Fudge PMPS 375 +1 280 +2 318

Hello,

I just wanted to share an update on Fudge and seeking feedback. Today I was doing a curve and was surprised to see a 58 at +4. I took it twice this time to make sure. So, his last prednisone dose was 1.4 mg last Tuesday as he tapers. He typically shows he needs another dose Saturday or Sunday by lethargy, poor appetite, agitation. This time nothing so I didn't give it which is fine as the taper was supposed to end a week ago but decided to add 2 weeks. This morning he was in the 350's and shot 1 u. Ate well, played. Then I noticed he was very tired and his eyes were wonky. I took the test at and in the 350's at +2. Well, still a little off and at +4 is 58. His SS is all over the place as far as numbers. Hmmm..I wonder if he dropped real low at +3...He ate another can of cat food all on his own as if he was starving. He never dose that..
I am doing slow approach. The last few days I was thinking up going to 1.25 but then this...What r u all thinking. Scary cause he was real spacey..He is very unpredictable and I hate that because what if I am at work. I question curves too ?? What if I brought him in for a curve. His numbers to me make no sense up until a few days ago I was picking up a pattern..until today. Ugh.

 

Because Fudge has only been off pred for less than a week. his body is still "normalizing". It can take a number of days to completely clear the system then a period of time for the body to get back to "normal" functioning without pred. With the big drop today I would suggest retesting again about 30 minutes after the last test. That was a big drop and he may need to have some gravy from high carb food and or some karo/honey. When a cat is extremely hungry and somewhat "out of it" that could be a hypo event happening. It is a whole new ball game without the steroids so he needs to be monitored carefully right now. Please repost his numbers when you retest and if they are still dropping please add a 911 to your title line. I won't be around too much longer and you may need some help with his numbers.

 

It appears Fudge has his nadir (lowest number) between +5-+7 so there is a good chance he may drop further.

 

48

 

how much honey do I give

 

OK You need to give him some honey/karo and a bit of high carb food...not too much...some of the gravy. Retest in 20 minutes and repost your numbers. You can add a 911 to your title to get more eyes on this

 

You can rub a small amount on his gums...maybe 1/2 teaspoon

 

Also please put "hypo alert" in your title and post the numbers and times ..it will help get more attention

 

Can I get some more eyes on this post. @Robin&BB @Sienne and Gabby I won't be around too much longer

 

The directions for how to manage low numbers are in the Shooting & Handling Low Numbers sticky.

The instructions state:

• Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
  (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
• Test again in 15 – 20 min. Depending on the numbers, give more HC food.
• Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
• Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
• Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

If you're using Karo or honey, you want to give a few drops unless you need to totally abort the cycle.

 

I'm here! Awaiting next # report ...

 

Thanks for stepping in Sienne. That was a major drop with Fudge's numbers!

 

Thanks Robin. I was afraid to leave but now that you and Sienne are here she is in good hands!!

 

49...

My lordy I was going to leave to go shopping hours ago !!! I wonder what is going on.

 

I feel sick

 

This is why home testing is so important!! Please put your times for tests in your posting so the people watching will know how long between tests. You have some great people to help you. They will walk you through and give you the best advice.

 

I am going to test in 15 minutes. I want to do it every 1.

 

Take a deep breathe - a number in the 40's is fine, we just don't want him any lower on insulin. Some of our OTJ kitties test in the 40's.

Give him a tsp or two of the high carb gravy if that is what your are using and test again in 20-30 minutes. It can take some cats 30 minutes for the carbs to go from the plate the blood sugar. We want him up over 50.

He has earned a reduction to .75 unit.

 

Okay..

posted 12 pm and will post 12:15. It seems like forever

 

Take a deep breath. Robin and Sienne are very experienced members and have helped with low numbers many times. I have to go but you are in the best possible hands right now. Good luck...and breathe and relax as much as you can.

 

Okay..This remin

Thanks for your help !!!

