Mazi 5/5/24 AM 188 No Shot +3 144 +6 113 PMPS 190 +4 106

Discussion in 'Lantus / Levemir / Biosimilars' started by Mazi's Mom, May 5, 2024.

  1. Mazi's Mom

    Mazi's Mom Member

    Joined:
    Apr 18, 2024
    https://felinediabetes.com/FDMB/threads/5-4-24-mazi-amps-305-5-88-pmps-149-4-188.289619/
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    So I made a mistake this morning and I feel awful! I think all the stress since Mazi's diagnosis and me preparing to start a new career, and late night studying is starting to burn me out.

    This morning I woke up and checked Mazi's AMPS which was 188. I gave him his breakfast and while waiting for him to eat his food I fell back asleep. So Mazi did not get his AM insulin injection. I feel terrible.

    I woke up 3.5 hours later and immediately checked Mazi's BG. His BG was 141.

    I obviously don't want to switch up his normal schedule, so I held his dose of insulin and will plan on getting back on schedule tonight.

    I plan on doing sporadic BG checks during the day just to document his response to the missed AM dose.

    I'm still new to this and I'm assuming Mazis blood sugar was lower than his AM preshot BG and after eating when I finally woke up because of the Lantus Depot (spare tank/reserve). Meaning his numbers are not elevated because his body is using the stored (spare tank/reserve) insulin to keep his glucose from becoming elevated.

    1st Question: Am I correct in guessing that his sugar isn't elevated due to the depot (spare tank/reserve) being used at the moment?

    2nd Question: Should I expect his blood sugars to be elevated the next couple days while his body fills up the Lantus depot (spare tank/reserve)?

    3rd Question: How long can I expect the next cycles to be elevated while the depot fills up?

    4th Question: I'm also thinking I may have given a fur shot last night on 5/4. Reason why I'm thinking that is because I tried a new area to give the injection. His PMPS was 149 and his +4 BG was 188. In the past he has usually had a decrease in BG by +4...I always feel the fur after injection and the fur was dry. Any thoughts?

    Thank you in advance for your feedback!

    Theresa & Mr. Mazi
     
    Last edited: May 5, 2024
  2. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    First thing, don't beat yourself up. :bighug: You aren't the first nor the last to miss a shot due to sleep, losing track of whether shot was done, etc. Could you put either "skip" or "NS" for no shot in the spreadsheet for units and a comment in the Remarks so people will stop asking why you didn't shoot.

    With Mazi being on a lowish dose, the other factor in the mix is that his pancreas may be sputtering and occasionally kicking out some insulin. Or he could just be getting really good duration. You are right about the depot - typically the first part of the following cycle can play out like you shot the normal dose. You'll see the rise later on. The skip can also play a factor in later cycles with higher numbers. The depot should be fully back in business after 6 cycles, but it may not take that long to get him back into good numbers.
     
  3. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    @Wendy&Neko as always, thank you again for your feedback and reassurance.

    I will keep and eye on his numbers and not worry if he spikes a little in the next couple of cycles. Mazi's appointment is tomorrow to have his Libre placed for his glucose curve. I'll be sure to tell the vet about his missed dose, so when he is interpreting Mazis curve he can put the wonky numbers in the 1st couple of cycles into consideration.

    I did just update Mazis spreadsheet to note the missed shot.

    Also just a heads up, since I'm used to the alpha track numbers and starting tomorrow I will be using the Libre and learning to interpret human numbers, im sure ill be posting questions on Mazi's BG's. If I get a weird number on the Libre, I plan on retesting with the alpha track.

    However, if I get the hang of the Libre and Human numbers, I may just switch over to a human meter in the near future. Paying $56 for the Alphatrak testing strips every 7 to 10 days are starting to hurt my pockets. I feel best testing him often and recently I have cut back on how often I test him because of the costs. That said, hopefully I can learn to trust the human meter over the next two weeks while using the Libre, so I feel comfortable switching over.

    Have a wonderful day!
     
