Yemala 12/30 OTJ ADVICE NEEDED AMBG 176; +6 114; +9 91; PMBG 125; +5 84

http://www.felinediabetes.com/FDMB/...tj-trial-day-10-ambg-113-6-73-ambg-93.208661/

This morning was an odd one. I am asking those experienced if we should extend the OTJ trial for a day or two - 16 days instead of 14 - or just chalk this one up to the ECID gods and finish the trial on day 14.

Last night, I noticed that Mala was, well, not her usual self. She's always readily communicative, loud in fact. Before I went to bed, I gave Mala, the foster boys, and Gary a little snack - all appreciated - and Mala ate very well.

But after getting into bed with me, she was fidgety. She didn't know where to find a comfortable spot. And if I tried to touch her tummy (Mala appreciates a good tummy rub), she growled.

This morning, she was at 176. She did not eat breakfast. She was distant, unhappy, her ears felt warm. We feared another bout of pancreatitis, so she got a tiny amount of pepcid and laxatone.

But we also noted that her left front leg seemed swollen. And she would not allow anyone to touch her there.

Once before, Mala had trouble with a leg. She got meds for pain and to reduce swelling, and she was fine. I think this is something similar. Mala pulled something, or landed wrong, between last night's snack and bedtime.

It's about 6 hours past her usual breakfast time, and Mala is up, hungry, and eating. She is at 114. Her left front leg is visibly swollen, but she doesn't favor it. She withdraws from touch on that side starting around the shoulder joint. If she continues in this manner, I'll see if she can get into a vet tomorrow.

 

Looking great!!

 

Almost there whoooo hoooooo

 

Happy Day 11!

 

Another OTJ pawty on the horizon! Nice work!!

 

Happy Day 11!

 

I just updated the first post for today.

 

Our thinking now is that the swollen leg may have something to do with the amount of lactated ringers Mala got last night.

We're giving her fluids every other or every third day. If a longer interval, she'll get 100 units; if every other day, it's more like 50.

Last night, she got more than 100. We have seen, in the past, that sometimes the fluids pool in her left front leg. It may be that this happened, explaining the swollen leg. And it may have caused her pain. Pain stressed her, thus the high AMBG.

She's in much better numbers now, has eaten, and is resting comfortably. I'll get another reading and see where she is.

 

Back in the greens. Whatever bothered her last night has passed.

 

I'm so glad she is feeling better!

 

Could I get one of the more experienced moderators to have a look at Mala's OTJ trial numbers? Having skimmed back through the long thread on earning reductions and OTJ protocol, I'm concerned that we may be pushing her into a remission that won't hold.

Should we take her back to a .1? She had a dose of 1 drop for weeks, and her numbers on that amount of insulin were slightly better than those she's had since coming off the insulin.

we want this to hold. It's her third time, and we want her to be healthy as long as possible.

Help?

 

I think she is doing fine! I know the wisdom here is that the lower you keep a cat's numbers before gradually tapering off insulin, the "better" the cat will fare with its remission. I personally do not think there is a "magic recipe" to guarantee that once in remission, a cat will not relapse. You could try giving 0.1 but I strongly suspect you will see that it is too much insulin for her and sends her into lime green numbers. Do remember that meter accuracy has a certain error range, so the absolute numbers you are reading could be a little off compared to reality. Also, some cats have more elevated BG than others -- we've seen some which are happy to live in the 50s, and others that are happier higher up. What I would look for when examining my spreadsheet is: overall, is there an upwards trend? If there is, it might be worth spiking her with a little insulin. Otherwise, I'd just relax and enjoy the trial!

FWIW my Quintus went into remission "brutally" and without following protocol. Tomorrow will be his one year anniversary off insulin. One data point... but so are all the others on this board.

 

Out of curiosity, what sort of numbers did Mala run in before she became insulin dependent again this time? Unlike Stephanie and frankly most of us, you have the luxury of knowing what "Mala normal" numbers were before starting this OTJ trial. As long as you are using the same meter now as then, you should have good reference data.

Yemala's night time numbers are pretty good, mostly green. It's the AMPS and day that has a little more blue than we'd like. Anything different about her routine AM vs. PM?

 

Okay.

Mala was first diagnosed in 2006, though those numbers are lost. Between 2006 and 2011, when she fell out of remission, we checked her no more than once a month. In that time, if I can remember accurately, she usually read around 80 within 1-2 hours after a meal.

She went into remission again in 2011, after just a month on insulin. Between then and her diagnosis this last fall, we were not regular in checking her glucose levels. I recall spot checks which remained in the zone - between 60 and 90 within an hour of meals - with one higher number thrown off about 2 years ago of 157. Her bgs came down into normal range right after that, and blood work at the vet showed her within normal range.

We have not been consistent with one meter. Part of it has to do with my insurance. I am also diabetic, and Mala uses the meter and strips my insurance will cover. In 2006, it was a One Touch; in 2011, it was another meter. This time, we started with one meter, had to switch to One Touch, and when we ran out of strips, we moved her to the CVS meter. We checked the CVS against the One Touch when we began with the same sample of blood, and noted that the CVS meter read appx. 10 pts. higher than One Touch.

AM vs. PM - Mala's meals are 6 AM and 6 PM, regardless of day or night. She eats roughly the same thing. She adores Weruva. Around 4 hours after a meal, she wakes and wants to nibble again. Her mid-cycle snacks are either Weruva (often the leftovers from her previous meal) or she'll get boiled chicken. She gets the chicken more regularly in the evening before bed, shared with the foster boys we're sheltering. The chicken is limited for her to no more than about 1/4 cup, often less. 10 pieces, more or less?

The daytime meals are more often what was left in her dish - Weruva mixed with some Nature's Recipe grain free food, which is even lower in carbs than the Weruva.

The switch to a new meter occurred around the beginning of December.

Is this the information you wanted? Does any of this make sense?

 

bump

 

Good to hear that whatever was bothering her has resolved! How's the pooping? Constipation always plays havoc with Bubba's numbers.

 

No constipation that we have seen. She tells us of her conquest over poop by storming up the stairs, caterwalling, and climbing to the highest point she can reach. We call it her post-poopial prance.

It's unchanged.

 

So based, on that, I'd say something around 100 could very well be her "normal". You've got some lower, some a bit higher, and an isolated 176 that I personally wouldn't obsess about.

What do you think?

 

Far from scientific but looking at Mala's spreadsheet, I find it interesting that even on a drop of insulin she was getting more blue pre-shots than she is now. I have often thought it would be so nice to know what our kitties baselines were before their diabetes diagnosis. IMHO, I'd ignore that 176 on the 30th as an anomaly. I don't know what all your holiday celebrations entail, but I imagine to some extent the normal household schedule may have been somewhat different recently which may be playing into the numbers a bit. I'd be inclined to hold the course and just keep an eye on her going forward.

 

I was lucky to have a bunch of glucose lab analyses for Quintus in the years before he got diabetes -- of course, they're blood draws, so stressed cat, but they were all somewhat high, which helped me worry a little less about his "on the high end of normal" remission numbers over the last year.