 

Yes, definitely please post the times with those #s. I know this is scary, but testing every 15 will work fine. We've all been through these types of episodes, and you're doing just fine ... the syrup really does work (just takes a little bit for it to do its work is all).

And see? There's a silver lining in this little rough patch, too ...

 

Wow..Weird how my body starts to shake...I have to start testing more often...now that the prednisone is the longest he has gone without. It 6 days without prednisone today. Longest was 5. He looks like he is perking up.

 

I gave him honey, gravy, and 20 temptations treats. He hasn't had those since this all began. He probably would have eaten the whole bag.
12:15-80 will post

 

You're rising - good! I think you can hold off on any more Temptation treats (20 should be plenty sufficient) and let's see where he is in another 15 minutes.

 

To think I was just sharing an update and look what happens. Yikes !! So, .75 tonight ?

 

If I wasn't here it wouldn't have been good. He definitely wasn't feeling good...Poor guy.

 

Keep breathing Holly. You are in excellent hands and doing great.

First time I had that sort of number I was pretty heavy-handed with the Temptations, too. Don't be surprised if Fudge starts climbing but nice work getting him to come up.

 

Thanks !! Right when last night I was thinking geez this isn't too bad at all.

 

My suspicion is that he's coming off the effects of the prednisone, in a rather big way today, too. (Did your vet talk to you any about steriod therapy as relates to "trainsient diabetes?" As this is not an uncommon situation after pred.) As for dosage tonight, others may have a different opinion, but as it's an overnight cycle: Unless you see a really high PMPS, I'd almost be inclined to reduce even a little more than that (even if just for tonight's cycle) - especially since he may not need all that much insulin now that he's off the prednisone.

 

Why do you think he dropped so low. Geez I am glad it happened today. I was gone from 9 to 4 on Saturday !!

 

Before I forget: Can you tell me which time zone you're in and what time would be your preshot test tonight?

 

The vet discussed transient but I almost thought maybe not because he has been on such a tiny dose and testing a lot in the 250-380 lately. So, I didn't expect this at all. What was different this time was he has been doing GREAT and his appetite is back to normal as of the last three days. I haven't seen that six weeks.

 

I think it's because much of the steroid is working its way out of his system. Which is why I'm advocating a little extra caution in his dosing tonight; I'd rather see you safe.

 

I am in Massachusetts. 7 am and 7 pm

 

That's really great news!

 

Great to hear that his appetite is better!

It's amazing how powerful a hormone insulin is. Genghis has been on 0.10 U for a while now, so we think of 1.0 unit as a pretty "big" dose.

 

Good to know; that's 5 pm my time out here in the west. Will be keeping an eye out (not that I'm going anywhere anytime soon.)

 

Doing great and that is lots of healing time for Fudge. After my first time experiencing this sort of think I know realize Doodles cannot be trusted! My testing has increased significantly Congrats on the reduction and wouldn't be surprised if he gets another one soon now that he's off Pred!

 

I had no idea I was going to have a hypo alert and just sending out a mail about update, feedback...

 

Oh, I know ... I did the same the first time I ever dealt with the too-low drop. I think we all have! I'd rather see the # a little to high from that than in the hypo-zone. (Holly, as we often say around here: Better oto high for a day than too low for a moment.) But now you just got to see for yourself how quickly you can steer your kitty out of a dangerous zone. Good job!

 

I feel like I drank 10 cups of coffee.

 

I will take high any day.

 

Yep, nothing like a BIG jolt of adrenaline, huh?

Me, too - because that's usually easier (and way less stressful) to fix.

 

Has it been another 1/2 hour since the last test?

As others have said, you don't want to overdo the carbs next time. Keep good notes on what you fed and you can use that information to know how much he needs to get him up. Some cats are more carb sensitive than others. I've seen people use 1 or 2 temptations to get their cat up. LOL.

The longer a kitty stays in the 50-120 zone, the more their pancreas will heal. Eventually you'll crave those good numbers.

