? 9/23 Henri: PMPS 114, +1 90, +2 53, 49@2.5, +3 60 Can I reduce her dose tomorrow morning

Can I reduce her dose tomorrow morning? It seems I am often using food to keep her above 50 and she seems to be dropping in her +1, +2 often and instead of letting her to continue to drop until she hits her nadir, I am often using food to bring her back up. I've only had to use the HC food once before we reduced her dose 9 days ago. Now when I see her getting into the 50-70, depending on where she is in her cycle I will use a high calorie but low carb food to bring her back up. The reason I use the high calorie food is bc it wont fill her stomach as much so I can ensure she will still want to eat. It's a more bang for your buck kind of thing. I work a 10 hour day tomorrow and my husband can check in on her during the day but I'm worried she needs more care than he'll be able to give her. I know with Lantus, she is supposed to be in the 100 range for a week before reduction, or if she drops below 50 but I'm confident that the only reason she hasn't dropped into hypo is bc im constantly monitoring her and have been able to catch it before it happen...and by using the LC food I am able to bring her back up slowly so i don't send her into a bounce.

Now if I do lower her dose, I read that "Did you decrease the dose recently? A dose reduction will usually result in a need for less stored insulin. The excess may be released into the bloodstream faster than usual, especially if several dose reductions are done back-to-back." (I took this from a sticky) Does this mean if I do reduce the dose she may actually be more at risk for a hypo event?

currently she's at +2 53 and I gave her 26 cals of LC food. I'll test her at +2.5 and continue the normal routing of raising her back up but i'm really fearful of tomorrow and think she should be reduced to .5 Units 2x a day

 

It looks like Henri may have gone below 50 for a short time. (I almost missed it on the spreadsheet) She looks most excellent on this dose, but maybe/probably has earned her reduction with that 49, by a smidge. And yes, the depot will still affect the next cycle or so, so you would still need to be prepared to monitor as closely as you can and use food to guide the surf. Great job. I would give just about anything to see a string of greens and low blues like that.

I'm sure someone with more experience will chime in & give you better guidance. That's just my two cents worth, and should be taken with a grain of salt until you hear from them.

 

Thank you for your input! As much as I love the blues and greens...they still scare me a little. I have been getting better at letting her get lower before I intervene with food though. I used to intervene when she dropped below 100! lol I have used food over the past few days to keep her 60 and up. When I see she's dropping into the 60's so early in the cycle, I use the high calorie kitten food to bring it back up. It's never take more than 2-3 feedings every 20-30 min to do it. I'm so nervous for tomorrow bc I can't be home to monitor and it's up to my husband...while he works from home he is often very busy. toe beans crossed!. I think I'll feel a bit better reducing her dose though.

I guess until the depot wears off, she'll remain pretty low and then after I should expect her numbers to go up again a little? hopefully not over 200

 

Every cat is different, so I'm hesitant to say. But she's been on this dose for ....2 weeks (?) so I really don't see a huge jump ahead. Don't let these greens scare you. The fact that you are not feeding really high carbs, as opposed to high calorie (correct me if I'm wrong) and she remains in healing numbers without a huge bump from the food is a good thing! (in my opinion) If it was me, and I couldn't get a test every hour.....which honestly, I wouldn't do because of time constraints, I would make sure to feed a teaspoon or two of the low cal every so often to keep her steady, or have food available when she needs it.

Please don't take my word for it. Even tho I've been at this for almost 11 months, Nova keeps me guessing, and I haven't seen what you are seeing in your day-to-day testing. I am really not qualified to guide you. I think you are doing a wonderful job using the food to keep her steady. Keep it up.

Toe beans crossed!

I think I'll tag some people for you.

@Wendy&Neko
@tiffmaxee
@Marje and Gracie

 

The 49 at +2.5 will trigger a reduction in dose down to 0.5 units.
But you need to be aware that the depot will still be in play and will influence the next few cycles so Henri could still drop into lower numbers tomorrow when you are not there. Can you leave some food out for him?

Where did you read this?

 

it's in a sticky titled "what is the insulin depot"
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

she wont often eat food thats been sitting out. I only recently learned this from using the automatic feeder :/ since my husband will be home and I can stop by on my lunch so she can eat:
7-7:30 breakfast
10:30 snack (I can stop home)
12:00 snack (my husband on his lunch break)
I can usually get my husband to go check on her between 2 and 3 but he cant sit with her and make sure she eats
and then he gets out of work around 5 but we give her insulin at 7 so we haven't been giving food 2 hrs beforehand.

does a depot lower BG more than it was previously bc of the fast release?

 

My cat can be picky about his food also. I use a ice cube tray and freeze a little block of his food so that when the feeder opens hours later- the food hasn't really been sitting out as long since it was thawing for the first few hours. I've used chicken and stock to do this as well as his glycobalance/gravy food when he was eating it. You might already be doing this, but I know people have those feeders with the ice packs so- just wanted to share in case.

