04/07 Pabay second opinion on new dose?

Pabs&Ro

Pabs&Ro

Member Since 2020
Pabay has been diabetic due to pancreatitis since June 2018. He is on his third insulin commencing Lantus on 1st April 2021. He commenced on a lower dose than pro-zinc of 1 unit. We have had better shaped curves than we have ever had but too high and it was looking promising.

I was out all day yesterday and in the evening his PMPS was 277. Low for Pabay but a lot of you will think this is too high and I agree but it is not for Pabay at the moment. I tested 20 minutes later and it was rising. I spoke to the vet last night and she recommended a dose increase of 0.25 units.

This morning he was uncharacteristically hungry and had an extreme thirst - one of the worst incidents of this: driven to drink as much as possible for over 2 hours. I had to manage it to keep the food inside him. This indicates a bounce to me.

I wonder if he was too low (for him) during the day on 5th April and again even lower on 6th April (due to low PMPS) and had a bad bounce last night.

Today Pabay is flat lining just above and below the 360 mark which he has not done since we commenced lantus.

I know this can happen when the dose is increased - dose wonkiness. However, given the low day time numbers and the high flat night numbers with extreme thirst I am just wondering if you think we should have reduced the dose rather than increased it.

Do I need to hold my nerve?
 
Hi! Welcome to the forum.
While it is possible that he is doing a bit of bouncing, if yellow numbers is unusual for him, given your nadirs and overall pinkiness of your spreadsheet, I would say the increase in the insulin dose is a good idea.
You should read all the sticky notes at the top of this forum conversations and decide what method you would like to use to change his dose. Because Lantus is a depot enzyme, you do need to increase slowly, so stick to 1.25 for at least 6 cycles before seeing what that dose is doing to the nadirs. Given where he was on prozing, I would expect he will still need increases in the future, but let's wait and see what the numbers look like.

I am concerned he has been in such high numbers for such a long time. I saw the values from 2020, but has it been like this since 2018?

The extreme thirst is never a good sign, but given he has been in high numbers for a long time, it might indicate something else....

I'll tag a few experienced members so they can give better advice.

@tiffmaxee
@Bandit's Mom
@Sue and Luci

I hope his numbers come down with better doses in the future!
 
The excessive drinking and hunger is due to the high bg. I don’t think he’s gone low. Max became diabetic after a few years of chronic pancreatitis as well. I stopped feeding dry food and followed TR. Feeding dry you need to follow SLGS and I agree with your vet that a .25 increase is needed. I fed Max some meals often.
 
Hercule's mum said:
Hi! Welcome to the forum.
While it is possible that he is doing a bit of bouncing, if yellow numbers is unusual for him, given your nadirs and overall pinkiness of your spreadsheet, I would say the increase in the insulin dose is a good idea.
You should read all the sticky notes at the top of this forum conversations and decide what method you would like to use to change his dose. Because Lantus is a depot enzyme, you do need to increase slowly, so stick to 1.25 for at least 6 cycles before seeing what that dose is doing to the nadirs. Given where he was on prozing, I would expect he will still need increases in the future, but let's wait and see what the numbers look like.

I am concerned he has been in such high numbers for such a long time. I saw the values from 2020, but has it been like this since 2018?

The extreme thirst is never a good sign, but given he has been in high numbers for a long time, it might indicate something else....

I'll tag a few experienced members so they can give better advice.

@tiffmaxee
@Bandit's Mom
@Sue and Luci

I hope his numbers come down with better doses in the future!
Click to expand...
Thanks - me too. I desperately want to give him a better life. It has taken me over a year to get those on board that needed to be on board to make the change to lantus.

I keep a close eye on his drinking and I do worry about it. I know from experience that extreme thirst is driven by an insulin bounce. When he is not on enough insulin he drinks a lot but today was different.

He has not been regulated since mid 2019. He was given a check up at the specialist vet a couple of weeks ago and overall he is in pretty good condition for a diabetic cat of his age. Luckily we have not had ketone problems. I keep an eye on his back legs - at times a little weak but nothing serious. He is too thin though which stops me putting a libre sensor on him as there is no fat to get the needle if to take the readings. He does have a lovely silky coat though and he is not in pain.
 
tiffmaxee said:
The excessive drinking and hunger is due to the high bg. I don’t think he’s gone low. Max became diabetic after a few years of chronic pancreatitis as well. I stopped feeding dry food and followed TR. Feeding dry you need to follow SLGS and I agree with your vet that a .25 increase is needed. I fed Max some meals often.
Click to expand...
Thanks. Tried and tried for years to get him onto wet food. He does eat a lot of home cooked white fish. I still try with the canned food everyday....
 
