Jai Jai - UPDATE and DISCUSSION

Current Discussion:

1. Dose Advice
(first discussed on 29/8, developments see below)

• On 30/8 AM (see the condo here), Jai Jai has some pinks and yellows. His nadir was about 200-ish. Some said that the curve is a nice smile one. Julie suggested that since the nadir was clearly seen, coupled with the cutting down of 2/3 from the dose of 1.5 right before the hypo incident, a dose increase by 0.25 units is appropriate (read here over L&L, #6)
• On 31/8 AM, Jai Jai vomited after the shot, and he ate very slowly. His BGs were flared up to 500-ish.
• On 1/9, more views supported a dose increase [Marje and Gracie (1/9, #7 over L&L) and BJM (1/9, #61)], the next dose is more likely to be 0.75.
• Starting from 2/9 am, the new dose was 0.75.
• Starting from 5/9 am, the new dose was 1.

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I setup this thread to link up all the discussion related to Jai Jai, after his HYPO incident on 25/8.

If you want to know more about the background information, please see the #2 post for the case summary.

Hyperlinks of Jai Jai's daily condo are in #3.

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I cordially invite you to help me and Jai Jai to manage his DB. If you are giving some advice on Jai Jai's dose, please reply to my daily condo (links are at #3). Your support, comment and advice will make my day. Thank you all for dropping by. Have a NICE DAY!

 

Insulin: Lantus

Protocol: TR

Current Dose (Start Date): 1 (5/9/15 am)

Previous Dose (Start and End Date):

• 0.5 (27/8/15 am to 1/9/15 pm, 12 cycles, 300>nadir>250, see 30/8 am)
• 0.75 (2/9/15 am to 4/9/15 pm, 6 cycles, nadir>300, see 4/9 pm)

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Summary of Jai Jai’s Case


Responses to Insulin

1. Encountered HYPO if the dose is more than 1.0 (five records of HYPO)

2. Nadir may be between +3 to +5 (see 1/8pm, 14/8 pm, 23/8 am etc.)

3. Sometimes, his next cycle’s pre-shot figure is lower than/the same level as the previous cycle’s nadir.


Possible Factors Affecting Jai Jai’s BGs

1. Weather, i,e, Hot Weather --> Higher; Cool Weather/ with air conditioning --> Lower (dropped quite drastically)

2. Bowel Wellness (had some soft poo before, improved after being given pumpkin puree)

3. SubQ Fluids

4. Stress (every cat does)


Health Concern

1. Had UTI twice (the last time was 6 years ago)

2. Out of normal range ALT, perhaps he needs liver supplements, but he is not given any right now

3. A bald spot has been found on Jai Jai's right inner thigh (see #18, #32, #33, #62), and it should be an inflammation from injection or blood drawing

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Useful Recommendations with Learning Points

1. BJM (26/8, #62) – Starting dose of 1.0 unit was too high according to Jai Jai’s responses to the insulin. 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. (UPDATE: did not skip the next shot, but the dose was 0.5 starting from 27/8 am)

2. Critter Mom (26/8, #82) – Seconded the 0.5 dose, suggesting getting +2 BG (If the BG had been a lot lower at +2 then we would know to be a bit more 'on red alert' for that particular cycle; if the it is higher or similar PS and +2 tests, the likelihood of a much lower cycle tends to be less) (UPDATE: will continue to monitor the +2 BG)

3. Critter Mom (26/8, #85) - 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. Suggested including 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. (UPDATE: will get a thermometer to record the room temperature)

4. Sienne and Gabby (29/8, #10 over L&L) – Pointed out that +11 and +12 could have a difference in value, even if without the benefit of food. Since Jai Jai is a grazer, and he does not finish his meal before me going out for work, a suggestion was made to adjust to test/feed/shoot time at 6:30am. These three actions have to be all done in a short period of time. Buying a feeder that is triggered by microchip or RFID tag will also work if Jai Jai needs more time to graze. (UPDATE: Started changing Jai Jai’s morning shot to 6:30am and test/feed/shoot were done within 20 minutes. Will try to shorten the time lag. Ablout the RFID feeder, it sells on the UK Amazon. I will get one later.)

