3/17 Merlin AMPS 145 / +2 140 / PMPS 205/ +3 209

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Steve & Merlin, Mar 17, 2019 at 9:54 AM.

  1. Steve & Merlin

    Steve & Merlin Member

    Joined:
    Mar 1, 2019
    I'm not sure what is going on with Merlin. If you look at his SS you can see he was in the greens all yesterday As the day wore on, he seemed to be becoming more unsettled and out of sorts. His BG was pretty low, and in a decline, at the PMPS so I delayed an hour and reduced the shot. That moved him into the blue for his AMPS. But I am feeling cautious since he had been flattish dark green so long and his behavior is still off. He didn't sleep that much and refused breakfast. He's not in any pain, just agitated a bit. So all things considered, I decided to hold the lower dose.

    Before January he was a very solid predictable curve cat. 2 units AM and PM. The PS highs were in the low 200s/high 100s and his nadirs were low 100s/high dark green. He never went below 50. This seemed a pretty good place for him and with our jobs, provided the security that if he went lower than normal, he wouldn't be in danger and not being able to intervene. We had a good low safety margin. Our vet thought his numbers were fine for a diabetic cat as well. Yesterday had a weird curve. He was just middling dark green. He also had no real safety margin and this month he has shown he can drop fast below 40 and needs intervention. So I was pretty much on alert the last 24 hours. Fortunately, I am now retired and can spend the time to monitor him.

    Does anybody know what's going on with Merlin's recent response to his original dose? If he swings higher today, should I consider increasing the dose or holding this dose a bit before thinking about raising it? If he shows a more normal response at this dose, I guess it becomes the new normal until it's not? The bottom line is nadirs or flat curves in the 60/50s make me very nervous as I don't trust him to not have an event that I may not be there to intervene. His agitation at these numbers yesterday also added to my anxiety as I was expecting something to happen. I guess I got spoiled with his previous safety margin.

    Any comments would be appreciated.

    http://www.felinediabetes.com/FDMB/threads/3-16-merlin-pmps-57-delayed-1-hour-69-2-79.212024/
     
  2. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    I'm sure someone will chime in with some insight. I know with Olive her behavior is a bit off when she is in numbers she isn't use to.
     
  3. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    The larger depot can influence 4-6 cycles after a reduction. He didn’t earn a reduction down to 1.0 units.
     
    Last edited: Mar 17, 2019 at 7:17 PM
    Reason for edit: spelling
  4. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    something has shifted.
    Do you have any data prior to 1/30/2019?

    Are you monitoring for ketones?
    Any weight changes?
    Has he been tested for hyperthyroidism?
     
    Wendy&Neko likes this.
  5. Steve & Merlin

    Steve & Merlin Member

    Joined:
    Mar 1, 2019
    Yes he was tested and was negative for hyperthyroidism. His ketones have been neg or <1 by blood testing. The higher ketone values were when he was in the 500s.
    He has been losing weight. That started the same time he went out of kilter BG-wise in Jan. He has lost a bit over a pound and is now 12lb 13 oz. One issue is his appetite is not so great and when he does eat, he eats small portions. No vomiting or nausea. If you click on the LAB tab of his spreadsheet you can see the results of his latest workup last month. They showed nothing wrong.
     
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Is Merlin taking in the same number of calories he was previously? You said the vet thought he wasn't metabolising his food properly. Did the vet ever suggest getting a GI panel done? The Texas A&M GI panel includes tests for B12 and folate, as well as a couple other tests that give a good picture of GI metabolism. That plus an ultrasound of the GI system. Besides diabetes and hyperT, a GI issue is the third reason for losing weight if still eating the same amount. It's fine if he's grazing, not so good if he's not getting the required calories in.
     
  7. Steve & Merlin

    Steve & Merlin Member

    Joined:
    Mar 1, 2019
    Good idea about the GI panel. I'll look into it.
    As far as calories in, I think that is part of the problem now. He is not eating as much as he used to. He would get 3 big meals a day and that kept him going. Now he only eats little portions and leaves the rest. So I have been feeding him every couple hours till bedtime. When I get him up in the wee hours for a BG test, I feed him some as well and he takes it. I would say for the last week we have stopped the weight loss, but he hasn't gained anything back. I was hoping that when we got him in the blues and greens that his appetite would perk up. But that hasn't happened. He has been perkier the last few days, but yesterday he seemed out of sorts. But today he is better.

    I know he didn't earn a reduction, but I was concerned that since he hadn't eaten anything for 12 hours and passed on breakfast that he might not have enough in him for a full dose. Plus, his numbers were low and flat all day so it didn't look like he was "burning off" what he had been given yet. The final straw was when his numbers started dropping again including his PS. I had a better safe than sorry mood. I was thinking of putting him back to 1.25u and see how he does with that for awhile. Right now I am actually more concerned with his appetite and weight than his BG numbers which aren't too bad right now. I've really been happy that he hasn't been bouncing like before.

    A trick I've been doing yesterday and today was taking the water from canned tuna and mixing a bit of it with his food. Boy does it smell, but he likes it and seems to eat about 50% more. The tuna water has no sugar, salt, or oil added. Just spring water and fishy bits. But I have been eating the fishy bits in a sandwich. He only gets the water.

    Thanks for your support. It really helps. :cat:
     
  8. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    that made me smile. What are his stools like? Anything unusual there to mark malabsorption (bulky, chalky, smelly, etc)
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    You can also buy bonito (tuna) flakes and sprinkle them on food. I agree, safety is the first consideration.
     
  10. Steve & Merlin

    Steve & Merlin Member

    Joined:
    Mar 1, 2019
    Never heard of Bonito Flakes. I will look tomorrow.

    Good question regarding his poopies. Vet asked that question too. His poopies have always been pretty normal. No smell, well formed and moist. Really awesome looking cat poopies :p But lately less of them as he has been eating less. When he was dehydrated they were a bit dry and hard, but that cleared up quick when I gave him subq fluids.
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I have seen bonito flakes both in pet food stores and Asian food sections of stores.
     

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