I'm really frustrated and don't know what to do....

I have decided to increase Jai Jai's dose to 1.5 u from this evening (See yesterday's post: http://www.felinediabetes.com/FDMB/...increased-dose-bg-in-red.143098/#post-1483172). He had consistent high BGs and I even got up at 4:30am last night to check on him at PM +9. I have gathered data to make the decision, but his body just told me the opposite

PMPS 335
+3: 47 (!!!!!!!)

I really don't know how to manage Jai Jai 's diabetes. I nearly collapse and everything is not understandable to me.

I do know what to do right now, but I just don't understand. I really don't.................

 

I'd suggest you start posting on the Lantus forum. Everyone there uses your insulin and can help you with dosing. There are lots of stickies on the top of the forum page that will be helpful too.

Lantus is dosed on the nadir - lowest point of the cycle - often 5-7 hours after the shot. They can help you with that.

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

 

Hi Hollis,

I've just seen Jai Jai's numbers. Have you given him any honey/karo? If he's not already back up above 50 on your human meter you need to raise his numbers NOW.

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Yes, I gave him the food and honey.

 

Phew!

How is Jai Jai behaving? And how long is it since you gave insulin. Please answer quickly because I need to get an idea of exactly how things are with you at the moment.

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URGENT ANSWER NEEDED:

Exactly how long ago did you give the food and honey? Was it after I asked you to or before that? What is the most recent BG test and exactly how long ago did you take it?

 

He acts normal like he usually does. Nothing special, he shows no symptoms of hypo, like previously did.

 

I gave him the food after the +3. I gave him 40g of food and he ate it all up. I then gave him some honey at around +3.75 or sth.

 

Give him more honey straight away. His numbers haven't come up.

 

Done, though he run away and tried to hide himself in the litter box............

 

That's not a good sign, Hollis. How far are you from the vets?

 

why? give me more details

 

He's very low, and he's hiding at the moment. I'm worried about him. It's difficult being half a world away and trying to help. The more info I have about how you two are fixed, the better suggestions I can make to help.

Before you reply can you test Jai Jai straight away to see what his BG level is at now, please?

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Cats sometimes hide in their litter boxes when they're not feeling so good.

 

Hollis, I completely missed the 47 at +3. That is a dangerously low number early in the cycle with a long lasting insulin. I am with Mogs. Go To the vet. His blood glucose need to be raised now and honey may not do it. He may need an infusion of glucose which the vet can give. If you have someone who can go with you, have them put some honey on his gums as you drive.

 

Thank you, Sue, for coming to help.

 

Unfortunately, I am leaving the house right now and can't stay on. (Going to the airport) You are doing great, Mogs, but I really think that low a number this early in the cycle is too much to try to deal with at home and agree with going to the vet.

 

I appreciate your coming to look at the situation quickly, Sue, because of the numbers in the 20s and the earliness in the cycle. I feel that the vet is needed here. I'll continue here and put a shout out on L & L if needed. Have a safe trip, and thank you again.

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Hi Hollis,

I'm here with you. Have you tested, and can you get to the vet quickly?

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Hi, Mogs. I understand that you can only judge based on the information I gave. It is difficult and it can go wrong if the data provider (that is me) made a wrong observation.

I would like to clarify that he is not really hiding, he went to the litter box pretending he wanted a pee but he actually did not.

His BG went slowly upwards right now. I know, it may not be the speed you are expecting, but it is way up.

Last time when I caught his hypo, it took me 2.5 hours to see his BGs back to 50mg.

Yes, I am scared, I was crying and am still very frustrated with the situation. I am also unable to understand why this is happening with the dose increase to 1.5.

 

Thank you, @Sue and Oliver (GA). Safe flight.

 

What is his BG at now, Hollis?

 

it's 25, a little up from 23 (20 minutes ago)

 

Hollis, are you able to travel to the vets? You will need to keep rubbing honey on Jai Jai's gums while you're travelling. If yes, how long will it take you to get there?

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It will be 20 minutes drive, but the first thing I need to call a cab.

