11/27/20 - Squeaky! AMPS 67 +1=96 +2=121 +6=600+ PMPS = 600+

https://felinediabetes.com/FDMB/thr...529-7-187-amps-472-6-464.239157/#post-2687565

What should you say to your cat when you leave the house? "Have a mice day!"

Good almost morning friends, Squeaky hit 88 three hours before AMPS. I will make sure he eats something, anything else I need to do? Is this unusual going low like this so late in the cycle? Seems he is coming off a bounce.

Do I need to test him in another hour? He just ate a nice big snack..... can I go back to sleep for another 2 hours and just test preshot?

Also it's been 3 days since we increased. THH may be right, he's only getting the low numbers at night after he's had his buprenorphine. Maybe I should try two divided doses or getting some gabapentin from the vet. Your thoughts? Thanks everybody.

 

Hi Jan, bounce breaking cycles often have late nadirs. If you can, you could get a +11 or +11.5 to be prepared for the AMPS!

 

Hi Bhooma, nice to see you. So that means I can go back to sleep for a couple hours? By "be prepared" I m not sure what you mean exactly. What would I be prepared for? Might just be my sleepy mind here unable to think....

 

A +11 or +11.5 will give you an idea of whether he is rising or falling at AMPS.

 

Some reading for when you are fully awake!
https://www.felinediabetes.com/FDMB...y-to-shoot-handle-lower-pre-shot-numbers.147/

 

2 thoughts here. He is a late cycle nadir kitty. And/or he is having pain the bupre is helping the pain.

 

Usually with buprenorphine you can give the same dose twice a day. Gabapentin can be good to add in; but if Squeaky's never been on it before, that would be another variable and some cats respond differently to gabapentin. For example, one of my cats who weighs 10# can tolerate doses as high as 300mg gabapentin with no side effects, while another who weighs 7# can barely walk with 50mg.

So I think it may be easier to give Squeaky the buprenorphine twice daily (with your vet's okay) instead of adding in a new medication.

Hopefully his current pancreatitis flareup will be over soon!

 

Wow, great Bhooma, THH, and Paula so glad you're here. Got it, we're getting ready to shoot a green cycle. I'm about to do a +11.

Yes the pain thing might be it. ..... YIKES THE VET. She has already said she thinks some of the stuff on this board is questionable scientifically. She KNOWS that I've been feeding Squeaky raw, doesn't do well on carbs, improved when I took him off supplements.... now she wants me to consider a canned diabetic food that has lots of carbs and supplements. How to work with her when we're kind of at odds about two points. I will have to pay her for a phone consult to ask her about buprenorphine twice a day. She also doesn't think that buprenorphine helps the pancreas. My other vet had Squeaky on it long term and she kept bugging me to get him off. I eventually did. Good thing I had some in the house for this current issue. Okay so we're at odds about 3 points. What I like about her is she comes to the house. Hey, is there a vet who works remotely who corroborates with this board?

Okay just took the +11.25 and he's at 70. Shoot low to stay low...... I'm ready for coaching.

Squeaky was mad about the test, he won't take the treats from me. I have to put him on the floor and the treats on the floor, then he'll eat them.

 

Bupre every 12 hrs is the norm.

When it seemed Ollie needed more I asked vet what the max dose was for 24 hrs. Then split that into 12 or 8 hr dosing depending how bad she was. Her last week vet and I were toying with either higher dose or give same dose more often. Still wasn't sure what was going on yet.

 

Interesting. Maybe I should just do it? Hey, he's at 70. Should I start "forcing" his food? In advance of the shot?

 

You don't have to call vet about the bupre. The bupre doesn't help the actual pancreas organ, it helps the pain it's in. Think of it like this, Pancreas is under attack, you need to protect and guard it. Take the total you give in 24 hrs, divide by 2 and give that every 12 hrs. You don't have to say anything yet to vet.

As far as the food, to appease vet but not "insult" their higher education. Buy 2 cans of the food. After 5 days or so take one can back say they won't eat it and get your refund. Keep other can in case you need a higher carb food to boost numbers.

 

How much are you shooting?

 

Okay sounds good. I'll split the bupre. Squeaky will be mad. Oh well.

