Help! Tigger's BG all over the place!

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Moms2Tigger&Blu, Jul 24, 2018.

  1. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    I dont know if I need help with doses or not - it seems Tigger is all over the place no matter what.
    We didnt even know he was diabetic 3 weeks ago. 7/1/18 DKA and 4 nights in ICU. He was sent home and we did 1.5 units Lantus like clockwork. No BG testing. Scheduled for an internal medicine consult 7/18. Tigger has chronic constipation, IBD? Poss Liver issues though it seems it may be pancreatitis/triaditis/diabetes undiagnosed???? Vet called off the BG curve because his level was 96 at +1. We stopped the Lantus completely. Sent home to do BG spot checks. About 30 hours later BG is 560, then 500 . . . told to restart the insulin but at only 0.5 units. Looked like it was going well BG 177 at +5. Next day, same dose, at +9 BG was 91 and falling. Told to stop again. Over next 2 days BG climbs back up to 560. What is this pattern? How can the highs be so high and the lows sooo low. Today I (tried) for a shot at 0.25. There was a tiny decline from AMPS of 482 down to 380 at +6. Then BAM! PMPS is 58?!?!?!?!?!?!?!?! What the heck happened in that time? He didnt vomit. He ate breakfast/lunch. He drank ok. He is alert. Social. Hungrily eating some gravy lovers fancy feast. PLEASE HELP. Vet thinks hes in remission. BG readings at 500+ are "symogi overswings." Insists we stay off insulin (obviously i didnt give him his pm dose) and watch his outward signs/behavior. He even suggested we stop spot testing . . . . but that makes me more nervous!

    For more info my other thread is in main health forum - http://www.felinediabetes.com/FDMB/threads/need-help-vet-too-nonchalant.198930/
     
  2. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
  3. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Yes, but I keep getting advice to post here! Considering the vet has Tigger on and off the Lantus twice now. And NONE of his numbers make sense.
    Again the other thread is here and has more details. Please, just looking for any advice. Maybe someone has seen this before?
    http://www.felinediabetes.com/FDMB/threads/need-help-vet-too-nonchalant.198930/

    Ugh - the Ketone Meter is now arriving tomorrow. Great, another day of worrying.
    This evening Tigger's BG is down on it's own to 457. That is the lowest it has been at the "2 1/2 days off insulin" mark. Maybe it really will continue to come down? I really can't imagine every number I've gotten is accurate. That is a 500 point swing at times! Anyway the vet said to email tomorrow with an update but I think I will write it now so it's the first one she gets in the am lol. One thing is for sure, the minute we get that ketone meter we will get it started and get a reading. If those numbers suggest anything is going on I will either demand we go back on the Lantus, discuss this other thing Prozinc, or begin treating him myself. I have the half mark syringes and 2 days off. Plenty of time to try out a tiny dose again and start the SLGS method. Do I literally start with 0.1 if I can measure it? Is Prozinc like when humans do a "sliding scale?" Also, has anyone heard of a cat going lowest at +12 and not +5-7 or whatever it should be?
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Welcome to the group! This is the best place you never wanted to be.

    Some of what you're seeing is normal behavior but first things first. There is a huge volume of information in the sticky notes at the top of the board. The information will help you get oriented to using Lantus, dosing, the insulin depot, etc.

    With cats that have had DKA, there are a few important considerations. DKA can be a life threatening condition. As a result, it pretty much trumps everything when it comes to making sure you are getting food and insulin into your cat. Ketones develop when a cat has some form of infection or inflammation, isn't getting enough calories, and isn't getting enough insulin. Did your vet happen to mention that you can test your cat's urine for ketones? Frankly, it's not a great idea to stop insulin in a cat that has so recently been hospitalized for DKA. You might need to lower the insulin dose but stopping insulin is not a great idea.

    For many cats, their bodies are not used to being in normal BG numbers. As a result, if insulin pulls the numbers down into a normal range, especially if they drop quickly, there is a tendency for the numbers to shoot back up into a high range. We refer to this as a bounce. So when Tigger dropped into the 50s on 7/24, you can see that they zoomed back up again. While this is hugely annoying, it is normal.

