7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SAID

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evening all

yet another flat pink day! I am on cycle 7 right now of an increase. very frustrating! I called my vet today to report some numbers....I chose a few random days. here is what he studied:

LAST THURSDAY 6/27 <3.75 units> (most movement in last week)

PS = 354
+ 5 = 119
+ 6.5 = 170
PS = 456


LAST EVE <4 units>

PS = 300
+ 4 = 286
+ 6= 244

TODAY <4 units>

PS = 352
+4.5= 301
+7.5= 385

This is what he said:

he did not like the 119 number! well, he loved that number....BUT didn't want it any lower than that. Wanted to hold off on an increase to see if that number was just some off random number......

he said he thought that Tom was most likely going to be raised to 5 units...but he didn't want to tell me that quite yet. I am supposed to hold dose of 4 units another 2 weeks....call back with 3 days in a row of just nadir values.

he had no explanation of why Tom's numbers were just pretty much level and not much movement.....was at a loss....EXCEPT THESE REASONS:

I am doing something wrong. (I didn't take this personally...hell, I may be doing something wrong!!)

~~~~I am not giving the shot right...ie fur shots. (I explained that I know when I give fur-shots as my nose burns from the nasty Lantus fumes ......I smell poor Tom's back immediately -wipe with a paper towel and hours later I still sniff....so I know when I miss)

~~~~~I am drawing the incorrect amount in my syringe. (well, I am positive I know how to draw up 4 units in a syringe!!....I do have the correct needles.., I have drawn up the insulin in front of him before too!)

~~~~~my Lantus is bad. Not cold enough in fridge. (my vial was opened May 15th - always stored in mid fridge...never have left it out....not cloudy or nothing floating within) ****mind you, it worked too good last thurs. according to him

