01/24 BuddyM OTJ Trial day 10: AMPS 145 | +4 68

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Mariette, Jan 24, 2021.

  1. Mariette

    Mariette Member

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    Nov 15, 2020
    Previously:
    https://www.felinediabetes.com/FDMB/threads/01-23-buddym-otj-trial-day-9-1-98-4-74-7-74.241964/

    Another bummer preshot time number. Not as bad as day 8 (which was 181). Much better +4 at 68.

    He's really a grazer now with the appetite not being in emergency mode all the time anymore. So he nibbles a little bit and then ignores the food for a while. Perhaps waiting for something better to show up. But I'm trying to remain resolute. I hate throwing food away. Not just from a money standpoint, but also from a moral standpoint. So I'm leaving the food down until it starts to dry out.

    I guess the pancreas are working, but would love to have his fasting bg come down. Anyone know why that would remain high-ish?
     
  2. carfurby

    carfurby Well-Known Member

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    Feb 19, 2012
    Happy Day 10! :):):cat::):):D:D:cat::D:D
     
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  3. Mariette

    Mariette Member

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    Nov 15, 2020
    Thank you Carla! :):cat:
     
  4. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Mariette

    He shouldn’t be having such high AMBGs even though he’s coming down later. Can you feed or leave him a +9 LC snack out at night to see if the AMBG will come down?
     
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  5. Mariette

    Mariette Member

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    I'd have to set an alarm and get him up to eat. He won't go to the kitchen by himself to eat. And I don't want to create a habit of him waking me up to eat at that time. I can do it as a one off, but it's not a sustainable solution.

    I wonder if higher carb food will help? I've been feeding very low carb. I've read here that some cats do better with higher carb, but I thought that was only insulin-wise - to prevent a crash. Could it help bring the bg down if he's not getting insulin, or is that going to be counter productive?
     
  6. Mariette

    Mariette Member

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    I could also just shift his AMPS time to be 3 hours after he ate. But that seems to defeat the whole issue.

    What I mean is I could just shift the whole sheet by +3. He usually remains green till a betime test. Now that he's not getting insulin the AMPS and +3 times are kinda arbitrary.
     
  7. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    You might have misunderstood about the HC food. Some cats do better with a higher low carb food like 10% but that’s for cats on insulin.

    The +9 snack is just something I am suggesting you try for the next nights of the trial and see if it works. We only do it with cats that are very close to or in a trial and their AMBG is higher. What time do you think you could feed him a LC snack and then do his AMBG three hours later?
     
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  8. Mariette

    Mariette Member

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    Thanks for confirming that it's only for cats on insulin.

    I think you misunderstood my question. I didn't want to feed high carb. I just considered 'higher', so more than the current 0-3%.

    Insulin time the AMPS was around 8am. 11am was +3. So I kept that same timeframe on the sheet for the trial.

    What I was saying is that if I used 11am as the AMPS time he'd be green. That would be the same as waking up 3 hours earlier (5am) to feed him, and test at 8am right? It would be a non-fasting test. It just shifts the problem earlier, to when he's fasting. Does that make sense?
     
  9. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    In all things, I think about everyone else who might be reading this so when they read “higher carb”, it means something different than what you meant. Thanks for stating exactly what you meant but there’s no need to change his carbs from the 0-3%.

    Yes, absolutely but the only issue is being able to see if he can overcome this dawn phenomenon which he seems to have that usually occurs between 4 and 8 am due to dumping of hormones. If you feed him at 5, his pancreas can kick in and get it under control by the time you test at 8. Again...it’s just a few days to see what he does.
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Mariette
    I am also concerned that you are not getting a AMBG each day and that 2 out of the 3 you have got (and you are up to day 10 of the trial) are way over the normal numbers you need to be seeing in an OTJ trial.
    We want Buddy to have a strong remission. If a cat falls out of remission it is so much harder to get them back in....and I can promise you it is much better to do the hard work now when you are almost there than it is to do after they fall out of remission.
    Giving a +9 snack at night is a good way to see if the AMBG will come down to normal numbers.
    Bron
     
  11. Mariette

    Mariette Member

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    Thank you for the advice @Marje and Gracie and @Bron and Sheba (GA).

