10/13 Oberon PMPS 192/1.6, +2 163, +4 146, +5 148, +6 136- test more? sleep?

yesterday: https://www.felinediabetes.com/FDMB...-pmps-318-6-5-1-313-2-303-3-270-4-306.236751/

Just barely under 300 at preshot (294), but ketones are HI (max on the meter is 8.0), so I'm calling that in the noise for my "no R if <300" rule and giving him 1.25 U. Fluids later, too. He's acting ok and eating, but I really want to get those ketones down.

 

Hugs to you and Oberon Good luck with R and hope those ketones come down.

 

Oh my...Oberon..you need to get with the program there kiddo...

I really hope you can get those ketones down...poor thing.

Best of luck to you today Lisa!

 

I hope the ketones come down. Sending prayers.

 

Rechecked ketones at +1, and got 7.0, so at least he's out of the mystery range.

 

Hate the “mystery” readings ! Happy he is out of them

 

Hope they continue to drop.

 

My regular vet just called with CBC results- everything's normal, yay! So the anemia was hopefully a fluke of some sort. Numbers are posted in the Labs tab of his SS.

 

BG holding steady at +4 (261; it was 255 at +3). Gave him 100 ml of fluids about 15 minutes before that. It might mess with the numbers a little later but I figured getting fluids into him was more important than getting good R data today. Off to teach for a while; back later for a +6 check.

 

Thank goodness for no anemia! Now if only those ketones would go away. Nice to see the labs improvement.

Looking at Oberon's spreadsheet and his last couple dives down to green on 9/11, 9/25, and 10/09. Know what they have in common? 14 days apart.

 

Yep, I definitely feel like there's a pattern there. The one before that (on 9/1) was only 10 days, but still. I'm still thinking it could be some sort of overlay of the Lantus and antibody cycles. Or it's just that the antibodies themselves are on a ~14 day cycle.

 

Made me go back and look at Neko's first year on insulin. The pattern was not so clear for her.

 

Ketones back down to 3.5, whew! (That's still high, but not as absurd as this morning.) Nice string of yellows so far today.

 

I'm seeing the same pattern for Howie. Nothing but high 200s, then every few days a deep dive and right back up again.

 

Good job on the ketones!

Just because she liked to be different, Neko in 2012.

And he's on Prozinc - looks like it's not any better. Though he had a great last night.

 

229 at +9. Starting to think ahead to this evening. Even if he heads back up now it seems unlikely he'll be over 300 at PMPS, so under my current "rules" I wouldn't give R. But the R seems like it's getting us some traction and I hate to lose momentum. Thoughts about relaxing that rule now that we have some data? 1.25 U hasn't lowered BG by more than 50 points in any trial so far.

 

You shouldn’t expect for him to be any better if he started on Prozinc and continues on Prozinc because the cat continues to be exposed to what is potentially causing the anti-insulin antibodies to form. The interesting thing for a cat that develops this issue with Prozinc vs Lantus is that it could be antibody response to 1) the type of insulin or 2) the suspension Prozinc is in.
Either way, same endo thought process....change the insulin IF you know for sure another underlying issue/diagnosis is not causing the issue.

 

Yes, cats who switched from Prozinc to Levemir have tended to have good reactions. No caregivers that I know of have switched back.

I'd think about building an R scale. Maybe if over 250, give a smaller dose than if over 300. The other thing I'm mulling over if this is a bounce breaking action. If he continues to go down towards PMPS, I would stay away from R. Flat yellow (in many cats, still TBD with Oberon) can also signal action to come.

 

You wouldn’t switch back. This is a situation where if the anti-insulin antibodies are due to the insulin or in the case of a Prozinc user, it could also be the suspension vs the insulin itself, the change to a different type of insulin may help.

So if a cat is having an issue due to AIA and other underlying illnesses that could be causing the problem are ruled out, a change might be made. This would not be a case where a cat isn’t doing well on Prozinc or Lantus and changes insulin, then develops AIA—-you would not then proceed to go back to an insulin that was already used and wasn’t effective for that cat.

In any case, I hope to see continued progress with Oberon

 

The reason they haven't switch back is that they've preferred the type of numbers they get in Levemir, flatter cycles. Some cats see an initial good reaction, but the antibodies learn to adapt to the new insulin.

 

Again, this wouldn’t be a case of switching back.

I do understand what you are saying about adaptation though. I’m on the same page of preferring a longer acting insulin in the long run, but Prozinc works really well in some cats. Definitely not one size fits all. I do wonder about strategies that may potentially get cats there faster though and will try to find out if there are any .....most certainly faster than 9-12 months.....which is a long time.