 

Call the cab to come ASAP. Ask them how long they'll take to get to you.

If you need to call the emergency vet to let them know you're coming in do that next.

Then rub a little more honey on Jai Jai's gums.

Then get his pet carrier and honey ready for travel and test him again.

Post the test results when you get them, please.

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I am now in a taxi, and am heading to the 24-hour vet. Will keep u posted.

 

Fantastic, Hollis. The vet is definitely the best place to be at the moment.

Keep smearing honey on Jai Jai's gums till the vet gets to see him.

Please let us know how things go later as and when you can. I will keep an eye out for updates.

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just saw this. Vines and prayers. Keep us posted.

 

Thank you for coming over, Elise. I'm very relieved that Hollis and Jai Jai are en route to the vets now.


(Boy, do I need the bathroom ... )
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I hear you. He needs to post on the lantus forum. It's cleaning day here so I didn't see this until he had already left. You did a great job. I hope a glucose drip brings him right up.

 

She has been posting on Lantus, Elise, just not in the last couple of days. Her most recent condo for Jai Jai is here:

http://www.felinediabetes.com/FDMB/...3-436-increased-to-1-25-changing-vial.143070/

I'll be on tenterhooks till I know that little Jai Jai's OK. I got a bit of a land when I started reading this thread earlier and checked the spreadsheet.

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Glad you were so vigilant @Critter Mom! I'm anxiously watching this thread. Thoughts and prayers to Jai Jai and Hollis!

 

Hey, I'm here waiting for the vet. He is in an operation and the vet assistant came and asked and took a look at Jai Jai's spreadsheet.

Taking the opportunity of having some attention around....did I make a wrong decision to increase Jai Jai's dose? I spot checked him last night and I think his nadirs were consistently above 300.

 

@Critter Mom Wow, Mogs - thank goodness you arrived on this thread when you did! Excellent guidance!!!
Keeping all fingers & paws crossed for Jai Jai!

 

I don't give dosing advice but looking at the numbers I might have raised him as well. Did you give food and honey when he dropped? Did you test every 20 minutes and give more? I would document on your ss exactly what was done for the next time he drops. I would also check the BG and if still under 30 ask if he need a glucose drip. If over 40 I would feed. If they took Jai Jai to the back then I'd ask what they are doing.

 

Hi Hollis,

Thanks for keeping us posted. Glad to hear you got safely to the vets.

Elise has given you some very helpful advice above.

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It's the only upside of having PTSD. I've also got a real soft spot for little Jai Jai and his mom.

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Yes, I fed him some food and gave honey when I found that he was hypo.

I checked on him for every 20 to 30 minutes.

My vet was very upset about our changing of Jai Jai's dose. She suggested hospitalizing Jai Jai for one night and meeting the vet in the afternoon. I am expecting that we will have another encounter tomorrow when we see her.

 

How are you doing yourself right now, Hollis?

 

Thank u for your dedicated support. At the vet, Jai Jai has 2.4 mmol (around 40ish). If you did not suggest visiting the vet, we were at home monitoring him that might cause a big trouble then.

 

I was thinking "wat did I do wrong?", "wat makes Jai Jai hypo?" I don't have much info except that the dose increased.

 

Have they put him on an IV glucose drip or are they just feeding and more monitoring ? He will likely be more sensitive to insulin now.

We don't know how they will react. Each cycle is a new potential change. You didn't do anything wrong and you got him to the ER when needed because you were monitoring. Don't blame yourself.

 

Hi Hollis,

I know how much you love little Jai Jai. I'm not much help, but any little thing I can do to help you I do gladly.

As Elise says above, there is no way of guaranteeing what will happen in any given cycle. Because you were home testing you were able to catch the low number and get Jai Jai to the vets for help.

I'm glad that they have checked Jai Jai's BG. Have they given you an outline of his treatment plan?
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Yes, Jai Jai is now hospitalized, and should be on glucose drip. I am already back to home with my hubby....Jai Jai is not around and I am so worried about him.

I cannot get over it right now. It's been too much recently......

 

Deep breaths. Take the opportunity to catch up on some much needed sleep while others are caring for him.

