27 Oct | Girlie | AMPS 652; +2=634; +4=466; +5:30=234 Impressive drop

[Girlie's mom]

Condo: http://www.felinediabetes.com/FDMB/...stop-the-nightly-bounces.185915/#post-2065038

Dose increase this AM to 0.8: hope this helps get her on a more even keel and stop the Dr Jekyll (AM) and Mr Hyde (PM) action we've been seeing for a while now. Utterly frustrated and confused at this point as I really can't figure her out or what to do... (whinge, whinge, whinge).

I want to start the Aloe Vera Juice this weekend: will start with 1/2 tsp tonight, I think. Hate to do a dose change AND the addition of AVJ, to be honest. Civvie Max is doing well on it: noticeable poo improvement.

Ketones negative this AM

Hope everyone surfs safely - and steadily! - tonight.

 

[Alicia & Maggie (GA)]

Good luck with your dosecrease!

 

[Tracey&Jones (GA)]

Jones is doing the same thing to me...don't know if I am too low on dose or too high....I feel like I am on some kind of trampoline and I just can't seem to get off. He is just high then cycle 3 or 4 later go from a pink to a blue....

Doesn't help that I am not home to help feed the curve or see if other higher carb foods will help....


I am wondering if I need to move to Levemir...

Good luck with the dose increase....hope it is the answer you are looking for.

 

[Girlie's mom]

The Abbott Optium Neo here in Australia does blood glucose and ketones. I had that meter and it is reliable.

Sheba was a huge diver and bouncer and I found the only way to help control the dives and therefore lessen the bounces was by feeding the curve and stopping the big drops. While Girlie is having those huge drops in a short period of time she will continue to bounce.

@Bron and Sheba thanks so much for that tip re: the Optium. That's easier to get here (monitor and strips) than

I've been trying to feed the curve, but I'm probably doing it rather ineptly. When she starts really high, LLC and LC6 doesn't seem to make a difference. I started her at LC9 this AMPS to try to get ahead of the game, and although she'd only dropped 18 pts by +2, she was acting like she was dropping, so I tested her, and she'd dropped 78 more points by +2:30. By +3 she was 502, so a 152 pt drop in two hours from her AMPS, roughly 50 pts an hour, which isn't too bad, by Girlie's standards on the AlphaTrak2.

On 25 Oct, when I saw that she was going to dive deeply again straight away, I was a bit too proactive, and gave her some MC gravy (15) at +1. This slowed her down a bit, and she had a more level day, but it was a high level day.

I'm wondering whether it might not be better to just keep her on the same LC food but use the honey to try to stall the drops. The problem is getting it into her: she hates it. Mixing it with food is a no-go with her. I see on your SS that you used a drop of honey; could I give it via syringe or some other way, do you think?

I really don't know what to do, to be honest. We'll see if this tiny dose increase from 0.75 to 0.8 will do something. Here's hoping!

 

[Girlie's mom]

Yes, Girlie is definitely hard to figure out. Unlikely, but possibly dropping low in the middle of the night causing those blacks? I only waited about 3 months to switch to Levemir, but am not one who's known to follow the rules. I think switching from one depot insulin to another is not as dramatic as a in-and-out insulin to a depot or vice-versa. Once your vial is getting close to running out, I would seriously consider it.

@Bronx's dad : just replying here so yesterday's and today's post don't get confused.

I've gotten a lot of night tests since 13 October, and although she can do her +2 dives, I can't see her dropping like she does during the day. She's a different cat PM than AM - at least, it seems that way to me.

Is there a big adjustment when you switched to Levemir? Did the numbers go haywire, or was your transition fairly smooth? I know Bronx is an Acro cat; it seems, though, from a quick glance at your SS, that it took a good month or two before you saw a real drop in the numbers: is that right? I'm wondering about any dramatic changes as I'm supposed to go overseas for a week at Christmas, and Girlie will be at the vet; if she's really looking too wonky then I might postpone the trip, but we'll see. I then have to go away again at the end of February for two weeks: I'll see where she is then, as well, I guess.

What a journey this is!