    We look at drops into normal range as a reason to reduce the dose. There are stickies that review the two approaches to dosing that we use here -- the Tight Regulation Protocol and the Start Low Go Slow method. These will help you to understand how we look at when to increase or decrease the dose. Frankly, many vets are not used to people home testing. As a result, they like a VERY large margin for safety, If you home test, you have considerable control over your cat's numbers.

    With Lantus, most cats' nadir around mid-cycle. Some cats have an early nadir (my kitty's nadir was at around +2 or +3) and others can have a late nadir. However, what you're seeing is a bounce breaking. This may not be indicative of when Tigger's nadir actually falls.

    At this point, I would decide on what insulin you want to use and stick with it. Lantus has a strong track record for getting cats into remission. The other vote in favor of Lantus is that this is a busy forum. If you need help, there's usually someone around here 24/7. There's about x10 the volume of posts here than on the Prozinc board.



     
  5. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Thanks for the welcome and the info. Like I said, I am going to give the vet one more day. When that Ketone blood meter gets here tomorrow - everything may change. I bought the Ketostix but it has not been successful. I think he waits to pee until we are in the shower, outside, or at work lol. If I have chosen wrong in letting him go another 3 days without insulin he may need I will feel pretty bad but I have zero confidence he wont go crazy low or Hypo when we are at work. I understand the bounce phenomenon is different but in my mind I cant give him any insulin at 7 am cause then he's alone for 11 hours. I can't give it at 7pm cause his lowest numbers have been at about 11-12 hours later - right when we need to leave for work. I already called out Tuesday and can/could absolutely not miss today or tomorrow. So basically I guessed it was safer to hold the Lantus for the time being. Am I to understand he may not be developing(?) ketones unless he has an infection/inflammation? I know he has GI issues but he's already doing better back on the miralax and all wet food. Would it matter in any way that the vets all think his diabetes was brought on by steroid treatment (for what was supposedly liver disease or may in fact be pancreatitis or triaditis?)

    I wish someone could just tell me what I should be more scared of - trying to treat and having him HYPO . . . . . . or not treating and letting his sugars stay high for a week??? I have different people saying those lows cant really be that low and others saying those highs may not be a true representation of his glucose levels. Maybe they are both exaggerated?

    Fingers crossed Tigger stays happy and "healthy" another day. I am 100% committed to any treatment that is right for him and will help. We've already joked 10 times that we can't do much after work, or stay out too late on Saturday with our friends, or schedule that mini vacation next month because we have to be home in time to give Tig his insulin :) I just dont want to put him in harms way needlessly either. If he needs insulin I will do everything in my power to do it as best I can. If not, or not right now I just want to know, to be sure. The indecision is killing me!
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I'm a numbers person. I believe the meter. You can always get an additional test if the numbers seem weird. There are times when you do get a false read -- there might be just enough blood on the strip that allows you to get a reading but not enough for the reading to be correct, the meter hiccups, the moon is in the wrong phase, etc. Any time I would get a number that seemed out of sync, I would re-test.

    There's really not a way to answer your question about whether highs or lows are an issue. In general, too high is safer than too low. However, all bets are off with a ketone prone kitty. For some cats, the period after an episode of DKA can be a vulnerable time. Some cats will develop more than trace ketones for no reason we can figure out. My cat had DKA at the start of her diabetic journey but never developed ketones again and I was pretty stupid/overwhelmed about all of this at the beginning.

    Looking at Tigger's spreadsheet, I'm pretty confident your kitty needs insulin. IMHO, the danger of waiting is that ketones redevelop.

    As for the ambiguity, the one thing that Lantus teaches us all is patience. If sheer will power could get a kitty into remission, all of our cats would be "off the juice." You'll hear this a lot -- it's a marathon, not a sprint. We really do have your back.

