group once they've learned that so that people who understand the dosing of their particular insulin can get to know their cat & situation, and to help them with dosing. You can do whatever you want, of course, there are no rules about it, but this Insulin Support Group is where most of the most experienced Lantus/Lev users spend their time.

 

I wanted to add one more thing - when you do get a green number (over 50), then you want to hold that dose for at least 10 cycles and see if he'll get to green again. I'm specifically looking at 7/28 when he got to 67 that night. When you get tests in that range, you don't want to increase until you're sure that he's not going to get to green numbers again. I'd have suggested at the time that you immediately give him a couple of teaspoons of his regular low carb food to help him "surf" in green numbers, and to retest in about 30 minutes or so to see if he was going lower or not.

That 67, or whatever else he got to in that pm cycle, caused a bounce. You can see how his BGs increased the next day to 158 and then 313. Bounces can last up to 3 days, so that would've meant holding the 0.5u dose until after 7/31, when the bounce would've likely been cleared and you could've seen how low he was going to get then. Instead you doubled his dose on 7/30, based upon his pmps of 470, which was a bounce number. Lantus dosing is based upon the lows - you can't use Lantus to "shoot down" high numbers. The most important number for his dosing at that time was the 67.

Even if he'd cleared the bounce and it was clear that he needed more insulin, you would've only increased by 0.25u, not 0.5u. Small incremental changes can make a big difference in a cat's blood sugar.

Just thought a specific example for you to see might help you understand a little more about the dosing, because I think that will help you help him.

Bounces are important to understand - you want to learn to see the difference between a high number that says he needs more insulin, a high number that is caused by New Dose Wonkiness, and a high number that comes from a bounce. Here's a link that might help you a bit. Please take a look at that information. Until people can see those things for themselves, they usually ask for help on deciding if they should increase the dose or not.

 

I shoot while Mikey is actually eating. He couldn't care less!

 

Hi, Julie. The vet did tell the following things I found wrong previously:

1. Hit on the vein on the ears for home testing, whereas people here hit on the sweet spot.
2. Home testing is done once a week, it is useless to test the PSs. What I am doing on Jai Jai undermines his quality of life.
3. Meals should be given at consistent volume (this is correct), but she disapproved me of giving Jai Jai more food even though I told her that the daily calorie intake at that time was too few.

So, I won't be surprised if I have some kind of practice that is not the convention. I had to "obey" to the vet's advice because the vets I have here are not "negotiable". One said that if I did not leave Jai Jai in his clinic for 3 to 7 days to determine the dose and change him to prescription diet, he would not take the case. That moment the vet had confirmed that Jai Jai was diabetic. I cried so hard and I stayed in his crowded clinic for two hours just to talk to him if there was any alternate plan. Of course not.

After Jai Jai's hypo incident on 25/8, my current vet (already an ex-) even politely asked me to seek medical advice from other vets. Vets ask for their medical records before deciding if they want to take up the case. I have been turned down for several times.

To sort out a more effective way to help Jai Jai, I did learn on FDMB, I started reading the stickies and information. I did not look into others' case because ECID. However, at this point, I think most of the valuable information is given through messages. I don't get the reasons for not putting this kind of useful information somewhere while it is worthwhile for newbies' reference. Anyway, I really thank for your patience in looking into the data and gave specific examples for me to learn.

Starting from this morning (30/8), I tried test/feed/shoot. My schedule is refined like this:

5:45am Get up
6:15am Test
6:30am Feed (40g)
6:35am Shoot
6:40am Feed (70g)
7:30am Go out for work
6:50pm Return home
7:00pm Test/Feed (40g)
7:15pm Shoot
7:30pm Feed (70g)

I will try shorten the test/feed/shoot time. Jai Jai notices any small move so I let him finish the small meal first. I avoid him developing some kind of association between eating and insulin injection.

About the NDW, Jai Jai encountered 2 to 3 times, I am getting used to it. What I am still do not understand is the 1.25 unit starting from 22/8 PM did not bring him down. During that six cycles, I did test mid-cycles and learned that his nadir was >300. I did not see him bounce since his curve on 23/8 was flat. I decided to increase the dose by 0.25 that ended up a serious hypo incident happened. That broke my heart very much.

One more thing I want to know, will you do a full BG curve when you change the dose? More likely that I change Jai Jai's dose in his PM shot, the upcoming one will happen on 31/8 PM. An increase to 0.75 seems appropriate and safe according to his previous records. However once again, I will not able to get his mid-cycle figures in day-time that makes me nervous.

Again, I sincerely thank for your time, and the learning points I need to know. Wish you a happy weekend.

 

Yes, I took the points Julie told, and I tried test/feed/shoot this morning. Jai Jai notes every small move, so I shot after he ate up the small meal. There was about a 6-7 minutes lag. I will try shortening the feed/shoot lag by letting Jai Jai get used to the new routine.

 

It sounds like Jai Jai is a bit more normal than Mikey.

 

It does make things a little more difficult (but not impossible) when you can't get any day cycle tests because you just don't know what happened then, eg on 8/26 you could get some tests and we can see Jai Jai went down to blue but if you didn't have those tests you'd never know as he finished the day in red - don't know where he started that day but maybe also red. This means that you don't actually know whether the 1.25 brought Jai Jai down or not because it could have happened in the daytime. On the other hand, and I would suspect this to be the case here given the numbers in the 20s that followed, too much insulin can result in high flat numbers that looks just like too little insulin. This is why we increase the dose in very small amounts - to make sure we don't go past the right dose.

The thing to learn about Lantus is when you shoot a dose it is not just the effect of that dose that you see in the cycle. Lantus forms a depot so in each cycle you could see the effects of the last six shots, e.g even if you had shot 1.25 again on PM 8/25 I suspect you still would have ended up with very low numbers.

The depot effect also means that you won't see the full effect of any new dose for up to six cycles and some kitties don't show any response to an increase in the first cycle or two, some get the NDW and actually go higher. With Jai Jai we don't know yet so (assuming you work Monday- Friday) I would probably do increases (when the time is right) early in the weekend so you can monitor several cycles to see how he does. You will learn his response as time passes and be able to plan for his increases accordingly.

 

Hi, Vyktor's Mum. It is nice to have more and more experienced people to join the discussion. Thank you.

So, do you mean that my plan to raise the dose to 0.75 on 31/8 PM has to be postponed to the next weekend?

 

It's hard to plan in advance when to increase. I see you have a couple of yellow tests today. I would keep testing to see how low he goes.