 

You'll have to forgive me, Holly, for not being up-to-stuff on Fudge's complete history (I see the lung nodule dx from last fall, etc.) ... am I correct in assuming that high BG wasn't an issue until 10/13/15?

ETA: Or maybe would be more accurate to say an identified issue? (Via BG testing at he vet's, I mean).

 

I noticed he stopped eating and
lost weight in what seemed a weeks time. He had bloodwork immediately and that's when he came back in the 350's in October at the vets.

 

Now that I look at the signature I have to rewrite it. Confusing

 

OK, I see that 107 now. Whew! You could offer him a little low carb food if you want to try encouraging a surf there in the healing zone. You can now wait an hour for the next test. The high carb food can wear off in a couple of hours, so you do want to keep testing that long.

Good job Holly! You did great getting him out of the lows. The first one is always really scary.

 

Sorry, Holly -- I'm at work and I'm on and off with checking the Board. (They seem to want me to do things that are non-cat related.)

Don't be surprised if Fudge's numbers zoom up.

 

Just quickly stopped in to see how you are doing. It looks like you have had excellent help and advice. I hope I did not rattle you too much. I was rather concerned about a drop of almost 300 points in 2 hours. But you are in good numbers now and have lots of great people watching out for you. I will check back later, but it looks like all is good

 

He is sound asleep on his kitty tree. Do you think I should wake him and feed him or leave him alone ?

 

I'd recommend a "sleep test" for the kitty. You want to be sure the numbers don't nose dive.

 

Scary...I swear it was just yesterday I was feeling a little relaxed with this whole thing.

 

Ok, that's what I needed to know. First, when a kitty stops eating, he can lose weight pretty darned quickly - so that alone could explain the weight loss. Second, it's common that a cat will spike higher BG#s at the vet clinic (called "stress hyperglycemia"). Some cats can spike #s that are actually more than 100+ points higher due to stress during a vet visit, as compared to the #s you'd get in home testing where he's more relaxed.
Third, steroids are known to trigger transient diabetes, which means that once pred therapy stops, within anywhere from days to weeks, blood sugar levels can actually return to within normal limits.

My concern here is that you saw a really steep drop today in Fudge's #s on the same dose he'd been on all along while on predisone. And he's been off the pred now for about 8 days, right? Given that we don't really know which of the above scenarios are in play here (may be just one or a combination of factors), if this were my kitty, I'd be inclined to drop to 0.5U tonight (unless, of course, you were to end up with an unshootable # at PMPS time, which would make this moot). And keep in mind, too, that you may see a higher PMPS due to the syrup & higher carb food administered to steer out of hypo zone (so any BG spike then could conceivably be due to that all by itself). Just my humble opinion ... of course, regardless of the reduction you choose, I know you're going to be testing around the time that you saw the drop this cycle.

 

Okay..107. I will check him hourly.

 

His last dose of prednisone was Tuesday..so 6 days without prednisone. Longest he ever was without since the taper was five. At day five he showed withdrawal symptoms but not this time around.

 

He was doing remarkable on Friday, Saturday, Sunday. Acting like a kitten.

 

Oh, that's the sort of thing we all love to hear! What did your vet say re: the nodules last visit? Were those related to whatever had caused his asthma?

 

Well, they say nothing about the nodules. I am hoping they aren't growing and it's slow progessing. I could get another x ray of the nodules but his stress level is not worth it and I won't do chemo. I make it down the block and he is tearing his nails out and hyperventilating. He had three days at the ER in May with 3,500 dollars worth of test. He hid under a blanket and wouldn't eat the whole time. He came home with herpes virus for one month wearing a collar. It was a mess.

 

Oh, man, Holly ... what a drag!!! Poor Fudge, going through all that trauma. (And you, too!) Were the nodules actually identified as malignant? As there are other causes for nodules/ types of nodules that can only look like cancer on x-ray ...

