11/16 Huey Accidental OTJ trial Day 6 AM+4 112 +6 87

Hello LL! Haven't posted regularly in a bit but I am suddenly in great need of advice and second and third and fourth opinions. This past weekend I was out and about more than expected and while I was trying to get Huey back on schedule, I noticed his pancreas seems to be chugging along better than expected. He seems to be doing OK but I'm not sure if/how to progress. He hasn't had insulin since midnight on Friday, but I'm calling this Day 3 because the timing and testing was pretty wonky all weekend.

Because I was shooting and testing at kinda odd hours last weekend, it was hard to figure out how to enter them onto the spreadsheet. Here is the narrative form:

• Friday night I was out and returned home around midnight. Since Huey was a little high and I had some flexibility on Saturday, I gave him his shot with the intention of skipping the next morning and catching up the next evening. (I was about to PTFO, it seemed like a better idea than waiting til the next morning and going 24 straight hours without insulin.)
• Saturday, I started testing and feeding and I noticed he was dropping A LOT from eating alone (I don't think my meter has ever showed a 41 before!) so I decided to see how he fared for a couple more meals. Also I was going to be away that night and didn't want to push things when he dropped to ~50 with no shot. All of the test numbers/times on line 151 are relative to that last shot on Friday.
• Sunday I got home and again with the testing and feeding and testing. Spreadsheet is back to "normal" (assuming shots at 9am/9pm unless otherwise marked).

1. Is this good enough???? His AM/PMBGs are still ~100-130, even though he basically drops into the greens as soon as he eats, and seems to stay there most of the day. I was holding off on an OTJ trial until his BGs were pretty much consistently green, should I start him up on shots again and try to get those AMPS/PMPSs down more before continuing? I want to get him OTJ of course, but I want it to stick, dammit! I have to admit I've gotten complacent about adjusting the dose and trying to get that 6am +9 snack in, which is probably part of what's making the difference the last few days.

2. Last night, he had a brief head twitching episode (only about five minutes or so). Later on, his pupils got very dilated. They started returning to normal around when I went to bed. His vision seemed normal though, and his sugar was also at a reasonable level all evening. Cursory googling suggests hypertension, but I don't think I've seen as much mention of that on FDMB. Does this sound familiar to anyone else?
He's been having some eye issues (constant tearing that's maybe feline herpes flaring up, pupils were different sizes for a while, eyes in general not as good as they were) that the vet didn't spend a lot of time on (because we were still settling into the diabetes). I'm going to make an appointment for him for the weekend or early next week to readdress his eyes but is there a chance this is related to the lack of insulin?

Any advice is very very welcome. I am very very cautiously optimistic but also mildly freaking out, especially after last night.

Re: 11/13 Accidental OTJ trial let's say Day3? AMBG 82 HALP

Another thought that just came to mind, the vet told me to give Huey a daily potassium gluconate supplement, based on observation and his own experience at the last visit. On the one hand, Huey's test values came out more or less in the normal range. On the other hand, he pukes pretty regularly if he doesn't get fed on time (just a bit of watery vomit) which more googling suggests can potentially lower potassium levels. I ended up giving it to him every other day or so. The symptoms for hypo and hyperkalmia all seem nice and vague, so I'm just mentioning this in case.

Re: 11/13 Accidental OTJ trial let's say Day3? AMBG 82 HALP

hi nancy!

Huey's blood sugar looks pretty good. If you haven't given him a shot since Friday midnight, this would be day 6 with no insulin, regardless of the testing issue. Typically on the way to OTJ the nadirs come down into green first, the pmps is next and the amps is last. Usually you'd want to see everything under 120 before you start an OTJ trial and most everything solidly under 100. His 82 this morning looks great.

The head twitching/eye issue sounds concerning to me. I think i'd want to consult with the vet about it.

The potassium . . . I don't know enough to comment on it other than to wonder why he would supplement with potassium if the blood tests were in the normal range. Potassium is really important in the body's functioning - i'm uncertain what the consequence would be of adding it when he's already normal with it. I'd want to explore that further.

Are you feeding him small frequent meals? That can help a sputtering pancreas.

Congratulations! Pretty exciting time at your place!

