12/28 Maverick AMPS 95 - PMPS 106

Dosing:
Can you guys peak at his spreadsheet and advise on dosing? That +5 last night at blue really surprised me. He had a +6 blue during the curve yesterday too. Here are a summary the variables that kind of complicate things. I was wondering if I should fatten the dose or just keep status quo.
*Remember I messed up dosing a while back (giving 1 unit instead of .5 for a few days) - in red on spreadsheet
*Then had a period of reduced appetite (advised not to decrease dose) - noted on spreadsheet
*He had a few good days of appetite
*Bought new syringes that didn't have 1/2 units - noted on spreadsheet the days that we used these. Now have correct syringes.

Feeding:
His appetite picked up on his own, but yesterday and last night it waned a bit. So I am going to assist feed but I'm complicating things. Before when I assist fed him I'd feed him 40cc's a few times a day. Normally he only eats 2.5-30z during the day and 5-7oz over night.

So when is it best that I assist feed him. Can I arrange to feed him 5-7oz during the day to make up for what he didn't eat the night before? If so, when is it best that I do this?

Happy Tuesday.

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

This is mainly a bump for you; I don't feel confident enough to give advice. I know with Kitty, we felt okay to reduce a dose after getting BGs under 100 for 7 days; your blues are so close to 100 that I think they'd count. On the other hand, Maverick is not in dangerous territory with these greens; they're just beautiful, healing numbers.

Is there history here regarding his appetite? Concern that he wasn't well?

Here's what the Tight Regulation protocol says:

Reducing the dose...

Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Click to expand...

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

bumpity!

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Thanks guys.

If I go by the daytime numbers from yesterday and today it looks like his nadir has moved up to +3? Can I go by these numbers with all the variables affecting his numbers in the past couple weeks? Late shots, eyeballing doses, appetite variation, moving up shot times. Its making my head spin. I'm guessing you guys will say to keep the shot right where it is at the .50.

Regarding the food... I don't know where to feed him. I can syringe feed him 3oz at a time but where? after AMPS, before AMPS, at +6 or +9? I doubt it will affect his PM appetite. Any extra food he gets won't end up in a large weight gain. He has to maintain 15+ pounds and is doing so eating between 7 and 9 oz. He is a free food grazer so there is variation in what he eats on his own every day.

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Karrie, I read your profile, and I guess the feeding issues are ongoing. I'm still not sure why they would prevent you from LOWERING a dose. Raising a dose, yes, I can see why that would be a hindrance, but lowering, I'm not sure.

Maybe one of the more experienced LL'ers can comment. It seems to me that you've met the requirement of seven days essentially below 100. You might want to shave the dose, rather than go down a whole .25. The problems you've had with dosing don't seem so extraordinary; so many of us have just done our best with estimating the amount of the insulin in the blasted syringe!!

Let's see what wiser ones have to say. Certainly, maintaining the dose at .5 isn't a bad choice. It gives Maverick that much more time under the renal threshhold to heal.

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Karrie....I don't know the answer to your question BUT I do remember once when Curry had a little bit higher numbers at her nadir but great PSs. Libby said something to her about an inverted curve which meant she needed a reduction. I would suggest you maybe put "Jill/Libby ??" in your subject line or PM them and ask them to put a close eye to that because they are the only ones who can really pick that out.....it's very, very hard to do from what I understand. And I have no idea what's going on but I sure wouldn't increase him with out very experienced eyes looking at that curve. I could be TOTALLY off base...I'm just recalling that from Curry's condo and finding it interesting.

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Dummy here. I see you were thinking about RAISING, not lowering! If anything, Maverick's numbers indicated a decrease to me. So what do I know?? Nuthin'. :roll: Bumpity!

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

When I looked at Maverick's SS, I thought about whether there's an inverted curve. However, we don't know if your measurement of the 0.5u may have been a little on the generous side due the syringes. Also, while the shifting to an earlier shot time is being done gradually, that may be a factor, as well. I'm thinking that you should hold this dose for at least tonight. Like Kathy, I'm also thinking more in terms of reducing the dose. I would like to get some input from either Jill or Libby, though.

Karrie -- how much is Maverick eating on his own without you assisting? If he will eat a sufficient amount on his own, I'd hate to see him get into the habit of liking the attention that assist feeding offers.

Re: 12/28 Maverick AMPS 95

Thank you so much guys!!!

He had an off week appetite wise and I'm not sure why. But is more consistent with the amount he was eating before his diabetes diagnosis. When I posted about a decrease I think it was Jill who said the reduction in appetite meant that if his appetite was at normal levels he may not have earned a decrease.