 

[Bronx's dad (GA)]

Yes, FD is quite a journey! It was a smooth transition from Lantus to Lev. Bronx was stuck in blacks & reds at that time so I had no concern of any crazy wonkiness. Not sure if it helped the numbers get lower at all (the SRT has done that), but many folks have switched to have a flatter cycle which Girlie is in need of. They say you should start with 70% of the Lantus dose to start, I didn't and only dropped from 7.5 to 7, but as I said earlier, Bronx's #s were all reds and blacks. Acro is making this journey much harder!

 

[LizzieInTexas]

I've gotten a lot of night tests since 13 October, and although she can do her +2 dives, I can't see her dropping like she does during the day. She's a different cat PM than AM - at least, it seems that way to me.

It would be a huge challenge but I wonder what numbers would show if you did a test every hour for 24 hours.

They say you should start with 70% of the Lantus dose to start

That would be a very small dose considering the current dose is 0.8U of Lantus.

 

[LizzieInTexas]

Is there a big adjustment when you switched to Levemir?

From the stickys

An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins

 

[Bronx's dad (GA)]

And forgot to mention what Lizzie just pointed out, the later nadir, I rhymed lol. Love the later nadir, I can shoot AMPS and go to work knowing he is safe until I get home & then shoot PMPS and go to sleep, knowing he is safe until I wake up.

 

[Girlie's mom]

From the stickys

Boy, would an onset of +4 and a late nadir change my life re: work! That would be a joy....of course, Girlie would probably decide to be different...

It would be a huge challenge but I wonder what numbers would show if you did a test every hour for 24 hours.

I've come close to that several times. She's so different depending on where she starts from with her PMPS. If it's high, there's almost no point, as there's almost no movement. If she starts from a decent blue, then it's a little different. Just a quick scan shows that when she starts from a fairly decent PMPS number, her nadir seems to be at PM+5. But those aren't generally too low and didn't cause a bounce as she was already in blues or almost blues.

I think she becomes a different cat at night...

 

[Girlie's mom]

And forgot to mention what Lizzie just pointed out, the later nadir, I rhymed lol. Love the later nadir, I can shoot AMPS and go to work knowing he is safe until I get home & then shoot PMPS and go to sleep, knowing he is safe until I wake up.

That alone would change my life HUGELY: to be able to go to work and to be able to sleep. Wow! Hard to imagine...

 

[Stacy & Asia]

I hope Girlie comes down for you soon and stops all the bouncing around

 

[Girlie's mom]

+4= 466
+5:30 = 247: drop of 219 points in 1.5 hours even with LC9 food all morning.

Of course because I'm getting ready to leave for work!

 

[Marje and Gracie]

Darrah

In response to your PM, when I first looked at her SS, the thing that’s popped out at me was that these high numbers started shortly after you started using the insulin ruler. Not immediately but shortly and, considering how the depot can affect some cats, it could take several cycles to see changes.

I read back all the way through condos starting on Oct 7 and I believe you said there was a 5u variation in some syringes and also that it looked like she was getting less insulin with the ruler measurements. I saw several people reference that you could only use the ruler with specific BD syringes but I did not read a confirmation that the specific BDs are what you are using.

FWIW, I was in the test group to use the insulin ruler in the US. We were sharing accuracy in dosing strategies with the German Katzen Forum and they asked us to try the rulers and we told them about dosing with calipers. I’m a biologist and so using any kind of measurement tool is second nature to me. I thought dosing with the insulin ruler was an absolute pain and I got a lot more inaccuracies with it than using the calipers.

If it’s not the insulin ruler, than there had to be something that changed for her numbers to pop up like that. Yes, cats can lose regulation but you don’t normally see them going from where she was to all that black with a loss of regulation. You typically start seeing more yellow and pink...maybe a few scattered red....but all that black...that doesn’t look like a loss of regulation to me from where she was, simply by her not suddenly having enough insulin.