    I understand what you're saying but I don't really understand how this will fix the higher AMBG numbers in the long term. Could one of you please explain this to me?

    If this is only for a few days and I do get the AMBG down - what happens long term? Will this be the new normal... to feed at that time? Or is the idea that it would only be needed short term? That doing this a few days could cause the numbers to stabilize in the future?

    Also are you saying that the higher numbers I'm seeing is specifically linked to the time of day, and not to the feeding schedule? That it doesn't matter really when he last ate, his hormones could be dumping regardless between 4am and 8am?
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Mariette,
    We know that when the pancreas is starting to work again, food will bring down the BG. You can see that Buddy’s BG comes down after he has eaten in the morning. If his pancreas wasn’t beginning to work, and he wasn’t getting insulin, the BG would go up.
    Well the same thing can happen if you give a snack at+9 at night. If the pancreas is kicking on, it will help bring the AMBG.

    The higher numbers are linked to the Dawn Phenomenon which humans have as well as cats. Dawn Phenomenon has to do with natural hormones the body produces in the early morning.
    Hopefully once you get the numbers down they will return to normal but I am not completely sure Buddy is done with insulin yet. You reduced the doses very quickly and only stayed on the 0.1 unit for a day. Normally we like to see a cat staying in normal numbers for a week on 0.1 or a drop before starting an OTJ trial. I am only concerned that you get a strong remission.

    Would you think about getting an automatic feeder for Buddy. Do you think he would use one?
    Then you could give him a snack at around +9 at night and not have to get up.
     
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Bron covered all my concerns and thoughts. I suggested a few days so we could see how the food affects his AMBG but I’m also concerned the trial was started too soon and he won’t hold remission.
     
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  14. Mariette

    Mariette Member

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    Thank you so much for answering me about the 'Dawn Phenomenon'. I have not come across this information before. Did I miss a sticky about this or is it common knowledge that has somehow eluded me until this point?

    He only had a few bites at 5am. AMPS at 8 was 122, but it was a nightmare to get the test. He was very irritated, and tried to whack me today. I guess my patience was not the best either because I'm exhausted. Couldn't get back to sleep until about 15 minutes before he woke me up at 7. Of course he slept like a baby from 5-7.

    Since his numbers have been better it has been incredibly difficult to get the AMPS test sans food. He's like a different animal when he has energy. The little head whips around looking at stuff. He jumps off his testing spot and sits in front of his plate. He doesn't really settle down until a couple of hours after eating.

    Of course I also want a strong remission for Buddy. Honestly I'm very frustrated this morning. I've been referred to Henry's spreadsheet so many times to look at an example of how to bring him down. As if Buddy will just turn into Henry or some other cat.

    I could tell that the amount of insulin he was getting was suddenly too much. I knew how much food was needed to bring his numbers up to a safe place. I could see that he was wobbly and feeling groggy. He was sitting huddled with his head lowered. I felt dismissed as being cowardly for not wanting to shoot when I expressed concern that the dose seemed too high. I would have loved to have some guidance on here about how to bring him down safely but unfortunately following the FDMB TR guidelines was not safe for him so I did feel we had to kinda go it alone.

    I refuse to risk Buddy's life to have him 'earn' a reduction according to FDMB TR guidelines. I wish this forum could be a little more flexible. We get told that every cat is different repeatedly but apparently that doesn't apply to how they need their insulin reduced.

    Sorry that turned into a bit of a rant. Not at all aimed at you. I just feel that I've been repeatedly judged for how I had to navigate his insulin reduction but I don't know what else I could have done. Except to send Buddy into a hypo to keep everybody on here happy that his reductions were earned.

    I've kinda bottled my frustrations up because this forum has been a total godsend to me and I really want to be able to lean on you guys for support. And I realize that he could well need insulin again soon or down the line and it's so hard doing this alone. But if you guys don't feel that his trial is 'valid' and you would rather not have me post about it I could refrain and ask on the Faceboook group.

    Other options are I don't call this a 'trial' or I extend the trial by another week.

    If Buddy drops from 181 to 51 without insulin I don't really think insulin is safe to give at this point, right?
     
  15. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Mariette

    No we don’t want you to go to FB. Our sister site there is not allowed to give dosing advice and the other FD groups there are.......well, to be polite I’ll just say their approaches are not what we would do or I think would be good for Buddy.

    I’d like to come back and address your concerns; I have an appt now that I have to get to but I appreciate your honesty and I’m sorry you didn’t get the support you felt would work best for you and Buddy. I’d like to take the time to look at his SS and then offer you some thoughts if that’s ok.
    I should be able to get back to you later this afternoon but continue to plan on not giving insulin tonight.

    Does that work for you?
     
  16. Mariette

    Mariette Member

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    Nov 15, 2020
    Thank you for listening Marje. I'd really appreciate your thoughts later today when you have time.
     
  17. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I haven’t forgotten you. I’ll have thoughts tonight.
     
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  18. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Mariette

    First, I think it is so incredible that you rescued Buddy. It looks like he had a tough time out there before your kind heart took him in. When I very first saw his avatar, I thought he was a Scottish Fold (I have folds) and empathized with the difficulty of testing those tiny ears but then I realized his had just been injured or perhaps he had ear mites at some time that ruined the cartilage. Still...I understand that testing on his ears might be a challenge so I applaud your efforts. It’s amazing that as a former feral, he lets you do all that.

    It might be a challenge to find but, yes, dawn phenomenon is defined in this site. It’s not uncommon and is the reason why the AMPS is often the last BG to come down.

    I understand your frustration and feeling that following TR reductions as written would potentially endanger Buddy. I also understand that you feel we’ve been trying to force you into “one size fits all” and risking Buddy’s safety. Yes, we do say ECID and we do have options for different cats where it’s necessary but, as others that were helping you, IMHO, it wasn’t necessary to do something different with his reductions. I know when newer members see all that green and those lower numbers, they often wonder why kitty still needs insulin or why they shouldn’t decrease by more than the TR protocol states.

    There are built-in safety nets to the TR protocol and as long as a member is testing and feeding, when necessary, as you are doing, you wouldn’t be risking his safety. We’ve done this with hundreds and hundreds and hundreds of cats. Our first priority is safety. There are times when a cat should have a larger decrease than we would normally do because they are coming down the dosing ladder fast and we need to get ahead of the depot. But I don’t see that in Buddy’s SS. Just being honest.


    I
    agree that Buddy isn’t Henry but members show you his SS so you can get some confidence in the protocol just as I’m going to show you China’s SS. Please start with her 2017 tab and move forward. You’ll see there are times that China was in green numbers but Chris still increased the dose a bit. The beauty of Lantus is that when it’s working right, the BG will be very flat. That’s a good indication they might be thinking about remission. But, you can see that even though Chris brought China down slowly, China still couldn’t hold onto remission.

    Often when a kitty looks like this, they are still receiving a small amount of insulin but don’t want to kick those blue AMPS away so we give them a low dose (drop) of insulin, feed a higher low carb food to help keep the BG nadirs up a bit and get the curve flatter, and give a +9 snack to kick the pancreas into gear. I’ve seen some cats this close that we have to give insulin to once a day and a couple times, they just got a drop here and there.

    I know we all want a strong remission for Buddy. What would you be willing to do? Would you be willing to give him a drop every 12 hours and feed him a little higher LC food? If you are feeding 0-3%, would you be willing to try 6-8%?. I understand you said he didn’t seem to feel well when you were giving 0.1u but that’s still a couple of drops of insulin. Do you have other cats or can you get him an auto feeder to give him a +9 snack so he won’t be so hungry and will let you test at AMPS? I’m just trying to explore what we might be able to do because his AMBG is just too high to make me feel he will have a strong remission.

    The bottom line is, we are here to support you and you know him best. While I believe, based on all my years of experience here, that you could have decreased him per the protocol and he would have been safe, I also want to acknowledge your concern and not be dismissive.