     
    Kris & Teasel likes this.
  7. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    So I just got home and tested Tigger - BG is 555. The Precision Xtra meter has arrived and his Ketones read at 1.2, which the booklet says is "intermediate" for a human - "call your doctor." Of course our "doctor" happily left work at 5 and I am only able to call the emergency hospital (which is actually where this specialist works so I never need to re-explain the situation.)
    So now - do I call? Is that ketone reading high enough to warrant a trip to the vet? Or do I restart a tiny amount of Insulin? Do the ketones go away? He doesn't seem dehydrated or really affected yet but if Ketones can develop rapidly what the heck are we waiting for???
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    We typically encourage you to call/take your cat to the vet if ketones are above "trace." You are absolutely correct in that ketones can develop quickly. At the very least, talk to the specialist or someone who has access to Tigger's records and can make a suggestion.

    IMHO, the recommendations should include getting some fluids on board to help dilute the ketones, insulin, labs to make sure electrolytes aren't out of whack and to make sure there isn't an infection that's flaring (WBC).

    As long as Tigger is eating, you shouldn't need an appetite stimulant.
     
  9. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    I may have slightly overreacted though. I was basing his reading on the leaflet that came with the meter. Apparently it is different for cats. 1.2 is not great but it is okay. Above 2.4 or so is when to be more concerned. This makes me feel better . . . . . but not much. His BG numbers are still crazy. If his Ketone number goes up or he displays any symptom I dont like he is going straight to the vet. Also if his numbers don't "come down" soon I am finding a second opinion. I can't believe I am longing for those glorious 12 days he just "definitely had the diabetes" and we gave him his insulin like clockwork. It was much simpler than this worrying and confusion!!!!!!!!
     
    LizzieInTexas likes this.
  10. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Well, I emailed the Doctor so much they finally called me and we have a plan! (Probably because his BG's dropped a bit on their own - like I said, that's how it works for us!) With no intervention his random BG checks were 279 and 314 - not great I know but a lot better than 500+!!!! Anyway, we are going to restart half a unit of Lantus BID . . . but we are going to wait until Friday night. After 6 pm on Friday I can be home with him for 60 hours straight - hopefully 5 cycles (without a problem!) We could probably start sooner but honestly now I'm petrified of him going Hypo while we're at work! Fingers crossed. Symptomatically he seems to be doing really well - holding a steady weight, no excessive thirst or urination. Please please please let this plan go smoothly!

    Update: Change in plans - Tigger's BG was 377 just now and his ketone number has gone up. I know its not exactly the same for cats but everything said to worry around 2.4, and that's what it was tonight. I think it's time to act. We gave him a nice bowl of FF and a shot of Lantus at 7. Doctor said to start with the 0.5 dose but I made it a little skinny. Do you think that's ok? It sounds terrible and makes me feel like a bad mother but I absolutely cannot call in to work tomorrow. The doctor also said to start off really conservative with his AMPS/PMPS #'s - if he is under 200 we are not going to give him the shot. Just until we have a good idea how he handles the dose right now. Does that seem like a good idea? Also, I've gotten advice to feed him the higher carb food for a bit so we can give the insulin with less worry, but is this at dinner (with shot) or later at his midnight snack (which is closer to his supposed nadir)?

    Also, if behavior, mood, appetite, etc is normal, do I need to call the vet about the Ketone number? Besides an infection/inflammation it says ketones develop when he is not getting enough Insulin . . . well he wasn't getting ANY! Now that we've restarted could that number go down, or does he always need fluids etc??? Plus it just said you should "start to worry around 2.4" - so not like full on panic? When I called the vet the first time (when it was 1.2) they didn't know what that meant for a cat on a human meter and they didn't know how to compare it even to the tests they do in hospital. Ugh. I hate this. :(:nailbiting:
     
