1/3 Webster AMPS=494 +4=385

[Websterthecat]

No post yesterday.

One of my resolutions this year is to reduce my feline diabetes related stress as well as other stress in my life. Since Websters diagnosis, my life has been turned upside down and my physical and mental health is really starting to deteriorate.

As part of my stress reduction plan, I have decided to cut out my daily postings concerning Webster. While only a small part of my day, it's one of the many small time consuming tasks that's has contributed to my overall level of stress.

In addition, I plan to start performing less tests in the coming days, giving that Webster starts to become more stable and stops crashing as he has been. With the recent crashes that we have been seeing at night, I'm obviously not comfortable letting him go without testing until +6 at this point. Hopefully these crashes will stop soon so that I can reduce my testing to 4-6 times per day instead of 12 or more times per day that I have been doing. Needless to say, the constant testing is really weighing on me.

I hope that you guys understand why I'm making these decision. I still plan to be a part of this community and will continue to post here several times per week (most likely stop by to check on things once every day), but can not commit to daily postings for the mentioned reasons.

That being said... Looking back over the past 7 cycles at 1.0u, ( with the exception of PM 1/1 where I made the dumb mistake of raising his dose to 1.25 but quickly backed off after a chat with you guys. Thank you once again BTW) Webster has been very responsive to his insulin, even at the 1.0u dose. 3 out of the past 4 nights my wife and I have been up until 1am-2am feeding his crashes, trying to keep him above 50.

For the past two nights I have been having to feed him MC-HC food until the point that he so full that he's almost throwing up. He started to make the gagging noise for the past two nights shortly after giving him supplement food in addition to his regular food. Fortunately, he kept his food down both times. We have typically been giving him 1oz of MC-HC food at a time. Because of the drop, hes so hungry and inhales it in a matter of seconds. We decided last night to reduce his supplemental feedings to 0.5 oz at a time which will hopefully prevent him from becoming sick after eating so fast.

So.. onto my point. Just a couple days ago I was feeling hopeless after what I viewed as a failing reduction. Now, After seeing how he's approaching dangerous territory at night, I'm beginning to think that Webster really is trying to work his way down the dosing scale. This has given me a new hope.

I'm now beginning to wonder if he's looking at yet another reduction? I 99% certain that he would have fallen far below 50 last night hadn't I pumped him back up with some HC.

Just think, one of these nights I might not be available at 1 am to 2am to feed his drop and check on him and he will drop below 50.

Instead of waiting until he reaches this threshold, why not go head and reduce him to the .75u or maybe somewhere in between like .875u? Do we always wait until he hits the 50 mark before reducing?

After all, at the rate that he has been going last night, the difference between 57 and 49 is only 8 points which could have easy occurred in a matter of an additional 10 minutes of failing to take action.

 

[julie & punkin (ga)]

there's no requirement for posting every day, mike. i've heard a couple of others make comments that it seems to be a requirement, but it's not. post when it works for you! Often people post daily while they are learning, or when their cat is having a difficult time, but once they've got the hang of things they stop posting daily. You have sounded really stressed - i hope taking a break can help with that, or if getting support from people here helps, then post. Whatever works for you! You know we're on your side, mike, trying to help and not make things worse.

The goal with tight reg is to get the BGs into normal range so the pancreas can heal if it's possible. If it's not possible, at the least it protects the rest of the body from damage from high blood sugar. That's an important goal to keep in mind - the goal isn't to go down in dose, but to get the BGs under control. Getting them under control, and thereby allowing the pancreas to heal and begin sputtering back to life is what leads to the kitty successfully holding dose reductions.

I think i'd try to keep him from earning a reduction for a little bit longer - not too much, but a little while more. Typically as a cat hits green more and the time they spend in it stretches out, the bounces will get shorter and of lesser intensity. So they might clear in a day instead of 3 days and the high might only be 200 instead of 500. Right now it looks like Webster cleared the last bounce in 24 hours - that's fantastic! Watch how his bounces change and how he starts spending more than a couple of hours in green at a time. Let that help you make a decision as to when to let him go below 50 and earn that next reduction.

here's an example of a kitty that went down the dosing scale and OTJ that was very bouncy: Jersey Begin looking at the ss around April 1st - you can see she's still bouncing fairly high, but at the same time she's spending long stretches of time in normal numbers. That's healing time.

here's Max's ss - Elise had similar experiences to what you've had, with max yo-yoing with dose reductions until about June when she started preventing him from earning a dose reduction in order to get his overall BGs lowered. Look around June when Elise started using calipers so she could give smaller dose reductions instead of the standard 0.25u. He got fairly tightly regulated and then lost it in the middle of July. She had to increase the dose the beginning of August to get him back again and now he's begun going down the dosing scale and holding the reductions.

The caveat to doing this (preventing a dose reduction by keeping him over 50) is that you have to keep in mind how much effort you're spending to keep him there. If it's lots of high carbs and carbing for hours at a time, then he needs to get a dose reduction to prevent him becoming overdosed. But if it's easy to bring him up over 50 and keep him there, then it's still ok to keep doing it. Does that make sense? This is in line with the guidelines on the Tilly's version of our protocol that has a holding the dose phase articulated:

Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.

If your cat remains in this range, testing for ketones is no longer necessary. But if your cat should, for example, develop an infection and suddenly have higher BGs as a result, start testing for ketones immediately and adjust the dose appropriately.​

 

[Sandy and Black Kitty]

Hi there

Jeepers, if I would have posted every day of our 21 month journey I would have lost my mind. Like Julie said, once you get the hang of things post as needed.
However please do keep the ss updated. It make all the difference should something come up and you need answers .

