8/30 Mačka AMPS HI, +3 537, +5 338, +8 620, PMPS HI on new dose

[Penelope and Mačka]

http://www.felinediabetes.com/FDMB/...3-5-386-7-497-pmps-493-increase-to-3u.218731/

He was in the 300s during the night last night. The HI of this morning is quite a bounce, if it is. It makes me worry so much when I see such high numbers.

Again, the more I increase the higher the numbers. Are we sure this is glucose toxicity and not a reaction of his body to too much insulin? I'm very confused.

 

[Penelope and Mačka]

+5 338, that's a huge dive. Any thoughts on such a dive? He basically went from 800+ to 300 in 5 hours.
I would think the dose is a little too strong, isn't it?

 

[Tina Marie (GA) and Jan]

+5 338, that's a huge dive. Any thoughts on such a dive? He basically went from 800+ to 300 in 5 hours.
I would think the dose is a little too strong, isn't it?

It looks good! Really! I think he bounced from pink!
He did go down a lot, and that looks good so far. He is responding to the insulin, and still fighting good numbers by bouncing. Go Macka!

 

[Justin & Sebastian]

Yup, you're on the right track. He's still on steroids which can give him the higher numbers, but you can see it's starting to average downwards overall. You're getting fewer reds and blacks in the middle of the cycle and more purples. As the steroids taper off and he gets more used to the lower numbers you should start seeing the blacks decrease. And ketones are still negative so it all looks good to me.

 

[Penelope and Mačka]

Yup, you're on the right track. He's still on steroids which can give him the higher numbers, but you can see it's starting to average downwards overall. You're getting fewer reds and blacks in the middle of the cycle and more purples. As the steroids taper off and he gets more used to the lower numbers you should start seeing the blacks decrease. And ketones are still negative so it all looks good to me.

Thank you! Could it be that we see more pink because I test more? I am not sure. That big jump downwards freaked me out. I couldn't test the ketones today because he peed in an impossible location in the garden, and I couldn't crawl under the hydrangeas lol. I'll try again later.

I have one week to get better numbers in preparation for the pet sitter. She will try to test, but no guarantee she'll succeed. Ah! so much stress!!

 

[Justin & Sebastian]

Could it be that we see more pink because I test more?

I don't think so. I'm looking at the numbers from like a week and a half ago and I'm not seeing much room for lower numbers. Like 8/18, whole AM cycle was between 468-440. 8/19 am was 490, PM to 8/20 was 490-480, PM was 536 to 547 the next morning, 8/21 PM was 695 to 547. So just a lot of long bounces. And now it looks like the bounces are now clearing faster and allowing for lower dips. So you'll probably still get the big jumps and drops for a little bit still as he gets used to the dose, but I think it's highly unlikely that you'll see dips below mid 200s within the next week or so while he's still on the steroids.

So I would continue on with the TR for the next few days. You'll be ready for another increase 9/1 PM, which I would only do .25 regardless of what his nadir is, just because you're leaving soon. Then you'll have 5 cycles to let that depot settle in and see what happens, and then if he does happen to go lower, big IF, you can drop back to 2.75-3.

 

[Wendy&Neko]

Remember New Dose Wonkiness? That can cause higher numbers after an increase.

No, the dose is not too high, in fact it is too low. You could have increased by 0.5 units. You have been testing enough that you would have caught any sudden lows and have been increasing by safe amounts, even if too slowly and going backwards in dose did not help. Patience.

 

[Penelope and Mačka]

+8 620 Poor Macka. Bouncing already?

I'm looking at the numbers from like a week and a half ago and I'm not seeing much room for lower numbers. Like 8/18, whole AM cycle was between 468-440. 8/19 am was 490, PM to 8/20 was 490-480, PM was 536 to 547 the next morning, 8/21 PM was 695 to 547. So just a lot of long bounces. And now it looks like the bounces are now clearing faster and allowing for lower dips.

Thanks so much for your analysis! If these are all bounces, maybe I shouldn't increase too fast to leave them time to clear nicely?

Remember New Dose Wonkiness? That can cause higher numbers after an increase.

I tend to forget this one

You have been testing enough that you would have caught any sudden lows and have been increasing by safe amounts

That's the thing, I am so afraid of missing a sudden low! And by increasing of 0.5, I worry I would create these lows. One thing I notice is, the higher I increase, the greater the bounces. If increases are more subtle, I also hope for less drastic bounces that will last less longer.

I agree that my second guesses may not have helped Macka's numbers. I always think that if I had not listened to any vet, but stuck with the forum only, he could be in a better place by now, but that's another big IF. Fear is not my friend.

 

[Justin & Sebastian]

maybe I shouldn't increase too fast to leave them time to clear nicely

You want the opposite actually. It might seem counter-intuitive but the higher the dose, the better the results will be. The bounces are going to happen no matter what, so it's better to get to the floor as quickly as possible so your overall bouncing time is less.

Think of it like this. You get a low of 350 and hold the dose for two weeks until they get used to it. But 350 isn't low enough so you increase the dose and get a new low of 300. Then wait two weeks until they stop bouncing, another increase to a new low of 250, wait 2 weeks, so on and so on until you're down <100. That's going to take months and you're still going to be bouncing the whole time. On the other hand, if you follow the TR and increase every 3 days, you're going to hit that ideal <100 range much faster.