    Last edited: Jul 31, 2018
  11. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Update - Tigger is still doing ok, he is such a good boy, never cries with all the pokes! Any advice on the SLGS method? We had a 75 at PMPS just 2 cycles into restarting a 0.5 unit dose. With Tigger's wacky ups and downs, and after some advice on here I decided to just go lower. I am putting ~0.3 in his graph because I can not honestly say I can eyeball 0.25 or that its not 0.4 (and yes Ive seen the pics of the syringes - I just dont think the ones i have have a nice flat plunger you can see making a clear measurement at anything under 0.5. the space between that half mark and the 0.0 line is impossibly small. but anyway . . . ) His BG's are all pretty high now, had one nice 222 at somepoint but Im still working towards lower. I also don't understand all the times he goes higher after the shot - I feed him FF pate - am I giving too much? How can you be sure of any number you get? I know you have to match the number to the symptoms if he were Hypo or showing signs of DKA again, but day to day - you could put any number on that meter and I wouldn't know if it made sense or not!
     
  12. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Unfortunately, you don't have consistent enough data to draw any/many conclusions as far as how Tigger is responding to Lantus. There is an outline of what a "typical" Lantus curve looks like in the New to the Group sticky. Lantus onset doesn't occur until +2. So, numbers are rising between when Lantus is wearing off at the end of the previous cycle and when the Lantus from the current shot kicks in. Keep in mind, though, that some cats have an onset that is earlier or later than +2. The other reason that numbers can be rising after a shot is that the kitty is "bouncing." If numbers dropped lower than what your cat is used to, the liver and pancreas may release a stored form of glucose along with counterregulatory hormones which cause numbers to spike upward.

    I would not rely strictly on observation to know if your cat is in a hypoglycemic range. Gabby had dropped into the 20s or 30s and was completely asymptomatic.

    There are a couple of ways to be sure you are measuring consistently. One way is to get a used syringe and draw up some colored liquid to the amount you want to shoot. You can then compare your syringe filled with insulin to the syringe you're using as your comparison. Alternatively, many of us use digital calipers to make sure our dose is consistent.

     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm glad you posted here to get help from very experienced people. :)
     
    Moms2Tigger&Blu likes this.
  14. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018

    I'm not saying I wont' but if I buy any more equipment for this situation I'm gonna have to take a second job LOL.
     
    Sienne and Gabby (GA) likes this.
  15. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Welcome to the group. It takes a while for things to settle down.
    First and foremost - listen to the members of this group - they know far more than your vet does about handling diabetes (yes, it's true)...vets, like doctors learn a lot of things about how to treat a lot of diseases in animals...even if they're cat only - they have a broad range of knowledge but nothing like the hands on experience of the folks here who've been doing this for years.

    That said, try to focus on a consistent dosage/time schedule daily. My Luci had ketones when she first saw the vet, but once I got her started on a consistent dose and did lots of testing (yes, lots of pinpricks and checking her urine daily) she never had ketones again (thankfully!)...

    So try to figure out a safe - small - dose to get Tigger settled down...Lantus is a depot drug and takes time to work. Have your High Carb (HC) foods ready in case he drops low...check on Dr. Lisa Pierson's cat food chart for the carb numbers and have some HC, MC and LC ready at all times. Karo syrup or honey will also give him a boost if he goes too low again. He sounds like a sick little fellow...so this is going to take time and patience to get his diabetes under control...and deal with his other medical issues as well.

    Sending hugs and healing vines to the little fellow...keep posting to the group here every day. They're wonderful people and will offer you much in the way of encouragement, excellent advice and sometimes just a shoulder to cry on. :bighug::bighug::bighug:
     
