9/19/20 Squeaky AMPS 273, + 7 335, PMPS 375

https://www.felinediabetes.com/FDMB...s-486-yikes-and-celebrating-good-poop.235526/

I still have some questions unanswered from yesterday, as I learn how to work with this group and decide TR or GLGS.

1. Is there anything I should be looking for or doing for the mid-cycle BG? ?????????

2. Okay so do I have this right. Diet is not an issue for us as we always eat homemade raw or cooked. TR means testing 4 times a day and adjusting the dose more frequently (as often as every 3 days) to match more subtle changes, better chance at remission.

SLGS means testing 2 times a day and once a week testing every 2 hours, but fewer changes in dosing, just once a week.

Is that it?

3. Is there a file to read explaining bounces, please?

4. How important is it to get the mid-cycle reading at +6?

5. About appy stims, is there one that you think is better than another? Or just mirtazapine ointment? Vet is willing to order it, says it will take a week to get here.

6. Also: Squeaky's history is that if he eats any carbs, i.e., any plant matter, he gets diarrhea. So what should I do about having something on hand in case of hypo?

Thank you all so much. We are making progress.

 

Let me see if I can answer some of these:

(a) Yes, your understanding of testing requirements, diet and dosing changes for TR and SLGS is correct!

(b) The idea with testing it to understand how your kitty behaves on the insulin - when is the onset, nadir and how low the dose is taking him/her. Think of your SS as a jigsaw and try to fill it in by testing at different times each day.

(c) Typically a +2 test will give you an idea of whether the cycle is going to be a normal cycle, an active cycle (where the kitty goes lower) or a bounce cycle. If the +2 is substantially lower than PS, you know you need to get a later test in.

(d) There is no file to read on bounces. We have all tried to understand them, but numbers can be quite a bit wonky during a bounce! A bounce can take up to 6 cycles to clear. As a kitty gets used to lower numbers he/she bounces less and the bounces clear faster. Some cats are bouncier than others and can take longer to "flatten out". I am told that there have been some cats here that bounce all the way to remission!

(e) Mid cycle tests are important to ascertain how low the dose is taking the cat. The nadir need not always be at +6. In cycles where the kitty is clearing a bounce, the nadir could be closer to the end of the cycle.

I'm afraid I can't help you with point 5. and 6.
Does he get diarrhoea with honey or karo too?

 

Lantus is dosed upon how low it takes the cat. That can happen at any point is a cycle. For many it’s +4-7. Others reach nadir very late in the the cycle. It’s the same thing about onset, when the insulin kicks in. For many it’s +2. For Max it was +2.5-3 except if he was going to have a very active cycle. To figure all that out I prefer to think of the cycle as a puzzle and grab tests at different times to fill in the pieces.

It’s said that you only need pretests for SLGS, but I don’t think that’s enough. Just my opinion. I would not want to dose my cat based on readings every 7 days. The preshots just let you know if the cat’s bg is at a safe level to shoot. The +2-3 is a good indicator if more testing is advised. If it’s lower than the pretest more testing would be a good idea. The number of tests can be minimized by using an auto feeder set to give food while at work or sleeping.

I used cyproheptadine as an appetite stimulant. It’s been used for many years before the vet drugs. I liked that I could give it twice a day if needed and just a sliver worked for my cats. The transdermal mirtazapine wasn’t around when I needed them but the pills agitated my cats and made them very vocal. There’s a bigger chance of seratonin syndrome using mirt so I stuck with cyproheptadine. I found that I got the same effect with Zyrtec for Max when he had a uri. My young Mocha has skin allergies and I tried it when she was scratching and it increased her appetite too even though it wasn’t needed.

 

I’m not sure what to suggest for a hypo. Does adding a little honey or karro to tge regular food cause diarrhea?

 

Oh, we have never done that. Why add sugar to food? He eats raw meat, that is all. Even I gave him some catnip, it was some little flakes on a toy, he ate it and got diarrhea.

 

Thank you that is helpful. I think we will go with TR. I can't see poking his ear every two hours for a whole cycle. That sounds like torture. At least with TR it is more spread apart, and we have a better chance for remission. Thanks again.

 

Oh, all the others are pills? I think maybe an ointment would be better, Squeaky hates being pilled.

I just hate to buy it, to pay for it, at a time when we don't need it right now, and knowing that it expires after 3 months. I have a very negative cash flow right now and that is BEFORE the diabetic vet and supplies bill. I've applied with DCIN but haven't gotten an answer yet.

 

Since carbs in food give him diarrhoea, an alternative would be to add a little honey to his regular LC food - this is for when he goes low and you need HC food to bring him up. This is in response to your question no. 6.

 

There is more testing in TR than in SLGS on the whole. In some active cycles, where the kitty is headed downwards fast, testing may be required every hour if not half hour.

 

If the numbers drop under 50 you need to bring him back up with carbs. Sugar does that quickly. If you need to go to the ER because if a hypo they our them in a sugar drip. There’s more testing with TR.

Have you printed out the yellow stickies? You really need to as reading them over and over makes things clearer. You need a hypo kit ready for when the bg drops and I’m concerned that you don’t understand this. It will happen and you need to be prepared.

 

In the case of a hypo, carbs trump diarrhea. Hypos can be life threatening. Diarrhea is not.

Karo, honey, maple syrup will work in a hypo.

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

Print these out to have on hand and read through a couple of times.

 

Thank you all for this discussion. I cannot afford ER visits. Would SLGS be safer? Easier to administer? Less chance of HYPO? I am definitely not the sharpest tool in the shed. I like the thought of TR because it sounds likely to bring remission. But I definitely cannot afford ER visits. Right now, my cash flow is about negative $1,200 per month, and that is without the diabetic supplies and vet bills. My pockets are not deep. I am wishing that this does not topple me financially.

I want to make the right choice between the two methods. Thank you all. I appreciate all input.

 

If you test enough you won’t need the ER with either method. You should not need any vet visits to manage his diabetes. But testing is crucial. A hypo Kit is necessary. You need to have high carb food and honey/Karo/ syrup available at all times.

 

Hi Jan,

IMO the best way to avoid hypo situations is to be prepared, test frequently, learn as much as you can from this forum, and ask a lot of questions. There are benefits and drawbacks for both models.

There are tips on how to make testing easier. I give Freckles a little dehydrated chicken treat every time I test her. She now runs to the testing station and sometimes even offers her ear to get pricked. Since I don't make it a big deal, she doesn't make it a big deal. It is her time for a treat, 1-1 attention and brushing.

Things will get easier as you gain experience and you get more confident. We've all been at the beginning line at one point, so we know how you feel! lol

 

Yes I hope his ears get more capillaries. He's not eating treats any more, except when he's outside in the grass. So that doesn't work. I do give him a massage before doing anything. He's okay if he's feeling well, but if he's not feeling well (which is about 2/3 of the time), he's unhappy about it.

So at this point the best time for me to work with him is between 10 and 11 am, and 10 and 11 pm. Last night hardly anyone was on the board, or at least they didn't look for questions. I suppose if I put 911 in the title that I would get answered promptly?

Thank you, I am trying to psyche myself up for this!

 

The 911icon is used for hypo situations and other serious emergencies. Seeing a 911 on the board almost gives people a heart attack.

You are doing the right thing by posting using a question mark. If your thread is being accidentally overlooked (sometimes the board is busy, there is no one online who feels qualified to answer your question, …), you can type the word "bump" to move it to the top of the pile.

 

Thank you, I am learning. Where would I type "bump" -- in the title?

 

no, just type 'Bump" in a reply box. You can also put the "?" icon in your title when you have a question. That often draws more eyes to your thread. When you have your question answered then you just remove the icon. (maybe you already did that for this thread? I can't remember! lol)

 

Hi Jan - So glad you are open to learning I hope you take the advice and read (and re-read and re-read...and re-read...you get the idea ) the stickies at the top of the board. They are chalk full of information! I reference them at least once a day - if I have a question, I usually start there. Also, the The Basics: New to the Group? Start here sticky may help you with your posts - I especially found the Make the Most of Your Lantus, Basaglar, & Levemir Land Experience post super helpful (talks about 911, how to ask questions, post titles, etc.).

I'm new here myself - really just one month engaged - and I've found that if I do my best to work through what I can on my own, the helpers (volunteers!) can focus their energy/knowledge on dosing & health advice. And, of course, at the end of the day, I'm responsible for my cat so I always try to keep that in mind Good luck and happy reading

 

Thanks Suzanne, Yes I'm reading as much as I can understand, and absorb. Today I read the slang. But one on one coaching is the most helpful at this moment, and having questions answered. Bit by bit!!!

 

Here is a post on bounces that might help. See the second half of the second post.

For appy stim, if you go mirtazapine, definitely go for the Mirataz, it's a newer transdermal formulation (ointment you put on his ear) that is supposed to not have the side effects of the oral med.

Neko didn't do well with wheat, I had to look for high carb food that had potatoes for carbs. The Weruva Grandma's Chicken Soup is 21% carbs, and a few of their Cats in the Kitchen pouches are 16-17%. The bonus was that they are low phosphorus. For cats who can't even do potatoes, a drop of karo/syrup/honey on his regular food will be high carb.

 

Thank you. I'm a bit overwhelmed and will take this a step at a time.

How often do I need to be testing the urine for ketones?

Also I think I would like to do TR, but if it ends up making me too nervous, then I could change to GLGS?

 

You can absolutely change from one dosing method to the other. Just change the signature to TR, and if you decide it's not for you and Squeaky, change the subject line to SLGS. That'll help us help you faster.

It's always good to get a ketones test in (well done today) if it's a high numbers day. If he doesn't have a history of ketones, it's less critical than if he does.