 

Hi Hollis,

As Elise suggests, try to get some rest while the vets get Jai Jai nice and stable. Even if you find it difficult to sleep while your baby's in hospital, just lying down and trying to rest your eyes will help you.

Perhaps tomorrow when you've recovered a bit you can let us know what additional support we might be able to give you so that you might feel less overwhelmed with everything.

Sending blessings to you and your hubby and some special stabilizing, soothing vibes for Jai Jai. Will keep an eye out for updates from you on his progress.



Mogs
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Oh my goodness, Hollis! I just now saw this thread! I'm so glad others were around to help. Is the vet going to call you with updates? I know that you are trying to get some sleep, which I totally understand.

 

Hi, @tiffmaxee , @Critter Mom , and @Shiloh & Rhonda . First thing first, congratulations to Shiloh for OTJ!!! I am so happy for you, Rhonda.

I was very tired and I had slept for four hours. Don't worry about me, I'm OK.

My hubby has just traveled to the clinic to get Jai Jai food and insulin........we did bring nothing with us last night. He has just told me that Jai Jai was 250ish at 4am. No seizure.

I have done some search but I cannot find any information on why Jai Jai's BG was not brought up even food and honey were given. Can anyone kindly tell me why? Is his liver shutting down? What other possible cause of this circumstance?

Under this situation, is TR not fit for Jai Jai? Should I go for SLGS? Sorry that I need to figure out my next step because the incident hit me so hard, and I do not have much idea on why the things happened.

Although your help is always there, I lost my faith to move on. I understand you want to post my dose question on L&L to get support from experienced ones. Please understand I do not have much time to manage the threads day by day. For me, L&L looks like a "progress report" type of community. This is just not for me at the moment.....(don't get me wrong, I am not complaining about it, it is just not the time)

 

Hollis, please don't lose faith! L & L can be kind of overwhelming. Others have told me that too. The only reason we suggest posting there is to get the most eyes possible on Jai Jai's situation. We aren't asking for day by day posts. But if you have questions, that might be the best place to post, to make sure you get the most experienced response.

 

I agree with Rhonda. Did the ER take a BG when you got there? It will read higher on a pet meter than the human but not by a lot. I understand how scared you are right now. There is nothing wrong with using the SLGS protocol if it makes you more comfortable. You can also stay with TR but modify it to not take increases quite as fast and to decrease at a higher point. You definitely test enough for that.

I'm not sure why the big drop but perhaps the increase was right around the time the previous dose increase kicked in.

These are just a few things to think about.

 

I cannot hold my tears when I am reading your message. Was I executing something that I don't really understand? It makes me so regretful particularly when my plan is still empty right now.

Regarding L&L, there are some protocols over there that are assumed to be followed quite strictly. They are needed when maintaining some sort of law and order. I am not disagreeing but I just do not have the time.

And, you know, about a few times, I needed to repost here to get some responses. It is understandable when not many are familiar with the case and progress in the meantime.

 

Thank you for your reassurance. Like you said, I may need to wait for more days for the new dose to work for Jai Jai if I continue to follow TR. The BGs at the vet were:

1:45 (approx.) 3.4 (40-ish)
4:00 14.1 (250-ish)

There are a few things I can conclude right now:

1. the weather was very hot, but it started to cool off a bit from last night. Today is rainy.
2. Jai Jai was not as enthusiastic as previous about his food, but we manage to get him ate enough
3. His poo these two days are wet, about one tsp of pumpkin is given every meal

 

Hollis, I sooooo understand. I have had more than one breakdown since Shiloh was diagnosed. It is so hard knowing that we could be responsible for our cats well-being. Please just take a breathe. And another. A lot of this is trial and error because every cat is different. What works for one may not work for another. You need to do what you feel is right for you and your cat. Safety for Jai Jai is the main objective, above the protocols.

 

Hi Hollis!! What a horrible night you've had and I'm sure glad that it seems Jai Jai is OK!!

If you'd asked, I think all of us would have told you to increase to 1.5, so you did nothing wrong!! Please don't blame yourself at all!!