  16. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    I feel much better in the past 3 days then I have for 2 weeks prior. I know it's early days but I feel like we are finely going in the right direction. Tigger's hypo box is all set up. I have a good stock of plain old FF pate and he eats it so well. He gets his BG tested and takes his shots like a champ! He's pretty lazy, as a 15 yr old cat in the middle of a dreadful summer - I don't blame him, but presented with the right toy and he's a spunky little guy again. He is constantly with one of us - no hiding whatsoever and that is his trademark when feeling bad. He has probably been better about all of this then I have! Even when we picked him up from the ICU, sure he was a little sick/skinny/confused looking but he also had that wonderfully rude "Get me the hell home!" look about him. We have not heard the end of it - leaving him in a place with dogs for 4 nights? Sometimes I wonder just a tiny little bit if he's not making this more difficult as payback lol. Honestly though I have learned more from FDMB than like 4 vets. And my own research which I have no problem passing on to them. They might not know they can think outside of the box, medicine is tricky, especially with animals who can't describe how they're feeling. I work for a very good, but set-in-her-ways Ophthalmologist. Getting her to change anything, even the color of our scrubs is a hard fought battle! I'm feeling a tiny bit more optimistic that this is going to get smoother with time. Even though his numbers are high, and I feel like he is probably going to need a higher dose than ~0.3units, I think the SLGS method is going better than before. I still get overwhelmed when I think of the future though . . . am I going to be testing his BG every single PS for the rest of his life? Am I ever going to be able to be out past 630pm? Do you eventually get to worry a little less? I sure hope so!

    I just realized though, he is only home alone 3 days next week, then I am on vacation (staycation now) for 10 days!!!!! I'm gonna monitor that boy so good!:D
     
  17. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017

    I'm so glad you're feeling better about the whole thing!:joyful: And I'm glad to hear Tigger seems to be feeling a little better - and giving you a little cattitude as well.:p He sounds like a real babydoll! Don't tell him I said that - those male cats get all indignant when ya talk too much baby talk to 'em....:rolleyes:

    Glad you're learning lots of stuff on here too...I felt the same way - so much information at first I felt completely overwhelmed - but also more hopeful than I'd felt in days! Since hearing the diagnosis when my world blew apart - I wasn't ready to put my cat down (per the vets suggestion)!:eek::eek: And there's a lot of tricks and tips to be learned here on this group - I'm still asking for help with things too - after all these month - so we're always learning:)

    So the answer to your last question - will you be testing his BG ever single PS for the rest of his life? Well...yes...to be blunt you will need to do that. You wouldn't want to get behind the wheel of your car with a bag over your head would you? Injections of medications - even slow acting ones - as I'm sure you understand if you work in a doctor's office - are serious business. You will want to know where you stand before EVERY injection. If he's too low for instance there are procedures you'll want to follow before giving that shot - otherwise it's a hypo cat situation - and you don't even want to go there - too many people have lost their cats due to hypoglycemia - it's heartbreaking - don't be one of them...even my vet told me that a young couple 'tried' to help their diabetic cat by giving him insulin - and came home to a dead cat - well, duh?:arghh: With YOUR directions doc, I'm not surprised! He didn't mention a thing about home testing - just gave them a script for a fast acting insulin (Novalin) go home shoot 2 u and then you're done - it's a wonder I didn't bliindly follow his limited instructions and do the same to my precious Luci! I would have been ... well, let's just say one mad M******R...:mad::mad::mad:
    And I'm sure that couple was heartbroken and to this day probably have no idea what they did wrong!:(

    So yes, you will have to change your plans and your days - twice a day - at your convenience you're going to have to test/feed/shoot your Tigger. If you can't test, then it's best not to shoot the insulin - you really need to KNOW where he's at.

    Is it going to turn your world upside down - well, yes...a bit. I've had to leave dinners early to go home and test/feed/shoot Luci - and well, you know what - everyone seemed to understand and got over it...and the next time I saw them - they all asked how Luci was doing. People respect what you're doing - and if they don't so what? :cat: We're all crazy cat people here...and well, they will get over that too and respect you for your love of your animal(s). I've skipped out on outings; sometimes my DH gets to go along and I don't - but I look at it this way - if she's ever going to get better then it's up to me to get her better. If you decide this isn't the undertaking you signed up for - well there's that other awful alternative - you know what it is...so we all have a decision to make - and I chose to help her...and it looks like you've chosen to help Tigger too... :bookworm:

    Some people shoot later in the a.m./p.m. and others do it much, much earlier so they can get another test before going off to work...

