3/14-Scratchie-AMPS-301

Good morning,

For the last year, I have been posting on the TR board, but thought I would post here to get some additional input about Scratchie and his dosing.

DH could not get him to eat well yesterday, tried 4 different types of Wellness to no avail which concerned me. So I returned what hadn't been used last night and went back to Friskies. My pocket book is much happier! So is my boy. The change in him last night was readily apparent. He has never tested anything but negative on ketones. On the Friskies I feed him a couple of the SD - Ocean Whitefish, Turkey and Giblets - and others that are under 10%.

It seems to me that the more I increase his dose, the higher his numbers become. I can't test during the day as I work 10 hour days M-F. It's best for me to do any 'dose changes' on Fridays so I can monitor over the weekend when I am home and able to test more. DH will be going out of town next week and I am concerned about having Scratchie on a higher dose when I can't be there to watch him during the day. I do have some flexibility at times here at tbp where I can leave and run home to test, but lately that hasn't been an option. Hopefully things will slow down a bit.

Anyway - any advise on what to do would be appreciated.

Hope everyone has a great day!

Jo

Welcome Jo & dear extra sweet Scratchie to Relaxed Lantus!

We will do our level best to throw out ideas on how to get your boy feeling the best he can. Glad to here the appetite thing was just not liking the diet, boy do I know that one. With 14 here I had to find something everyone could agree on and that was also safe for my two extra sweet ones. We went through I think everything on the original Binky's list and the only thing my kids can agree on it ironically the lower end of the price scale..which my bank account is happy about. :smile:

When you get a chance can you also give us a 'whole cat' report? How are his 5Ps? All in place? We do things just a little different over here than they do in TR, as we are very relaxed about posting rules to start, plus we tend to hold a dose longer and make changes much slower. I know you told me that your DH can't test him during the day due to his own health concerns, but can he at least keep testing for ketones during the day when you aren't home? I really hope so because that is going to become important while we try to find the perfect dose for your boy. Because after looking at his SS I have to agree with you the higher you go the worse he gets numberwise. So logic dictates if up doesn't work, then the direction needs to be reversed and you need to go down. How far down, especially with the change again in diet also has to be within your comfort range and within your ability to test him for ketones while we try to sort this all out for you.

To bring everyone up to speed as I discussed with you in PM I did send a link to his spreadsheet last night to a very dear friend that has a lot more years of experience with not only treating FD and Lantus than I do and I expect to be talking to her later this morning to get her input as well on what is the best way to help you help Scratchie. (love his name BTW). So for now until I get her imput as well I am going to refrain from giving you much on dosing advice. As first and foremost I want to make sure any changes we make is completely safe for your dear boy. I do know that there are a couple different opinions on the board about the existance of Somogyi's rebound...personally I do believe that it exist, mostly because I have seen it in my own cats. Autumn is a pretty good example, if you look at her spread sheet that even though I had reduced her dose after a low 30 she was still getting very high numbers, yet I cut her dose again last night and so far this morning she is giving me better numbers.

Also over here everything that is suggested is just that suggestions based on what we know about our own cats. There are no true experts here, just a bunch of folks trying the best we can to help our extra sweet babies. But in the end you are the one that holds the syringe and you are the one that knows Scratchie the best. So you are free to try what is suggested or completely ignore it.

If you haven't seen this yet I would like you to look it over when you can as this is kind of how we determine when to raise and lower a dose over here in relaxed since we tend to be more Start Low Go Slow http://felinediabetes.com/start-low-go-slow.htm The only real thing that I tend to disagree with is that I don't really like the raising and lowering by .5u and I still hold to the fact that anything below 40 for a long term diabetic like Scratchie and my Autumn earns a reduction, and anything below 50 for the newly dxed get a reduction.

My other question is what does your schedule look like as far as how many tests you can get in during a day? My personal preference is at least 3-4 per day.. of course his preshots, if you can a spot check during the day (or a curve once a week) and a "lights out" test right before you retire for the night. Does that sound doeable for you?

Mel, Maxwell, Autumn & The Fur Gang

Mel,

WCR - he's a happy boy despite his numbers. All Ps in place - he's an avid groomer - he likes to be very clean! He purrs during testing, we play almost every morning before I leave and he's waiting at the door for me at night when I get home. We have an incredible bond. He's a very loving boy.

I test for Ketones at least twice a week, normally once during the week nights and then again on the weekends. Don't think the DH will do that one! ;-) Currently I test before each shot, and at night I do a +3 then get up at midnight - when I feed him - and test again. I don't do this if he is over 300 at +3 or if I don't see/feel a change in him. I can usually tell when he is going lower and he lets me know as well. During the weekends I generally try to test him at least every 3 hours but again if he is in the high 300's then I don't bother. I think those show on the spreadsheet. When he is in lower numbers I do test more often, especially at night.

He generally has a 40 pt food spike and he holds that for about 2-1/2 hours after eating - hence the +3. Lately I'm not sure that I see that all the time as last night he dropped 38 pts between PS and his +3. Hopefully I have answered all your questions, if not, let me know! :lol:

I'll read the article you have linked this evening and thanks. Input is what I'm looking for and I appreciate the time...

