2/27 Fortune AMPS 482 +2 470 +4 366 +6 384 +9 331 PMPS 363 +2.5 361

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by RachelG, Feb 27, 2021.

  1. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Yesterday

    ETA:
    Oh btw- and more relevant to FDMB, lol - I am trying to wrap my mind around the plan for Fortune's BG.
    The internist documented that Fortune's diabetes is out of control and hard to regulate. That really made me sad. I know he keeps getting curve balls, and now with two skipped shots, I assume we are going to see an effect of higher BGs for the next few days. With TR, I was reading that if Fortune is still getting high BGs we should go up every 2-3 days (4 to 6 cycles) by .25IU, but that wouldn't be in effect here, right? With the skipped shot, where would we be in increasing his dose?

    I am also adding to my spreadsheet some of the knowledge I have gleaned (token dose if under 50% of food, 50% of food half dose, 50%+ food same dose).

    The other thing is around feeding - currently we have Fortune eating twice a day - with his shots - per our old GP's instruction. I re-read that feeding smaller meals is preferable. Can someone point me to more info here? It may be easier to get him to eat less more frequently, but I want to make sure we are tracking and doing things appropriately...

    ----

    We started our new med and insulin timing today! So despite little sleep, we kept waking up at 6, 7 and 8 am to try something new.

    Fortune ate one can (out of the normal two we try to plump him with), but we were excited by it - and we’re able to shoot his normal dose! Yay!

    Still having tremendous guilt for not shooting at all yesterday and very nervous for what is in store.
     
    Last edited: Feb 27, 2021
  2. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    Good morning Rachel and Fortune:):cat:

    Glad he ate a can of food and got his full dose as a reward!
    The +2 is practically the same as AMPS, but he is usually higher at +2, so maybe he will see better numbers today. Hope so, so you will quit feeling guilty. You are doing the best you can and more -- your boy just has to feel the love. Don't feel bad for taking care of yourselves over there every once in a while
    :bighug::bighug:
     
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  3. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Ditch the guilt. It would have put you in a crazy schedule in terms of timing. It was just one day. :bighug:
     
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  4. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Rachel, glad to see his number has come down @+4 and that he ate.
    This precious boy needs to catch a break.
    I hope he starts to feel better soon.
    My heart just breaks for him.
    I'm always praying for him. ♥:bighug::bighug::bighug:
     
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  5. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    I got the medical records from this week (Wed night-Friday) and oh goodness. There's a lot.

    They weighed Fortune and he is down to 4.6kg, where he was 5.12kg just a week ago. I did notice over the past few days he has felt a bit more bony, but I assumed just a few days of eating less (still eating!) would not cause him to lose so much, so fast!

    His BP was also higher (260) than it had be previously (150). He also was observed to have a focal grade 2 auscultated heart murmur.

    I don't know what that means, and neither the weight loss, BP, or heart murmur were raised in the conversation with the internist.

    We increased his ondansetron to three times a day, and just tried 4mg at the mid-day dose. I'm also worried that he is sleeping so much, so we are debating scaling back on the gabapentin...
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Heart murmurs can be benign or mean something. Lots of cats have them and don’t have heart disease. One was detected in Max when he was 5 after surgery when a vet pierced his bladder. His was benign at age 14 or 15. Later in life he did have unrelated CHF according to the cardiologist. Don’t worry about that.
     
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  7. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Ok, that's reassuring. We are always told how "complex" Fortune is, and the internist gave us quite the headache. I'm very unimpressed and unhappy with her overall, and the fact that none of this was shared with us (the weight loss in particular) when we are trying to figure out his QoL factors is frustrating. They think this is just a "bump" in the road for him, so I'm trying to hold onto that.

    It makes it hard to evaluate when to bring him in for treatment, since his "new normal" is not normal, but he is stable with opportunity for improvement.
     
  8. PerfumedCatMom

    PerfumedCatMom Well-Known Member

    Joined:
    Oct 8, 2020
    Keep eating your fuds, Fortune. We gotta fatten you up so you can stay strong and healthy. ;) Hugs to you, Rachel! :bighug:
     
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  9. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Oh btw- and more relevant to FDMB, lol - I am trying to wrap my mind around the plan for Fortune's BG.

    The internist documented that Fortune's diabetes is out of control and hard to regulate. That really made me sad. I know he keeps getting curve balls, and now with two skipped shots, I assume we are going to see an effect of higher BGs for the next few days. With TR, I was reading that if Fortune is still getting high BGs we should go up every 2-3 days (4 to 6 cycles) by .25IU, but that wouldn't be in effect here, right? With the skipped shot, where would we be in increasing his dose?