5. Julie & punkin (29/8, #2, over L&L) – Seconded the test/feed/shoot approach. Advised that SubQ fluids should be given 3hours after the insulin shot, because the BG may plummet. (UPDATE: The subQ fluids are given on alternate days, will follow the advice accordingly.)

6. Julie & punkin (29/8, #3, over L&L) - When seeing greens during mid-cycles: (i) give some regular low carb food to help him surf; (ii) do not increase the dose until you're sure that he's not going to get to green numbers again.

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Previous Thread: http://www.felinediabetes.com/FDMB/threads/im-really-frustrated-and-dont-know-what-to-do.143249/

 

Jai Jai's Daily Condo:

26/8 (Treated HYPO, Back Home)
27/8 (1st Day of 0.5 Dose, photo at clinic)
28/8 (Bald spot)
29/8 (Skin Irritation, Dose Advice)
30/8 (Skin Irritation, Changed Routine, Loose Stool)
31/8 (Skin Irritation, Vomited and High Numbers)
1/9 (Review Info, Threads, Comments. Considering Increasing the Dose)
2/9 (Dose Increased to 0.75)
3/9 (Need to Revisit the Thread on How to Handle Low Numbers)
4/9 (Planning for Increasing the Dose)
5/9 (Dose Increased to 1)
6/9 (Lower than Usual AMPS! Bounce!)
7/9 (Stabilizing from the Bounce)
8/9 (Another Bounce)
9/9 (Asking for Dose Advice)
10/9 (Asking for Dose Advice, HYPO at PM cycle)
11/9 (Dropping Fast at PM Cycle)
12/9 (Still Dropping Fast at PM Cycle)

 

Some Interpretations to Jai Jai's BG Data:

1. Julie and punkin (ga) (28/8, #3)
2. Vyktors Mum (28/8, #8)
3. Julie and punkin (ga) (30/8, #6)
4. Marje and Gracie (31/8, #60)

 

(Reserved)

 

Hi Hollis, how is Jai Jai doing on his new lower dose of 0.5? I hope you're both doing better.

Shane

 

Hi Hollis,

Bet those patience pants are getting a battering today. It is disheartening seeing the red boxes on the spreadsheet but when you actually look at today's data and compare it to the data from a few days ago, both are high and flat. As such you haven't lost much ground so far in terms of the BG numbers - BUT - Jai Jai is currently safer at the lower dose.

I must say you've done a great job of setting up a 'support base' for Jai Jai on the forum, and the link to the active discussion thread in your signature is very clever: I like that!

I haven't forgotten my promise about giving you more info on feeding and also the tips on active curves and +2 tests. I've just been a bit befuddled today but I will get to it. I'd also like to go through the handling of low numbers with you.

Blessings to you all,


Mogs
.

 

Hi, Shane. Thank you for asking. Jai Jai is doing fine with the 0.5 dose. Like what Mogs has just said, his numbers are high, but the curve looks quite flat on 27/8 pm.

We keep giving him subQ fluids on alternate days. The vet said that the fluids are water and do no harm to Jai Jai.

I will hold the dose for more days to see if Jai Jai gradually lowers the BG a bit. Thank you again for dropping by. Have a nice day~~~

 

Hi, Mogs. The idea of setting up a kinda "support base" popped up in my mind when I myself found it difficult to keep track of the threads and messages I posted on the forum. Getting all the links of the threads together should save some time for seek and found - at least for myself

Adding the "Active Thread" in my signature is once again facilitating me to instantly retrieve the page when I am back (yes, I am lazy and messy, and have a problem in managing data).

There is no rush for the feeding and tips on +2 tests. I will keep doing what you advised anyway. We may need some more days to see the performance of 0.5 dose. My patience pants are on, and I am calm and will be persistent as long as Jai Jai is eating, peeing and pooping. Please take some rest. We all love getting your advice but at the first place, you must be staying in good conditions. Sending my hugs and love to you and Saoirse.