I just don’t think that drop to 83 in the a.m. cycle of 10/10 triggered that 504 at PMPS. That cycle clearly indicates a loss of duration, for whatever reason....that is what causes numbers to go from 83 to 203 in two hours. I notice she got the Zydax in between those two numbers but others have said that med does not appear to raise the BG. Or it didn’t in their cats.

I also think the dose increase on the pm cycle of 10/21 was rushed because she was clearly bouncing from the drop and green on the a.m. cycle of 10/19.

The things that I think can cause this sudden change in BG include:
—dosing errors
—medication
—illness (but not just CKD in and of itself) or infection
—pain

On her labs:
—that is a really big jump in creatinine from July until now and yet her phosphorus, her potassium, her calcium and a few other things I look at with CKD look good. Yes, it could be just progression of CKD but when I see a jump like that, I think about kidney infections. Quite often, you don’t see any evidence of a kidney infection in the urinalysis because it’s much higher up in the kidneys. This was the case in my last CKD kitty, Gus. He never had any protein or bacteria in his urine and he had two kidney infections...both of which caused his creatinine to increase. It was determined it was a kidney infection based on ultrasound. I’m not saying this is what is going on with Girlie but just throwing out ideas for you. We would usually start subq fluids at the point where she is with this creatinine.
—Could you please recheck the hematocrit? You have 0.034....I’m hoping it is actually 0.34
—she is in the “gray” area for her thyroid for elderly cats. What this means is that she could be trending towards hyperthyroidism, at least by US standards. A tT4 over 2.3, by US standards, indicates a gray zone for hyperT in elderly cats. Her tT4 equates to 2.72 when converted to US measurements.

She is now definitely in a bounce/dive pattern. I would not have increased her dose today if it were me. As Bron said, to try and get her flattened out a bit, it’s going to take some managing the curve with food. She certainly does not seem carb sensitive as HC food barely slows her down.

What I’d like to do is look at this a little closer and take more time to read what you’ve fed her exactly as she’s dropping and see if I can pick out any patterns but perhaps I’ve given you enough above to start trying to figure out if any of the things I’ve mentioned could be at play here. The fact that she’s gone from 0.1u to 1u in less than 20 days definitely throws up a big flag to me that something is going on. I see a couple of instances of rushing the dose increase during a bounce.

Thanks for your patience while I look at little more in depth at this. I will post more tomorrow.

 

[Girlie's mom]

Darrah

In response to your PM, when I first looked at her SS, the thing that’s popped out at me was that these high numbers started shortly after you started using the insulin ruler. Not immediately but shortly and, considering how the depot can affect some cats, it could take several cycles to see changes.

I read back all the way through condos starting on Oct 7 and I believe you said there was a 5u variation in some syringes and also that it looked like she was getting less insulin with the ruler measurements. I saw several people reference that you could only use the ruler with specific BD syringes but I did not read a confirmation that the specific BDs are what you are using.

FWIW, I was in the test group to use the insulin ruler in the US. We were sharing accuracy in dosing strategies with the German Katzen Forum and they asked us to try the rulers and we told them about dosing with calipers. I’m a biologist and so using any kind of measurement tool is second nature to me. I thought dosing with the insulin ruler was an absolute pain and I got a lot more inaccuracies with it than using the calipers.

Marje, I can't thank you enough for everything you wrote and your insight re: her SS. I've been thinking of ordering calipers; I'd like to get the one you reference in your post, but we don't have that brand here in Australia. I'll keep searching. I haven't been able to find the Terumo half-unit syringes here in Oz; I'll have to see if I can get them from overseas. I'm using the BD Micro-Fine 0.3 ml 1/2 unit U100 syringes, which are the right ones for the insulin ruler, at least. Interesting what you have to say re: that you found more inaccuracies using that than using the calipers.

If it’s not the insulin ruler, than there had to be something that changed for her numbers to pop up like that. Yes, cats can lose regulation but you don’t normally see them going from where she was to all that black with a loss of regulation. You typically start seeing more yellow and pink...maybe a few scattered red....but all that black...that doesn’t look like a loss of regulation to me from where she was, simply by her not suddenly having enough insulin.