Jo

Hi Scratchie's Mom!!

Frankie and I are new and have only been at this about a month. We started with Diet change to Friskies. Both of my cats love Friskies and were fed it as "treats" before so the change was easy. Frankie was basically given a death sentence by the vet and within mere days of the diet change, I saw Frankie do a 180. I have never spent any time in the TR forum, but they come over and check on Frankie now and then. My take on TR is that their speed does not match with my schedule/lifestyle. I'm a busy real estate professional, DH to a lovely wife who is pregnant with identical twin boys and Father of an awesome 5 1/2 year old son. I am fortunate enough to work from home and can test/monitor when I do not have appointments, but often I am out for the entire day on inspections, So I feel your pain on making changes to dose.

If there is any one thing that I can say about this forum is they have compassion for real life. They understand that your life and family should not have to suffer from the needs of your cat and although, (especially in the early stages) I have had to make some sacrifices, none have been to the detriment of my work, or my family... in fact, for some reason I feel more productive... maybe it's because I'm being forced to get up at the same time every morning or maybe that the progress I have seen in Frankie has given me some sort of personal satisfaction, but I am setting in to it nicely. My cats were rescued from an early demise, when they still had their eyes closed and umbilical cords attached, I found them while inspecting a vacant house when it was 110 degrees outside. I hand reared them and they see me as the "mom", so I could not let myself have Frankie PTS especially after I found that it could be managed and even possibly cured without spending thousands of dollars.

Anyways, before I ramble on too long, I need to slap keys and make some $$, but welcome, I think you made the right choice

Ho Jo and Scratchie!

Being fairly new also, I don't have much by way of advice, I pretty much stick to being the Welcome Wagon and Support Staff/Cheerleader. :lol:

But if I can help in any way, please don't hesitate to ask.

Hope you and your boy are comfortable here in RL and he can find his niche and get better numbers. I'm still learning Lucian's dance steps.

I just have a question and maybe Mel asked it in her PM- have you every decreased a dose?

The reason being that if you go up and have worse numbers there could be either insulin resistance (something I've never dealt with to be honest) or too much insulin (something I AM dealing with right now).

Jo,

One other question for you...How old is your insulin? If it is fairly new like within the last 15 days since you opened it...here is my suggestion for Scratchie after putting my head together my mentor.

Make sure you have ketone stixs and try to squeeze in as many checks on those as possible because we are going to kinda try to reboot him so to speak. Because both she and I concur he looks like he is getting way too much insulin. To the point I'm not even sure where his nadir is he looks so flat. It doesn't sound like he is terribly prone to them but still want to keep a close eye on them regardless when reducing a dose like we are with him.

Now that he is back on Friskies and eating well for you again, lets keep the amount of food consistant so we can eliminate that being a factor. What I usually do when I have a new one here, is take a sharpie and write on the top of the cans what the carb %s is and while not feeding the same flavor I do try to feed the same carb content, so if you are feeding 8% carbs try to stick to flavors that are all 8% carbs.

And lastly roll him back to .75u b.i.d. and hold that for 7 days, then try to run a curve since I know you really can't get a lot of spot checks in with him. Then we will recheck his numbers and if he needs to be raised (and I suspect he might a little) lets try only raising him in increments of .25u at a time. Until we can fine a good range for him then you can either fatten or skinny that up if you need too.

Does that sound like a workable plan to you?

Mel, Maxwell, Autumn & The Fur Gang

Given that Jo has re-started Scratchie's dose over beginning at 1.0u on 1/18, I'm not sure what the rationale is for repeating a strategy that has kept Scratchie in high numbers. The only time this kitty was seeing more consistent numbers below 200 was when the dose was over 5.0u. I would hate to see Scratchie double the amount of time in yellows and pinks. IMHO, Scratchie needs more insulin, not less.

Sienne that is your opinion and you are welcome to it, it doesn't happen to be mine, nor is it that of someone that I highly respect that I asked to look at Scratchie's SS as well. Remember this is not TR this is relaxed. Jo has tried it your way for over a year now, and has asked for a different opinion.

Mel, Maxwell, Autumn & The Fur Gang

It's also my opinion, Mel, that taking him down again is just begging to leave him at high numbers. Jo took him up slowly and steadily. She didn't rush the doses and she didn't take him up by too much.

Yes, Jo was posting in TR, but she couldn't follow TR (not anyone's "way") by the letter and that's totally understandable given her schedule. She's done a great job considering all she has to deal with. But the bottom line is, TR or SLGS Approach, he needs more insulin. The goal is to find a way to do it so that Jo feels comfortable that he is safe when she works. And she needs to be able to sleep at night so she can work.

There is a solution so she can live her life, work, sleep but keep him safe. But I know she adores her Scratchie and she does not want him at high numbers. As Sienne pointed out....he was starting to see some progress on about the 5.25u dose. He might even have to go up higher than that now if he's built up any insulin resistance.