    As for his dosage - try to hold the dose for the period of days/cycles recommended by the protocol you're going by - then at the end of that time - ask if an increase is in order - and go with the advice - do it in tiny increments - and be watchful after every increase for a downward swing in those BG numbers - sometimes it takes a day or so - sometimes off they go - have your hypo kit ready - post a 911 if you freak out - and get scared - it's a scarey thing to see those numbers drop way low - if no one answers you right away - feed him some HC food - and keep testing until you hear from someone. Try not to panic. You can test frequently when he drops low to make sure he's turning around and not going lower - have the syrup ready to slap on his paw - he'll lick it off...or if necessary rub it on his gums.

    An old adage around here - if you can't stay home and are worried because he's trending down - get that HC food out for him - better a day too high than an hour too low. You can always work on adjusting the dose/food later...

    Consider getting an automatic feeder (I bought one and love it!) for when I can't be home...my Luci is a diver - meaning when she starts down to the lagoon (the greens) sometimes I can't even slow her down and she's into la la low land before I know it! I've had to learn through trial and error about her and her diving habit...sometimes I even have to feed her HC or MC at PS just to keep her from flying off the edge like that... anyway...we're learning here...all learning...listening to the experts and making adjustments as necessary, as often as necessary...whatever it takes.:cool:

    Hang in there...you're in a good group now:D:D
     
    Kris & Teasel likes this.
  18. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Both Tigger and his brother Blu have those feeders that open only for a specific cat (with microchip or collar tag) because Tig wanted Blu's "normal" food (back when he was on i/d and fiber response) and Blu wants ALL the food. . . even non food items are fine, give him some shoelaces and crisp Fall leaves and he's happy lol. I've heard so many people say their cats would never eat out of one of those but it really wasn't a problem - training took less than a week and they have been awesome. Blu is a piggy and Tigger is a grazer so really they have been more than worth their ridiculous price. I feel really good that I can watch him eat half his breakfast PS then leave the other half in his auto feeder and his fat brother won't get it!

    I know today is only day 4 of ~0.3 dose but there is finally a small pattern developing. It's still too high, but that's fine cause we're working on it. I know I should keep this dose for a week, but if an increase is needed, and I believe it is, that will fall on a Thursday, and a day I can't do a curve. I'm sure I know the answer will be to wait 2 more days and do the curve/increase a day I can monitor but I'd just like a little back up.
     
    Sue and Luci likes this.
  19. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Prior to making any kind of dose adjustment, the idea is to learn how low that dose is taking kitty before changing anything. If you can continue to get mid-cycle spot checks, running a curve becomes unnecessary because you have already accumulated enough data to support whatever decision you make.

    Make sense?
     
    Kris & Teasel likes this.
  20. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Anyone have a cat who has always been a puker? When to worry? Tigger has been a chronic puker his whole life for one reason or another. Switching him off the fiber response has not helped his constipation and therefore his puking. The emergency vet says to call immediately if he starts vomiting. We call and they literally say "well you can bring him in now or you can wait" - what am I supposed to do with that?!

    He ate dinner fine last night. Then snack at midnight - found that vomited up this am. But he was starving for breakfast this morning and ate it fine. Just now he ate dinner with his shot and threw it up a few minutes later. BG is 418. It was 340 before dinner/shot. I know it's too high but we are SLGS. And this has been his normal right now.

    Do we panic? Do we have to take him in? I feel like he's working on a hairball or constipated. He definitely has not had a good poop today, or yesterday really. He doesn't seem dehydrated nor lost any weight since Saturday.
     
  21. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Also, how the hell do you notice lethargy in a cat. It was 95 degrees today - my girlfriend said no one in the house did anything but lay around today - herself included!
     
  22. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    so we increased Tigger's dose to 0.5 unit. I read somewhere on here about it taking as many as 6 cycles to make a difference. is this true or am i making it up - there is soooo much info on here i cant seem to find it again. anyone wanna take a look at his SS and give their 2 cents, much appreciated!
     
  23. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    How long you hold a dose depends on which set of dosing guidelines you want to follow, SLGS (Start Low Go Slow) or TR (Tight Regulation). These info stickies explain it all:

    http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

    http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/

    http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/
     
  24. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Kris is right. You aren't dreaming. Lantus and Levemir have depot effects. It takes awhile to build up the depot.
     