I just don’t think that drop to 83 in the a.m. cycle of 10/10 triggered that 504 at PMPS. That cycle clearly indicates a loss of duration, for whatever reason....that is what causes numbers to go from 83 to 203 in two hours. I notice she got the Zydax in between those two numbers but others have said that med does not appear to raise the BG. Or it didn’t in their cats.

I agree: she made a HUGE jump to 504 PMPS on 10/10, and the only thing that seemed to be different was the Zydax injection and the blood and urine tests at the vet's. She was on the way to getting constipated again; and I gave her the BCS of 0.1 on PM 10/10 and AM 10/11, but she's come back quickly from a BCS before. I asked the Acupuncture vet re: Zydax vs. Cartrophen: Wendy and Neko and Bron and Sheba used cartrophen with no ill effects; although both are Pentosan, the vet said that they could be using something to hold the active ingredients in the Zydax that could affect BG levels. I'm going to check on this, but it wasn't having a noticeable affect on her arthritis anyway, so I think I'll skip the next shot that's due shortly.

She also hit high numbers consistently from 24 - 31 Aug (Zydax injection on 28 Aug, but she was in high numbers before that). She wasn't constipated.

On her labs:
—that is a really big jump in creatinine from July until now and yet her phosphorus, her potassium, her calcium and a few other things I look at with CKD look good. Yes, it could be just progression of CKD but when I see a jump like that, I think about kidney infections. Quite often, you don’t see any evidence of a kidney infection in the urinalysis because it’s much higher up in the kidneys. This was the case in my last CKD kitty, Gus. He never had any protein or bacteria in his urine and he had two kidney infections...both of which caused his creatinine to increase. It was determined it was a kidney infection based on ultrasound. I’m not saying this is what is going on with Girlie but just throwing out ideas for you. We would usually start subq fluids at the point where she is with this creatinine.

—Could you please recheck the hematocrit? You have 0.034....I’m hoping it is actually 0.34

—she is in the “gray” area for her thyroid for elderly cats. What this means is that she could be trending towards hyperthyroidism, at least by US standards. A tT4 over 2.3, by US standards, indicates a gray zone for hyperT in elderly cats. Her tT4 equates to 2.72 when converted to US measurements.

There was no sign of bacteria or infection in the urine sample. I'm going to see the vet on 15 Nov, unless you think I should get her in sooner. I'll ask her to do a kidney U/S. Girlie wees a fair bit; she doesn't strain to wee, but she'll stand there for a bit before it starts. Could that be indicative of an infection? She's not distressed in any way when she wees. Poo is another matter entirely, unfortunately. Getting her constipation under control is proving challenging.

Subq fluids: I can ask the vet re: subq fluids; she didn't think that was necessary just yet, but wanted to see where Girlie was in a month (Nov). I'm happy to give those if it's indicated. The hematocrit is 0.34! Sorry.

Thyroid: I looked it up, and other than drinking a lot, she doesn't show any other signs. The lab report said "Result consistent with normal thyroid function. Values in the upper portion of the reference interval may occur in some cats with hyperthyroidism. If clinical signs are suggestive of hyperthyroidism, further diagnostic options include repeating T4 (waiting at least 1-2 weeks) and free T4." Could it just be the difference between Australian and US numbers? We'll be repeating the blood and urine tests, so I can ask her to check whatever I'd like. If you have any specific suggestions, just let me know, and I'll get those tests.

 

[Girlie's mom]

I also think the dose increase on the pm cycle of 10/21 was rushed because she was clearly bouncing from the drop and green on the a.m. cycle of 10/19.

The things that I think can cause this sudden change in BG include:
—dosing errors
—medication
—illness (but not just CKD in and of itself) or infection
—pain

She is now definitely in a bounce/dive pattern. I would not have increased her dose today if it were me. As Bron said, to try and get her flattened out a bit, it’s going to take some managing the curve with food. She certainly does not seem carb sensitive as HC food barely slows her down.