Again I respectfully disagree and I am very willing to agree to disagree. I was asked for my opinion and I have given exactly that...MY opinion. I also understand that I don't have the years of experience that you both do. But I do have 2 diabetics of my own that I have had success in treating Maxwell has just celebrated 2 years OTJ and Autumn for as horrific shape as she was in when I adopted her is thriving and doing extremely well for a cat that arrived in my care with a BG in the 500s, severely dehydrated and with moderate ketones and barely tipping the scales at 5lbs, and almost unable to walk due to neropathy. Today she is healthy lean 14lbs, running and jumping, purring, playing and enjoying life again. She isn't as low as I would like her to be, but we are working on it, and she is better than she was.

Am I an expert No, nor to I profess to be one. Which is why I asked another that I know has far more experience than myself and has several diabetic cats for their own, several that are also in remission to also look over Scratchie's Spreadsheet and give me their opinion as well. Before I was willing to offer any dosing advice. And really what is it going to hurt to try this course of action? He is already living in the yellows and pinks for months on end. His chances of remission are small at this point so if it doesn't work and we end up where he is today and have to keep going up then so be it. At least we can say we tried.

I'm not asking Jo to give up her sleep, I'm not asking for multiple tests per day. And I am leaving it in her hands to decide how she wants to proceed, as she holds the syringe and she knows Scratchie better than any of us ever will.

Mel, Maxwell, Autumn & The Fur Gang

Mel...of course we can agree to disagree. That's why this is a peer review board. Suggestions are made, the caregiver considers them, and then makes the decision that is right for their cat.

No one is questioning how well Maxwell has done or how healthy Autumn now is. I have to hand it to you for adopting diabetic cats when you knew full well what you were getting into. I can't say that I would be able to do the same so I do admire you for doing that.

But Maxwell and Autumn are not Scratchie or Frankie or Lucian. ECID and I do think that is perhaps what is missing. You can't compare those cats to your cats.

What will it hurt to take him down and try it? Glucose toxicity. Yes..he is high and flat right now and it will take a lot less time at high numbers to get him back up to a dose where he has a breakthrough.

He's at 4u now and he was seeing green at 4.5u in January. Will he again? I suspect he will need more insulin to see green again. But if you take him down to .75u for a week, raise him .25u for a week, do it again, etc, and his fitting dose is above 5u.....he's going to spend alot longer in high numbers and is at risk for even more glucose toxicity.

Jo is testing enough that I doubt he's going so low that he's rebounding. They were easily catching the blues and greens before. He's just high. Let's work to bring him down into some good numbers.

Thanks, Mel.

I'm not looking at getting him into greens right now I'm looking at getting him regulated...Which as I understand the definition to be is under 240 at preshots with a nadir around 100 or lower...He like Autumn is a long term diabetic for all any of us know he will always be insulin dependent so holding those normal numbers to give him a chance of remission isn't really the goal right now...it is finding a dose for him that hold him below renal thresh-hold, hopefully in the 100s as much as possible or at least the low 200s so that Jo doesn't have to worry about him crashing while she is away from him..that keeps him healthy and happy and living a long life even if that is as an insulin dependent diabetic.

This is where we are crossing paths...you are trying to get him into greens for her, I just want to help her find a dose that they both can live with and maintain his health and her sanity. But you also have to admit for a cat on a low carb canned diet and insulin 5.5u b.i.d is an extremely high dose especially when I look back at his spreadsheet and see where on several occasions he was getting low yellows and blues on a much lower dose.Too much insulin and not enough can look exactly alike...that was drilled into me from the very beginning on this board. Yes I realize that there are differening options on whether Somogyi's rebound exists or not but because it is controversal does not mean that it does or does not exist only that no one has scientifically proven it one way or that other. I believe it does from what I have seen with my own cats. And that is what I believe is happening here...Which is why I offered what I did as far as my opinion on dosing. I don't think he is bouncing off lows that weren't caught, I believe he is in cronic rebound.

Mel, Maxwell, Autumn & The Fur Gang

This is where we are crossing paths...you are trying to get him into greens for her, I just want to help her find a dose that they both can live with and maintain his health and her sanity

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But we are not crossing paths. Go back and read what I wrote. I simply stated what dose got him into greens. The last thing I said was:

Let's work to bring him down into some good numbers

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I agree with you 100% that if we can get him in the 100-200 range, it would be great! I also agree with you that the primary goal is to get him regulated.

I don't think he is bouncing off lows that weren't caught, I believe he is in cronic rebound.

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I'm sorry but this makes no sense to me. Chronic Rebound is what results from a drop into very low numbers due to a chronic overdose. So in order to be in chronic rebound, he has to be hitting lows somewhere.

I do agree that too much insulin can look like too little but I'm just not sure I understand why you think taking him down will offer any different result than what already occurred when she dropped him back in January. I'm not trying to be obtuse....I just don't understand the basis to repeat something that didn't work.

Thanks, Mel. I appreciate the friendly exchange. It is a great learning tool for new members.