You can feed up to 2 hours before shot time too....you just could see some food influence in the numbers (depending on the cat and metabolic rates). Maybe your husband could just offer her gravy on her LC food and if she needs it -she'll eat it. Most of the time if my cats BG is dropping - he will eat whatever he can ...even my pizza off the table apparently.

 

she's actually only been on it for about 9 days ...plus a cycle since we upped it for an evening dose. and she's been over eating bc of the food I have to give her to keep her up lol it is all low cab and high calorie when I try to raise her. I find I can do a slow raise bc she can eat more calories....bc I was hoping to avoid a bounce.

I've been getting better handling the greens now I'm going to have to really learn when it's important to test her and when it's important to give her a break though lol

I think I set up a schedule where either mu husband should be able to pop down and give her some food I've portioned off for her and I can stop by in the morning. She should be covered with something ever 2-3 hours

 

I was wondering where you read that too. Thanks!

As for the auto feeder, many have said to put an ice cube in to keep it somewhat fresh. If you feed smaller amounts accoring to your schedule, she won't fill up, and if her #s start to go toward the 50 mark, she'll probably want to eat. Nova does this, and I think it's a natural reaction to BG dropping.

I have not heard of a fast release when lowering a dose.

 

The depot changes with the amount of insulin you are giving.
If for example you have been giving 2 units of lantus and you reduce the dose down to 1.75 units, the depot will still be at the amount it was when you were shooting 2 units for a couple of days until it drains a bit and the depot stabilises at the amount for a 1.75 units dose.
Its the same for when you increase the dose. If you were giving 2 units and increased to 2.25 units, it would take a few days for the depot to increase and stabilise to reflect the 2.25 unit dose.
That is why you need to be aware that when you decrease the dose, the depot can still influence the numbers for a few days. And when you increase, it can take a few days for the numbers to reduce because the depot needs to fill.
Does that make sense?

 

I have the automatic feeder with the ice packs but I'll try freezing some as well. She's a little piggy too...for the HC gravy lol so I know in a worst case scenario if she drops he can get that into her so long as shes conscious. I portioned some food out in little containers and if I stop off at home and my husband can get a few min in the afternoon, we should be able to make sure she has a snack every 2-3 hours. IF I make sure she has a good breakfast, that should be ok I hope. friday I only have a 5 hour work day and then I get 3 full days with her...and maybe we can nap lol

 

yes...that makes perfect sense! thanks for the explanation!

 

Most of her "meals" are 15-25 cals except breakfast. I give her around 60 in the morning bc shes still on the denamarin and I find if she doesn't take it with enough food she gets nauseous and then doesn't want to eat the rest of the day. I stopped the anti nausea meds yesterday and so far so good. It's going to be this way for the next 20 days

 

With a history of ketoacidosis and hepatic lipidosis it is important that Henri continues to eat well and she gets her insulin. Offering several smaller meals a day is good. Does she get the extra meals in the PM cycle as well?
Are you still testing for ketones?

 

I test her urine for ketones roughly every other day and its never more than trace. Lately it looks like its in between none and trace. I only work 2 days a week...so the days im home she eats 7 am (a big meal), 10:00 am (snack), 1 pm (snack), 4 pm (snack),7pm dinner (medium meal), 10 pm (snack) and she usually wakes me up around 3 for a snack lol

The other 2 days the 10 am and 4 pm snack doesn't always happen. I set aside the food for my husband for him tomorrow to make it easier on him amd I told him it HAS to happen. I dont care if his boss thinks he's having a potty problem lol.

The ketoacidosis is resolved but we won't know about the hepatic lipodosis and the inflammation in the vesseks of the gallbladder until the abdominal ultrasound next month.

We stopped the anti-nausea and appetite stimulant meds yesterday and so far so good

 

You are doing a great job looking after Henri. With a history of ketones its always a good idea to keep them in mind as they can reappear if she stops eating/gets sick/doesn't get her insulin when needed.
Testing for ketones is a good insurance policy as its only a month since she had DKA isn't it?

 

Yes...it'll be 4 weeks on Saturday

She always gets her 180 calories in and lately more bc of my using food to keep her from going too low.
Her drinking habits have normalized too. She was stopping from eating to drink in the middle and after every meal...it was constant

Now it's occasionally after eating and when she wakes from a nap.

I'll definitely continue to keep an eye on it though. I think once you had DKA, you're more susceptible

She also get her insulin every 12 hours (minis or plus up to 5 min

 

Looks like Henri is doing just fine with your guidance with the leftover depot. Hoping she stays steady when the depot drains. Looking SO good!!!

 

Thanks! I had to rush home from work at her +10 bc she dropped to 59 and she wouldn't eat for my husband. Slightly stressful day. I came home adhesion in between jobs bc if she needed to eat while I was at the 2nd job I wouldn't have been able to leave :-/

Do you know how long it takes to get rid of the depot?

 

4-6 cycles.

Looks like Henri is keeping you on your toes!

 

Oye...she definitely is. Its getting harder bc I have to over feed her to keep her numbers up and shes getting full :-/

Thanks for the info!