What I’d like to do is look at this a little closer and take more time to read what you’ve fed her exactly as she’s dropping and see if I can pick out any patterns but perhaps I’ve given you enough above to start trying to figure out if any of the things I’ve mentioned could be at play here. The fact that she’s gone from 0.1u to 1u in less than 20 days definitely throws up a big flag to me that something is going on. I see a couple of instances of rushing the dose increase during a bounce.

Thanks for your patience while I look at little more in depth at this. I will post more tomorrow.

I have no doubt that I've made many mistakes, and I'm happy for you to tell me what you see so that I can learn and try not to make them in future! I so want to learn and understand so I can help her.

Doses: I always try to get advice on dose changes, as I'm not confident in interpreting her SS. When she goes to solid reds and blacks, I have to admit it concerns me: I'm afraid she might be getting stuck in those high numbers again. When I look at the TR protocol and then at her SS, it seems that I've hung on to doses too long at times, but I could very well be mistaken. I was torn re: whether or not to give the dose increase this morning. She seems to be bouncing so high at night because of the deep drops during the day from those high numbers at night: it's becoming a vicious cycle.

The 0.1 U to 1 U in less than 20 days really stumps me, as well.

The dramatic dives and equally dramatic bounces have plagued us from the start. She hates the deep dives: she desperately wants food, but it's hard to balance giving her food to try to slow her down with the possibility of a real nose dive into shark territory when I need her to be willing to eat for me. Trying to find this balance is really hard for me. If food doesn't seem to do it for her, I wonder if I should try to experiment with honey? She finds it appalling: she won't accept it voluntarily. She's not keen on glucose syrup, but that's a thinner liquid, and she's used to getting liquid meds. We're having better luck with the Cats in the Kitchen MC and HC gravy these past few days. The hypo on 4 July that landed her in hospital for a week, where she got Caninsulin and then rapid-acting insulin before they settled on Lantus again, really shook me: she looked so terribly ill at the vet's. She had a really rocky start with FD due to the severe constipation and enema under anesthesia; the resultant pneumonia; asthma attack as she'd been off Flixotide for a while; refusal to eat much at all (Mirtazapin fixed that); and then the hypo. I've probably overreacted to drops and new blue and green numbers out of fear of another hypo.

When she starts from lower numbers (anything under pink), she does much better, of course. She still dives, but it doesn't seem to spark the kind of bounces we've gotten recently from her huge drops from really high black numbers. But how to stop the dramatic dives in the AM and the subsequent PM bounces?

Food: Finding the right food and the right carb level has also been a challenge. Early on I mistakenly thought FF I was giving her was LC, but it was actually MC in Oz. Then I was mixing half LLC and half MC to get a 6 or 7 LC food: not a good idea? Then I tried to just stuck to FF LLC 1 (Savoury Salmon) or Wellness Beef and Salmon (LC6) or Wellness Beef and Chicken (LC4). She can be picky with food unless she's really diving; she's never been food motivated.

Anyway! I'll leave it at that. Thank you again, so much, for taking this time to help us. Girlie and I are very grateful!

 

[Beenie (GA)]

Hope you can get Girlie's dose straightened out. I know there's been mention of Lev, are you considering a switch? Seems to have leveled out some bouncy kitties.

 

[Bron and Sheba (GA)]

@Bron and Sheba thanks so much for that tip re: the Optium. That's easier to get here (monitor and strips) than

I've been trying to feed the curve, but I'm probably doing it rather ineptly. When she starts really high, LLC and LC6 doesn't seem to make a difference. I started her at LC9 this AMPS to try to get ahead of the game, and although she'd only dropped 18 pts by +2, she was acting like she was dropping, so I tested her, and she'd dropped 78 more points by +2:30. By +3 she was 502, so a 152 pt drop in two hours from her AMPS, roughly 50 pts an hour, which isn't too bad, by Girlie's standards on the AlphaTrak2.

On 25 Oct, when I saw that she was going to dive deeply again straight away, I was a bit too proactive, and gave her some MC gravy (15) at +1. This slowed her down a bit, and she had a more level day, but it was a high level day.

I'm wondering whether it might not be better to just keep her on the same LC food but use the honey to try to stall the drops. The problem is getting it into her: she hates it. Mixing it with food is a no-go with her. I see on your SS that you used a drop of honey; could I give it via syringe or some other way, do you think?