  25. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018
    Ok, thanks - I'm just freaking out a tiny bit cause his BG's have gotten HIGHER since increasing his dose!
     
  26. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I have a couple of thoughts....

    It does take roughly 6 cycles (3 days) for any change in dose to stabilize. This is because of the insulin depot. The depot needs to "catch up" with any dose increase or reduction.

    While it's totally counterintuitive, in some cases, a dose increase will result in higher numbers. We refer to this as "new dose wonkiness" or NDW. There's no good explanation for why it happens but it sometimes does. However, I don't think this is the case for Tigger. What you're seeing is a "bounce." When you increased Tigger's dose, his numbers dropped to 270. Yellows are not yet a range that Tigger is used to. When numbers drop low, drop to a range your cat's not used to, or the numbers drop fast, the liver and pancreas release a stored form of glucose along with counterregulatory hormones which cause numbers to spike back upward. Bounces can last around 3 days before they clear. As your cat gets used to lower numbers, the bounces clear more quickly and are likely to be less extreme.

    I'd strongly encourage you to stick with the guidelines for SLGS. In other words, increase the dose by 0.25u. There are times when changing a dose by a smaller amount makes sense but Tigger's numbers are still in a range where you want to get him in a better place as soon as you can.

    Please make it part of your routine to get PM tests in addition to your PMPS test every single night. You've already seen that he dropped into the yellows on 8/10. Many cats experience lower numbers at night. You want to be sure Tigger is safe and that you don't miss a dose reduction which is why getting at least one PM test is critical. In addition, without that information, you're missing half of your data and it will be very difficult to make dose decisions.

    Also, can you open a new thread? This thread is from July. We encourage people to open one thread per cat per day. Even if you don't post regularly, it's helpful to keep a dated string of threads (aka "condos"). You can link the condos together so it's easy to find information vs having to search through every post in what can become a long series of posts.

     
    Jill & Alex (GA) likes this.
  27. Moms2Tigger&Blu

    Moms2Tigger&Blu Member

    Joined:
    Jul 23, 2018


    Thank you for the info and advice - I will start new threads from now on.
    I have a few follow up questions first. Today (this morning) is his 6th cycle with the increased dose . . . if a bounce ends or breaks does it always result in a big dive or sometimes just normal or lower numbers? Basically, what I'm getting at is should I stay home all day? As for the 0.25 dose increase I was really only writing ~0.3 on his SS because I would not bet money on the measurement being an accurate 0.25 unit dose originally. I have found that the BD syringes have almost no space between the 0.0 line and 0.5. I got some walgreens brand and the markings seem much sharper and distinct. Also, do I link the threads easily with the link button up above or another way? I have not come across the info on that yet. Thanks again.
     
  28. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    The "link" button will link a previous thread provided you add a few steps. Copy the URL for your previous thread. Type out what you want to call the link (e.g., Yesterday's Condo). Highlight the name, then click the link icon. A box will open, paste the URL into the box. Click "Insert." You're done. Alternatively, just copy and paste the location from the previous condo.

    There's no way to answer your question about bounces that applies to every situation. Some of what helps you decide is based on having data. The more BG tests you get across a variety of situations will help you make the decisions you need to make. Some cats will end up in low numbers when a bounce breaks but it's likely that this happens because that's the "usual" range for that cat. Other cats are not as dramatic when it comes to a bounce ending. So much of how you make decisions is based on having the data which I why I was nagging about getting tests. I will not suggest you test like I tested Gabby. She was a difficult cat to manage and I'm a data hog. You have to figure out how much data will allow you to be comfortable making decisions about your cat. At least for me, having more information informed me to the extent that Gabby would be predictable. I don't know if Tigger will necessarily drop below a yellow if the bounce breaks.

    You're absolutely correct that some syringes are trickier than others. The idea, though, is to be as consistent as you can. If no one has mentioned digital calipers, they are also helpful when it comes to measuring doses.
     

Share This Page