The goal with tight reg is to get the BGs into normal range so the pancreas can heal if it's possible. If it's not possible, at the least it protects the rest of the body from damage from high blood sugar. That's an important goal to keep in mind - the goal isn't to go down in dose, but to get the BGs under control. Getting them under control, and thereby allowing the pancreas to heal and begin sputtering back to life is what leads to the kitty successfully holding dose reductions.

Julies recommendations are all spot on. I'll just add that with regards to healing pancreas (if it's in the cards) , healing can take time. How much time is unknown - ECID. And should the pancreas start sputtering, as long as the numbers allow, continuing to support them with exogenous insulin before putting them back to work full time is wise.

I know it's tough and burn out is a potential pitfall. I had my periods of exhausted hopelessness and despair with BK constantly swimming in a sea of relentless pink in spite of all our efforts. And then being dx with IAA, something no one ever even tested for much less dealt with before.
Sitting here 5 years later, with the cat that literally no one , myself included , ever imagined would get regulated much less go OTJ - all I can say is hang in there.

Do your best to pace yourself and remember Webster is leading the dance and the dance will change.
Go with the flow.

 

[Websterthecat]

there's no requirement for posting every day, mike. i've heard a couple of others make comments that it seems to be a requirement, but it's not. post when it works for you! Often people post daily while they are learning, or when their cat is having a difficult time, but once they've got the hang of things they stop posting daily. You have sounded really stressed - i hope taking a break can help with that, or if getting support from people here helps, then post. Whatever works for you! You know we're on your side, mike, trying to help and not make things worse.

The goal with tight reg is to get the BGs into normal range so the pancreas can heal if it's possible. If it's not possible, at the least it protects the rest of the body from damage from high blood sugar. That's an important goal to keep in mind - the goal isn't to go down in dose, but to get the BGs under control. Getting them under control, and thereby allowing the pancreas to heal and begin sputtering back to life is what leads to the kitty successfully holding dose reductions.

I think i'd try to keep him from earning a reduction for a little bit longer - not too much, but a little while more. Typically as a cat hits green more and the time they spend in it stretches out, the bounces will get shorter and of lesser intensity. So they might clear in a day instead of 3 days and the high might only be 200 instead of 500. Right now it looks like Webster cleared the last bounce in 24 hours - that's fantastic! Watch how his bounces change and how he starts spending more than a couple of hours in green at a time. Let that help you make a decision as to when to let him go below 50 and earn that next reduction.

here's an example of a kitty that went down the dosing scale and OTJ that was very bouncy: Jersey Begin looking at the ss around April 1st - you can see she's still bouncing fairly high, but at the same time she's spending long stretches of time in normal numbers. That's healing time.

here's Max's ss - Elise had similar experiences to what you've had, with max yo-yoing with dose reductions until about June when she started preventing him from earning a dose reduction in order to get his overall BGs lowered. Look around June when Elise started using calipers so she could give smaller dose reductions instead of the standard 0.25u. He got fairly tightly regulated and then lost it in the middle of July. She had to increase the dose the beginning of August to get him back again and now he's begun going down the dosing scale and holding the reductions.

The caveat to doing this (preventing a dose reduction by keeping him over 50) is that you have to keep in mind how much effort you're spending to keep him there. If it's lots of high carbs and carbing for hours at a time, then he needs to get a dose reduction to prevent him becoming overdosed. But if it's easy to bring him up over 50 and keep him there, then it's still ok to keep doing it. Does that make sense? This is in line with the guidelines on the Tilly's version of our protocol that has a holding the dose phase articulated:

Phase 3: Holding the dose
Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing. A well regulated cat looks like this.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.

If your cat remains in this range, testing for ketones is no longer necessary. But if your cat should, for example, develop an infection and suddenly have higher BGs as a result, start testing for ketones immediately and adjust the dose appropriately.​

Thank you Julie. I knew that you guys would understand.

Thanks for the reminder when it comes to the actual goal that we are reaching for. While I would really like to see him move down in dosing and eventually get off the juice, I have to remind myself that we are looking at getting his BGs to remain in an acceptable range. Whether or not his pancris decides to start functioning normally once again will of course be the big question.

Thanks for the advice on determining a reduction. We are going to try to hold this 1u as long as possible until either the additional food load is becoming unreasonable or we burn out from staying up until 2 am, and then getting back up at 6:30 every day. I'll be sure to pop back in and see what you guys think before taking a reduction.

 

[Websterthecat]

Hi there

Jeepers, if I would have posted every day of our 21 month journey I would have lost my mind. Like Julie said, once you get the hang of things post as needed.
However please do keep the ss updated. It make all the difference should something come up and you need answers .


Julies recommendations are all spot on. I'll just add that with regards to healing pancreas (if it's in the cards) , healing can take time. How much time is unknown - ECID. And should the pancreas start sputtering, as long as the numbers allow, continuing to support them with exogenous insulin before putting them back to work full time is wise.

I know it's tough and burn out is a potential pitfall. I had my periods of exhausted hopelessness and despair with BK constantly swimming in a sea of relentless pink in spite of all our efforts. And then being dx with IAA, something no one ever even tested for much less dealt with before.
Sitting here 5 years later, with the cat that literally no one , myself included , ever imagined would get regulated much less go OTJ - all I can say is hang in there.

Do your best to pace yourself and remember Webster is leading the dance and the dance will change.
Go with the flow.

No worries Sandy. I will be sure to keep his sheet up to date.

Thank you for the words of encouragement.