~~~~tomcat is not eating the same everyday.......(well, he is eating basically the same thing daily....LC free eating except 2 hours PS) mind you, my vet put him on dry prescription and canned prescription ....which I brought back.

~~~~~~perhaps I am not preparing the insulin right...not rolling it correctly or long enough. (well, I didn't say anything to this as I thought why bother....you don't roll Lantus right????!!!!!!!!!!)

so I said:

what about site injection? well, yes that may make a difference. I do shoot in the lower scruff area (not good I know, but I can always give good shots there) he said to move to thigh......even inner thigh. he said I can do what I can do. he said the scruff doesn't have the best absorption....which we knew. but could that really be the problem with non-movement? I just hate to try another area and get a FURSHOT!! he said it didn't matter if I got muscle or not.....that wasn't a concern.

I wouldn't quite say it is the scruff area.....I pull up a lot of skin right at his shoulder blades...so the injection site is about 2 inches below the s. blades.

I just tried to pinch up some skin on Tom's thigh.....super tight....don't think I can do it?

he said NOTHING nothing about a bounce or a freaked liver. nothing.

so that is where we are.

WHAT DO YOU ALL THINK IS THE PROBLEM? SURELY THE BOUNCE IS OVER BY NOW.

THANKS ALL

~kelly

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

I don't think you are doing anything wrong.. Something is keeping him high...

1. no sign of any infection? How are his teeth? No UTI? Ear infection?
2. What's the carb % in your foods? Some cats are more carb sensitive than others. You might want to try foods only under 5% ie just the fanct feast classic pâtés .. See here column C % calories from carbs.. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf
3. You haven't found the right dose.. I may get corrected but I think the protocol says you can increase by 0.25 every three days with nadirs that high

Wendy

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Oh my Kelly - that's quite an interesting bunch of vet talk!

I'm not one of the FD experts, just visiting your condo for the first time. I noticed in your SS that your kitty may get contraband (i.e. dry food) from the neighbors. I have the same problem with a neighbor that leaves food out for the strays. I have talked with her and she is trying to only put out the food when she can remove it right way. But I decided that Sweetie's best chance of remission is to have complete control over his food. So he is now an indoor only kitty. He has transitioned well now after a few months (in spite of the civvie who can go in and out), so it can be done!

I don't talk with my vet much about the FD anymore. Just go for the necessary non-FD stuff, call for prescription renewals as needed. I feel very comfortable with the level of expertise on the FDMB myself.

(Edit: and I stick with 5% or less carbs too as Wendy suggested.)

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

A thought to consider.

Have you compared the fat content on the varying foods you feed? Just saw an article today on humans - so may not apply - which had a different way of looking at impact on glucose levels which included fat.

Fat is nothing more than a bunch of carbohydrate chains connected together at one end. In pets, fat has 8.5 calories per gram vs 3.5 calories per gram for carbohydrate and protein.) Pet food manufacturers that remove carbohydrates often replace with fats, which are less expensive than proteins. So maybe you're getting some effect from fats.

A way to test - per Cat Info, you may replace 1/5 of the food with plain meat/poultry/fish to up the protein content. Test that for a few days while monitoring; go back while monitoring. If you observe a change and can reliably reproduce it by reducing the amount of fat, you have your solution.

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

wendy and sweeties mom,

I never thought or paid attention before to his carb sensitivity. guess I will add that to the list of observations! ok, I will feed only 5% or less carbs for a few days and see if there is any difference. good suggestion (I always do feed less than 10 now)

I don't know if he has any infections....poor sleepy cat, hard to tell if he is "sick" or just feels lousy! He did have a possible UTI at DX and was treated for about a month with orbax and clavmox (sp). Clavamox made him sick after a week so he was switched to orbax. I would just catch his urine when he went outside...so it was a "clean catch"....but another member told me there is no such thing....as soon as you open up your container it is contaminated....not to mention the cat's leg hair touching......he has no outward symptoms ie: uses liter box fine and pees normally. the vet told me not to worry too much about it until we get his numbers better .....as the sugar in his kidneys/bladder are counterproductive to the antibiotic treatment.

is there any product I can buy to tell if he has an uti?

I will look inside his mouth and look at his teeth. he did have a cleaning and a few teeth removed about 2 years ago....but I guess with the diabetes....that was a lifetime ago for teeth

I did notice today he is sneezing. about six or seven times......really noticed it, as in Nov. he did get a cold (cat fight) .....he got over it just fine though after about 4 days. of course the day I took him to the vet he was much better.
I will watch to see if he gets "snotty" ........a cold would make his numbers high?

I don't notice any ear troubles.....I will smell next time I test....I assume the ear will smell or look bad?

which brings us to dose: I know I have asked this before....but when I look back at his 3.25 dose there were a lot more blues....albeit, high blues.....there were many blues. have I over- dosed? how do I know if I have.

and finally....just the opposite: do I increase .25 as I "should"? or should I wait (poor cat) until I find out what is up with his sneezing?

~~~~~~~~~~~~~~~~~~

sweeties mom: oh the sadness of "locking" up an indoor/outdoor cat. I always think of that poem:
A prayer for the wild at heart, kept in cages. Tennessee Williams

well, I let him go outside during the day when his levels are safe......at night I go out with him with a harness on. when he becomes regulated with low numbers this will stop. I know it is coming and it is best.........

thanks for your concern and input gals.

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Ok..

When he goes outside during the day, is he able to wander ie goto a neighbors house and get kibble?

Infections.. You might want to have the vet check his teeth. Also look in the ear, if its infected you may see dirt specs or dark stuff in there. If it is a cold, then he has had it since day one as he has been pretty much high the whole time.


Wendy

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

he basically just lays and sleeps on the back porch most of the time.....walks the gardens when he is feeling good .....very rarely! does he go across the street to the neighbors (his old home by the way)....I keep very very very close tabs on him......I peek on him every 15 mins or so. his high values this entire time are not from kibble.

good to know about the cold....he for sure hasn't had that this entire time!

`I will just try the lower carb foods......and just go from there.....

thanks

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Let's try that and also you might need to be more aggressive on dose increases.. But ask here first. Eventually though if you can't get him down he will need a vet visit to check for underlying conditions..