    I am also adding to my spreadsheet some of the knowledge I have gleaned (token dose if under 50% of food, 50% of food half dose, 50%+ food same dose).

    The other thing is around feeding - currently we have Fortune eating twice a day - with his shots - per our old GP's instruction. I re-read that feeding smaller meals is preferable. Can someone point me to more info here? It may be easier to get him to eat less more frequently, but I want to make sure we are tracking and doing things appropriately...
     
  10. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
     
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  11. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Feeding small meals for the first half of the cycle often helps level cats out. Right now he needs to gain weight so no worries with that.
     
  12. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    So would I just offer him food throughout the day? Will that mean that he still needs to eat immediately before insulin?

    He is eating, but not as much and on his own schedule, not ours :rolleyes:

    What about increasing his insulin? Obvi we are likely to see increased numbers following yesterday, but overall would it be 6 cycles from last night to determine an increase? Or because he had some greens the other day (from where, I do not know) are we going to hold the dose?

    Tonight I'm worried he won't eat very much, again. Sent DH to get a billion options, but poor bunny is interested at the can and just super nauseous. I'm wondering if the mirtazapine is cancelling out the ondansetron :(
     
  13. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    One more thing - because he is having such a hard time eating well, can we try some higher carb options and perhaps increase the dose to offset? It kills me that his BG is still so high, when in January we were SO CLOSE and starting to see progress.
     
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    If a cat is seeing green on a dose, we hold for 10 cycles. I dunno if 2/25 was 2.5 unit depot, vet visit reaction (some cats go lower at vet) or what. Right now, Fortune's depot is anybody's guess due to the skips. I'd give him a few cycles to try to build that depot up before deciding where to go next.
    This is specific to Fortune. Onset is not until a couple hours after shot time, so you have a couple hours after the shot to get food in if you think he'll eat later, or you can assist feed. I almost always gave Neko full dose, regardless of her appetite. Of course she was was Levemir then so I had longer before onset to get food in.
    How high carb are you talking? If Neko's appy was especially iffy and she was dancing greens, I'd give her some 8% to give her a little boost. Of course, ECID on how carb sensitive a cat is.
     
  15. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Oh that is really helpful to know! We were able to shoot this morning at 830, so we are doing that tonight. Fortune ate around 3 oz (a full can) of miscellaneous eruv low carb(4-7%)/low phos. so we are shooting the full dose, but of course I want to feed him whenever he will eat because he has lost so much weight.

    I was considering that he LOVES foods with gravy - I was going to see what low phos gravy options there are, but of course if it's higher carb that's challenging. I'll keep looking for low carb options before we try medium-high carb (like 10%+)

    He likes the Fortiflora, and is still excited, vocal, comes over when he hears us rustling a pouch or a can. He is just so nauseous :(
     
  16. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Oh - and I don't think it was the 2.5 depot - he was super HIGH with 2.25, so I would expect him to hang in the yellows and blues before hitting green, unless it was an out of the ordinary reaction. Perhaps the chemo/sedation impacted him? Not sure. Just concerned with the hyperglycemia in the face of the diffuse neuromuscular disorder.
     
  17. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    The Weruva have "gravy" and so do the TikiCat After Dark, but it's not HC gravy, just lots of liquid.

    The chemo day probably included some fluids and for some cats, fluids can lower the numbers. You had a green on 2/19 on 2.25 units so not what I'd call super high. ;) Remind me again what happened with the PM dose on 2/21? Skipped or not entered?
     
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  18. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Fair enough - I thought that was from the 3 IU at the vet the morning before?

    The fluids make sense - he was on an IV and his numbers were in the 100s PS! I'm just worried about the overall high numbers :nailbiting: Wearing those patient pants, but they are a little snug! :p

    He ate a bit of the "stew" from weruva, and one of the pates. I'll check out the TikiCat After Dark. He did eat around one can's worth, so we shot his normal dose! But now he is snoozing. We will put some more in front of him when he wakes up.

    But this is also a kitty that is NOT picky, loves food, and will eat bread, pizza, whatever (not that we OFFERED those foods, but he is sneaky :D The night before his collapse he got into the garbage, and at first I thought he was having DKA from high sugar and something he ate in the garbage! Sigh. I really hope this passes, and is just a bump from the chemo.
     
  19. RachelG

    RachelG Member

    Joined:
    Jan 8, 2021
    Oops! Forgot to reply to your question - yes, it was given, just forgot to enter! Just updated. DH gives the shots and I manage the sheet :smuggrin:
     

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