8/21 Tiberious PMPS 501 +2 575, +4 414, +6 383

Yesterday's Condo.

Good Morning

I was hoping to get advice/ suggestions about my hypo from last night ( see condo from yesterday ). Just to clarify, I had not given Tiberious Tramadol for more than 24hours prior. (only dose was Friday 8/19 @ 8:50pm 1/4 of a pill) So I don't believe it was the pain med. Just wanting to see, I know some kitties may drop their BG more in the evening's?... Let me know what you think.

Thanks !! :smile:

 

Re: 8/21 Tiberious AMPS 263

Hi Susan & Tiberious,
Sorry that you had a rough night. It does sound as if the Tramadol's effect was taking a long time to wear off. If a cat (or a person, for that matter) is not used to a drug, it can have a lingering effect. I hope that things will improve today. You asked at some point yesterday if it would be a good idea to drop Tiberious's dose at night. I think that all of the knowledgeable people would council you not to do this. Lantus works best when a consistent dose is used for both the day and night cycles. Jill suggested that if you think Tiberious' dose is too high, you should lower it, since it is always possible to go back up. Why don't you see what happens today? The Tradamol should be out of Tiberious' system by now and you will have a clearer picture.

We are sending lots of healing vines to your boy,

Ella & Rusty

 

Re: 8/21 Tiberious AMPS 263

Happy Sunday to Tiberious ;-)

 

Re: 8/21 Tiberious AMPS 263

I have very mixed feelings about dropping the dose. IF there is an infection present, not enough insulin is part of a recipe for ketones, especially if Tiberious' appetite is off. I'm not entirely convinced that this was a hypo. Cats can sleep very deeply. You may have just caught Tiberious at a point where he was sound asleep. If you had trouble rousing him and he was staggering or there were other signs of hypo, I'd be more concerned. Keep in mind that if you tested almost immediately after feeding HC, it wouldn't have had time to work and if numbers were that low so as to cause a symptomatic episode of hypo, I don't think that Tiberious' numbers would have jumped into the 90s and kept going up. The effects of HC are relatively short lived. However, some cats are very sensitive to carbs.

All of that said, it's your call as to dose. None of us were there with you and you have to trust your eyes and your instincts and be comfortable with your decisions.

 

Re: 8/21 Tiberious AMPS 263

i answered in your yesterday's condo - sorry, didn't see this one yet. my gut reaction would be to see if it happens again.

 

Re: 8/21 Tiberious AMPS 263

Morning Susan, Kevin, and Tiberious

Sorry you had a scare last night. I'm glad to see him up at a decent number today and Sienne has been on to guide you. How are his respirations? Did the vet talk to you about giving him buprenex for pain since the tramadol was not working for him?

Kevin: I'm sorry I didn't see this earlier...four cats (two renal, one FD, and a busy young one) and my DH works weekends so I was swamped and didn't get to many condos. You are very, very welcome but just wanted to let you know I was only the "front man" for LLEF on this one. There is a whole team of us that work together and others were involved in the background. Randi, in particular, made alot of magic happen. We really appreciate your expression of thanks. I'm so glad we could make it work.

Pls let us know how he is doing.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

Please!!
Any thoughts about such high + 5 and +7 numbers?

 

Re: 8/21 Tiberious AMPS 263

Marjorie,
His breathing is the same today. Not any better. When I spoke with the vet Sat morning, he advised to cut the dose of Tamradol to 1/8 of pill. We had yet to give him any ( since his initial dose on Friday )and we decided to go ahead (since his levels are so high today) and give him the 1/8 of a pill today. We did that at 11:15 am est , so it's been about 5 hrs. His reaction is much better. but the breathing hasn't gotten any better. Any thoughts as to why his BG is through the roof on +3 and +5 today? (pain med would only show up on +5 and later was given after +3)
Thanks!!

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

Susan;

I'm thinking he is definitely "bouncing" from the low numbers last night that he was not used to. When a kitty gets lower numbers than they are used to, the liver releases a form of glucose and counterregulatory hormones to counteract that. We call this "liver training school" and most of them go through it. Sometimes it takes 24 hours to see the full effect of it. It can take up to 72 hours to clear and the numbers may go up and down a bit. Take a look at Gracie's SS and you'll clearly see her bounces after lower numbers and what it looks like when she is clearing a bounce. She started a bounce on the PM cycle of 8/18 and cleared it yesterday morning. The waiting is the hardest thing because you can't increase their insulin until the bounce clears or you could have your hands full. Once he starts getting lower numbers more routinely, you'll see how long it generally takes for him to clear.

The other possibility, although based on his numbers less night I think it's less of a possibility, is just not feeling well and the effects of the possible pancreatitis and pain.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

Ok , Thanks again Marjorie!!

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

the high numbers are indicative of a drop to lower numbers than his body is used to.

how low did he drop last night? did tiberious actually experience a symptomatic hypo or was he simply in a deep sleep? we'll never know.

according to responses, it appears *unlikely* the drop was caused by a single dose of tramadol administered some 28 - 29 hours earlier. imho, we're dealing with too many unknowns for my comfort.

since the dose was not dropped this morning, i would encourage you to monitor carefully as this bounce breaks. if you look at his spreadsheet, it took a full 3 days for the last bounce to clear. he may or may not clear the bounce faster this time.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

Just so I'm clear-- While he is bouncing, I'm keeping his dose of insulin the same, correct?

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

You're welcome Susan. Glad Jill checked in, too.

Just an FYI...and I know you are busy but there is alot to be learned from looking at other SSs. While ECID, it's still a helpful tool as it helps you pick out trends, etc.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

it probably wouldn't be a bad idea to maintain the same dose while he's in high numbers.

i have a question:

on your spreadsheet you've written:

8/17 --- per protocol adj dose by.25 as his nadir was so very low. I'm worried abt hypo/ gv Karo last night as he exp symptoms. even with Karo AMPS only 212.

you were referring to the night before. what kinds of "symptoms" did you see?