 

The vet feels 1.4 mg of prednisone every 4 days is not a therapeutic dose for cancer. Who knows. I questioNed well maybe I should keep him on it and do the 1 unit 2x a day. But, since he was doing better than ever (unusual) this weekend I didn't give it. My vet wants him off. Then this. After this, I feel the prednisone has to go. I will kill him before the cancer. I was going to leave for shopping and would not have been here today.

 

There were two tiny nodules on his x ray. The vets called them nodules. They didn't aspirate them.

 

Two different radiologist read them.

 

That was in May 2014.

 

That's great news!

I'd just leave him be and not put food in front of him unless he wants it. Just test him while sleeping, as Sienne suggested, an hour after the last test.

 

Actually, a few small lung nodules can be pretty common (in both humans and animals), and can appear from a variety of causes ... and more often than not, they are benign.

 

He actually has had an excellent quality of life. Just in October when I picked him up and said wow you are light. And, reduced eating. I caught it right away though and brought him in for bloodwork.

 

You would never know he had cancer.

 

Before I forget, Holly: Unless Fudge starts dropping again, try to avoid feeding in the two hours before his preshot test time - just to help make sure that his preshot # isn't being affected by more food.

 

Oh. So the radiologists did i.d. this as cancer?

 

He said nodules...and his outcome was fair. I figured that was cancer. Isn't a nodule tumor ? OMG so bad I don't know this.

 

Unless they actually identified this as a type of carcinoma, that may not be the case. Because without a biopsy, a nodule can just be ... a benign nodule! Benign nodules can form in the lungs for many more reasons than cancer itself. (You'll have to excuse me for my tendency to be somewhat leery of health care providers, but having had much experience with them over the years: I've seen more than my/my family's share of erroneous diagnoses by both radiologists and treating physicians ...)

 

I see that 182. If it has been 2 hours since he last ate the high carb buffet, I think you are OK to take a break in testing now. You could even go out shopping now if you want to.

If you are concerned about tonight's shot, you can always test 1/2 hour before shot time and post the question. I still recommend .75U as his new dose.

 

Thanks.

Will check his numbers at 4 and 6 and post question.

 

Ah Holly, well done. First time is very scary. Hate to say it but there probably will be another or two. Each time you will just know what to do and do it. I don't think there is any rhyme or reason as to when it will occur. At least not in my case. All of a sudden Smokey has decided to be low during the day and close to PMPS time. And you have the prednisone issue on top of it.

Again well done, breathe, pour yourself a drink.

 

The good thing about this is I know he needs to be off the prednisone. There is no question about it and before I thought what if it is stopping the cancer from growing. But being on prednisone is too risky and I am willing to accept the risk and before I wasn't sure. I don't think I could ever get an accurate curve if I am giving it as needed. I would have never forgave myself if I lost him while out grocery shopping. If the nodules grow without the prednisone so be it...But way to risky in my case.

 

We have a number of kitties who are on daily prednilisone, for other conditions that are otherwise harder to treat than diabetes. You just adjust the dose to counter the effects of the pred.

 

If I definitely knew he needed it I would give it to him. But to see him doing so great without it as we get to the end of the taper period is encouraging he may be fine without. The chance is worth it in this case.

 

Hey Holly!! Great job today!!

Never a dull day doing the sugardance

I never knew that his "nodules" hadn't been tested....it's quite possible the weight loss was from his undiagnosed diabetes and not cancer at all. Hopefully he'll continue to stabilize without the prednisone and his numbers will start to stabilize too!

I agree with Wendy....tonight I'd go with a .75 dose....he's been tapered very slowly and was on a very tiny dose

Looks like the HC Temptations are kicking in and he'll probably bounce too...might get 1 more test in an hour and if he's still going up (which I'm betting he probably will be) give him a break until +11.5 or PMPS (depending on how high he is at the next test)

Congratulations on the reduction....and for surviving your first low number!

 

Thanks Chris !!

 

I haven't even started my day I feel completely discombobulated.

