09/27 Wendy AMPS 504 +3 340 Dose

Wendy and Eva

Wendy and Eva

Member Since 2022
Wendy is a female and is 13 1/2 years young. She was diagnosed on 08/01/2022 and was put on vetsulin 2.5u when first diagnosed. I was not given any information on this disease. All I was told was to feed Wendy 1 hour before the shot and absolutely no meals the remainder of the day. I was in total disbelief that my healthiest cat had diabetes and so I started researching like a mad woman. I came across this amazing group and read as much as I could so that I could make the necessary changes.

I changed her diet right away to only wet food (Fancy Feast Pate) but would only feed her twice a day per vets instructions. Then I came across a post on how to feed and I felt horrible that I had been starving my poor baby
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so I started feeding all day long and as much as she wanted.

On 08/19/2022, I decided to change vets and he changed her insulin to Lantus 2 Units. I've been giving her shots on time and never have missed a dose. Also, I recently started testing before AM/PM shot and mid-day. I am concerned that her numbers are not getting any better. One of the experts has been helping me by increasing the dose and we are at 4.5. Yesterday she wanted me to increase the PM shot to 5 units, but I was unsure because Wendy seems off, and didn't change the dose. Wendy doesn't seem to get any better and wanted input from other experts before proceeding with the increases.

On 09/16/2022, I took Wendy to the vet because she was lethargic and didn't have an appetite. I had to feed her with a syringe and gave Sub-Q fluids which brought her back to life! The vet recommended that I continue with fluids until she felt better. Her kidneys values are normal and there are no other underlying health issues.

On 09/22/2022, I stopped the Sub-Q fluids and I noticed the difference. She drank way more water (actually lays by water bowl with her head in it and drinks for a bit then stops with her head still in the bowl) and ate less. Then the following day she didn't have much of an appetite and drank a lot of water (leaving her head in the bowl after drinking some water).

I am regularly testing for ketones and there's no trace. I also hold food 2 hours prior to shot and add water to wet food. Wendy eats throughout the day and as much as she wants.

I know I'm in good hands with the expert, but has anyone else gone through something similar to this? I'm at a loss and feel so sad to see that Wendy's numbers are not improving. I'm concerned that we keep increasing the insulin and there's no improvement. Do I continue to increase every 2.5-3 days as instructed by expert or should we take a different approach?

I'm still learning but I am very consistent with not feeding 2 hours prior to shot, shots and testing (I started testing more regularly since I made the necessary changes with my work schedule).

PLEASE NOTE: Wendy's kidney values were tested and are normal. When I administer Sub-Q fluids, she's more alert and spends less time by the water bowl. Also, previous to diagnose, there were no underlying health issues and was very active. Since we started this journey with the insulin, Wendy is not active at all and it's heartbreaking to see her in this condition
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Hi Eva- would it be worth continuing sub-q since she seems to respond so well? I cant give you dosing advice but you might want to read the dosing guidelines and decide which method you would like to use? Looking at Wendy’s spreadsheet it looks like you were getting some yellows at 3 units- could you have shot past the ideal dose?
Wishing you good luck with Wendy!
 
Hi Eva! Glad to see you posting over here!

You're doing everything you can for Wendy so stop beating yourself up. One thing I'd really like to see is some tests on the PM cycle. Most cats go lower at night so it's important to get at least a "before bed" test to make sure she's not dropping too far or too fast.

It's possible that you've gone a little too fast with the insulin. While 200's are still certainly too high, (especially when they're that close to 300), since you went to 4.0, other than that one little blip of yellow on the first 4 unit cycle, her numbers are just getting higher.

I'm tempted to suggest dropping her back to 3.5 and holding that dose for 8-10 cycles. While most cats will show how well a dose will do in 6 cycles, some seem to need just a little more time and you only tried the 3.5 for 4 cycles. While you're there, please get some tests on the PM cycle and keep testing for ketones.

If she seems to feel better when she gets the fluids and the vet has said her heart is OK, I don't see any reason why you can't give them to her. How much are you giving?

Hopefully some of the others will pop in and we'll see what they say too.

@Wendy&Neko @Bron and Sheba (GA)
 
Hi Chris, thank you for checking out Wendy's spreadsheet! I will start checking as of tonight after PM shot. I just updated her spreadsheet and her numbers look more steady today after AM shot.

Do you suggest I start tonight with 3.5 units PM shot? I did test for ketones today and there's no trace (thank goodness!). As far as the fluids go, I give her 100ML at one time and she perks up.
 
I'm curious to see where you found this "expert". Even our most aggressive dosing methodologies would not let you increase as fast as you have, without more data than you have. As Chris said, it's entirely possible you have zoomed past a good dose. Especially without night time tests. A lot of cats go lower at night. We determine how to change the dose based on how low it takes the cat, hence the need for some night time data. It doesn't have to be middle of the night, but a before bed test, if it's at least a couple hours after the PM shot, will give us a clue if she's diving at night.