 

Hi Hollis I've been following your thread for a little while now and I just want you to know that I went through the same exact thing that you're going through.
I had three anxiety attacks in 4 weeks that were pretty major one which put me in the hospital because I was so stressed out over my cats diabetes.
It takes time,a lot of patience, and stress, but with a help from this forum you can get your cat to where he needs to be.
I had to put my patient pants on and now my cat Riley is in remission from diabetes Thank God. I used prozinc which everyone tells me that its a much milder insulin. My cat Riley was bouncing around like crazy just like your cat he was really really high and then he would go down really really low, we almost lost him twice.
Everybody on this forum help me get him to where he needed to be by lower doses. We kept going down lower and lower until we were down .5 units with only feeding soft food and finally his numbers just went to normal.
He also had a UTI infection which raises the numbers and he was at the vet with also raised his number. So the vet prescribed him more insulin then he needed because after the antibiotics were taken his infection was gone so that lower the numbers and his stress level was gone when he was home and that lower the numbers. All of these factors have to be considered when changing the dose.

I truly believe that his diet alone changing to the soft food save his life and also got his irritable bowel disease under control.

Don't give up stay strong and just keep asking questions.

My vet didn't tell me anything he just gave me a prescription for insulin and send me on my way. That dose almost killed him. I got all my information from the people on this forum.
You went through a lot and I'm so glad that you're doing much better and your kitty cat is as well I pray that his number get lower. Please don't give up.

 

Hi Hollis,

I know it's tough seeing the reds, but because Lantus is a depot insulin the effect of changing a dose may not be apparent for several days. By waiting several days on the 0.5 unit dose it will allow the depot to drain a little and then stabilize at the capacity that matches the lower dose. Once that happens we will hopefully have a better picture of what just half a unit is actually doing for Jai Jai when he's not on his invisible trampoline. Thereafter we can look at adjusting the dose very gradually to see if we can find a 'goldilocks' level that helps improve his numbers. Does that sound like an OK plan to you?

Oh, thank you, Hollis! Sending lots of love, hugs and scritches back to you and your baby boy.


Mogs
.

 

During my time in the corporate world I often found it was people with traits like yours who were often the most effective organizers and project managers.

People have commented in the past about how much information is in Saoirse's spreadsheet but it's only that comprehensive because with the PTSD I can't hold anything in my memory any more. Nowadays I can't organize my way out of a wet paper bag.
.

 

Hi, @dana moore. I am so happy for you Riley is in remission and you are a happy mom.

Thank you for your encouragement. I was hit by this incident so hard, I cried so many times when thinking of the possibility that Jai Jai was leaving me. But I am OK now and I am ready to see him having high numbers.

I will do what you suggested, stay strong and do not give me. Cheers~

 

What a compliment, Mogs.

 

It's meant sincerely.

 

My patience pants are on. Don't PANIC. Don't PANIC. Don't PANIC.

Please come earlier, please come earlier.

I am ready for this, I am persistent and determined.

Phew........hope that my murmur does not scare you all off from this base.

 

That's the spirit, Hollis! If you wear out your patience pants, we've got plenty more where they came from!

You've had a rough oul' time of things lately. It's great to hear you sounding more upbeat.

.

 

OK, it is just not easy. I have found that Jai Jai has a bald spot on his inner thigh. What do you think it is?

 

It may be related to stress I wouldn't worry too much about it just ask the vet.
I know when it rains it pours.

After I got Riley home and we finally got this diabetes thing under control then he got a huge infected toenail on his foot and it's taken 4 weeks to heal so your right, nothing is easy.

 

I will tell you if that ever prescribe steroids that will make the diabetes worse that's what caused my cat to get diabetes in the first place so be careful with that.

 

Jai Jai was not on steroids. I agree that it is caused by stress. What a day!

 

A little surprise by his 28/8 PM +2 as well, it is 254 (dropped 200 points from the PMPS of 464).......should I be concerned??? <== seemingly a machine error, very unlikely that it is a correct BG figure

ETA: I thought it was a machine error, because we only got a little drop of blood in this test. We did the +3 test (one hour later) and it is 382. The first time I see pink these days.

 

Not necessarily an error, Hollis. Sometimes you can get a quick dip like that early in the cycle and then the BG comes back up again. I would leave it stand as a valid result in the spreadsheet column and maybe put a comment in the Remarks column that you're not 100% certain of the PM+2 test validity because it was a small blood sample.

I'll be interested to see what happens at tomorrow's AMPS.

Would you be able to get a +4 reading tonight?
.

 

Hi, Mogs. I should insist on retesting at 28/8 PM +2 so that we need not to guess whether it is a good test or not. Lesson learned.

I have just got the 28/8 PM +4 and it is 367. Believe me, the 28/8 PM +2 showing 254 is an invalid data.