  4. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    @Wendy&Neko Mazi's doing great! AM 188, No Shot, +3 141 and now +6 113.

    I'm proud of Mazi, I dont want to get my hopes up that he is close to remission, so I'm just going to assume this is his Lantus Depot being used up.

    Also im not giving him any snacks this AM period, because I wanna see the true influence the no shot has with just a big breakfast in the morning. No worries tho, when I woke up all his food was gone, and he's currently not begging for any food. I feel bad, but one 12 hour period isn't going to hurt him. And at least I'll know he'll be super hungry for his PM dinner.
     
    Last edited: May 5, 2024
  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The way he's going, I'm not sure there's any value in placing the Libre. But that's just my opinion. One thing to keep in mind, we've heard reports the first cycle or two of Libre numbers might not be as accurate, so spot checking with the BG meter is a good idea. More here: Freestyle Libre for Cats; Tips and Information

    His numbers do look really good. But with his history, and a skipped dose, a ketones check would provide peace of mind.
     
  6. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    I kinda feel that same way about the glucose curve test, but to entertain the vet I'm just going to do it, plus I already bought the sensor.

    However, I wouldn't mind seeing how Mazi responds to the sensor and how it works. I was thinking it might be a nice resource if I ever go on vacation and have to leave him with a family member. Although, if I go on any vacations anytime this year, Libre or not, Mazi is coming with. Its way too soon for me to feel comfortable enough to not have him with me or for me to be more than 45 mins from home.

    Plus this will give me an opportunity to test and treat using a human meter.

    I will read thru the article to help me prep.

    I do not have any ketone strips, I think thats the only thing I'm missing from the "must have supplies". I will go to walmart tomorrow and pick up some strips.

    Do they have strips that you can dip in the kitty litter or is the only option is to collect a urine sample? @Wendy&Neko

    I might as well pick up some strips that test for glucose in the urine too while I'm there. Any idea if walmart or amazon have strips that can be tested in the kitty litter or is there just strips that you need to collect a urine sample in order to test?
     
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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  8. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    @Wendy&Neko I think Mazi's depot is close to running on empty. His PMPS was 190.

    He's currently eating and getting his shot in the next 5 mins. Not looking forward to seeing elevated BG's the next couple cycles, but like you said, bc he's on such a small dose, it hopefully won't take long to fill the depot.

    Have a great night!
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    A favour from you - when you've had your questions answered - could you change your subject line to update with the latest BG data and remove the "?" prefix. If you have a new question, feel free to put it up there again. There are those of us who scan the board for "?" so good to know if questions have been answered - less work for us. Thank you.
     
  10. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
  11. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    @Mazi's Mom
    Hi Theresa you need to put the date and Mazi in your title.
    I thought you were going to give 0.10 units tonight :cat:
     
    Last edited: May 5, 2024
  12. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Can you add Mazi to your title Theresa :cat: :bighug::bighug:
    @Mazi's Mom
     
    Last edited: May 5, 2024
  13. Mazi's Mom

    Mazi's Mom Member

    Joined:
    Apr 18, 2024
    @Diane Tyler's Mom Hi! Thanks for the reminder about the date.

    I'm going to adjust his dose tomorrow night after I talk to Mazi's vet tomorrow.

    Last time I spoke to the vet I told him if I had any questions or wanted to change anything that I would call him. In which I didn't.

    Reason being is because he was not a supporter of feeding mazi a snack during the early part of the cycle and at the early part of the night cycle. He said it was bc he want Mazi to have the tightest glycemic control. However, I did change his feedings without consulting with him bc I dont feel comfortable not giving him snack specially when he's having a few hypo episodes and he's already on a small dose. With me going back to work next month, giving him snacks makes me feel like Mazi will be safe. When I go back to work, I really need to focus on adjusting and learning my new role. I can't be distracted constantly worrying about Mazi. My hospital patients deserve to have me focused only on them while under my care.

