11/24 Butters +12 41/+12.5 85/AMPS 128/PMPS 279/

Yesterday

That is not a typo. Butters' BG dropped from 149 @+9 to 41 @AMBG. I double checked. So much drama, Butters. Making this all about me as usual, I feel cheated that I didn't get to see numbers below 100 prior to that 41.

She did not give me a sign that she was low...like demanding food. She was spooning and grooming up until test time. I'm feeding her 1.5 tsp 15% now.

She is too low to shoot. I've always wondered if, in this situation, I can give her a token dose at any point. Or if the rule is no insulin until the evening. I know that if I can get her to stay up for two hours without food, I could shoot & adjust the schedule accordingly. That's an option.

I'm interested in your thoughts on whether I go back to the shaved reductions I was doing previously or should I take the full reduction? I could go either way on it. Butters never held a full reduction well. But times have changed, as previously discussed. My goal is a happy, well-regulated cat. But I didn't see many numbers <100 on this dose...so...again I'm not sure. Missing today's shot AND taking a full reduction seems like a lot less insulin all at once.

Thanks for any input! Have a great day, everyone.

 

I'm heading out the door to work but wanted to suggest you look at the handling low numbers sticky to see if you can shoot when he starts going up. I can't remember how food affects that. Since he is so close to 30s you should take the full reduction. I'll try to check in from work. Good luck.

 

Thanks Carla.

She is already up quite a bit: 85 @+12.5. I'm going to retest in an hour. If she can go for the next 1.25 hours without food and she is still up, then I will shoot. My work is back in stricter lockdown so I should be okay with later shot times for the next few days.

 

So the PS drop DID come back quite dramatically lol.

Hoping Butter holds >50 for the reduced dose Though a skip is okay too - I skipped once for Jax as I didn't want to wait the two hours.

Hope you have a wonderful day

 

Seriously, Susanne?????? Remember writing this yesterday? LOL.

 

I like your plan Lyla! As long as she is continuing to rise, reduce the dose & give the insulin.

[This is actually a great example of what often can happen “behind the scenes” due to the dynamics of glucose & how fast it is changing at times]

 

I won't be giving dosing advice, but GOSH Butters, that dark green sure does look good on you Hopefully she surfs in the greens today! And that one day my boy can join her!

Have a wonderful day

 

I should have known to specify HOW Butters should drop at PS. Namely, to stay above 50 please. And let your mama see the lagoon time - she doesn't care about the sharkies. Silly me

 

I'm not sure if I should take a full reduction or shaved ones (.125u), which is what I have been doing. What would you do?
The change did happen fast. Would've gotten some interesting data if I had a libre on her.

 

I personally would reduce by 0.25. There is always the ability to adjust it later.

It would be interesting to see what is going on especially given the history of “failed” reductions
!

 

I saw what you did there. Why is "failed" in quotes?
I was thinking a full reduction as well! Thanks Amy.

 

way to keep things interesting, butters
good luck w the reduction.

 

You don't have to wait two hours to shoot. This is from the sticky Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers:

• Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

 

....the first time I used the Libre & witnessed some of the very fast & transient lower BGs, I immediately thought of how many times I read about what were deemed as “failed reductions”. Obviously, safety is key, so with limited info you have to act on that info. You don’t know in detail what came before or after, how fast, how slow & whether there were multiple additional transient drops or just the one you caught. All important info for dosing decisions.

Technically, the reduction “failed” but the implication that the dose change is the issue vs the information that determined the dosing change is why I put it in quotes . It is like putting the wrong address in Waze or GPS and saying the GPS failed when you end up in the wrong place .