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

If you think that your cat may be carb sensitive, then switching to a lower carb food will help. Your cat's teeth may also need to be cleaned.

Of course, some cats just need more insulin. I'd be tempted to raise your cat's dose to 4.5u. He's been at this dose for7 cycles and the majority of the nadirs have been above 300.

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Goodness your vet is not giving much encouragement!

he said he thought that Tom was most likely going to be raised to 5 units...but he didn't want to tell me that quite yet. I am supposed to hold dose of 4 units another 2 weeks....call back with 3 days in a row of just nadir values.

Click to expand...

I don't think you're doing start low go slow and I wouldn't hold this dose that long. In fact, you could raise it tomorrow and I would. He's high and flat enough that you could raise it by .5u.

~~

~~I am not giving the shot right...ie fur shots. (I explained that I know when I give fur-shots as my nose burns from the nasty Lantus fumes ......I smell poor Tom's back immediately -wipe with a paper towel and hours later I still sniff....so I know when I miss)

Click to expand...

.

As you said...it's difficult to miss when you give a fur shot. Everyone gives them at some point in time.

~~~~~I am drawing the incorrect amount in my syringe. (well, I am positive I know how to draw up 4 units in a syringe!!....I do have the correct needles.., I have drawn up the insulin in front of him before too!)

Click to expand...

Your might not be drawing the incorrect amount but all the syringes are notoriously inaccurate from syringe to syringe even in the same lot number. So you could pull up to the same mark every single cycle but it could be a different amount of insulin. Many of us dose using calipers. You might find this post on Dosing with Calipers helpful.

~~~~~my Lantus is bad. Not cold enough in fridge. (my vial was opened May 15th - always stored in mid fridge...never have left it out....not cloudy or nothing floating within) ****mind you, it worked too good last thurs. according to him

Click to expand...

Lantus is not as fragile as alot of people think. You've probably read the sticky on handling and storing it. I have mine in a cheese drawer with a refrigerator thermometer sitting right next to it. It is less subject to the temp changes of opening/closing doors if its in a drawer.

~~~~tomcat is not eating the same everyday.......(well, he is eating basically the same thing daily....LC free eating except 2 hours PS) mind you, my vet put him on dry prescription and canned prescription ....which I brought back.

Click to expand...

I'd say consistency in feeding is very important.on a day to day basis, I would keep it simple...feed a similar food with similar % calories from carbs.

~~~~~~perhaps I am not preparing the insulin right...not rolling it correctly or long enough. (well, I didn't say anything to this as I thought why bother....you don't roll Lantus right????!!!!!!!!!!)

Click to expand...

:roll: :roll: :roll: 'nuff said.

He said it didn't matter if I got muscle or not.....that wasn't a concern.

Click to expand...

I would not shoot IM unless he has no fat at all.

I wouldn't quite say it is the scruff area.....I pull up a lot of skin right at his shoulder blades...so the injection site is about 2 inches below the s. blades.

Click to expand...

I believe I posted the Testing and Shooting Tips to your condo. I'd try the different sites on the diagram in that post. Absorption can vary but BGs are also influenced by so many other things as well.

Check out Mr. Greys SS. He had a few blues at lower numbers but had to keep going up to hit a breakthrough dose and then it was a crazy race back down.

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Is the sneezing still going on? Vet check for URI? You could add lysine to food for starters.

If he's sick, he'll have higher numbers, and you should increase the dose to cover the higher numbers. Then, when he gets better and the numbers come down, you can lower the dose if needed.

A vet saying to roll Lantus? Doesn't sound like a great vet.

Gayle

Re: 7/2 Tomcat AMPS 352,+4.5=301,PMPS 359 +4=372 WHAT VET SA

Lysine comes powdered, as a gel (oral), as tablets, and as chews. My cats all thought the Vetri-lysine was a treat and clamored for them.

Merck Veterinary Manual Online

"Oral supplementation in cats with 250–500 mg of l-lysine daily may reduce the severity and frequency of recurrence of FHV-1 conjunctivitis and keratitis."