 

I'm not 100% sure. I'm waiting to see if Jai Jai gives a tick-mark curve ... It'd be great if you could get a +11 in the morning as well an AMPS.

On the definitely positive side, you've got pinks instead of reds this evening.

.

 

The 28/8 PM +11 is 472 (bounced from pinks to red. Don't PANIC. Don't PANIC. Don't PANIC.)

Since I started feeding Jai Jai after the +11 test, the AMPS figure may be influenced by food. I will get the figure anyway.

 

Great getting the +11, Hollis. When was the last time Jai Jai ate before the +11 test?

 

I wouldn't be concerned unless Jai Jai is biting or grooming in that area excessively.

You're doing a very thorough job with record-keeping!

 

It was 10 hours ago. The 29/8 AMPS is 493

 

Yes, I always find that he is licking that part, but I do not see any infection, rash, inflammation over there

 

That's a good sign that there are no infections or rashes. It could be a just a habit. Nothing to worry about.

 

Just a recheck on Jai Jai's inner thigh.......Oh bad. There is a round shape inflammation.

 

Did he have any injections or blood tests there, Hollis? If I'm right in my viewing of the affected area on Jai Jai's leg, Saoirse had a mark like that a few months back. There was a red ring and the skin was a bit flaky in the middle of the ring. I was really worried that she might have contracted ringworm during a recent hospital stay. Turns out it was a reaction to a clumsy injection. I've read here that vets sometimes take blood from the leg to check blood glucose. I wonder whether Jai Jai's mark might be from his vet visit the other day?


Mogs
.

 

Except for blood glucose tests, they did not run other blood work. The vet told that they injected glucose, but I assume they did it by IV infusion. The inflammation appeared last night. It is a bit red but not flaky.

 

Hello, all. It's Saturday, and I hope everyone is having a nice weekend.

I have got a question to ask. How do you know if the bouncing is over?

I did Jai Jai's curve today. His BGs are still high and the curve is flat. Similar results were recorded in these few cycles. Does it suggest that the bouncing is over? I want to hold the same dose for more days (10 cycles at least), but I am going to start planning in order for collecting more views and advice.

I will post on the L&L forum to see what I will get.

 

I wonder if benadryl with help with that area that he's licking it could be a hotspot. Again I was just call the vet and ask them what they think.

 

They may have taken the blood sample for the BG tests from his inside leg. @Squalliesmom Lucy's previous vet wanted her to home test using blood samples from the hind leg ...

Maybe you could ring the ER at a convenient time to ask if it's their standard practice to do blood glucose tests using samples drawn from the inside hind leg?


Mogs
.

 

Every time I took Squallie in to see that particular vet she drew blood from the vein inside his hind leg. She shaved the area and told me to draw blood from that vein with an insulin syringe to do home testing, as well. (Lol, didn't happen!) I would definitely check with your vet to see if they injected anything into, or did a blood draw from, that area.

 

Nice yellow at +4!

 

Is it a surprise he dropped so much? His +6 is 281. Goes up slightly, not sure if it is a bounce or the nadir had reached at +5.

 

The effects of too much insulin may be wearing off, letting him get settled in better numbers. Testing for urine or blood ketones is still a good idea.

 

Hi Hollis,

I had a quick read of your current L&L thread. Is there any chance you could do a quick summary of how you currently feed your three kitties. Also, can you summarise how Jai Jai typically eats - especially his meal around injection time.

Am I correct to say that Jai Jai needs to be in the same area as the other kitties while you're at work or else he gets anxious?

I'm asking so that maybe we can help you work out a way of feeding Jai Jai and getting the tests in to know it's safe to give him insulin in a way that works for both his diabetic needs and also for the rest of your kitties and your household in general.


Mogs
.

 

Hi, Mogs. I have also read your update of Saoirse vet visit, and I am glad that the vet had ruled out the possibility of cyst and lipoma. I hope you are feeling relieved, and had some good rest without worrying. Lots of positive energy is sending to you and Saoirse.