 

Wow, Butters. So dramatic!! My goodness, you're keeping things interesting today. I obviously don't have any advice, but I hope Butters hangs out in the lagoon for you today and doesn't scatter back up into the lemon tree.
Have a great day, Lyla

 

I'll keep this in mind for next time. I fed her MC @+12 (and some LC because she remembered it was time for breakfast) to get her back above 50. I was relatively confident that when she went to 85 @+12.5, she was likely zooming up at that point, but I figured I'd just wait an hour to make sure the food wasn't influencing her numbers too much. So I have messed her up a bit. Hopefully she will get back on track. Thanks for checking back in and for your help this morning.

 

FWIW, I'd check the sticky - that section is confusing to me. That bullet Carla referenced is aligned (formatted) with "50s or higher" and "40s or lower" so I've always assumed it applied to both when kitty is not fed. So you get a 40 at shot time, then wait 20 minutes without feeding, and see if kitty is rising >50 - if so you can feed and shoot. If kitty is not rising, you can try LC and test in 20 minutes and see what's happening & if kitty is >50. Note there's also a bullet under the "40s or lower" section that talks about feeding kitty HC, shooting, and then being in danger bc the HC wore off.

I think as long as you know kitty is rising on its own, there are ways to shoot. Good job keeping Butters safe

 

Thanks!She is safe and sound.
I think "knowing thy cat" and having data is important precisely for these situations. In 15 minutes, the amount of time I chose to stall, she gave me roughly the same number: 43 then a 41. Sure, the cat may start to rise at the end of the cycle, or the cat may go even lower the more you stall. I have enough data to know the latter is what happens with Butters more often than not. So I opted to focus on getting her back above 50 and staying above 50, then figuring out whether or when I could still be able to shoot given I had fed her a MC meal...because the other thing about Butters is the MC doesn't always do the trick. Even if she goes into the 80s, she often drops back down.

 

Morning Lyla, you sneaky little girl Butters.
Good luck with the reduction, please behave Butters♥
Have a nice day Lyla

 

I was reading this and so excited to see that you did take the full reduction and did shoot! Great work team Butters! Covid is good for something I guess. If you had to go to work things would have gone differently.

 

Wow! That's the way to keep things interesting Butters!

Hope you are doing ok with all of this and making all the feeding, dosing choices. You sound amazing calm - hope the day is a good one!

 

This makes perfect sense and I know it is something that has been discussed before. The new vet has just started using the Libre on some of his feline patients with DM, which I found interesting.

Team Butters was amazing.
My area just went back under lockdown and my work put the tighter restrictions back in place today, otherwise she'd have gotten an HC buffet and no shot.

 

That’s what I meant about going differently. You would have had to skip. No momentum lost thanks to Covid.

 

i read that fourth bullet as a reminder for the section on stalling. and possibly the most important to note is embedded in the example of the 40s second sub-bullet, i.e. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here.

which is as you say

 

Surf safe for mama Butters! Hope you have a great day Lyla!!!

 

I guess this means she is feeling so much better from the pancreatitis.

 

One thing I had discussed with the new vet during the interview was Butters' gallop rhythm and heart murmur. He said there are long wait times to get in for an echo with a specialist. He said that he could do a proBNP test and it might give an indication whether there is something to really worry about or not. He wasn't pushing it; just threw it out there as an idea.

I read the IDEXX page on the Snap proBNP. I was wondering if anyone who has dealt with heart issues would recommend doing it? Because I'm kind of thinking that since she is already scheduled for an echo (not til the end of January), why bother with it. I'm spending plenty of money on Butters, so I don't need a reason to spend more unless it might be of use.

Anyways, she is off to the new vet tomorrow, and the plan has been to have him rerun her labs as we are over a month since she was in the hospital. So if this test is worthwhile, it would make sense to have him do it then. Thanks!

 

I think so...as long as I keep the pain meds going. She seems happy and her BG has improved so I think my goal is to maintain the status quo right now.

 

Ollie had the probnp done. Came back normal. She had galloping heart, murmur and echo showed hcm 2 weeks later. Here is some reading.

https://todaysveterinarypractice.com/cardiac-blood-tests-in-cats/

 

Good luck with the vet tomorrow! Sounds like this guy is really onto it. I agree with you that if Butters is booked in for an echo at the end of January, I wouldn't bother with the extra test unless things change.