I really don't know what to do, to be honest. We'll see if this tiny dose increase from 0.75 to 0.8 will do something. Here's hoping!

@Girlie's mom

If you have a look at Sheba's 2015 SS you will see that she would often bounce during one of the cycles then drop the next, much like Girlie is doing. Early in 2015 I was just learning to feed the curve...but Sheba was still bouncing a lot. Then on 12 May I made a concerted effort to monitor her closely and feed the curve, and you can see the results I got over the next few weeks. After dropping to 1.9 on 29May she bounced high ....but you can see how I managed to feed the curve and stop her dropping too far too fast during the previous weeks. And I was rewarded with some lovely numbers.

Next time she is coming off the bounce, why don't you try and bring her down slowly.....by carbing her up so she doesn't drop down from the blacks to the blues or greens in one cycle. You have to test often in the first half of the cycle to keep ahead of the drops. Then hopefully next cycle you will have maybe a yellow or even a pink preshot which you can then feed and bring down lower to the blues. Then hopefully she might settle down. You might have to do this a few times before it works but it is worth the try.

If she doesn't like honey, have you tried mixing it with a bit of food?
I found a drop the size of a smartie was all that was needed. But ECID and it is trial and error.
LC did nothing to slow Sheba down and depending on the strength of the cycle, sometimes MC would be enough and sometimes HC or honey was needed.

 

[Marje and Gracie]

Hope you can get Girlie's dose straightened out. I know there's been mention of Lev, are you considering a switch? Seems to have leveled out some bouncy kitties.

We really like to see cats be on Lantus for at least six months, if possible. I’ve used both insulins and my insulin of choice would be Levemir from the get go. But that doesn’t mean she won’t bounce. I’ve worked with many CGs on the switch and it helps some to stop bouncing and others, not so much.

We need to find the reason the numbers have jumped so radically before we start switching insulins.

 

[Marje and Gracie]

@Girlie's mom

If you have a look at Sheba's 2015 SS you will see that she would often bounce during one of the cycles then drop the next, much like Girlie is doing. Early in 2015 I was just learning to feed the curve...but Sheba was still bouncing a lot. Then on 12 May I made a concerted effort to monitor her closely and feed the curve, and you can see the results I got over the next few weeks. After dropping to 1.9 on 29May she bounced high ....but you can see how I managed to feed the curve and stop her dropping too far too fast during the previous weeks. And I was rewarded with some lovely numbers.

Next time she is coming off the bounce, why don't you try and bring her down slowly.....by carbing her up so she doesn't drop down from the blacks to the blues or greens in one cycle. You have to test often in the first half of the cycle to keep ahead of the drops. Then hopefully next cycle you will have maybe a yellow or even a pink preshot which you can then feed and bring down lower to the blues. Then hopefully she might settle down. You might have to do this a few times before it works but it is worth the try.

If she doesn't like honey, have you tried mixing it with a bit of food?
I found a drop the size of a smartie was all that was needed. But ECID and it is trial and error.
LC did nothing to slow Sheba down and depending on the strength of the cycle, sometimes MC would be enough and sometimes HC or honey was needed.

Thanks, Bron. This is exactly true......managing the curve with food takes more testing and a more adaptive way of feeding to catch the numbers from the get go. I used it very successfully with Gracie as well. However, I think Sheba and Gracie were more carb sensitive than Girlie appears to be.

I am going to take a closer look through the SS and see where’s the drops are, what food was fed, what the result was, etc and try to come up with some ideas specific to Girlie instead of the general guidance I give on managing the curve. You might also have some thoughts to offer to my ideas (miss you and I hope you, Rob, and Harry are doing well).

 

[Marje and Gracie]

Marje, I can't thank you enough for everything you wrote and your insight re: her SS. I've been thinking of ordering calipers; I'd like to get the one you reference in your post, but we don't have that brand here in Australia. I'll keep searching. I haven't been able to find the Terumo half-unit syringes here in Oz; I'll have to see if I can get them from overseas. I'm using the BD Micro-Fine 0.3 ml 1/2 unit U100 syringes, which are the right ones for the insulin ruler, at least. Interesting what you have to say re: that you found more inaccuracies using that than using the calipers.




