Elmo AMPS at 162 ...stalling food

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Critter Mom said:
I think you could be looking at a skip again tonight, Beth. BG's falling.

How long before PMPS was the last time Elmo ate anything, and what carb%/amount did he eat?


Mogs
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Hmmmm.....let me look.....last eat was at +2.5 and was a 1 teaspoon ....1/2 5 carb. And 1/2. 8 carb
 
Beth 73 said:
Mogs, u think he might do well on higher carb....mostly eats 5's
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There's no way of knowing without doing a food trial. Some cats do better on slightly moderate carbs, some cats do better on ultra-low carbs. For example I was feeding Saoirse a food less than 2%. I gave her a different food one day which was about 4.4% and her BG levels went down on the slightly higher carb food (think it's something to do with how the pancreas produces insulin in relation to what has been eaten in previous meals).

With a food trial you give a meal, lift the food straight after and then test at +1, +2, and +3 after the meal to see what happens to the BG levels.

It's something to think about for the near future. At the moment I think the only thing to focus on is keeping Elmo safe and steady doing what you're doing food-wise at the moment.


Mogs
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Beth 73 said:
Wondering if thyroid is a factor...is under control but due for a recheck
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I don't know anything much about feline hyperthyroidism. Over the last couple of days I've been trying to help new members Jeff and Scooter over on the Welcome board. Scooter is hyper-T and Jeff has been having difficulty with diabetes regulation and thyroid levels (currently complicated by what looks like too high a dose of what's probably an unsuitable insulin for Scooter's needs).

I'd be interested to hear back when you get Elmo's thyroid levels checked again. I like learning about other feline health issues.


Mogs
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So protocol for tonight same as last night : 1. Eat whenever he wants. 2. Check BGs several times before bed. 3. Leave out snack for overnight ( I ordered an auto feeder but not here yet). Questions: 1. Stay at 5 carb for now? (I am restricted by high ish kidney numbers and no fish cos of thyroid). 2. Contact vet in morning to get Lantus prescription and u 100s( ;) Kris)... does that about cover it for tonight ??? At a MUCH better comfort level about this tonight...cos you all have my back :bighug:
 
Beth 73 said:
So protocol for tonight same as last night : 1. Eat whenever he wants. 2. Check BGs several times before bed. 3. Leave out snack for overnight ( I ordered an auto feeder but not here yet). Questions: 1. Stay at 5 carb for now? (I am restricted by high ish kidney numbers and no fish cos of thyroid). 2. Contact vet in morning to get Lantus prescription and u 100s( ;) Kris)... does that about cover it for tonight ??? At a MUCH better comfort level about this tonight...cos you all have my back :bighug:
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Sounds like a good plan, Beth. You've been to hell and back so doing this part again tonight is nothing.

BTW - Lantus is a U100 insulin so you have to use U100 syringes. The half unit marks will allow half unit dose fractions but you'll have to eyeball 0.25 u fractions. It's when you use U100 syringes with a U40 insulin that all the dose fraction options are available.
 
Kris & Teasel said:
Sounds like a good plan, Beth. You've been to hell and back so doing this part again tonight is nothing.

BTW - Lantus is a U100 insulin so you have to use U100 syringes. The half unit marks will allow half unit dose fractions but you'll have to eyeball 0.25 u fractions. It's when you use U100 syringes with a U40 insulin that all the dose fraction options are available.
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Nooooooo.....going with Lantus means MORE eyeballing :eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek::eek:....
 
And I'm still in need of changing insulins or do u think Elmo can do it on vetsulin....I'm willing to do anything but just asking your opinion
 
Beth 73 said:
And I'm still in need of changing insulins or do u think Elmo can do it on vetsulin....I'm willing to do anything but just asking your opinion
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Lantus works well for many cats. If you want to try something that's more like Vetsulin (ie., an in and out insulin) there's ProZinc. It's expensive - $100 plus for a vial - but is slower in onset than Vetsulin and usually lasts around 12 hours.
 
Kris & Teasel said:
Lantus works well for many cats. If you want to try something that's more like Vetsulin (ie., an in and out insulin) there's ProZinc. It's expensive - $100 plus for a vial - but is slower in onset than Vetsulin and usually lasts around 12 hours.
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Just saw that u had experience with both and wondered why u switched
 
Beth 73 said:
And I'm still in need of changing insulins or do u think Elmo can do it on vetsulin....I'm willing to do anything but just asking your opinion
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I think it would be more straightforward - and SAFER - to switch to a gentler insulin. Look at the problems you're having with dosing the Vetsulin now in order to keep Elmo in safe numbers.

You may find that your vet is very happy with the numbers Elmo is seeing at the moment. Many vets have diabetic patients who never achieve this level of regulation because their guardians don't / can't home test. Consequently many vets aren't as ambitious as we are about treatment goals. (A lot of them are just happy to see their diabetic patients below the renal threshold for most of the day.) Your vet may even suggest a remission trial (i.e. stop insulin treatment to see whether Elmo will stay in the normal range with diet control alone) but based on my own experience and what I've learned from observing other cats here I think that could be somewhat premature.

