11/30 Jackson AMPS 233 +4 219 +6 274 +8.5 363 +9.5 395 PMPS 416 +3 349

https://felinediabetes.com/FDMB/thr...30-6-5-382-pmps-394-3-295-4-244-5-296.271284/

Well, ended up mostly yellows all night. A reading that was briefly, barely blue at 1 am. And a solidly mid-low yellow preshot today. We will see what happens today, the bounce should have ended itself by now… I hope the drop he took from +11.5 to AMPS doesn’t mean he’s going to try to crash this morning. He couldn’t have done this yesterday when I was home all day…

 

I hope Jackson slides down today.

 

Well he is, apparently… at last… and while I’m not home. Thankfully my cousin is watching him for me. Though she is also working…. So more like just hourly checks so far…

 

Well… mixed bag results today. Jack actually spent most of last night and today in the yellows! But then started climbing after a nadir of 219 at +4 this morning, and at +9.5 is almost at 400. Ergh. For a bit over 12 hours I was starting to think we’d found a stable, non-bouncy dose…

Well, at least it’s not actively a bounce anymore. Just not enough insulin.

I would like to ask for advice, as to dosing now: I dropped to 1.25 units a few days ago after he went deep green on 1.5 units. I don’t want him to go hypo (or to even get close during the day when I can’t be home to watch him). However, is it possible that he did so because he was still carrying some depot from the 1.75 unit dose a couple days before that?

Basically, how safe would you all say it would be to go back up to 1.5 units, or should I try like a skinny 1.5? Or, should I instead hold pat for a while, is it possible/likely that he could settle lower on a same dose over time if I keep patient?

 

The larger depot influences 4-6 cycles after a reduction, so there could have been a tiny bit of the 1.75 unit depot influencing him the night of the 26th. However, with SLGS, you hold the dose for 7 days before considering an increase. You are just half way there.

 

I just wasn’t sure if that still applied because I’d been reducing before this - I wondered if the “go back to last known working dose” applied instead. I’m fine with waiting. He did have nice yellows. I would just like to see him not climb so easily back up into pink and even red.

 

You reduce immediately on SLGS if they go below the reduction threshold. It's just for increases that you wait a week. "going back to the last working dose" only works if you are following TR, or did a temporary reduced dose for a petsitter or vacation.

 

I think I get confused on which parts of SLGS I’m supposed to follow exactly, and where I’m supposed to speed things up. Since Jackson had DKA to start, I was advised to increase his dosing more rapidly at first despite being on a SLGS feeding routine. Actually, of course TR was recommended first of all - and I absolutely agree with the desire to get kitty healthy faster! Jack has caused me a lot of lost sleep and worries! But my life and work schedule simply do not allow for intense monitoring every day, especially using numerous ear pricks to get exact low numbers, nor does it allow for the numerous small measured meals required. I am simply not home for long hours. On the other hand, I do have better insight into his numbers and patterns through the day than many SLGS followers thanks to his Libre (other family members do help with scanning that with the reader). So I kind of have been feeling betwixt and between on my methods and plans.

The good news is that the original intense fear of ketones returning has seemed to be null and void - once he recovered and had been on insulin for a bit, I’ve never seen any in his urine. I was checking daily for a while, now more like every couple days. I think it helps that he’s free fed, as I understand it that keeps ketones away, even if it makes regulation a slower process. So maybe I don’t have to be as worried about being quick. Maybe it would be better for his body for me to just stick to SLGS rather than trying to hybrid the methods.

It’s just been hard for me to know what to do, always. I worry when he’s been in pinks all day, and especially when he hits reds. I really worry about the reds. But trying to take him too low with TR dosing, without the ability for in-the-moment monitoring and feedings in response, is also dangerous. More immediately dangerous. I’m just always a bit torn, and it’s hard to stay patient.

 

We don't mix and match TR and SLGS. There are safety mechanisms built into each dosing method as it is written. You are doing reductions at a lower value, which makes sense given how much you and your family (team Jackson) can monitor. For now, I would stick to SLGS as it is written, except for the reduction point, and keep monitoring regularly for ketones. I would try to get a ketones every day, or at least every other day if he's in higher numbers. And please update the spreadsheet when you get a ketones test - looks like the last one was a week ago. Ketones can go from trace to high really quickly. Also keep a close eye on his food intake and activity levels. Any changes should be noted and might be reasons for faster increases.

Have you considered getting a blood ketones meter? It would be easier to get a ketones test, and might give you a head up if his ketones are trending up.

 

I haven’t been weighing his food or anything like that - especially since lately he’s been sharing a room half the time with another cat that’s being picked on by others. But he’s eating very well - two 3 (or 2.8) oz cans of food for meals, plus YM Zero free fed in between. I do know that’s he’s eating more than the specified amount of YA for his weight, but also was told/read here that post DKA cats need more calories. Plus I’d like him to gain a little bit more weight back still. He’s gained some, but it’s slow. At least I can’t feel his spine bones when petting him now. His hips are still a bit boney.

His drinking and peeing are less now than they were. Again not a measured thing, but less. I think closer to normal cat level, compared to the other cats’ pee balls in their litter boxes, and he’s not spending long minutes in front of the water bowl anymore. He does still drink after eating either wet or dry food, which I appreciate.

Activity with Jack has always been a… subtle thing. He has bursts of wild play now and then… I see them once every day or sometimes two days (he may be doing it while I’m gone sometimes too) but mostly he just lays around, whether sleeping or just watching the world. He’s big on cuddling. He does like to sit and stare out the window. He’s showing more interest in life and everything than when he was first diagnosed or out of hospital, but he’s never been what I would call super active.

I actually do have a blood ketone meter, and looked up info on levels as they should be on that, but for a while it’s simply been easier to test his fresh pee spots. (I’ve only seen “trace” once, mostly “negative” results.) Jack hates ear pricks. And when I got the meter I was really really bad at getting blood. I’ve had to use the glucose meter a few times since… I think I may be getting better at it. He still hates it. It’s true though that it picks things up before they would show on a urine strip (though I read that actual trace numbers on a blood test are totally normal, so not to expect actual blood zero…)

It’s true though that I haven’t been able to catch it fresh every day. It’s been a couple days, now. I’ll try to get a test one way or the other ASAP, and remember to note it on the spreadsheet. I think I skipped posting the last couple.