Pabs&Ro said:
He does have a lovely silky coat though and he is not in pain.
Click to expand...
That is a good sign! Hercules was drinking loads wehn he was diagnosed and has stopped now. So it should get better when his numbers come down. I have switched him to wet food and always add water to the food, which keeps him well hydrated.

I have no doubts that you have tried loads of things to switch him over, but there are a number of members that have experience with picky kitties, or given him a home made raw-food, which might be more to his liking? does he like freeze dried treats? If so, you could try crushing the frezze dried treats on top of a bit of wet food to motivate him?

If not is not the end of the world, just foolw SLGS :)
 
Freeze dried raw food might be an option. My cat likes Vital Essentials Duck Patties. And there are some relatively low phosphorus options like Nulo Turkey and Duck
 
Wow - thought I had tried everything. I have a freezer full of raw food (non-diabetic kitty won't eat any of it either) but never dried freeze dried raw. Looking into that immediately. Thanks.
 
Primal and Small Batch make freeze dried treats my girls love. I used Stella and Chewy’s freeze dried for Max. I would not use S&C as a only food but do feed Primal and Small Batch frozen to mine but but did start when about a year old when they loved all food and never fed dry. Good luck.
 
As Elise mentioned above the extreme thirst, etc. is due to prolong high numbers. None of the numbers on this SS indicate that he's getting too much insulin.

Since he's now just starting Lantus, you need to find a dose and hold it for 7 days (14 cyles) per SLGS - please reading the info on SLGS dosing method - and yes, it's a lot of info, so perhaps read it over, then read each section a few more times - it took me a while to absorb all that info myself! So don't feel alone in that regard.

Hold the dose steady unless you get a really low number at AM or PM pre-shot time - meaning a number at this point under 200 - you might want to post and ask for help and direction at that point....just to make sure that the circumstances support you proceeding. After a while you can be more aggressive and soon you'll be shooting those green numbers with ease.

It take time for the depot to build and yes, since he's been so high for so long, you're going to see some bouncing along the way - it's completely normal and is expected....

So let's take a deep breath and read up on the information in the yellow stickies (above) and then take it one day at a time. You're doing a great job of testing!

Do not change the dose based on AM or PM pre-shot values - you'll want to gauge when to change the dose based on his lowest number during the cycle - nadir numbers are for determining dosage. Don't change the dose unless he falls below 50 at any time...let's see if we can coax him into some better numbers...you may have to increase and decrease multiple times to get to the perfect place for him.

Hang on...and we'll all help you...please continue to ask questions.

Welcome to the forum!
 
Sue and Luci said:
As Elise mentioned above the extreme thirst, etc. is due to prolong high numbers. None of the numbers on this SS indicate that he's getting too much insulin.

Since he's now just starting Lantus, you need to find a dose and hold it for 7 days (14 cyles) per SLGS - please reading the info on SLGS dosing method - and yes, it's a lot of info, so perhaps read it over, then read each section a few more times - it took me a while to absorb all that info myself! So don't feel alone in that regard.

Hold the dose steady unless you get a really low number at AM or PM pre-shot time - meaning a number at this point under 200 - you might want to post and ask for help and direction at that point....just to make sure that the circumstances support you proceeding. After a while you can be more aggressive and soon you'll be shooting those green numbers with ease.

It take time for the depot to build and yes, since he's been so high for so long, you're going to see some bouncing along the way - it's completely normal and is expected....

So let's take a deep breath and read up on the information in the yellow stickies (above) and then take it one day at a time. You're doing a great job of testing!

Do not change the dose based on AM or PM pre-shot values - you'll want to gauge when to change the dose based on his lowest number during the cycle - nadir numbers are for determining dosage. Don't change the dose unless he falls below 50 at any time...let's see if we can coax him into some better numbers...you may have to increase and decrease multiple times to get to the perfect place for him.

Hang on...and we'll all help you...please continue to ask questions.

Welcome to the forum!
Click to expand...
Many thanks. I really want to get this right for poor little Pabay. Everything is being done along with our vet. I have just spoken to her. He had the 1.25 units. I am talking to her again before his next dose in the morning. Great to have your valuable experience and insight. Thanks.
 
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