I agree: she made a HUGE jump to 504 PMPS on 10/10, and the only thing that seemed to be different was the Zydax injection and the blood and urine tests at the vet's. She was on the way to getting constipated again; and I gave her the BCS of 0.1 on PM 10/10 and AM 10/11, but she's come back quickly from a BCS before. I asked the Acupuncture vet re: Zydax vs. Cartrophen: Wendy and Neko and Bron and Sheba used cartrophen with no ill effects; although both are Pentosan, the vet said that they could be using something to hold the active ingredients in the Zydax that could affect BG levels. I'm going to check on this, but it wasn't having a noticeable affect on her arthritis anyway, so I think I'll skip the next shot that's due shortly.

She also hit high numbers consistently from 24 - 31 Aug (Zydax injection on 28 Aug, but she was in high numbers before that). She wasn't constipated.


There was no sign of bacteria or infection in the urine sample. I'm going to see the vet on 15 Nov, unless you think I should get her in sooner. I'll ask her to do a kidney U/S. Girlie wees a fair bit; she doesn't strain to wee, but she'll stand there for a bit before it starts. Could that be indicative of an infection? She's not distressed in any way when she wees. Poo is another matter entirely, unfortunately. Getting her constipation under control is proving challenging.

Subq fluids: I can ask the vet re: subq fluids; she didn't think that was necessary just yet, but wanted to see where Girlie was in a month (Nov). I'm happy to give those if it's indicated. The hematocrit is 0.34! Sorry.

Thyroid: I looked it up, and other than drinking a lot, she doesn't show any other signs. The lab report said "Result consistent with normal thyroid function. Values in the upper portion of the reference interval may occur in some cats with hyperthyroidism. If clinical signs are suggestive of hyperthyroidism, further diagnostic options include repeating T4 (waiting at least 1-2 weeks) and free T4." Could it just be the difference between Australian and US numbers? We'll be repeating the blood and urine tests, so I can ask her to check whatever I'd like. If you have any specific suggestions, just let me know, and I'll get those tests.

Thank you for the info. Just getting my morning coffee and will provide some responses. Please know I was not being critical or saying you made mistakes. I wish I had a dime for every decision I made with Gracie that didn’t pan out. It happens because we are dealing with hormones and living, breathing creatures. I was just trying to provide an overview.

I also would be careful when considering whose dosing advice to take when it is unclear to you what is going on and whether there needs to be an increase or not. Sometimes, it is clear and intuitive and many members can be helpful if you just need a second opinion to reinforce your gut opinion. Until we can figure out what is causing this and how to minimize it, dosing might not be so intuitive with Girlie and it might be harder to see when and how the protocol applies.

But, just because a member has a well regulated cat or a cat that went OTJ quickly, does not mean they understand the insulin, dosing, or reading a SS. There are only a handful of people still on the board that understand how to actually read a SS and the nuances. I know Wendy has helped you and she’s is certainly one of those people that I would always trust. She knows her stuff. But, like me, she’s been involved in a lot of intense family matters. Some of the others in that handful have been dropping in and out but it seems like everyone has got something going on and most of us have, very sadly, lost our FD babies over the past few years.

 

[Photorecon]

Morning,

Girlie is quite new to the business, let her adapt to new dosing before increase / decrease. If ketone
is at bay and you can test dont freak out at low or high GL. Let her go, if you see she's a disaster on legs
and the dose is what's needed, no need to destroy yourself by testing every 20 min. FD is a long journey,
she's get ''stable'' at one point. Nice you're going to the vet. No matter the insulin management, if there
is a mess under the carpet it has to be fixed for your effort to worth something.

Again, no hurry, let a dose do it's job for some time before switching, you're helper the pancreas,
not replacing it. It will start doing it's job when realizing there is a better conform zone down below.

Best wish.

Sébastien.
.