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

another question...

at what +hour did you give the pain med (tramadol?) today? did you give the same dose as last time or did you reduce the dose... if it was tramadol?


edited to add: the reason i'm asking is because there's the possibility tramadol *could* lower his numbers sooner than we'd think they'd come down from a bounce alone.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440

The symptoms on 8/16 were---He was shaking in his sleep ( like I have NEVER seen before) and i couldn't get him to respond, (he was limp in my arms) my DH thought he had passed away. I gv karo and food and brought him around. The comment ( on 8/17) was referring to the night before- his +9 on 8-16 was 49, which was definitively a hypo. I adj the dose~ earned reduction? ( from 1.0u to .75 u) on 8-17 because that happened. The symptoms I saw on 8-16 were exactly the same as to what i saw early this morning. I just didn't notice any shaking.

I gave the tramadol @ 11:15 am est today, yes a reduced dose of 1/8 of a pill. So it's been almost 7 hrs

Also- I just took his +9 today and now it's 491. should I be worried? Can BG go TOO high?

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440,+9 4

I wouldn't worry about the higher numbers. He'll come back down.

From what you're describing, it sounds like there may have been more going on than Tiberious just being in a deep sleep -- although this is still a possibility. Here's what I'd suggest. How about using numbers in the 50s as your cut off for a dose reduction (i.e., reductions are earned if he falls below 60 vs. below 50)? I thing this will give you more of a buffer.

There are a couple of caveats here. It may be that Tiberious is sensitive to lower numbers for the present because he's not used to being in those numbers. As he spends more time in normal numbers, we may want to adjust the cut off back to the below 50 range especially if dose reductions aren't holding. Also, the next time you have a vet visit, bring your meter. Have the vet test on the office meter and you with yours. (Or if you have a back up meter, test with both on the same drop of blood.) I want to make sure your meter is calibrated correctly. If the vet uses an AlphaTrack or a serum chemistry analyzer, there will most likely be a 30 point difference in your readings.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440,+9 4

Whew, Ok I will bring in my meter to the Vet. I was getting a little panicked because these are the HIGHEST numbers I've seen out of him. Thanks for the reassurance :smile:

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440,+9 4

susan, we've seen cats here that regularly hit "HIGH" as the number reading, which is over 600. Gus spent a lot of time in that category - this morning his amps was something like 230. Other cats hit high numbers sometimes as well. 491 isn't desirable, but a short visit to higher numbers isn't a crisis. he'll come back down. there's not really anything we can do to hurry the process. this bouncing is just part of it. as they get more regulated the bouncing decreases.

you're doing a really good job managing him - it's frustrating to not be able to get quicker responses but you're doing a good job controlling the things you can.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440,+9 4

One other quick question...

Did you tell you vet about Tiberious eating litter? I have no clue whether this may be contributing to his symptoms but it may be something to make sure your vet is aware of.

Also, next vet visit, could you get a copy of Tiberious' labs? FWIW, I keep a record of Gabby's labs on a tab on her SS. There are any number of people here who can lend a hand and it's always good to have lots of eyes on your kitty's labs.

 

Re: 8/21 Tiberious AMPS 263 +1 355,+3 353,+5 467,+7 440,+9 4

Ok will ask vet for a copy of the labs!! The litter issue I thought was a one time occurrence, until yesterday that is! After his second attempt @ the litter yesterday, I had had it. I threw away the fresh step i was using and got world's best ( made of corn).
He has used the litter box since switching, and if he decides to eat it it wont hurt him. I will ask the vet when we go back which Is this Wens!! Thanks for all of your help, I was feeling down in the dumps after getting better BG numbers, to only have this bounce happen. :evil:

 

Re: 8/21 Tiberious PMPS 501

i guess this is kinda odd, but i'm thinking corn=carbs . . . would that make a difference to his BG?

we use wood stove pellets - same as feline pine only way cheaper. the cats don't just LOVE it, but they'll use it. it's just made of compressed sawdust. i don't know if that would be "better" if he ate it than corn or clay or not.

 

Re: 8/21 Tiberious PMPS 501

I watch him when he goes to the LB/ I haven't seen him try and eat the new litter at all.

 

Re: 8/21 Tiberious PMPS 501

I was going to suggest World's Best....we've used it a long time and I love it.

Gracie used to be a cornaholic when she was a kitten but I quit letting her have it and now with FD, there's no way. She has never ever tried to eat the litter. It's not appetizing I don't think. But it's an awesome litter.

Come down most handsome Tiberious!!

 

Re: 8/21 Tiberious PMPS 501 +2 575

lol! some kitties have been known to eat the corn litter. just keep an eye on him.

susan, i agree with sienne's suggestion to let tiberious earn reductions when he falls below 60. i had another thought... if you should ever get up in the middle of the night or come home in the middle of the afternoon and tiberious is sleeping soundly... wake him. see if you have any trouble. i just wonder if sleeping soundly is "normal" for him. i only wonder because one of my civvies sleeps so soundly that i have a heck of a time waking him sometimes. he's scared me more than once. after i wake him he looks at me like i'm nuts and wonders why i bothered him! :lol:

 

Re: 8/21 Tiberious PMPS 501 +2 575

lol... I can almost see that kitty look-- of "MOM... Whaaaat?????, gosh I'm only sleepin'". Sounds like a good idea. :razz:

Thanks!!

 

Everything ok there Susan? You're up late!

 

Yep, It's almost always a late night here- My DH works until 12:00 am est , I like to spend time with him when he gets home. Thanks though! :smile: