? Jack 03/22 - AMPS 318 - Feel like we hit a wall

Yesterday

Starting to get discouraged with his numbers. He got some good blue and green numbers after a few days on 1.75 but then mostly sailed through yellow and pink the whole time he was on 2u and now same thing since we bumped to 2.25. He got a single blue the first day on 2u but nothing since. The only thing that makes me somewhat optimistic is that he spends most of his time in yellow now than he does in pink, but that's also why I feel he's being extra resistant, as if he wants to drop but his liver isn't letting him.

I read a few posts saying that in some situations people will increase doses every 2 days instead of every 3 days. At what point would you assume that to be necessary? I feel like his body is just becoming more and more resistant and will go in circles forever. It's like he drops at one dose, then resists through a few more dose increases, drops again, resists a few more dose increases and every time he finally gets green numbers it's always the same or similar kind of pattern as the last time he went into green/blue only on a higher dose every time.

Is it possible that my insulin is going bad? I keep it in the fridge but have left it out by accident a few times (probably spent a total of 5 hours out since I opened the bottle) and it spends 1hr a week in a lunch box with an ice pack when I go to my mom's (ice pack usually has 1 ice pack and 2 bags of frozen breast milk for my son). Or could it be that he's not on the right insulin? A few people have mentioned in prior posts that he looks like he could be a candidate for Levemir but I don't know how to tell or how long I should wait before trying something new. I also get worried because I read about things like IAA, acromegaly and Cushing's but don't know if he shows a pattern similar to those disorders.

Just feeling discouraged and looking for any possible reason or option :/

 

Hi Angela. I can sympathize with your discouragement when they are getting increases with no real movement. Since insulin is a hormone and not a medication, their needs are constantly changing as how much they need. He is a newly DX diabetic and it can take up to 6 months to know how well a particular insulin is working for them.

The high dose conditions aren't usually suspected until a kitty gets up over 5 units of insulin and still no good control of their numbers. Jack isn't there yet. I am linking the stickie about Acro and high dose below for you so you can keep it in the back of your head what to look for.

Acro and other high dose conditions

As far as the insulin going bad, usually in staying out of the refrigerator for that short of time is not going to effect it. More detrimental to insulin going bad is freezing, not higher temps. So, when you put the bottle of insulin in the lunch bag with ice, make sure the bottle of insulin is not sitting right on the ice; have it wrapped up in a bubble wrap and a towel. Things to look for insulin going bad would be if it is cloudy or has floaters in it.

At this point, I would just stick with the TR protocol of changing the dose every three days if you don't see him return to a green number. He just hasn't hit his dose yet. Hang in there. It will happen. Meantime, how is acting otherwise? Is he eating well? All the 5 P's in place? Peeing, Pooping, Purring, Playing, and Preening?

 

FWIW to my eye his ss does not look like that of an IAA kitty.

Take a step back and look at the slightly bigger picture...the last 2 weeks (28 cycles)

AMPS- (14 total)
5 pink
7 yellow
2 blue

PMPS- (14 total)
1 red
7 pink
3 yellow
3 blue

Now the Previous 2 weeks:

AMPS (14 total)
1 red
12 pink
1 yellow

PMPS (14total)
2 red
11 pink
1 yellow

Red PSs are disappearing and blue PSs have come on the scene. The number of pink PSs have decreased and the number of yellow PSs have increased. That’s progress.

Regarding your insulin, it’s hard to say. I myself have bought a new vial after thinking the one I was using lost it’s oomph- most of us have. If it’s not going to strain your wallet it may be worth trying a fresh bottle.

Try not to get hung up on the size of the dose and dont try and rush things along. Stick with the TR guidelines regarding increasing and decreasing -it will keep him safe. Regarding increasing faster than the TR guidelines recommend, if a kitty is recovering from DKA and/or producing ketones fast tracking the dose increases is appropriate. Does he have a history of ketones or DKA?

Keep in mind there is a healing process that needs to take place and healing has its own timetable.

Hang in there and hang in here. You are doing fine.

 

He's been acting okay. He's never been much of a player (always been a lazy cat) but I can tell the difference between his lazy sleep and high BG sleep (with lazy sleep he usually stretches into comfy positions like a human would and looks happy, while with high BG sleep he gets into a basic position and stays there the whole time and his eyes usually get bloodshot and sticky) but he snaps out of it when he gets into lower yellow numbers. Eating is fine, pooping is fine and the peeing is obviously higher when his numbers are higher but nothing crazy like peeing outside the box and luckily hasn't peed enough to drag around wet litter like in the past.

The insulin doesn't seem cloudy or have any floaters. I usually keep it in a ziplock bag and wrap the excess bag around it when I transport it. The ice pack I use is shaped to fit baby bottles in between the grooves so I have the bottles touching it directly and the insulin standing up on the side next to it (it touches it but has room to flop around so its not pressed against it or anything).

I guess I'm just discouraged because I see lower doses giving good numbers and then a bunch of bounce/resistant cycles and then higher doses giving similar results to the lower doses. I know that some cats need to go up in doses before going down because of resistance, bouncing, glucose toxicity, ect but I never realized how high they might need to go before finally getting used to better numbers. Is there a chance of him crashing?

 

I never thought to look at it that way, that actually makes me feel a lot better. I know that he's improving I guess I just get worried because sometimes I feel like his body will just resist forever.

For the insulin I already have 4 extra pens in the fridge - I bought a 5 pack in February. Insulin is cheaper in Canada, got 5 for 100$ CAD so I might try another bottle in a week or so since the insulin still looks good. Was planning on replacing after 3 months so 2 months of use isn't too bad.

I haven't been checking for keytones to be honest, I really should - I just can't think of a way to do it without making a huge mess everyday. He won't use the box without a lid for me to use a ladle, won't pee on a pee pad and the litter box is in my room so the thought of using special litter or pellets sounds so messy, smelly and hard to clean (we only have a single tiny sink with no backsplash). He only pees once or twice a day so I feel like the whole day would revolve around getting his pee. I had him tested for keytones 3 times at the vet though and he was negative (he was above 400 all 3 times that I had him checked). The vet said if I'm not comfortable with checking his pee, to smell his breath, try getting him to play with a lazer or something and make sure he's eating and that its not a replacement for checking but better than nothing. He also said that he thinks he's low risk for keytones since all 3 times I went in, he'd been consistently in high numbers (between 320-475) for 48hrs and didn't have any traces.

 

Good news about the insulin not being cloudy or floaters. Honestly, I would use up the pen to every last drop as long as it is within 6 months of opening it.

About checking for ketones, it was impossible for me too get Bubba in the box to test the urine, so I invested in a ketone meter. The particular on I got is an Abbott Precision Xtra. It was on Amazon, not to pricey, maybe about 30 bucks. It's the strips that are very expensive. Perhaps in Canada you will find them cheaper. I sent to Universal Pharmacy in Canada for my strips as they were the best price. Then while you have you BG meter set up to test, have the ketone meter loaded with a strip and use the same blood sample. Easy breezy.

Check out Bubba's spread sheet from 2015 to 2016 and you will see how stuck he was too. He hit his dose at 5 u and started earning reductions. He got OTJ 3 times and I am hoping for time number 4 soon. Fingers crossed. Hang it there. Just keep doing what you are doing...

 

This is Jack’s two month anniversary of diagnosis. He is still relatively new to the FD dance and his body is still learning how to work with the new injected hormone. You are doing all the right things to help him get there. As Sandy pointed out, there is progress. The colours are looking prettier on the SS. Glad he popped that blue today.

I used a cartridge to the last drop, longest was a little over three months. Two weeks when Neko has a big gulper.

 

Thanks guys! He's in blue today finally, yay! For some reason he's acting extra lethargic - he did this last time he went down to blue also :/ But yay blues! He managed to steal some broccoli and a chunk of banana from my son so its even extra awesome (2 weeks ago he stole a baby cookie and spiked right away). Frickin cat had had never been interested in human food until we took his dry food away. Now he digs through the high chair liner looking for pieces of food that I missed or grabs things as soon as my son drops them (I usually keep the dog around during meals since Jack won't go anywhere near her).

Hadn't even realized that today was his 2 month anniversary, you're better than me @Wendy&Neko

Will look into the blood keytone meters and see if I can afford it. I'm on maternity leave at the moment. If it's too expensive I might just try pushing the pee pad again or emptying his bladder manually. Let's say a cat goes below the renal threshold, would any existing keytones go away? And let's say a cat were to go below the renal threshold daily, is that enough to eliminate the risk of ketoacidosis?

 

Changing meters tonight. Only have 1 strip left for the ReliOn Prime and will start the Contour Next. I really loved the Prime but I got the Contour covered by my insurance so that I wouldn't have to drive down to the USA for strips (even with insurance, it came out to the same price as the ReliOn!)

Hopefully the new one isn't that off from the Prime.

 

A little bit worried. Jack was hiding under the bed and when I looked underneath, he gave me the saddest meow ever. I got him out and noticed he had a pretty noticable tremor. It feels like purring but coming from his limbs and spine and his head twitches. It's been happening a lot recently but not as intense as today. It never happens when he's in high numbers, only when he's in low yellows or lower. Could it be that maybe he thinks he's hypo even though he isn't?

Here's a video of him shaking.

 

Did you check his BG?

 

Yeah he was at 103.

 

How is he behaving now?

 

Seems a bit more perky. BF came home and started bouncing a mini basketball off the wall to entertain our son and Jack went NUTS over the ball. Still trembling though just less lethargic, at least.

Tested again and he was at 122 (first reading with new meter - ran out of the other one)