The one thing I wonder about is this...is there any chance the lines on the syringe you used last night were wonky? I've seen some lines that were close to .75 units off where they should be so I have to wonder if that might be what happened

Sending many hugs for you and your dear Jai Jai!!

 

I would suggest a somewhat different tack. There is a tremendous demand for the time of the seasoned experts on L&L and realistically they may not be able to devote as much time as they might wish to all the cats on that board at any given time. I would recommend that Hollis post on both the Lantus and Levemir ISG board (for dosing review/suggestions) and on Feline Health (for broader discussion of her concerns about Jai Jai, for wider general diabetes education, and for a good bit of moral and emotional support - things that are possible on Feline Health because it's is not as 'high volume, high traffic' as the L&L ISG board ).


Mogs

ETA:

I still think it's a real shame that Relaxed Lantus was closed, because it was the ideal place for people who find the Lantus board overwhelming (myself included; would have been lost without it when Saoirse was still receiving insulin).
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Thank you, Chris. The syringes are fine, and I did ask my hubby to double check to confirm it was 1.5........we always do that because anything can go wrong when we are busy.

 

Hi, Mogs. Thank you for trying to figure out something that can work for me. I read the threads on L&L when I have time, I can hardly follow the cases unless there are some dramatic things happening, such as OTJ (I can remember the recent OTJ cases, but I cannot remember the day-to-day information others pop up. this may be the similar situation for people reading Jai Jai's case).

For dosing, I actually have an observation on the BGs of Jai Jai:

1. Jai Jai's BG started to drop at +3, and rose upward at +6, his nadir should be between +3 to +5 (see 22/8 pm);
2. He sometimes had PS number lower than +6 or later (see 23/8 am). Not sure it has some implications or not.

 

Hi Hollis,

What a day you've had! You've done an amazing job managing Jai Jai. I understand how overwhelming this is. I've had so many meltdowns since Mikey was diagnosed. Please know that this does get easier. Don't lose faith, and don't give up. You can do this. We're all here with you. Post on whatever board works for you. The L&L board has a lot of experts who are always glad to help. I think the problem you may run into, is that many of them are in the US, so they are not around when you are. Still, if you have questions, and you want to post there, please do. Just don't get frustrated if it takes time for your post to get seen. One other thing I would like to add, is that if Jai Jai goes hypo or has any kind of serious emergency. please add the 911 icon to your post. That will get you the most attention and the fastest help. In an emergency, I wouldn't hesitate to post on both boards, just be sure some one sees. You're doing great. Sleep as much as you can while he's at the vet's. You have to take care of yourself, so you can take care of him.

 

I think I see what may have happened. The short version: his dose is too high.

The dose for Lantus is raised increased dropped/reduced/lowered (my fingers have been on autopilot!!!) when the nadir, the lowest glucose, goes below 50 mg/dL for Tight Regulation protocol or 90 mg/dL for the Start Low, Go Slow protocol.

Now look at the data for 7/1/2015 - he got down to 52 mg/dL (2.9 mmol/L). For the Start Low, Go Slow protocol, that would get him a reduction in dose from 1 unit to 0.75 units. And that was only the 2nd day on Lantus; after another shot or two at that dose, he probably started getting below 50 mg/dL, which would earn him a reduction on the Tight Regulation protocol.

After several days at that dose, you start seeing black and red numbers. What was probably happening was that his body was compensating for too much insulin. Lantus builds up in the body and only stabilizes in effects after 5-7 days on the same initial dose and after the first dose level, changes may take 3-5 days to stabilize. There just aren't any between shot tests on those days to show it.

Skip the next shot to let the build up (called the depot) drain somewhat. Reduce the insulin dose to 0.5 units ASAP. It will take a minimum of 3 days to stabilize at the new dose and may take up to 7 days.

 

Hi, @Marycatmom. I was thinking I could handle Jai Jai's situation because it is not his first time having hypo. He is just a good boy and he did not make a sound. I caught the hypo because I did the testing. And in the two previous time, his BG raised back gradually to normal. Hence, I was not seeking for help last night, and I did not put up a "911" sign.

I was frustrated with the dose that should be given to him. Hold the lower dose --> all reds. Raise a bit --> hypo.

What if I am not here with Jai Jai? I am not here half a day because of work, am I going to lose him when I am away? This thought makes me really sad and I cannot hold my tears for this.

Every time I have a crisis in my life, I see myself a weak person. I am sorry that I do not have much positive thought right now, because I do not how to move on.

I will see the vet about 4 hours later, and I think she will try to prove me all wrong. I think she needs me to be 100% obedience to her decision, otherwise she may not want to take Jai Jai's case anymore. I have the sense because the vet assistant left some bread crumbs after his talking to my vet.

Let 's see what is going on. Thank you all for your care, attention, and loving vibes. They are all heart warming, and they are sunshine on the rainy days.

 

You have to be patient when you use Lantus. It is like steering a huge ship. You turn the wheel and nothing happens until a day or more later. With Lantus, you make a change and it takes 3 - 7 days for the change to have its full effects.
There are 2 unusual things to know about:
1) New dose wonkiness - a phrase we created - an increase in dose causes increased glucose levels, which is backwards. You have to wait for it to settle that 3-7 days.
2) Bouncing - bouncing happens when the glucose a) drops too low, or b) drops very fast, or c) drops to an unfamiliar level. This causes hormones to release stored glucose (glycogen) which raises the glucose level back up, higher than before, for around 3 days.

 

Hi, BJM. Your view and comment are always the best. In July, we gave him about 130 calories a day which we are not quite aware of the intakes were so low. We raised the food intakes to be close to 200 calories/day which resulted in high BGs. (Please see the figures from 14/8 and onwards). I do not understand why the dose of 0.75 was kept for 5 days (14 - 18/8) without an effect.

Jai Jai is now in the hospital.....I am unable to take the control of his dose right now. Probably I cannot make a decision for a while too because the vet disapproves of.

 

I saw that. Stick to your ideas and if needed, find a new vet.

Some of us let our cats free feed, so if they go low they can eat as needed to bring up the glucose.

 

I tried to find a new vet some time before. The one with some good reputation refused to take the case, suggesting that Jai Jai should be stablized before changing the vet......Sigh.

Do you leave the fresh meaty food all day? Do you separate the cats in rooms for free feed? I do not have a spare room to keep Jai Jai in fact.

 

I'm in the US and I feed Friskies pates to all 15 cats. I put it down twice a day, and they graze on it until its finished.

I have 2 semi-feral cats who get some Evo Cat and Kitten dry food and 2 guest cats in my basement who also get some of that.

Although I do not have a diabetic cat any more, I continue feeding the low carb canned to the majority of my cats.

 

@BJM Shouldn't "RAISED" be "DECREASED"!

 

Woooow, 15 cats??? I got 3 and I have already used up my energy.

Jai Jai won't eat if he does not want to, the leftover will be eaten by others before Jai Jai wants to eat more. That is why I do not leave food for free feed.

We used about 1 hour to feed Jai Jai in the morning. We split the big meals into two, so that he has something in his stomach before the insulin injection. We then gave him the rest. Most often, we can see him clear his plate before we go out for work.

 

@MrWorfMen's Mom - Good save, Linda.

 

Met the vet. Like what I expected, she is going to refer us to other vets. This is a polite way to hands off the case.

I'll take Jai Jai home now. The dose is back to 1 unit and I will hold this for a longer time to see what will happen.

 

Hi Hollis,

I'm sorry that the vet gave you a hard time.

I am very happy to hear that Jai Jai is coming home with you. I know that you will feel better for that.

I am going to suggest that you post here on Feline Health for the time being and just stick to the one thread (much easier for you to cope with right now - we can tag someone to help with dosing issues if needed). We'll do our best to keep a closer eye on you both. (I'll be watching your spreadsheet, too.) Please ask us any questions you have, and don't be shy about posting if it's all getting a bit much for you and you just need some moral support. We all know how tough this sugar dance can be at times, and we have a bottomless pit full of hugs ready to share with you when you need cheering up. You are a wonderful cat mom to Jai Jai. You will get there.