My cats does not eat the same thing because they had different taste and different kinds of problem. They eat:
Jai Jai (male) - chicken breast + tuna canned food (Thrive Complete)
MM (male) - dry food + small amount of chicken breast canned food (Thrive Complete) because he has diarrhea if given wet food solely
BB (female) - dry food + tuna canned food (Thrive Complete). I intend to give BB all wet food but she likes eating MM's dry food

With the advice by Julie and Sienne and Gabby, I have changed the feeding schedule like this:

5:45am Get up
6:15am Test
6:30am Feed: Jai Jai (40g) | MM: dry food | BB: tuna
6:35am Shoot
6:40am Feed: Jai Jai (70g) | MM: dry food + some chicken breast | BB: dry food or the leftover tuna
7:30am Go out for work
6:50pm Return home
7:00pm Test/Feed: Jai Jai (40g) | MM: dry food | BB: tuna
7:15pm Shoot
7:30pm Feed (70g) | MM: dry food + some chicken breast | BB: dry food or the leftover tuna

All the three cats are kept in the sitting room. I cannot take him to my bedroom because it is too small to put the LB inside. Also, my hubby has some allergies that the hair will make him sneeze a lot. Washroom and kitchen are small too, he won't find a place for sleep in that small cubicles.

I am going to get a RFID feeder that will prevent other cats from eating his food. It is quite expensive and I need to wait for the shipment that may be 2-3 weeks.

 

The vet has just called back and told me that they did not take blood from his leg. They will give me some ointment. I hope that works.

 

Hi Hollis,

Nice Lantus 'smile' curve on the 0.5 units today.


Mogs
.

 

Hollis - I see you have a 911 on this thread. Do you have an emergency or did you mean to put up a question mark icon next to the thread title?

 

Starting from 30/8, I changed the feeding routine, and I adopted the test/feed/shoot approach. I was concerned what I would do if Jai Jai vomited after the shot. Oh, bad. I was just asking. I was not thinking of this happening!!!!

Previously, Jai Jai had some occasions that he vomited right after eating. It happened almost once a week, and at that time, we noticed that he groomed a lot. He vomited hairballs and he had diarrhea. We gave him pumpkin puree and the problem was solved. He did not vomit after eating then.

This morning was a bit different. There was white foam on the floor. Jai Jai vomited some last night as well. After the AM shot, he vomited the small meal I gave him. I then fed him again but he didn't eat his the food.

I then gave him a can of tuna mousse (cat food), which is very enticing. Jai Jai eats very happily every time we gave him the tuna mousse. This time, it still worked but he was not as crazy as he was.

I need to ask for a half-day off because he didn't eat enough. I am so concerned as there are so many things happening this week.

What will you do if the fur babies vomit after the shot?

 

I think it is an emergency because Jai Jai vomited after I gave the shot. After that Jai Jai didn't eat much. You know, I am recovering from the previous hypo, and it makes me very nervous.

 

Thanks for the background, Hollis. I see from Jai Jai's spreadsheet you've given half a unit. I am hoping that with his current numbers not being too low he should be OK this cycle but I'd suggest monitoring carefully. Have you posted a condo on the Lantus board for today yet? If not, I suggest that you start it now with the AMPS plus "Need Help: Vomited after AM shot" in the title and put up a 911 there. Unfortunately I'm really not well and I'm very sorry I can't stay to keep an eye on you two.

White foam on the floor can be a sign of excess stomach acid. Have a look at this page from Tanya's site to see if he is showing nausea symptoms. If he is nauseated ask the L&L people for suggestions about what to do (especially as you are between vets at the moment and you might have difficulty getting an Rx at the moment should one be necessary).

I'm glad that Jai Jai is on the lower dose right now. Fingers and paws crossed that everything will be OK. I'm sorry I'm not able to help more tonight. I'll check in on you both tomorrow.


Mogs


PS: I saw a brief mention of the Start Low, Go Slow protocol on one of your L&L threads but I couldn't see whether anyone over there gave you further information about it, so here's a link to the SLGS protocol forum sticky. It's not as aggressive as FDMB's implementation of the Tight Regulation Protocol and it suits some cats and caregivers better than TR.
.

 

When a cat vomits, you may want to wait a little bit on giving more food so his stomach can settle a bit. Lantus has a slow gentle onset, so it is OK if he hasn't eaten much when you inject. Monitor him and feed in small amounts to reduce the chances of throwing up again.

 

Hi, Mogs. Don't feel sorry as you've already rendered so much support to me and Jai Jai. You don't know how thankful I am!!!!