I'd also keep testing for ketones daily if you can, especially since she seems to be off her food. I see she had no ketones at 4 units and above. But did see some ketones at 3 units and also lethargy, which is a bad sign. Here is some reading for you: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

I'd also talk to the vet about getting some anti nausea medication, to see if that helps her appetite. Ondansetron is a good option for cats.
 
I’m wondering if Wendy is dropping lower at night and bouncing during the day. If you are able to get some tests in during the pm cycle, as Wendy suggested, that would be helpful.
It sounds as if you are feeding Wendy lots of food which is good as that helps keep ketones at bay. I agree that an antinausea such as ondansetron might help. It’s hard to eat if nauseated. Are you also offering lots of food during the PM cycle?
Has she been tested for any thyroid issues? T4?
 
Bron and Sheba (GA) said:
I’m wondering if Wendy is dropping lower at night and bouncing during the day. If you are able to get some tests in during the pm cycle, as Wendy suggested, that would be helpful.
It sounds as if you are feeding Wendy lots of food which is good as that helps keep ketones at bay. I agree that an antinausea such as ondansetron might help. It’s hard to eat if nauseated. Are you also offering lots of food during the PM cycle?
Has she been tested for any thyroid issues? T4?
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Hi! Yes, I will start testing tonight to get a better feel of how she does after PM shot. I feed Wendy lots of times during the day (a min of 2-3 times per hour) and at night I put Wendy away in her own room. There she has 3 full bowls of pate food (5.5 ounces each bowl) that's watered down for her and I check in around 3am to make sure she still has food. Auto feeders are in transit and will be using for night feedings.

Wendy hasn't been tested for any other issues. The vet first wanted to see how she did with the new insulin (Lantus) and with the increase of dose before testing any further. I will requested for the antinausea med and I'll let him know that she continues to do well on daily sub-q fluids. Hopefully once she gets regulated she won't need the fluids. Do you recommend I start requesting for further testing?
 
Wendy&Neko said:
I'm curious to see where you found this "expert". Even our most aggressive dosing methodologies would not let you increase as fast as you have, without more data than you have. As Chris said, it's entirely possible you have zoomed past a good dose. Especially without night time tests. A lot of cats go lower at night. We determine how to change the dose based on how low it takes the cat, hence the need for some night time data. It doesn't have to be middle of the night, but a before bed test, if it's at least a couple hours after the PM shot, will give us a clue if she's diving at night.

I'd also keep testing for ketones daily if you can, especially since she seems to be off her food. I see she had no ketones at 4 units and above. But did see some ketones at 3 units and also lethargy, which is a bad sign. Here is some reading for you: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

I'd also talk to the vet about getting some anti nausea medication, to see if that helps her appetite. Ondansetron is a good option for cats.
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Hi! I was assigned an expert (on FB group) to assist with spreadsheet and then it took off from there. She has been awesome and checks in with me daily. However, I just didn't have a good feeling about the dose increase and wanted input from other experts. I will continue to test daily for ketones and also start testing after PM shot. I appreciate your input!
 
Wendy and Eva said:
What would be your recommendations be for testing after PM shot? +2 & +4?
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Those are great places to start! A lot of times the +2 can act a little like a crystal ball in predicting where they might be going later in the cycle.

If the +2 is about the same as the PMPS, it's usually going to be a pretty normal cycle...gradually down to nadir and gradually back up to the AMPS

If the +2 is higher than the PS, that could be the starting of a bounce and during bounce cycles, you can usually take a break in testing and catch up on your sleep.

If the +2 is lower than the PS, that's your early warning that she might be going a lot lower later in the cycle so those are the times when you'll need to get some extra testing in and keeping a closer eye on her (and if it's at night, you may need to set an alarm to make sure you wake up to test until you're sure she's not going to drop anymore)

For some cats, the +3 is more predictive but let's see how she does for now.
 
Wendy and Eva said:
Hi! I was assigned an expert (on FB group) to assist with spreadsheet and then it took off from there. She has been awesome and checks in with me daily.
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That wouldn't have been the FB group connected with FDMB, as they are supposed to point people to here for dosing advice. Some of the other FB groups give some pretty dodgy advice. And frankly, there have been some unsafe increases, to the point her numbers are looking worse as the dose went up. I'm glad you decided to get a second look. I hope the slightly lower dose and more testing provides a clearer picture of what is happening.
 
Wendy&Neko said:
That wouldn't have been the FB group connected with FDMB, as they are supposed to point people to here for dosing advice. Some of the other FB groups give some pretty dodgy advice. And frankly, there have been some unsafe increases, to the point her numbers are looking worse as the dose went up. I'm glad you decided to get a second look. I hope the slightly lower dose and more testing provides a clearer picture of what is happening.
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Eva contacted me privately for advice. I told her the FDMB FB group was the place to be and encouraged her to reach out to them for help in setting up a spreadsheet to get started. One of your admins (please reach out to me privately if you need to know) helped her with the spreadsheet and is giving her the dosing advice. With even the little knowledge I have, even I was concerned with the dosing advice she is getting and encouraged Eva to set herself up on the board and start asking questions.

Thank you soooo much for helping Wendy and Eva. I wished I had found this awesome board sooner when my little guy was struggling.
 
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