Same thing applies with not increasing enough. Low of 350 and increase by half as much as you should have, new low of 325, then 300, then 275, etc etc etc. You're just dragging out how long it takes you to get down there, which is going to be far worse for the cat than how high the spikes are. You're checking ketones and not seeing them and that would be the big worry with such high numbers. So I really wouldn't worry about how big the spikes are and focus on how low the lows are and how much time it is between the lows.

 

[Wendy&Neko]

maybe I shouldn't increase too fast to leave them time to clear nicely?

Don't worry if Macka is bouncing when you increase. You don't need to wait for them to clear. Just try not to increase in the same cycle they are clearing the bounce. Check out this post for more detail. If Macka's numbers are too high, they are too high. You need to get him seeing lower numbers in order for him to get used to them and slow down his bouncing. Being timid about increasing is hurting him, not helping him.

 

[Penelope and Mačka]

Just try not to increase in the same cycle they are clearing the bounce.

That's hard to tell, he never cleared them at the same cycle! What can be the warnings of a bounce clearing?

 

[Jerry dutchboy]

Testing and being prepared for low BG's. Clearing a bounce can take up to 6 cycles but ECID so you never know. Testing will tell you.

 

[Penelope and Mačka]

PMPS HI

 

[Justin & Sebastian]

PMPS HI

That's okay. As long as there's no ketones, high really isn't that big a deal. Focus on the lows. You've got purple nadirs three cycles in a row, which is a new record.

More importantly, how's Mačka doing today? Happy and energetic? Always remember it's more than just the numbers. If the cat is happy and active, that's a big sign you're doing it right.

 

[carfurby (GA)]

 

[Penelope and Mačka]

More importantly, how's Mačka doing today? Happy and energetic? Always remember it's more than just the numbers. If the cat is happy and active, that's a big sign you're doing it right.

He's okay. Not extra energetic, very, VERY hungry. I read that diabetic cats are hungry, but not him, not until I stopped the antibiotics 3 days ago. Should I be concerned that his appetite is becoming more ravenous? Isn't it a sign he's processing food less well?

 

[Justin & Sebastian]

He's okay. Not extra energetic, very, VERY hungry. I read that diabetic cats are hungry, but not him, not until I stopped the antibiotics 3 days ago. Should I be concerned that his appetite is becoming more ravenous? Isn't it a sign he's processing food less well?

It can be but again the lack of ketones I think is a big sign that he's okay. It's something to keep an eye on, things like pancreatitis are always a risk and increased, or decreased, appetite can be a sign of that, but, at least in Sebastian's case, it was accompanied by ketones.

How's his weight? That's another key thing I've learned can be an indicator of problems. I bought a baby scale and I weigh Sebastian twice a day when I do my PS tests and I've found it to be a pretty effective tool for spotting issues that don't present themselves otherwise. Like about a month ago, I hadn't checked his ketones in a bit because they had been consistently low and those strips are expensive, but then I noticed his weight gain started to plateau and decrease a hair and my gut said something was up, so I started checking again and sure enough, they were building up, leading me to get blood work done and discovering he had some infection markers that we ultimately got cleared up with the dental.

I'll tell you that Sebastian eats a ton. Like, a TON. Take whatever the food package recommends as a daily amount and he eats 3-4 times that much. But he's relatively fine overall. Much like the insulin, they need what they need. I'm sure it varies from cat to cat but I've always been much more concerned about a decreased appetite since that always precluded a big issue, never had any problems from an increased appetite.

 

[Penelope and Mačka]

I'll tell you that Sebastian eats a ton. Like, a TON. Take whatever the food package recommends as a daily amount and he eats 3-4 times that much. But he's relatively fine overall. Much like the insulin, they need what they need. I'm sure it varies from cat to cat but I've always been much more concerned about a decreased appetite since that always precluded a big issue, never had any problems from an increased appetite.

Thank you. I was also more concerned by the lack of appetite and nausea. I check ketones every day on the urine strip. He never had any again, after his DKA episode. I have a bag of fluids ready, just in case. I was also under the impression that as long as they eat well, ketones do not form? His weight has been stable. He actually regained +/- 200g compared to a month or so ago, since I increased the calorie intake in fact.

Regarding the dental, Macka is finally going to see a pet dentist on September 11th. This clinic is in such demand that it takes forever to get an appointment. I am still suspecting his numbers to be the consequence of a dental issue, originally, even if my vets are not convinced. He had a dental last year though, but tilts his head when he eats at the moment. We shall see.

 

[Justin & Sebastian]

Regarding the dental, Macka is finally going to see a pet dentist on September 11th. This clinic is in such demand that it takes forever to get an appointment. I am still suspecting his numbers to be the consequence of a dental issue, originally, even if my vets are not convinced. He had a dental last year though, but tilts his head when he eats at the moment. We shall see.

That's great news. Teeth can definitely do it. We can see Sebastian's BG dropping after this last one and there weren't even any major issues. Just a little bit of inflammation is all it takes.