I have read your post and I know you really need some rest and comfort. Please do not carry along the worries with you. You have to stay strong in order to take care of Saoirse.

Please get some sleep and don't worry about me too.

 

I am doing it right now and I am so glad he eats. Oh, god, I was so scared of another hypo.

 

Now that he's down to 0.5 units, that is much less likely. He may still be draining some of the depot from the former high dose. Also, vomiting is a stressor and may actually raise the glucose level a bit.

 

Exactly, his AM+2 on 31/8 is 527. This is the first time seeing black after changing to 0.5 units.

 

Cats can tolerate higher glucose levels for a moderate period. Do test for urine or blood ketones and smell the breath (2 of 3 ketones have a distinctive odor - like nail polish, or fruity).

 

Ketones -ve. I check it everyday per your advice.

BG is 562 at AM +5 (31/8). OMG. Is it a bounce from the yellow and pink yesterday?

 

Hi Hollis,

I am wondering whether Jai Jai might go lower at PMPS.

By the way, what sort of personality does Jai Jai have? Is he a sensitive little kitty? From his picture, he looks to have a very sweet nature.


Mogs
.

 

Hi, Mogs. Have you had a good rest? How about Saoirse? I hope you two are fine.

Do you think Jai Jai had a bounce this AM? I discussed with my hubby and he also felt that holding the 0.5 dose until 2/9 PM was right, he thought Jai Jai had high BGs because of vomit. To keep Jai Jai hydrated, we will give him 100ml subQ fluids two consecutive days. We hope that he will be fine.

Jai Jai is very sweet. Before I found out that he is diabetic, he always sat next to me when I was using the computer. He sometimes slept on my laps. But, if we do something that he does not like (brush his teeth, prick his ears, etc.), he has a very bad temper.

I do not remember if I had mentioned, MM is a black cat. Here is what he looks like:



MM is a very naughty cat, and he has some hate against Jai Jai. I think Saoirse is a much much more lovely and adorable cat.

 

Hi Hollis

I haven't posted to you yet but after reading this thread, I feel the need to as I don't agree with some of the information you've been given.

First, your signature block says you are following the TR protocol but Jai's Jai's SS is not indicative of that....in other words...whatever dosing advice you've been given is not TR. Just to clarify, although it doesn't affect you or Jai Jai, but SLGS is not a protocol. It's an approach. It has no scientific basis. That doesn't mean it's not effective or doesn't work....it does work for some kitties and was the approach used on this board for many years and resulted in many cats going into remission. TR just provides a better chance. Here is an excellent post on Can you do TR and work full time that you might want to read.

But given your circumstances, maybe SLGS is better for you and Jai Jai and you can hold the doses for a week at a time and then run curves on the weekends per that approach.

I know you are worried about a hypo and I always am, as well. I'm sure the night he spent all that time in the 20s was horrible for you and it's not something any of us want to see for others' cats or our own. However, you shot 1.5u that night. I have to agree with Julie that you've cut the dose to 1/3 what he got that evening. And the above advice I quoted is not correct for a decrease that leaves a cat in these high numbers. For a cat getting high numbers like this, you don't leave the dose for "several days". If a low number has caused a bounce, let the bounce clear, take the dose up if the kitty doesn't come back down into normal numbers. From the modified TR protocol we use:

The question is...what is the last good dose for Jai Jai? In order to be cautious, I'd give him 0.75u and see how he does within six cycles of consistent dosing. And I do think that inconsistent dosing is also an issue here. There might be other things we can suggest regarding feeding, etc., to help him flatten out a bit.

While I don't know if it occurred, let's just assume he dropped lower in the a.m. Cycle of 8/28. He's had plenty of time to clear the bounce. While I have seen a couple of cats take longer than six cycles, those cats were extremely overdosed (I'm talking 10u) and had an enormous depot. I don't see that here. I also agree with Julie's comments on the L/L forum that Jai Jai needs a 0.25u increase. I understand you work and are worried but hyperglycemia is also a serious issue if left unaddressed.

One other thing is that many things control what happens to the BG in a cycle. Syringes sre grossly inaccurate and 1.5u could have been a lot more if you got a really bad syringe that cycle. Jai Jai could have had some extra absorption that night due to the fluids even though you didn't seem to change anything from how you've done it before. I'm not saying 1.5u wasn't too much.....it was that cycle and that's all that matters. The dose had to come down.