And talking of that never-ending supply of hugs, here's a first installment ...





Mogs
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Hollis,

How much did Jai Jai weigh at diagnosis, and how much does he weigh now? Is he over or underweight according to this body condition chart?

.

 

He was around 4.3 kg when diagnosed. He is now 4.45kg, the vet said that his ideal body weight is between 4.5 to 5kg. He is a bit thin right now.

 

Do you have any BG numbers for today for Jai Jai? Also, how many hours till his next dose is due?

 

Morning, Mogs. Thank you for your support. It's not easy to explain to the vet the belief I am holding. She thought it was totally ungrounded given the fact that Jai Jai was hypo.

We both knew that we had no way to persuade each other to accept one's belief. She just let me go.

Her last advice is that I have to keep Jai Jai's dose for a longer time, not to change immediately after 6 cycles. OK, I buy that.

His BG at around 16:00 is 18.0 (320-ish). I have one hour before the next shot.

 

I speak mmol/L, Hollis (I'm in the UK).

Can you do a blood glucose test now please, Hollis? The +11 and the PMPS together will give a little more insight into where Jai Jai is heading at the moment.

Did your vet advise you to drop down to the 1.0 unit dose?

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Great to learn that I need not to use the calculator to do the maths. He is now 22.2 (400 mg/L).

The vet recommended 1 unit and she said I need to start all over again.

 

One thing I want to ask, do you recommend small meals? I voiced out my concern that Jai Jai sometimes did not finish his food before our going out. My vet recommended giving small meals throughout the day, but it is kinda difficult for me to manage.

She then suggested caging Jai Jai in day-time if other cats will eat up all his food. I do not want to do that, it will make Jai Jai very nervous.

 

Thanks for the update, Hollis. I'll answer your food questions shortly. I'm working on BG and insulin at the moment.

Do you know roughly what time Jai Jai came off the glucose at the hospital? Also, did they give him any higher carb food while he was there? If yes, was it wet or dry and did they tell you the name of it?

I'd appreciate it if you could answer quickly because the next insulin injection is due and I'm still concerned about whether 1.0 unit might be too high at the moment (I'm very much in agreement with BJ's analysis earlier in the thread.)

ETA:

HOW LONG TILL DOSE IS DUE?
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He ate his usual food, low carb and low calorie.

 

No idea about his glucose drip off. but I think it is before the morning shot, because Jai Jai had a very high BG last night.

I do not have the figures, I recorded down by my memory

 

OK. It's valuable to know that Jai Jai's BG was very high last night and that it seems to have recovered a bit today. It gives some pointer that there is probably still a fair amount of insulin in the depot looking at this morning's cycle.

OK. Here's my take.

I very much agree with @BJM's analysis of Jai Jai's data. If it were my cat I would reduce the dose to 0.5 units of Lantus and hold that dose for at least 5 and probably 7 days (unless a dose reduction was indicated in the meantime in which case I'd reduce the dose further as appropriate). I would also diligently monitor urine for ketones as part of normal diabetes management good practice.

Here is my reasoning:

- First and foremost, the safest dose you have given Jai Jai to date has been 0.5 units.

- Too much insulin can produce hypos.

- Too much insulin can result in high numbers as the cat's body works to dump glucose into the bloodstream to prevent hypos (i.e. too much insulin can sometimes look like too little).

- Looking at your spreadsheet, for doses of 1.0 IU Lantus or greater, Jai Jai has either gone too low or has remained in high numbers much of the time (for the test data available). Also his data for a 0.75 unit dose is ambiguous (may have been too high).

- Jai Jai has had FIVE known hypo events at doses of 1.0 IU or greater.

- It took a lot to raise Jai Jai's blood glucose back to safe levels last night.

