? Trying to get Alley back on track, need advice

Hi everyone,
Because I don’t know how to link previous posts, I will recap my situation here: I had to leave town for a week. Alley started with a sitter. She eventually stopped eating, so we got worried about injections, and decided to get her into medical boarding at the vet. She was so stressed out that they gave her gabapentin for several days, she wouldn’t eat much, and could not get her full insulin dose injected. As expected, her numbers were horrible when I got home.

I’ve been trying to get her back on track for the last couple of weeks, but to no avail. Her appetite has resumed, at least until this week. I thought the recent dose increase was going to do the trick, but she seems really out of it, and with numbers in the 300s. No ketones the last time I checked, probably Wednesday or so.

I have been trying to follow the TR protocol, it was going really well before I left town, now I’m at a loss.

Could someone please have a look at her SS and let me know what you think? I feel really discouraged as it seemed like we were moving in a good direction before my trip. Now we’re worse off than when we started.

 

Here’s your last condo.

http://www.felinediabetes.com/FDMB/threads/to-board-or-not-to-board.201091/#post-2245078

Looking at your ss I think I would increase by .25 tonight but see what others say.

Don’t fret. You will get back in control. I hope everything is okay otherwise.

 

Alley might have some glucose toxicity going on. All you can do is raise dose until it breaks through. Your following TR. Stick to it and raise after 6 cycles (3 days). Beware when it breaks it's possible Alley might barrel down rapidly. Make sure you always have plenty of strips, syrup and hc food.

 

Does it look like she bounced after I upped her to 2.5? Is glucose toxicity the result of high numbers for too long?

 

Basically yes, here is information on toxicity. Olive had toxicity possibly resistance before we knew about the acro. Insulin was like giving water.

http://www.felinediabetes.com/FDMB/...-what-is-it-what-should-i-do-about-it.144381/

 

How did you discover Alley was diabetic?

Please test for ketones daily. Numbers do not need to be crazy high for ketones to develop and they can develop quickly.

I would increase by .25u to 2.75u. You have held the 2.5u dose for 9 cycles and the BG has remained essential the same.

It’s important to get least one mid cycle test each and every cycle, AM and PM.

 

So, do people increase even in the midst of a bounce? I’ll up her tonight. AM mid cycle hasn’t been a problem, PM is a different story. If her PMPS is low, I’ll set an alarm to get up. Otherwise, I just can’t swing it daily. I test for ketones as much as I can. With no other humans in the house to share in Alley’s care, this is the best I can do for her right now.

I discovered Alley was diabetic when I got home from being away on an extended research trip at the start of July. She stopped eating, drinking, and pooping one I returned. She had developed pancreatitis and ketones, BG high 400’s. That’s when we started the insulin.

Prior to my late-August trip, it seemed like we were headed in a good direction. As I mentioned above, it now feels like we’re starting from scratch. In my line of work, travel is unavoidable. Given that Alley doesn’t respond well to boarding or sitters, I’m running out of options.

 

It’s best to wait for a bounce to clear before increasing. The combined momentum of a clearing bounce and a new dose kicking in can result in too much downward momentum. I don’t see that as a concern right now for Alley.

I am concerned about ketones.

The recipe for ketone development is -
Not enough calories + not enough insulin + infection, inflammation or some other systemic stress.
Being that Alley has a recent history of ketones, Pancreatitis and her appetite is off, she is vulnerable to a recurrence. Vigilance is required. Ketones can go from negative to large in 24hours. I speak from experience (see 6/22/2008 to 6/23/2008, PM+1 on Black Kittys ss).
When it comes to ketones, an ounce of prevention is worth a pound of cure.

Don’t despair. Getting the upper hand on FD takes time. The early phase in particular ir is common to feel like you are taking one step forward and then two steps back. That’s why it’s referred to as the “Sugar Dance “.

If you have not already done so, read the info here for helpful tips on following TR while working full time.

Hang in there and hang in here
It will get easier

 

The biggest issue with bounces and dosing is timing. As Sandy noted, if you increase a dose at the same time that the bounce is breaking, you may see the momentum behind the drop back to the "usual" range on top of the momentum of a dose increase. I inadvertently did this and it can be a bit of a wild ride with regard to keeping numbers in a safe range.

I think Alley may have bounced on 9/19. It looks like there are some evenings when you don't have any test data. It will help if you can get at least a "before bed" test every night to see if Alley is dropping into lower numbers. Many cats do experience lower numbers at night. PM tests will also let you see if there's a bounce or if a bounce is breaking.

