? Fabby needs some advice

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by AlphaCat, Nov 1, 2017.

  1. AlphaCat

    AlphaCat Member

    Joined:
    May 9, 2017
    Hello my experts. It's been a while. Fabby was on a real good stretch for a while, and now we're on what looks like a bad stretch. May I get some advice, please?

    After Runswith passed, I had a bit of a breakdown. Not really because of Runswith, but grief combined with stress took me down. So I made some changes (to the household mostly). I got my crystals boys and my civvies transitioned over so they all eat the same food. It came at a cost increase, but it is now an item I didn't have to take care of 3 times a day. (I just had Juan's urinalysis done and his PH and all other urine factors are good, so yay on the new food!)
    Fabby is still on Friskies pâtés. I also stopped doing my PM mid test as I was not ever getting a full night's sleep. I'll catch it every now and then if I'm up. My spouse took over that feeding, that way Fabby is still getting 4 meals, and I get sleep.

    My concerns:
    Fabby has been going pee right outside the box again. (We have changed boxes several times to find the right fit.)
    She's looking thinner.
    She's stopped grooming.
    She's very food aggressive again.
    She has been going to the water dish a lot. She doesn't sit over it like she did when she first was diagnosed, but she doesn't lay down in one place for very long without going to the water dish.
    Her glucose are higher than they've been in a long time.

    Her keytones are fine.
    Sometimes she has an appetite, other times she won't eat the whole portion of the half can serving, and I have to chase her around/spoon feed her like a princess.
    She tends to bounce at one unit, so I try to watch her numbers.
    We have about 1/3 of our vial of Vetsulin still left.

    I don't know if I should just hold steady at one unit and it will work itself out (because mostly we are still getting drops) or if we need to try a different amount, or if we need to bite the bullet and change insulins. I do know I'm tired of scrubbing cat pee (even if it is almost clear and odorless).

    Any thoughts, ideas?
     
  2. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Her numbers are WAY too high. Id raise it to 1.5 and see what happens. If like to see her dip her toes in blue waters.
     
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  3. AlphaCat

    AlphaCat Member

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    May 9, 2017
    We can try that tonight.
    I'm worried though if she tests at 500 and drops to blue we're just going to bounce to even higher numbers. So right now, I'd be really happy to go back to our two' and three hundreds... but I really don't want black and blues... :)

    We'll see what morning brings at 1.5. I'll try to get that mid test over night.
     
  4. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    You can try 1.25.... But I'm thinking you're seeing some insulin resistance and you need to get some breakthrough. You can't let her stay in these high 250-400 numbers... It's not healthy. BTW, how old is the vial you're using?
     
  5. AlphaCat

    AlphaCat Member

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    May 9, 2017
    We went with 1.5 she was 475 PMPS.
    The vial was purchased from our vet on 8/9/17.

    So when you say "you can't let her stay 250-400" I am terribly confused. We were diagnosed around 500+ before insulin. After insulin she is regularly in the 200-350 range preshot and nadir. We've had a couple blues here and there but nothing consistent.
    I think I'm not interpreting how to do that effectively. My understanding of the goal was use insulin to drop a third of preshot number consistently and lower the preshot number as the nadir's lower.
    We were doing good on that path, but it does seem we got stuck in the 200-300 range. If I went up in insulin dose she would start having high preshot numbers and we'd start all over lowering it down.

    So if she can't stay above 250+ range, how do I get her lower without bouncing?

    I really thought I had a grasp of this... now I feel very lost.
     
  6. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    It's really hard when you have a very bouncy kitty. I would aim for getting closer to 50% of the preshot number. So if the preshot is 400..... Figure out a dose to get closer to 200.
    You haven't had decent blues since September, and even then they were above 120. (Normal on a human meter is 50-120)
     
    Last edited: Nov 2, 2017
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  7. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I'll be curious to see where the 1.5 takes him today.
     
  8. AlphaCat

    AlphaCat Member

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    May 9, 2017
    Fabby is 389 at AMPS which was a good drop, but not the almost half you mentioned as the aim.

    Should I stay with 1.5 this morning?
    (She's eating now, haven't shot yet.)
     
  9. AlphaCat

    AlphaCat Member

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    May 9, 2017
    Her eyes are dialated better this morning, and her appetite is back. (She ate faster than expected, and over her half can portion.)
    So I'm going to stay with 1.5 this morning because the drop from PMPS to AMPS was 100. That seems good, but also because I have no confidence in changing it by myself.
    I'll try to get a couple glucose checks through the day to see how low nadir is going on 1.5.
     
  10. Amanda and a Loudogg

    Amanda and a Loudogg Member

    Joined:
    Jun 16, 2017
    Good morning! My Lou can be bouncy as well, and so I have to take increases slow and give them time to work (and time to clear out any possible bouncing). Usually I find not much activity during the first cycle after I up his dose, but then things start moving during the 2nd or 3rd cycle. Since Fabby has been high for so long, she may have some resistance to getting back into lower numbers (glucose toxicity). Basically, her body has gotten used to those high numbers, so it may take a higher dose to break through that. I would hold the 1.5 dose for at least 3 cycles, but maybe as long as 6 cycles to see how she does. Hopefully we can start bringing those high numbers down and getting Miss Fabby feeling better!! :bighug:
     
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  11. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I would keep at 1.5 for a few days and see where it goes. I am glad she's feeling a bit better today. We are always here to give opinions on doses if you feel you need a second opinion. :)))
     
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  12. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
  13. AlphaCat

    AlphaCat Member

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    May 9, 2017
    Fabby had a really bad day. The insulin didn't seem to make any impact on her glucose. She was 220 at 4am, and by 9:30am she was in the high 400's. Then she stayed high 400's all day. Even with her 1.5 shot at 9:30.
    She's been eating well, and a bit food agressive.
    She peed outside the box 3 times today (and also inside the box).

