Oj vet update

Previous post from here
https://www.felinediabetes.com/FDMB/threads/12-8-oj-vet-and-fresstyle-libre-questions.239745/
Previous post from lantus forum
https://www.felinediabetes.com/FDMB/threads/12-17-oj-pmps-333-1-325-3-146-4-162-5-144.240168/

I spoke to his vet on the phone today. With him bouncing so much she now doesnt want to do his dental because his numbers are going too low. So we play the waiting game for ANOTHER couple of weeks. At this rate i feel like that tooth will never come out. His libre is on the fritz. Only works maybe 20% of the time i scan him the last two days. So i bought a relion prime meter and have started using that as it would be closer to the libre numbers than the alphatrak was.
His ketones have been negative for almost 3weeks now so thats a plus and hes eating well and still putting on weight, however today he's drinking and peeing non stop. He's peed 3 times in the last 2hrs. Like full bladder empty pee's not little here and there ones. Maybe because he's spending the majority of his time being high now because of all the bounces???? I've tried feeding the curve for a couple days now and no luck. Im debating giving him his full dose in the am and maybe doing half a unit less at night to see if that helps at all. I have to figure out something to get his numbers to stop dropping so quick so the vet feels more comfortable anesthetizing him. I wish the libre wasnt crapping out he's gotten used to not getting ear pricks and gave me a super hard time today.

 

Correction. Just went to scan him and it says replace censor so its totally kaput which sucks because im not going to be able to keep better track of his levels at night now

 

Arrrggghhhh..... that is so frustrating! It's such a huge drawback to the Libres, and it's unfortunate, because they're so great when they work. Sigh.

The no ketones is fantastic!

On the dose: with Lantus, we've found that it's really best to stick to a single consistent dose. Morning/evening splits just never work the way you want them to with the depot in play.

It's a little hard to interpret the spreadsheet right now without knowing which meter was used when-- is it all Relion/Libre (ie, human numbers) past a certain date? The formatting is still for the AT2, which makes a couple of the numbers (the 50 the other night, for example) look scarier than they are. We can help fix the formatting-- if you're comfortable with spreadsheet mechanics, it's just a matter of going in and changing the conditional formatting for one color change (the dark green-lime green cutoff, from 68 to 50). I'll also tag @Bandit's Mom, who can fix it for you if you don't want to mess with it yourself.

 

I change the conditional formatting if its a one time switch from human to pet meter or vice versa. But it looks like you are using both meters - AT for some readings and Libre for others?

 

Im not using the alphatrak anymore. I only did recently when he scanned at 58 to see where he was on the AT and it said 99. The 15th-20th +5 was just the libre. Everything after the +5 yesterday is relion premier meter

 

Okay thanks. I gave him .5 less last night as i hadnt gotten any responses. When i pricked him before work he was still in the 300s albeit high 300s but i could at least get a read, where with the libre he was being too high(over 500) to even get a read. So im sure without the libre how much he dropped overnight but he seemed consistent. A few hrs later for his am shot he was still in the 400s. I have to talk to the vet tomorrow. Not sure if i want to give the libre another try. But he runs out of gabapentin tomorrow and his antibiotic shot runs out tomorrow as its been two weeks so im not sure if he should get another one of those as well. Especially since i was talking to my human diabetic friend who was in dka twice herself. If the antibiotic is keeping an infection away that might be why he's been doing so well with negative ketones

 

And i tried to change the numbers up top with the colors but doesnt seem like i know what i'm doing lol

 

OK, so looking at the spreadsheet, he definitely seems to like to go lower at night (sigh! cats!), so that's probably where we should look for dosing insights. You shot 2.75U this morning, so it makes sense to continue with that, but I'm wondering if 2.5U might end up being the better dose for him. He came reeeeeeally close to going under 50 on 2.75U already.

On the other hand, if the gaba/antibiotics are running out and his teeth start to bother him again... It's such a tough situation. I don't know about doing another antibiotic shot, it might make sense for typical antibiotics to have a longer course, not sure about that one (your vet will know).

I wonder if showing your vet the details of the patterns on the spreadsheet, in particular the fact that he goes lower at night, not during the day when they'd be doing the dental work... maybe you could talk the vet into doing it?

 

Thats what i was hoping for. I was emailing her his graphs while the libre was working so it was very clear he runs super high in the morning and stays in the 200-300's during the day. I mentioned the dental and she was saying now he's going too low for her to be comfortable with anesthesia and i was just thinking "are you doing the dental at like 4am or something? By 7am he was shooting back up to too high to read. Im trying to do TR so we're back up to the 2.75 during the day but i also dont think i should go higher than the 2.5 at night which is why I went for 2.25. If i did that during the day i dont think he would ever be consistently in yellows so its like. Keep him too high during the day and okay at night? Okay during the day and too low at night? Ugh!!i tried for a couple days feeding him at his pmps and his +1 and +2 but did absolutely nothing to slow his drops. His vet is off on mondays so im going to reach out to her tomorrow. If i have to bring him in to get this libre removed as its dead now might as well have them do the additional 2weeks of antibiotics. And he needs his gabapentin refilled as well.

 

That's the thing about Lantus, it doesn't really work intuitively like that, unfortunately. It would be so much easier if it did! But, because of the depot, decreasing the dose at night isn't necessarily going to mean he won't go as low that night. He'll still have the depot in play, so it's very probable that only later (maybe even during the day!) the effects of the reduction will be felt. Someone likened changing doses with lantus to be like turning an ocean liner-- you can spin the wheel, but it may be a while before you fully turn. In the meantime, it can make it hard to interpret the numbers if the dose keeps changing. That's why we recommend sticking to a consistent dose if at all possible.

I hope you and the vet can figure out how to do the dental. I just feel so bad for the little guy-- toothaches are miserable!

 

Most vets have you not give insulin, or give just a half dose the morning of the dental. That way they don't have to worry about low numbers during the actual dental itself. That bad tooth needs to get out of there to help his numbers. I know, bit of a catch 22.

 

Thanks~~ yeah i thought we were all set to go ahead and schedule but she saw his dips in his graphs and was like nope. She doesnt work mondays so she doesnt know the libre broke yet. We had a touch base call scheduled for today so im going to try and put my foot down on the matter

 

Ughh. She wants to wait anooooooother two weeks before proceeding to make a dental appointment. She wanted him to go lower in dose but i said no way. She said 1-2units is usually enough for a cat to regulate and i was like sure maybe with no underlying issues but he has that tooth that isnt helping anything. He's going back tomorrow for another 2week antibiotic injection because im so worried about ketones coming back if the tooth is infected since its still sitting in there. Im debating doing another libre or just saying forget it and checking him with the meter. Only thing that sucks is not knowing how low he's dipping at night without it since thats been his thing lately. If after these two weeks go by and i still have no date for a dental i'm going to have to switch vets again i think..