 

It's 374

 

A bit of relaxation breathing instruction here:
Exhale slowly and completely.
Pause a second or so.
Slowly inhale comfortably fully.
Repeat for 15-20 minutes.
- from The Relaxation Response by Herbert Benson
There is a bit of a learning effect with this, so regular practice makes it easier to let yourself relax.

 

I am nervous about going to work tomorrow already. Ugh

 

Holly I just got home and checked in to see how you were doing. I imagine you are worn out from too much excitement....but with the help of the other members and you testing and feeding the lows you did a great job!!! As I said initially and others have also mentioned, now that Fudge is off the pred you need to be watching his numbers as much as possible. Even though the 58 he hit at +4 was not a scary number, the fact that he dropped 300 points in 2 hours was a red flag. Fingers crossed that now that Fudge is not on pred he may need less insulin and hoping this may be a transient diabetes.

But you have survived your first round of scary numbers/drops and come through with flying colours!!! You now have a frantic freak-out under your belt and you did great! Keep posting his numbers and as was suggested maybe test a bit before his next shot time and post the number and ask for input as what to do. Kudos to you and the great support members of this forums!!

 

Fudge is still sleeping since noon.

 

Poor Fudge is probably as worn out as you are. How long until PMPS time? As you can see his numbers will be high in response to the big drop and lower numbers than his little body is used to. This is a totally normal response to the cycle he just went through. It would be a good idea to check his numbers maybe an hour before his next shot time and post about dosage without feeding him first. Obviously you do not want to give 1.0 unit, and as has been suggested giving a .75 unit dose may be the best approach. It would be good if you could get a +2 and maybe +4 test in tonight to see how he does. Even though this has been a scary day for you, this could be a bit of a turning point for Fudge. Testing is necessary to see if clearing the pred out of his system is what caused the wonky numbers today.

 

He is at 375

 

That is to be expected. In short the body perceives the big drop and lower numbers as an emergency and releases stored "glucose" to keep it where it "thinks" it should be. Test and post his number at +11....1 hour before shot time...you can add "dosing advice needed" to your title and see what the other members think.

 

He's earned a reduction down to .75 no matter what

If you have to work tomorrow, I'd go ahead and do that decrease tonight and not try to "shoot through the bounce" (give one more dose of 1U just to help him get through the bounce number)

 

Okay !!

 

Please if you believe in prayer that my night will be uneventful or send me strength. Seems like all my senior pets are unwell today. Feeling bad for myself...and doing it all on my own.. I haven't even brushed my teeth yet.. Ugh. I am a psychotherapist and can't even apply my own skills on myself..

 

It's always easier to give advice to others...putting it into practice in your own life is the last thing any of us want to do!

Be easy on yourself!! You're doing great and Fudge is doing OK too!!

 

It is always darkest before the dawn. You did WONDERFUL today in dealing with an unexpected turn of events.

I can solve everyone else"s problems EXCEPT my own. But you handled today like a pro. You would not believe how many major meltdowns I have had in the last year. I have been doing life in general on my own for over 13 years and sometimes it can just be overwhelming. When my civie kitty Maxie...Tuxie's sister had a UTI at the same time Tuxie was having a pancreatitis attack I thought I would lose it...but we carry on carrying on because we are much stronger than we realize and we love our kitties. Sending you tons and tons of positive energy for an uneventful evening so that you can rest and restore yourself.

 

There are many days I pray to the powers that be that I DON'T have to leave the house for an unforseen emergency...if anyone saw me on those days...I would probably be sent to the pysch ward

 

Will keep fingers, toes and paws crossed for an uneventful night for you and Fudge. (You're a great "Cat Mom," Holly!)

 

Thanks everyone !!


I shot a .75. It was difficult to get it just right on the syringe but I did. I will test him every hour until I drop. Geez he just sneezed. I haven't heard him sneeze in months. ugh...

 

Holly....those "in between" doses are hard for ALL of us!!

Might be easier for you to use some kind of colored water and draw up what you decide is .75....then you have a "template" to compare to

What's important isn't so much that you're exactly at .75 but that whatever you decide is .75 is consistent