I am also concerned about you posting in two forums. It makes it really, really difficult for people helping you to keep track of all the threads. Can you imagine if everyone did that? For people giving suggestions, especially about dose, it takes time to read the thread, study the SS, etc and to have to go back and forth between forums adds time. So I would suggest that you pick the forum where you are most comfortable. Consistency in this will also help you and Jai Jai both. Keep in mind that on the L/L forum, we have the most people with a long history of using Lantus and levemir and familiarity with the TR protocol as well as SLGS Approach. But it is your choice.

If Jai Jai were my kitty, I'd spend some time deciding whether I wanted to follow the TR protocol or the SLGS approach and then I'd stick to it as closely as possible. Yes, there are going to be occasional exceptions that will cause the need to do something a little different. You aren't following the TR protocol if you hold a "steady dose for 5 to 7 days" even if he's sky high. Frankly, looking at his SS, I don't see that Jai Jai needs longer than six cycles at a dose to tell you that he needs more insulin or not. What I do see is some missed reductions for some really low numbers (7/17, 7/19, 7/25).

In summary, my suggestions, based on five years of experience with Lantus and levemir and looking at hundreds of SSs, is that you decide TR or SLGS and then that you post daily in the L/L forum so we can help you stay on track with following the method you pick. Anyone helping you in this Health forum can also post in the L/L forum and, that way, you have one thread going that everyone can track. You won't need to do an "active thread link" in your signature because we post a link daily in the L/L thread to the previous thread. Easy.

BTW, you are doing a good job of getting nighttime tests now and that's important.

 

You tested a full 5 days to see if restarting at 0.5 units would help get him stabilized and see if maybe that would work better for him. It hasn't and the nadirs are high. It's time to resume following one of the Lantus protocols and increase the dose. Moving up to 0.75 units makes sense.

Another thought is to review the info on dosing with calipers. Using calipers would help ensure the doses were as consistent as possible, despite any variations in the syringe markings, plus allow you to carefully fatten or skinny doses, should he be more sensitive to insulin after those hypo episodes.

 

An update of Jai Jai's inflammation, the area had less redness, and Jai Jai did not lick much these two days. I think he will recover from the irritation soon.

 

Hi, @Marje and Gracie. I read your message several times, and I asked my hubby to have a look too. I thank for your time for the message, and I actually get something from it.

I spent some time to read through the messages (here and over the L&L again), and also the TR and SLGS. If TR is not the right thing for me (at least for the time being), I need to switch to SLGS in order for Jai Jai to settle a bit.

I don't know which is his last good dose. 0.75 is too low, 1 is too high and caused hypo. There may be something that is between 0.75 and 1.0.

Sorry that I prefer to keep this link, because I have link up all the referencing which I cannot do on L&L. I can easily find my condos in #3, and current discussion topics in #1.

It is also useful when I need urgent help without creating other post. Whenever I am in SOS, I do not have time to create a thread and follow the rules on L&L. I always have a delayed post on the L&L forum because of it. I am trying but I need some time to transit. Please don't take it personally.

 

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Thank you both for taking the time to read it and consider the info.

Discuss it with your husband and see what you both think is the best thing for Jai Jai. TR is a great protocol to follow and I think most people can do it but it's not the only way to get a cat into remission and you have to decide what YOU think is best for you and Jai Jai.

I addressed this on your L/L thread today.

No need to apologize. It's your signature block and your time.

I've been around way too long to take things personally here and you should never be worried about that with any member. There are only three things we ask in L/L forum. First, that the subject line be in a certain format so we can follow the numbers. Sometimes, you might not see an issue but we will. Second, that you post the link to the previous day's thread in the current day, and third, one thread per cat per day with all your questions. IF you have a 911, don't worry about linking a thread! Put up the 911, put the date and Jai Jai's name in the subject line along with something that catches our eyes like "very low BG" and then write your post. If there is a 911, we aren't going to care about the normal posting guidelines. You are doing a great job with your posts in L/L but just remember that most of us don't have the time to read a thread there and then another one in Health about the same cat on a daily basis. Yes...there might be times when there aren't many people in L/L and you need to post in Health to get eyes on his thread but usually someone is around. I know the time change makes it difficult.

Hang in there!