Looks like Butters has kept mama on her toes! Surf safely, pretty girl <3

 

Wishing you all the best tomorrow with the new vet.
Just beg him to give her pain meds when you run out.
I assume you can't go in with her ?

 

Thanks Paula. My takeaway is since I am going to go ahead with an echo for her in a couple of months, I should save my money on this test and not bother with it.

 

I cannot go in with her. It is curbside drop off. I am walking a tightrope trying to get her meds but not outright begging for them.

 

Hope things go well tomorrow - sounds promising and I hope it continues to be good discussion with someone who seems to know what he's doing

 

Make copy of ss to give to them. Show them when she doesn't get pain med, glucoses jump up. And when she gets it, how it comes down.

 

Prayers that the vet visit goes well and that you found a good one. Make a list of any meds you need. I know her history is already written out but I’d have a separate list of meds needed. I’d skip the blood test too. I don’t think it’s reliable enough.

 

Good luck with the vetty visit. I'd consider what the vet suggests when looking at whether or not you get the blood test done. He might have a better idea after hearing her heart. But then, I had a civvie who had a thromboembolism and had to be PTS 2 days before his scheduled echocardiogram. Lots of woulda, coulda, shoulda, went through my mind. If I'd had a quick blood test tell me to get it done sooner, I might have tried to. It was preventable.

 

Same here curbside, before it started to get worse here again, we were able to go
inside, but that didn't last long.
I hope everything turns out good for Butters tomorrow. That precious girl

 

Thank you so much. The vet also mentioned it wasn't super reliable, but also said it can be okay as a first step, especially for people who may not get the echo because of $. I have written out the meds I need: bupe, cerenia, gabapentin and ondansetron. I wonder which ones they'll actually give me.

 

He led you to believe he will give you pain meds. I would make sure to emphasize the rise in bg every time the pain was not in control and what has worked.

 

I'm so sorry. The woulda, coulda, shoulda feeling is an awful one. I will talk to the vet more about it during the exam.

 

He sure did. So did the IM vet and that didn't work out very well. I am going to do what Paula suggested and get him a copy of her spreadsheet so I can show him the pain meds and bg seem to be related. It seems like things are finally working so let's keep them as is while we figure out what is going on with her. I hope he agrees.

 

Most vets here haven't allowed anyone in since March, as far as I'm aware. Thanks Diane.

 

I like that plan.

 

Good luck with the vet visit and wow look I’m sorry I missed, her numbers this morning. Back to better numbers

 

Good luck, Lyla. I
I'll be interested in how things work out with the vet. Have a great day!

 

If you can have them get an IGF-1 that would be good . Standard of care for endos now is to get one with all newly diagnosed cats (DM) vs the prior practice/thought that one was only necessary if a cat was diagnosed with DM, difficult to regulate requiring higher doses of insulin or had easy to recognize acro features, etc..

The potential heart issue is actually an additional “flag” to check the IGF-1 as they are finding that it is often the underlying (& missed) cause for HCM and other heart issues even in cats without diabetes.

Hopefully, it is not elevated but definitely important info to know (or to rule out).

 

Don't forget to ask for appy stimulant to have on hand. I always took in copy of ss when Ollie went to vet.

I printed out blank ss (in excel) for my daily use (handwritten then transferred every couple days to pc to print out). Modified it a bit. I used 2 rows for a day. Tests, meds, subqs on first row, 2nd row had meals, vomits, poops. Anything else where it fit for the time it happens. 2 weeks fit per page. I always took in current page and previous for their records. Always had to refresh her how to read it. One time she took it home and studied it then she understood it. She liked seeing what was going on hourly, daily. Copy of in progress then a printed completed page.

 

Good luck with the vet visit today ♥