- Jai Jai has just had a hypo in the last 24 hours. I think the 'hiding' in the litter box may have been evidence of a symptomatic hypo (some cats lose control of their bladder/bowels when they are low). This is conjecture, but what if Jai Jai *felt* he might be about to go to the toilet when he went into the litter box last night? Cats may be much more sensitive to insulin after a symptomatic hypo. Even though Jai Jai may have 'got away with' 1.0 units recently, the possibility that his insulin sensitivity may have increased is yet another risk factor that should be considered when deciding whether 1.0 units is still too high a dose.

- Per Roomp-Rand Tight Regulation Protocol guidelines, a starting dose of 1.0 unit is right for a cat of Jai Jai's weight - BUT - the 0.25 IU per kg formula is for a cat that has not received any insulin treatment at all. The protocol has a modifier for starting doses when a cat has previously been treated with insulin, viz. any data on the cat's previous response to insulin MUST be considered when determining an insulin dose, and the starting dose should be adjusted accordingly to make sure it is safe. (Saoirse, for example should have started at 1.0 unit Lantus for her bodyweight, but I agreed with our vet to start her at 0.5 units instead because we knew from her Caninsulin data that she was very sensitive to insulin. This worked well, and kept Saoirse safe. In fact, Saoirse never got as far as needing 1.0 units of Lantus. She actually only had four cycles on 0.75 before I needed to reduce her dose back down to 0.5 units again.) You may be 'starting over' but you're not 'starting from scratch': 1.0 units may now be too high a dose (and the data supports that possibility).

- You may see higher numbers after the hypo from bouncing. Also Jai Jai's numbers may still be influenced by the carbs he got at the hospital. (No way of proving that until the data is in but if it were my cat I would err on the side of caution and treat the current numbers as though they may be temporarily 'falsely' elevated and dose conservatively to be safer).

- It may take several days for any bounce to clear. But it will clear. Some cats take longer than others.

- Going back to 0.5 units is a better safety hedge. If after the dose has been given a longer time to settle Jai Jai's numbers need improvement, the dose can be increased again. (NB: Looking back at Jai Jai's data, for where he was earlier in his treatment I think somewhere between 0.5 and 0.75 IU may have been his 'goldilocks' dose. Sometimes even the 0.25 unit increases are too big, especially in cats that don't need a lot of insulin.)

I have always had a very conservative approach to treating my cat with insulin. It has served us well and kept her safe. Tight Regulation is a very aggressive treatment protocol. For Jai Jai's safety I wanted to give you an alternative view to consider. Again, I say that I fully support BJ's analysis of Jai Jai's earlier data. She has much more experience than me, and if I were in your position I would give her advice serious consideration. Other members may have very different opinions for you to consider.

You hold the syringe, Hollis. It is for you to decide whether 0.5 or 1.0 units is the dose you wish to give. Whatever you do decide, we will be here to support and help you both in any way we can.



Mogs
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Hi, Mogs. Please accept my apology. When I read your message, it has been one hour past for my shot of 1 unit. I appreciate your every effort to analyze the situation and provide much useful to gather the pieces together.

The 0.5 unit can be started tomorrow.

I agree with holding the dose for 5 to 7 days. I will give him subQ fluids that should keep him safe from ketones.

 

YES!!! Sorry - went back and fixed it.

 

No apology necessary, Hollis. I didn't want to set out a half-baked response to consider and between my OCD and concentration problems it takes me forever to type stuff.

IMPORTANT:

You NEED to get a test at PM+2 tonight to get some sort of idea of where the cycle is going. If it is lower than the PMPS let us know here so that we can review things with you and advise whether you need to take any action. I want you, your hubby and dear little Jai Jai to have a calm and uneventful evening, so the +2 test should give us a heads-up of what the cycle may do.

BTW, one risk factor that I neglected to include above is the observation you've made in your threads about warmer and cooler weather seeming to have a possible influence on Jai Jai's numbers. It is not unreasonable to consider such factors in making dosing decisions. Weather can affect the human endocrine system, e.g: some people get cranky when they're too hot; some get depressed when too cold. Some cats' BG levels are affected by the moon! The pancreas does not work in isolation within the body and its function is mediated by other bodily systems. Unlike insulin and food intake such factors cannot be controlled, but the risk needs to be managed nevertheless. Weather sensitivity may be Jai Jai's little idiosyncracy. The more clues you gather, the better able you will be to learn the steps of Jai Jai's own unique sugar dance. It would help if you could check back over your notes and threads and include a comment in the Remarks column of your spreadsheet for the times when the drop in temperature seemed to correlate with a drop in Jai Jai's BG levels. It's very helpful to have observations like that recorded for future reference.