    I still did the 1.5 tonight because last night she had her drop of almost half.
     
  14. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Nice to see that 212.....
    I think when she's 300-380 do 1.5. When she's 380+ try 2. You said she's food aggressive. How many ounces a day is she eating? How often? Is she underweight?
     
  15. AlphaCat

    AlphaCat Member

    Joined:
    May 9, 2017
    She's 11 pounds right now. Before diabetes she was 18 and a little over weight.
    My goal is to get her back up to 14-15 pounds, but there have been times where it's been a struggle to even get the minimum in her per day.
    She's getting a minimum of 2 cans a day of the Friskies pate. (10.10 oz) which will maintain her weight, but she is too thin.
    I give her the option of eating a whole can at each feeding (4x per day). Right now she is consuming 3/4 of a can at each feeding (estimated), which is 3 cans per day. Ideally, this is what I'd like her to stay at or even go to 4 cans per day so she can begin to add weight on. But her body has to be able to use the food first...

    Food aggression in Fabby: (go ahead and laugh)
    She's quarantined in our bedroom. (Other cats have access, but are kicked out at feedings.)
    Sometime between 2am - 4am (feeding is at 4am) she will begin knocking stuff off my night stand one by one until she wakes me up. I refuse to feed her every 4 hours, so I'm not getting up at 2am. So I push her off the night stand, or shake the squirt bottle that's by my bed for just this reason. Other times she might come up and paw at our faces to get our attention or wake us up.
    If we're not in the room she will sit at the gate and meow loudly when it eats close to her dinner time.
    (When she wasn't on quarantine it was worse because she would sneak human food from the kitchen, or find new ways to access the civvie food. And if you had food she was staring creepy at you and trying to paw at you before you get the food in your mouth.)

    We have allowed her to have food access 24 hours a day, but it didn't make a difference in glucose nor in eating volume. It does however limit the civvies from being in the room with us. So we don't continue that b/c we just don't get any benefit.
     
  16. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    you could set up a feeder to open at 1am. Maybe you'll get better sleep.
     
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  17. AlphaCat

    AlphaCat Member

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    May 9, 2017
    I'm usually awake until midnight - 2am (natural night owl). Luckily my spouse taking over the 4am feeding helps tremendously. On normal days we've got the feeding thing (4x a day) down now (finally).... but when she gets really unregulated (high 400's-500's) and gets food aggressive she is like that meme of the cat who has an empty spot in their bowl so they think the bowl is empty....
     
  18. AlphaCat

    AlphaCat Member

    Joined:
    May 9, 2017
    Okay... we've been through over 6 cycles of 1.5u and I'm not really happy with the progress.
    We had one blue nadir, but other than that the drops just haven't been very significant. Sometimes nadir was close to only 100 drop.
    We're still starting our Pre-shots in the high 400's most days.
    She's still peeing outside a clean litter box.
    She's not grooming herself (she will actually let food dry on the top of her nose and leave it there).
    Her eyes are way dialated most of the time.
    Food aggression seems seems to be getting slightly better, but not enough to say it's gone.
    She is drinking a lot still, but slightly less than when we started the 1.5.
    She's lost more weight (visibly measured) despite eating 3 cans per day right now. All the weight we managed to add after starting insulin is gone and she looks to be back to pre-diagnosis skinny.

    @JanetNJ I didn't go to the above suggested 2u if above X number for two reasons: I wanted to see what the end of two complete cycles looked like on 1.5 and before this week she had a little over 1/3 of her Vetsulin vial left. Going from using 1u every 24 hours to 3u every 24 hours has made me start to worry about the volume we have left.

    So I'm in a position now where I need to decide if we are sticking with Vetsulin or changing to Lantus, which our vet recommended at the visit last month. I declined to switch then because Fabby was responding well to the Vetsulin, but her patterns have since changed. I'm already second guessing my decision to not do what the vet suggested. (I did discuss sticking it out on Vetsulin with her and she agreed to what I decided. I really like my vet I have now.)

    I suppose that decision looks easy from the outside. Fabby is not doing as well as she was on Vetsulin, the vet recommends the change, we're getting near the end of our vial. I'm just still stuck on the "but we were doing so well" and can't we get back to that mode. Change is hard. I suppose it's time for some human suck-it-up time, and get this cat a chance to be better.

    *Vial isn't terribly low, but we have an out of state wedding trip where we were taking Fabby with us, and if she goes to 4u a day, I'm not sure we'd have enough to last the trip next week.
     
  19. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    You've done 14 cycles on 1.5. If it's clearly not enough them raise it. Do a few days at 2.
     
  20. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    You went down to 0.5? Why? Can you update the last two days on the spreadsheet?
     

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