So we are about a half an hour away from the shot. How can I line someone up to coach me through?

 

Oh, I forgot to update. 3.5 units.

 

Will I be okay for doing this? I have to leave the house at 12:30 for about 2.5 hours. It is now 8:30, shooting is at 9(ish)

 

The bounce has cleared for sure. He needs to eat some food or she might drop more. Don’t force a lot of food. Just a few teaspoons should help. Remember you have two hours after shooting to get her to eat. Leaving at that time could be a problem, especially if he doesn’t have an appetite.

 

Well looks like we'll be shooting late. I know that affects things, but I don't quite understand that yet.

 

Shooting late can act like a decrease BUT sometimes if you stall he will continue to drop and with a bounce ending cycle that’s likely. I would not stall.

 

He ate three small treats after +11.25. And he just ate another six small treats.

 

Okay we have a routine. It takes a while. I will start it. Will you coach me? I will try to shoot at 9:05 which is 15 minutes later than the 8:50 we did last night. Probably won't quite make it. It takes us a while to play mouse, then pick him up, relax him, do the inhaler, test the bg, give the pill, now we will also give buprenorphine. Then he eats. He might not eat much, so it'll take longer for me to cook for him. Then the shot. I'll do the fastest I can.

 

He never eats a whole big meal. He grazes all day long. I take the food away about 2 hours PS.

 

@tiffmaxee - Elise, she'll be gone for 2.5 hrs and is leaving a few hours after AMPS.

I don't generally recommend feeding this close to your AMPS unless numbers are in dose reduction territory. With TR, if you're data ready, you can shoot anything above 50 providing you can monitor and have strips and high carb food on hand.

Your vet probably doesn't ike prescribing bupe because its a controlled substance. (It's a narcotic.) Drugs are cleared through the liver or kidneys, not the pancreas so I'm not sure what she's talking about. Gabapentin is used for neuropathic pain -- it's unlikely to help with pancreatitis. Opioid therapy if what's recommended. See the section on pain meds in this link.

 

@tiffmaxee @Olive & Paula @THH

Will any of you be here to coach me?

I am already getting confused. I gave him about 6 treats 15 minutes ago. His shot last night was 8:50 and it's now 8:55 and I haven't even started our routine. It usually takes about 30 minutes. I can try to rush but that will agitate Squeaky.

I have no clue what I'm supposed to do. I'll start our routine and wait to see what you all advise me about the shot.

Okay he is not willing to play. Just sitting there. Usually does that when not feeling well or lazy.

 

Here are a few articles on p'titis. The 3rd link does state analgesic (pain relief) is a priority.

They all agree on meds, feeding them (not with holding food), fluids (at home subq) can be done as soon as symptoms start. If it's a chronic condition, at home treatment started early enough can lessen severity of the episode.

I can't say if these are the best articles to give to vet, it's all that came up when googled.

https://bluepearlvet.com/medical-articles-for-pet-owners/pancreatitis-in-cats/

https://www.manhattancats.com/blog/2019/august/pancreatitis-in-the-cat/

https://veterinary-practice.com/article/diagnosis-and-treatment-of-feline-pancreatitis

 

Squeaky might like it better.

 

Thanks I'll have to read them later.

 

@Sienne and Gabby (GA) @tiffmaxee @Olive & Paula @THH

Given my circumstances, Will I be shooting or skipping?

 

I'm around but I'm kinda lost on dose amount. No matter what you give, are you home to monitor, have plenty of strips, syrup, honey, high carb food (can with gravy) in house?

 

I will be home for 3 hours. Then I'm leading a hike and I can't get out of it. Well let me make a quick phone call.

Strips and honey, yes. We don't do carbs, have been advised to just use honey.

 

See what the actual AMPS is.

 

If you can’t be home I would not shoot.

 

Okay, thanks, we are about to test. Give me 10 minutes, need inhaler, etc.

 

If not home, I would skip.

I think the 3.5 is to much and or if giving pain pain in afternoon or evening that could be why low reading, because pain is gone. Possibly another reason to try pain med twice a day. If those high numbers drop a bit, you know they are caused by pain.

 

67 at 9:15.

I gave him 1/2 dose of buprenorphine also.