I need to take a bit of a break right now (very fatigued) but I will come back later and post something about food schedules.




Mogs
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I just read this entire thread this morning.
Hollis, please hang in there. We will be thinking of you and your kitty today! Sending positive thoughts!
Mogs, wow! You are amazing.

 

@BJM - UMMMM.........."DECREASED" not increased!

 

Fixed ... again. I am not awake!!! I wish caffeine didn't give me vision problems!!!

 

Mogs, you are really amazing. You help me get through the toughest moment. I respect every suggestion you made. Please take a good rest, and I know Jai Jai's case made you feel overwhelmed too.

The PM+2 is 437, higher than PMPS: 400. Does it mean that Jai Jai will have a safe night? I don't get the idea of testing +2. Can anyone kindly teach me?

 

With Lantus, a test at +2 that is level or spikes means it is likely to be a normal cycle.
An obvious drop in glucose at +2 suggests that staying alert and monitoring would be wise as the numbers may continue dropping, possibly to a risky level.

 

Hi Hollis,

It's great that Jai Jai is numerically higher at +2. Allowing for meter reading variance, the 400 and 437 are roughly in the same ball park. There will probably be a little bit of food influence, too. If it had been a lot lower at +2 then we would know to be a bit more 'on red alert' for tonight's cycle (great heads-up to have because we can make sure someone keeps an eye out for the two of you). There are no guarantees about where Jai Jai may go later in the cycle but with higher or similar PS and +2 tests, the likelihood of a much lower cycle tends to be less. I will dig out the forum sticky that talks about +2 tests for Lantus users so that you can learn more.

Will you still be up late enough to get a +3 test, Hollis? Also, when Jai Jai has been at lower numbers in the past does he come looking for more food?


Mogs
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Oh, thank you, BJM. Can you also tell me where can I find the info? I am not aware of reading similar info like this. This looks really helpful to get to know the relationship between the testing time and the cycle performance.

 

Yes, I am still here, but my hubby suggested leaving Jai Jai a peaceful night. Jai Jai did not ask for food, he was lying down like he normally does. If testing is not done, I have no way to know he is hypo!

 

Check out the stickie posts at the top of our Lantus forum here.

 

I can understand your hubby wanting to give Jai Jai a little rest after his heavy duty night last night, but I strongly recommend you get the +3 test. It's the point in the cycle where he went low last night. I really do think it is MUCH safer to do this. I would not advocate as strongly for this were I not to think it important for Jai Jai's safety and your peace of mind.

EDITED TO ADD:

Because the preshot and +2 tests are pretty similar (allowing for meter reading variance), you can't yet rule out an 'active' cycle.
.

 

Oh, I have just got this message, and the test is for +4: 497

I think Jai Jai is going to have black numbers tomorrow.......will his bouncing be cleared after 3 days? Oh, I need the patience pants now.

 

Alas, but there isn't a crystal ball to tell us, Hollis. At least you know he's not low tonight because he's playing on the ...




Grab hold of them there patience pants, Hollis, and hang on tight!

I wish you, your hubby, Jai Jai, and your other kitties a peaceful and restorative night. If you're at all worried, leave down plenty of food for all of them. One night of naughtiness should be OK.



Mogs
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Hello, all.

Since Jai Jai is now home, and he has to start over of the DB management. I have created a new thread to summarize the above discussion and learning points.

I will reserve the first five posts to update Jai Jai's situation. I hope that it will be more convenient for anyone to grasp Jai Jai's situation immediately and then join the discussion. The new thread is here: http://www.felinediabetes.com/FDMB/threads/jai-jai-update-and-discussion.143333/