I do also wonder about the ability to take a cat who has not been on Prozinc, change the insulin, resulting in the AIA resolving and then moving on to a different longer acting human insulin like Levemir. I’m not sure how long a cat would need to remain on Prozinc before making a switch, but would hope it would be pretty fast. Again, waiting on the book and then I would still need to ask questions.

In the meantime....you two are like Top Gun...what was it Maverick and Goose !

 

I'll check him at +11 to get an idea of where he's heading. This doesn't feel like one of his big dips so far, but if the pm shot kicks one off I wouldn't want him to have R on board.

 

Neko switched from Caninsulin to Lantus after 3 months, so did have an insulin change. Unfortunately at the time I started with a faulty meter that didn't properly show high numbers, so didn't see what the initial reaction was. By the time I got a better meter, those tricky antibodies had adapted and her numbers were up in the clouds again. Never trust an antibody.

 

239 at +11... I'll see where he is at PMPS, but right now my gut feel is that I should skip the R tonight.

Meanwhile, since I know he's not anemic I finally started him on the Veraflox (1.5 ml). He fought us (my daughter held him while I got his mouth open and squirted it in) but I got it in and he forgave us pretty quickly. 6 more days of that.

 

So are you Goose or are you Maverick ?

If I’m not mistaken, Neko had acromegaly vs just AIA? The insulin suggestion was for AIA only vs acromegaly, so that may have been why something more simple like a change, even after SRT. Immune system is SO much fun .

 

No Veraflox bath ? Impressive and it’s so nice that your daughter is helping! What a sweet cat to forgive you so quickly. He knows you are helping him!!

 

He sort of gagged right afterwards, but everything stayed down, and he got treats and then ate right afterwards. Whew! He was really fighting being restrained and having me pull his mouth open more than the medicine itself. We'll have to just work on training him to let us do it. Should be doable; he's already trained to come for BG checks. Previously my daughter taught him to give high fives for treats (though I think he thought he had trained us to give him treats when he gives us a high five...).

 

Morning data: +9 284, AMPS 294/HI, 1.25 U R, +1 296/7.0, +3 255, +4 261, +6 249/3.5, +9 229, +11 239

BG still falling (192 at PMPS) and ketones 1.6 (yay!!). So definitely no R tonight, and it looks like it could be an interesting evening.

 

I am certain he thinks he trained you guys...LOL!
He will definitely learn or at least maybe sit still for his medicine.

Fingers, tossed crossed and prayers that the antibiotic helps with an inflammatory process that may contributing (maybe even to a significant extent) to the BGs and they come down quickly.

 

I think some cat read about him being predictable in his dives. But I consider this a good thing.

Baby steps on medicating. Start with liquids, then up to pills. I found holding the scruff helped open the mouth. Gotta be quick though.

Yes, Neko had IAA and acromegaly. That's a lot more common combination than IAA by itself. Though that is from experience here, not that anyone has researched that particular combo. The number of confirmed IAA only I've seen on my time here, not sure if it even hits double digits. So odds of seeing an insulin switch too, even lower. Plus you can still see the effects of IAA by itself, even in an acromegalic cat.

 

Down to 163 at +2... good, but he's been looking like he doesn't feel so hot this evening. Nothing dramatic, just a little down; for a little while he was meatloafing and making a bit of a face. Still eating ok, though. Not sure what's up. (This started before the Veraflox, so it isn't that.) I'll keep an eye on him and keep encouraging food.

 

He's not been used to blues lately. Maybe out of his comfort zone?

 

I hope Oberon is okay, Lisa. Maybe a reaction from the low number he isn't used to?

 

I was wondering about that. Glucose hangover? He usually doesn't stay this low for this long- quick dip and bounce back up. So long as he's still eating I won't worry too much.

 

No meatloaf allowed Oberon.....poor guy! Hopefully just some passing painful gas. Really happy he continues to have a good appetite

 

146 at +4... starting to slow down a bit, but I have a feeling I'm going to be up late. Luckily I don't have anything much going on tomorrow until late afternoon.

 

Just noticed that the fluids I gave him earlier seem to have settled in his arm... maybe that's uncomfortable?

 

136 at +6... still dropping slowly. Dang it, cat. I would really like to go to sleep. My husband will check at +9... I don't know how fast he might drop in the next three hours. Sleep, or stay up and test?

 

I'd leave a little food out and catch some winks. He's not dropping fast now.

 

Sounds good. Good night!