I called, someone else can lead the hike for me. I can get out of it.

He ate 5 treats and a bit of food. Shoot or no shoot? Token shot?

His shot last night was at 8:50. So it is 9:30 now. We are 40 minutes late, allowing for 15 minute variance, 25 minutes late.

 

He still dropped even if a few points. I say skip. Treats take longer to work.

 

Okay, sounds good. That makes sense. And I should keep feeding him and test him at +1 right?

You know he didn't play this morning at all. His numbers were in the 70s. Makes me wonder if 70 is too low for him.

 

Give the bupe two to three times a day is what I was told. I think it’s effecting the bg but it can also cause some to lose appetite.
I don’t think 70’s are too low. It’s the pancreatitis.

 

Okay, and I have all of you to thank for catching this. It says on the bottle every 8 or 12 hours, I had forgotten (I have a neurological condition and my memory doesn't work well) that we did it twice a day.

I just gave him a dose and will continue giving it twice a day. OMG you all are absolute angels. I could not be doing this without all of you.

Okay so I will skip unless there is another opinion to consider.

 

So skipping.

I need to continue feeding every so often right, and test again at +1?

 

I believe you need to keep testing until he has two consecutive rising numbers.

 

The main reason why I would skip is you fed him less than two hours before and he still dropped a little.

 

I would get a +1 and +2.

 

Here's a link to show your vet about the need for pain management for feline pancreatitis:
https://www.idexx.com/files/spec-fpl-treatment-for-feline-pancreatitis.pdf

 

Oh I didn't know that. Good to know. Thank you so much.

 

Thank you, Elise. I'll do so and post.

 

That makes sense. Listening to all these subtleties, I am learning. Thank you.

 

Just feed small amounts. You need him to keep eating.

 

True, but they need to be rising numbers without, hc, syrup, honey influence and maintained. Some kitties will have 2nd drops.

 

Happy, the bupre seems to have helped, his appetite is better.

Is there any problem with him eating a lot of organ meats? He reliably eats them.

 

Thanks Olive, bit by bit I am understanding more and more. We're still new at low numbers.

 

Still small amounts, and you do know pancreas organ should not be fed to diabetics. I learned that when I home made cooked food for my 1st kitty.

 

Wow you know so much Paula. It's beef liver and heart.

 

I am so glad the buprenorphine is helping!

 

Yes I can see the difference immediately. THANK YOU for catching this.

 

Not really. Just what I learn here and what worked for me doesn't mean it works for someone else

Heart is okay. I think the liver has to be a particular ratio though. You can give to much. None of my cats like liver in anything. So I didn't have to worry to much about it. Check out the ibd website. Its where I got my recipe for home cooked and they explain the ratios.

 

Wow, mornings like this. I feel like I've been hit by a truck. Time for breakfast and self-care. Oops. After +1.

 

on the bupre, watch for signs it might be wearing off and see how long its been since giving it. You want to find out how long the dose is lasting.

 

Oh good idea. Never thought of that. Thank you so much.

+1=96

 

Jan -

Just to try to consolidate some of the information that's in this thread...

With TR, once you are no longer new at managing your cat's numbers and are data ready you are able to think in terms of shooting progressively lower numbers. You've shot a reduced dose with a PMPS in the 80s. You might want to think in terms of what number you'd be comfortable shooting.

Ideally, you want to be able to shoot any number above 50 providing you're not seeing dropping numbers. There was functionally no difference between your +9 (at 80) and your AMPS of 67. (There's a 20% variance that's due to the meter so these are essentially the same number.) For most cats, Lantus onset isn't for 2 hours. In addition, you're feeding your cat at shot time. Between the influence of the previous dose wearing off, the window of time between feeding your cat and Lantus beginning to work, numbers are typically rising until approx. +2 so you have a reasonable margin in which to shoot. Further, shooting low often results in a flat cycle.

Obviously, with shooting low you want to have the ability to monitor to insure your cat is safe and/or have enough data to know how your cat responds. Likewise, I would never advise someone to shoot low if they did not have strips and high carb on hand.

 

Thank you , I will read it carefully once I have some focus back. I appreciate your helping me through this morning.