Elmo has spent the day in the normal range but it is still the higher part of the normal range. He's a ketone-prone kitty so the more you can do to let his pancreas rest and return to the lower part of the normal BG range the better so that his body will be able to manage normal metabolic processes and keep him ketone-free. Also the pancreas heals more when a kitty spends more time in the lower part of the normal range. By continuing treatment with a gentler insulin it could help Elmo's pancreas beta cells rest longer and recover more insulin-secreting function and perhaps set him up for a strong remission.

Another thing to speak to your vet about is how Elmo has low energy levels mid-cycle on Vetsulin. A switch to a different insulin could make him feel better for longer each day while he's undergoing treatment.

Before you talk to your vet about a switch you might want to post on the Lantus and Levemir board to ask the members there about both of the L insulins; some cats seem to feel better in themselves on Levemir. I'm tagging @jayla-n-Drevon to see whether she can tell you a little about her experience with the different insulins.

For the way that Elmo's responding to Caninsulin I would not suggest Prozinc as the next choice.


Mogs
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Wow. I miss a day and a half (birthday party out of town for this surrogate Grandma) and come back to all sorts of excitement (saw all the low number issues from last night). You're in good hands here with Mogs and Kris and so glad they have been here to help out. Kudos to you ladies. You are the best!
Glad to see Elmo is doing well but I agree with Mogs. A gentler insulin like Lantus or Levemir would IMHO make your life much easier. And as a Momma Bean who has used both Lantus and Levemir, my experience is that my girl is much livelier with the Levemir and doesn't conk out quite so much on it as she did with Lantus.
 
Beth 73 said:
Just saw that u had experience with both and wondered why u switched
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Long, complicated story, Beth. Teasel is extremely unpredictable and bouncy and he was like that on Lantus as well. I wasn't following the FDMB way of doing things but was doing a weekly curve for my vet. Long story short, he ended up in DKA from chronic rebound that kept him in high numbers. When that episode resolved I wanted him off the Lantus. My vet suggested ProZinc although she had no one else using it. I don't think she'd ever had a client using Levemir either. So here we are.
 
Kris & Teasel said:
Long, complicated story, Beth. Teasel is extremely unpredictable and bouncy and he was like that on Lantus as well. I wasn't following the FDMB way of doing things but was doing a weekly curve for my vet. Long story short, he ended up in DKA from chronic rebound that kept him in high numbers. When that episode resolved I wanted him off the Lantus. My vet suggested ProZinc although she had no one else using it. I don't think she'd ever had a client using Levemir either. So here we are.
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A perfect example of the right insulin being the one that agrees with the cat. :)


Mogs
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Thanks for the tag @Critter Mom
HI!
So Dre was dx over a year ago and my vet stated he was NOT a FD expert-
He gave me a bottle of vetsulin-syringes and DM food wet and dry.
I asked the dose and he said "I can't imagine he would need less than 1 unit 2x a day:eek::eek:"

I was a bit traumatized not because of the 1 unit but because of the "guessing" and not instructing me to test-ESPECIALLY with vetsulin!
Dre was beyond miserable on vetsulin - he would drop hard and fast and rise again quickly.
We went to pro zinc and Dre was happy again BUT it lasted 6 hours if we were lucky-
Dre is a grazer so I was more than happy to switch again to lantus-he was still happy on lantus but he is just a natural diver I guess and he could easily go from 300 to 50/ +4
I am now on Lev and I really like it-he is happy it has no sting and his nadir is usually +9 and he goes down slowly so I can catch him and intervene if needed to avoid a dangerously low number.
I also like Lantus and Lev because he doesn't have to eat on such a tight schedule.
I am pretty sure remission is not in our future and I think Lev lasts the longest with him.
Good luck!:bighug:
 
Mercy ladies, lots of great info on not enuf sleep, me thinks. I will read over and have a think in the morning when I will call vet. Hopefully eye rolling will be kept to a minimum or I may punch him out in my sleep deprived state :blackeye:. Seriously tho, I covet all ur input and feel free to continue to give it .
 
I switched to Levemir due to the sting from the Lantus rather than clinical observations (she's a high dose kitty due to Insulin Auto Antibodies) but I was amazed at the difference in Menace's general behaviour and activity level with the Levemir compared to the Lantus. My vet had no experience with Levemir but she agreed with trying it and she is now quite agreeable to using it given my experience.
 
Well, I must admit I find the prospect of deciding and then learning to use a new insulin a bit intimidating. Better after sleep , I'm sure .
 
I am so much less stressed on lev knowing I can shoot and not worrying about if he ate enough before onset because we had 4 hours before it kicked in.... lantus would sting him even on a low dose.
I hope you get rest!
 
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