Re: 11/13 Accidental OTJ trial let's say Day3? AMBG 82 HALP

If potassium is within normal range, he doesn't need supplementation unless he's on a potassium sparing medication. A bit of throwing up won't deplete potassium a lot - many episodes of throwing up can tho' the body can reregulate that fairly quickly. Diarrhea can also lower potassium. Potassium allows the muscles to work correctly. Too low potassium will cause weakness. Hypokalemia vs Hyperkalemia - you're right, there's not much difference in the visible symptoms but internally there's a lot of difference. Hyperkalemia can cause the heart to race too fast and strong causing permanent heart muscle damage, can cause kidney and liver damage too. It can even affect hearing and eyesight. It's not something that you want to give without having blood tests done to verify levels. Some cats need potassium supplementation all the time but the only way to learn that is repeated blood tests until you know how his body uses it. Glucose and potassium are also related. If glucose number is high, potassium is often lower than that body's 'normal', not necessarily outside the proper 'range' but lower than that body's 'normal'...hope that part made sense.

Unfortunately potassium issues are something I know quite a bit about...hubby has a rare genetic mutation causing major potassium issues all the time.

GOOD LUCK on the accidental trial!

Re: 11/13 Accidental OTJ trial let's say Day3? AMBG 82 HALP

Nancy & Huey said:

Another thought that just came to mind, the vet told me to give Huey a daily potassium gluconate supplement, based on observation and his own experience at the last visit. On the one hand, Huey's test values came out more or less in the normal range. On the other hand, he pukes pretty regularly if he doesn't get fed on time (just a bit of watery vomit) which more googling suggests can potentially lower potassium levels. I ended up giving it to him every other day or so. The symptoms for hypo and hyperkalmia all seem nice and vague, so I'm just mentioning this in case.

Click to expand...

Hi

I have been reading about supplementation recently and if you read Tayna's CKD webpage on it she mentions that cats with levels below 4 (on either scale) should be supplemented and so if your cat was just about in the normal range 3.5 then that would fit in with what your vet said.

http://www.felinecrf.org/potassium.htm

My cat remi is at 3.0 and his head twitches. I am slowly introducing supplementation and just giving a little every day. I wonder if you would be better splitting the dose and giving half every day. But then I would go back to the vet in a couple of weeks to see how he is going as you don't want him going too high.

Finally I would agree about spreading the meals out Into not mini meals as this is one way I help to control my cats vomiting.

Re: 11/13 Accidental OTJ trial let's say Day3? AMBG 82 HALP

Thanks for all the info about the potassium! Lyresa, your husband is lucky to be under your care. The vet prescribed the potassium supplement because Huey seemed pretty out of it at the last appointment and in his experience "most diabetic cats end up needing it" or something along those lines. I have an appointment set up for Huey for tomorrow evening, and it's definitely something I will revisit, along with the rest of the list.

Sorry for constantly dropping in and out of the loop, yesterday I was PANICKING because I got home Friday night and Huey had not touched any of the food that I set out for him during the day. (Yes, he's getting mini-meals, typically AMPS, +4, +8, PMPS, and if i can remember/manage, +4 again). He's been constipated the last few days, was straining Friday morning to pass just a little poop, and I think it killed his appetite. Another thread suggested that GI unpleasantries could be related to stopping insulin. I gave him a qtip of glycerin a la felineconstipation.org :shock: and he pooped some overnight, not sure if A->B but I'll take what I can get! I also went and got some of his tried-and-true favorite cans and spent yesterday afternoon preparing a kitty smorgasbord that finally met his approval.

Now that Huey's eating more normally again, he seems to be holding steady, that is, preprandial BGs in that 100-120 range, dropping into the greens as soon as he eats. I think I'm going see the vet tomorrow and then give it a couple more days to see if things change once his eating/pooping settle down, but I suspect I'm going to cut this OTJ trial short and give him a little more time with the insulin to see if we can keep everything consistently green. I'm still calling this Day 6, but even if I continue, it will probably go a little long because I will be out of town this coming weekend and my neighbors will feeding and testing. I'm OK with that because this feels like it's been a relatively unorthodox OTJ trial... I wish there was a smiley for ::exhausted:: !