How does Alley do when you're gone for the day? Does she eat? How does she relate to other people in general? My diabetic kitty was was mostly aloof with my friends -- only a few people were exceptions and she seemed to have a vendetta against my cat sitters. She mostly wanted to take their arm off if they tried to test her and it took a good a bit of negotiation for some very talented sitters to be able to shoot. A couple of thoughts... Would it be possible for your cat sitter to stop by and feed Alley a snack both when you're home and when you're out of the house? Cats are creatures of habit and between your being gone and a stranger visiting and poking with sharp objects, it's no wonder more of our cats don't do well when we're gone for a few days. If Alley has favorite treats, make sure your cat sitter indulges her. (In other words, have the cat sitter bribe your cat!) If Alley has a usual "spot", make sure you leave a smelly tee shirt or something similar there. Your smell may be a comfort. If you have a land line and can set your voice mail so it's audible, you can always call the house and talk to Alley. If you do have friends she likes, can they stop by while you're traveling?

 

Alley does fine when I’m away during the day. I have an automatic feeder that I set befor I leave, so she eats every four hours. I also set it at night to keep her levels stable. When her appetite is off, I can tell by what goes unfinished. I could definitely try the sitter stopover when I’m in town, just so alley knows she’s ok. Maybe that will allow us to build up to more days when I need to leave town. We lost so much ground over my last trip, I’d hate for that to be the norm whenever I leave town.

In terms of PM numbers, I wake up super early, so the +2.5 is my before bed number. I’m trying to squeeze in more pm tests, but I’m burning the candle at both ends as it is with two teaching jobs and trying to finish my dissertation. I’m just not able to do the 3am tests consistently I did get one in last night, though. She bounced. I figured that was going to happen after a day in the blue. Sugar dance indeed. Should I expect a bounce to eventually break? I’m concerned we’ll just be going up and up with her units.

 

Bounces eventually break. Alley is not getting that large of a dose. The bottom line is that your cat needs as much insulin as she needs to get the numbers in a range you're happy with.

I commiserate. I remember grad school days.

 

It’s rough. Everyone says the dissertation is the home stretch, but it’s kind of like the last six miles of a marathon: after doing twenty, it feels like six will stretch on forever.

Any tips for preventing bouncing? I upped Alley to 3units this morning, she vomited breakfast after I shot, she’s down to 90 at +6.5. We haven’t had many greens, and she’s getting additional LC snacks throughout the day. I’m also popping home to test every few hours. Is there another trick? Especially later tonight?

 

Any idea what the vomiting this morning was about?

My boy was not bouncy so I don't have much first hand experience coping with it however a few of the triggers are:
your kittys body is not accustomed to numbers it has not seen for a while, it has in fact come to view higher numbers as normal. So a number lower than the current status quo is perceived as life threatening and triggers the release of counter-regulatory hormones to bring the BG back up.
Likewise when BG drops really fast kittys system perceives it's trouble and sends out the counter-regulatory hormones.
So in large part it's a matter of your kitty getting used to the lower numbers.
Back in the day we used to call it 'liver training" although it's not only the liver that is responsible for releasing counter-regulatory hormones.

 

The vomiting is a mystery to me. It happens periodically. At first I suspected it was that Alley had eaten too quickly, but I don't think that was the case this morning. I stared to give her 1/4 can at a time over the course of a half hour or 40 minutes to slow her down. That tends to do the trick, but I'm wondering if she's having a pancreatitis flare. I've suspected that in the past, she'll get lethargic, may also vomit, and will then go back to being mostly normal. Her numbers also tend to be considerably higher when this happens. It comes and goes so fast, though, that I'm not sure. I haven't taken her to the vet since the boarding incident, in part because it stresses her out so much, and also because I can't afford to do so. I can try to get some syringes of the pain meds for when I suspect flares.

In terms of the bounces, hopefully we can keep trending downward so Alley's body can get accustomed to lower numbers. I'm picking up some extra HC food so she doesn't go too low tonight. Are TR reductions earned only when the nadir is 40-50? That seems super low

 

Miss Alley got her green on for a couple hours today- wonderful!
and no counter-regulatory freak out...so far...(some kitties will have a delayed bounce reaction)

The TR guidelines for taking a .25u reduction for newly diagnosed kitties (<1yr) is a dip below 50; for long term diabetics (>1yr since dx) it is a dip below 40.

Are you checking for ketones?

 

It seems like maybe she bounced yesterday? She vomited again this morning. Today’s numbers have been better, but I can’t make sense of this.

Before I left town (that’s the gray bar on my SS), things were pretty predictable and morning in the right direction. Now I can’t tell.

I need to leave town for a night next weekend and haven’t figured out how best to arrange care for Alley after the last trip. I’m looking ahead to upcoming work trips in November, then the holidays, and then moving overseas. Ugh...