    So that said, im basically going to repeat all that to Mazi's vet and I guess I'd rather have that conversation in person and have my spreadsheet data to back me me up to show that his snacks are not making his condition any worse.

    Same thing for the dose change. The vet wanted me to give him 0.5U bid, I want to show him Mazis hypo and how I lowered him to 0.25U and he was still experiencing hypoglycemic episodes. I want to have that conversation in person with my spreadsheet to show with the data and evidence. Tomorrow while meeting with him I'm going to show his hypoglycemic episode the other day and tell him I want to lower him to 0.1U and see how he does for a week. If he starts to go high within the 7 days, ill boost him back up to 0.25.

    In the past my vet said it was impossible to give an accurate 0.25U dose and that I'd have to eyeball it and each dose may not be consistent. So I want to use my spreadsheet and show him that me eyeballing the 0.25U is working..

    He had mention if Mazi couldn't handle the 0.5U, he would think about switching insulin. Which that is something I dont want to do. Lantus is the best! I believe he had mentioned prozinc (sp?) in the past. Plus I know a lot about Lantus so I would like to stick with it.

    Another reason why I want to talk in person is bc he wants Mazi to eat 3/4 can of friskies bid with no snacking in between. Besides the fact that I would like Mazi to snack during the 1st half of each cycle. I actually want to cut down on how much I am feeding him. 3/4 can bid is too much for him to eat all at once. Im afraid that he'll throw up or the big meal will trigger his pancreatitis.

    Before diagnosis he was getting fed 1.5 cans of friskies a day at 1/2 can three times a day.

    I'd like for mazi to eat 1/2 can bid for his big meals and for his snack he would eat 1/4 bid. That equals 1.5 cans which is what he was used to before diagnosis. Its the same amount the doctor wants him to eat if I was to feed him 3/4 bid with no snacks. My suggestion is the same 1.5 cans a day but its just spread out thruout the day so he isn't eating so much at once.

    Hope that makes sense.

    I feel bad, like I went behind my vets back and made changes but I am going to tell him I have to do what best for me and Mazi. That means stretching Mazi's meals out throu out the day and stretching them out so I can actually get back to work and take care of me. Taking care of me also means taking care of mazi.
     
    Last edited: May 5, 2024
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  14. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    @Diane Tyler's Mom just added Mazi's name. I promise one day in the near future I will get it right. But thanks for the reminders and holding my hand thru all my questions and mistakes...lol

    Always and forever grateful for you and Wendy!
     
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  15. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    :bighug::bighug::bighug:
     
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  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Remember, you hold the syringe. You are the one there with Mazi and observing what he needs. ECID - every cat is different. You can't pick one way of doing things and apply it to all cats. Every caregiver has to learn what their cat needs, and you have been doing that. Stick to your guns on Lantus and feeding.

    Being overweight is a common factor in diabetes. Helping him lose a little will only help him. The Royal Veterinary Clinic (London) has been doing an extensive study with overweight diabetic cats on a trial food that helps them lose weight. And having really good success with remission.
     
  17. Mazi's Mom

    Mazi's Mom Member

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    Apr 18, 2024
    I promise I will @Wendy&Neko! I'm a people pleaser so I feel bad for changing things. But I will always advocate for Mazi, family, friends, and my patients.

    I also remind myself if someone tells you, "No", you're asking the wrong person. Sometimes that means doctor shopping.

    Plus I can always hit him with the "We would never diagnose a human with diabetes, give them insulin, and tell them not to snack on low carb food after an injection".

    Also like I said, I am thankful for the spreadsheet, bc that gives me concrete evidence that the 0.5U dose and even with a snack, Mazi was still going low. Can't argue with evidence based science.

    And additionally, I can remind him that ECID, and what works for 1 cat may not work for another. And that's also true for humans.

    I have a right to have a say so in Mazi's treatment. We are suppose to be a treatment team. Regardless of his way of doing things, what we here have been doing with Mazi has been working and like you said, I'm the one who holds the syringe at home. I liked that saying Wendy! Lol
     
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