    Options?
    • put him on 1 drop bid and feed the higher low carb food; try to feed a +9 snack; test him as you were when he was on insulin and then we can see how he feels and what his BG looks like overall if he drops below 50 (we’ve had some kitties that we actually had to let the kitty drop three times between 40-50) before stopping insulin.
    • Don’t restart insulin but try religiously and get that +9 snack in him and see if it can bring him down; do all you can to get the AMBG. We can let the trial ride a bit longer. Sometimes, if we feed the +9 snack several days and the pancreas kicks in as it should, the body adjusts and the dawn phenomenon no longer becomes an issue.
    Let me know what you think. Again....I want to respect your concerns for him. I am also all about listening to the cat and what he/she wants; if we have a cat whose SS looks like this and he’s telling you physically that he’s done, we need to listen to him, too. BTW, I have an amazing animal communicator I’ve used for 20 years. If you are interested so you can figure out what Buddy really wants, PM me.
     
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  19. Mariette

    Mariette Member

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    Nov 15, 2020
    Thank you very much Marje for your kind and considered reply. It means a lot to me and I feel understood and supported.

    Yes, Buddy had terrible parasites. I'm assuming ear mites or mange. By the time I was able to get him to the vet I had already treated him wih Revolution so I don't think she could test what it was. It really is amazing that he has built a rapport with me, because he didn't even know human touch before a year ago. He came around for about 4 years but we were never able to get close. He'd hiss and swat. Things progressed quickly when I started touching him. With a broom for a shield! We now have a very strong bond and a mutual trust. I am very glad to hear that you understand that, and also my that I could have a gut feel about when something's not right with him.

    I respectfully disagree that TR in the way it is currently practised would have been safe for Buddy. (With no back-to-back reductions advised) TR dictated that on the 4th of January I would have had to give him 4 units. Maybe even 4.25. You might not see him dipping below 50 with the 3 units I gave because I plied him with a lot of carbs to keep him afloat. There is no way that TR would have allowed me to get to the 2.25 dose that almost sent him into a dangerous hypo on the 7th. I would have shot a much higher dose. He would have had to practically go into hypo at every cycle to earn reductions. I saw what he felt like when he was dipping that low. It was extremely worrying to me and I couldn't repeatedly put him in that state. I know some people don't really bat an eye sending cats into 30s. But how do we know that it doesn't actually harm the cats? Buddy was showing some hypo-like symptoms some days when I doctored the bg higher with food. But he was wobbly and losing balance even though he was testing at 71.

    I could definitely try and give a drop of insulin with higher carb food. I'd have to stock up on new food options though. I'm very stocked with the 0-3%. Are there go-to foods in that range that you could recommend please? I know about Dr. Lisa's chart, just wondering if there's something easy like the Fancy Feast that's a no-brainer for these cases.

    Until I'm stocked up with food I will have to go the other route for a while at least and give a snack at 4/5am. I do have an autofeeder, but for some reason Buddy will not go into the kitchen by himself at night. So I actually haven't used it yet. I could just start by bringing him out and giving the food in there at that time to create a habit. This morning I had to carry him into the kitchen like a little emperor. He didn't want to really eat either. I guess he's used to his old feeding schedule. But it wouldn't be a trainwreck if he can get used to coming out to the kitchen by himself and using the autofeeder.

    I'll remove him from the trial and just have a no-shot limbo for the time being. Does that sound good?

    Thank you so much for taking the time to study his spreadsheet and writing me your thoughts on him. It's wonderfully kind of you to want to help him get better.
     
  20. Mariette

    Mariette Member

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    Nov 15, 2020
    His ouchy head before he came inside. But I was able to touch him and be close.

    before_head.jpg
     
  21. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Poor sweetheart. I can’t imagine how horrible he felt. He looks so much better now thanks to your amazing care.

    I’m sorry I missed this last night. I was sound asleep!!

    I appreciate your thoughts and want to answer in detail. Could you please start a new condo today so that I can? Thank you!!
     

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