Is there any harm in keeping status quo? I think I'll keep up with the chicken dust on his food and weighing him daily. If I see a weight loss trend I'll start assist feeding. Thats what we did before. We went by weight, not by BG : )

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Maverick's numbers look beautiful to me--We all have issues with our furbabies appetites..Also when their number are green & Bg's are like Maverick's, their appetites get smaller-You are doing a good job! We all do the best we can!

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

just dropping in to say Hi!

and nice amps...

Re: 12/28 Maverick AMPS 95 - dosing and feeding question

Has Maverick been maintaining a good weight? If so, how much are you feeding (i.e., how many calories per day is he getting)? And does he eat that amount regularly?

I think Jill had said that it was OK to reduce a bit if Maverick wasn't eating well. If his appetite returns, then you may need to increase the insulin. I don't think you should base dose on how well Maverick is eating since that could change from day-to-day. His numbers need to dictate the dose.

You may want to try skinnying the dose. If you are going to keep it at the current level, please monitor carefully.

Re: 12/28 Maverick AMPS 95 - PMPS 106 - dose tomorrow?

I don't know the calories. Just the amount of food. He gets weighed often and is always between 15.4 and 15.5lbs. (Graco baby scale). He maintains his weight eating on average 6-7oz over a 24 hour period. He normally eats more at night than in the daytime. Back when I was shooting him at 7:30 - he'd eat 3oz between 7:30PM and 10PM. I wonder if the insulin timing has impacted this. Its now 9:30 and I'd say he's eaten an ounce since I put the food down a couple hours ago. Edit update 10:00 and he's eaten all but 1/2 oz.

I shaved the dose a little. I didn't move the time up any because I spent 10 minutes figuring out the micro dose.

Should I decrease him to .25 tomorrow and see if he holds it - even though we are getting some blues? If not and we have to go back up, does it impact his chances at remission (I know I asked this recently but can't remember the response).

Thanks so much for your help.

Karrie

Re: 12/28 Maverick AMPS 95 - PMPS 106 - dose tomorrow?

Last time I saw blues it was suggested to go to a fat .5 instead of the .5 I was giving. Now I'm confused why I reduced tonight to .4 ohmygod_smile Or why I asked about going down to .25 ohmygod_smile ohmygod_smile Maybe another few days at .50 and keep shot time consistent? Or do I try the .25.

Evening weight for him is 15.52lbs (after eating 1.5oz of food). I'll get a morning weight for him tomorrow after LB visits to compare.

Edit again Doh - I'll just post tomorrow for what to do after we see what he does tonight with the blue PMPS, and good appetite.

Re: 12/28 Maverick AMPS 95 - PMPS 106 - dose tomorrow?

Just as an FYI, Janet & Binky's list has the calorie count for the foods listed. If Maverick is still eating the Special Kitty Turkey & Giblets, it's 172 calories per 5.5 oz can (approx. 31.25 cal. per oz). So, he's maintaining his weight on between 188 - 219 calories per day. The calories are helpful to know if you change food.

There are a few things to keep in mind regarding food and appetite. When a cat is newly diabetic, they may be sufficiently sick that they don't want to eat. This may be the case if they have pancreatitis at the time of diagnosis and, as you know, are at risk for HL. In other cases, they are ravenous because the diabetes interferes with the way glucose, the end product of food being metabolized, is utilized by the cells. Basically, glucose isn't getting into the cell to provide the needed nutrition and instead, it floats around in the bloodstream. As a result, the cat loses weight. As a cat becomes better regulated, appetite begins to decline because glucose is now reaching he cells. Most of us see a reduction in our cats' appetites as they are in better numbers. Given how good Maverick's SS looks, it's likely he's less hungry because he feels better. Weighing him is a great method of seeing what's going on with him.

I'm not sure when you are referring to about Maverick being in the blues and it was suggested that you fatten the dose. The reason we suggested shaving the dose was because Maverick has been in normal numbers for well over 7 days on this dose. If you go back to the Tilly Protocol:

Tilly said:

When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose.

Click to expand...

Is this clearer?

Thanks Sienne. I appreciate the help.

Good to know the calories. I'll make note of this for the future. Good to know about the appetite too. That could be a big reason. I wish Maverick was one of those cats that could eat 3oz in one sitting and I could ration his food. Not one that I had to monitor to make sure he's eating enough.

Makes sense - thanks