? 26April2020/Maxi/AMPS:274/+2:223/+4:136/+6:78/+8:109/+10:81/+11:69/PMPS:58, 72/Diarrhea/Inappetence

[Judy and Freckles]

So, does this mean maybe I will still give Maxi his shot tonight if his numbers go up high enough?

I don't even think it's a case of if his numbers go up high enough. It's more what you are comfortable shooting and if you think you can steer him with food if needed. The first time shooting green is hair raising for everyone.

 

[Judy and Freckles]

Has Maxi ever had ketones?

 

[bambinaki]

He now doesn't want to finish his regular food. He's just licked away the gravy. This means he hasn't gotten his cabergoline for the day. I don't know if I should squirt some in his mouth. I think someone told me cabergoline has to be tapered off, so I'm not sure if it's ok for him not to get it tonight. I've also heard cabergoline can cause stomach upset.

I've wondered if the new finickiness is due to his kidney disease (common with that disease). But re. the kidney disease he's been ok, as far as I can tell. He hasn't had a blood test for over a month.

 

[bambinaki]

I don't even think it's a case of if his numbers go up high enough. It's more what you are comfortable shooting and if you think you can steer him with food if needed. The first time shooting green is hair raising for everyone.

I'm ready to follow any advice as long as it comes from someone who knows very well what she's talking about and will hang out with me or at least tell me exactly what to do in any scenario. I just want to do what's best for Maxi.

 

[bambinaki]

Has Maxi ever had ketones?

No, he hasn't. And his urine was tested for ketones by the vet a week ago.

 

[Bron and Sheba (GA)]

Do you have any cerenia or ondansetron if you need it for nausea?

 

[Judy and Freckles]

I'm ready to follow any advice as long as it comes from someone who knows very well what she's talking about and will hang out with me or at least tell me exactly what to do in any scenario.

I would love to be able to give you advice that I was confident about, but the only acro cat I have experience with is Freckles, and she hasn't been too complicated for me! lol

I just want to do what's best for Maxi.

I know you do. We all want that too.

 

[Sandy and Black Kitty]

Skip (and think of it as a first shot)

Better a day too high than an hour too low.

 

[Bron and Sheba (GA)]

I'm ready to follow any advice as long as it comes from someone who knows very well what she's talking about and will hang out with me or at least tell me exactly what to do in any scenario. I just want to do what's best for Maxi.

Very sound thinking.
That is why we are all hesitant in offering advice. If it was straight low numbers it would be easy. But with the acro, carbergoline, R, reduced appetite, diarrhoea in the mix we are not experienced enough

 

[tiffmaxee]

Oh good Sandy is here.

 

[Bron and Sheba (GA)]

Skip (and think of it as a first shot)

Better a day too high than an hour too low.

Sandy, thank you!

 

[Sandy and Black Kitty]

I’m out back in the cottage- On my way back to the main house. Will post from there.

 

[bambinaki]

Do you have any cerenia or ondansetron if you need it for nausea?

I might have some cerenia, but the way he ate the Friskies earlier, I don't know if he's nauseous.

 

[bambinaki]

Skip (and think of it as a first shot)

Not sure what that means.

Do you mean give him his AM shot tomorrow at the 9.25 dose and consider it the first shot at that dose rather than the third, which is what it actually would be?

 

[Bron and Sheba (GA)]

Not sure what that means.

Do you mean give him his AM shot tomorrow at the 9.25 dose and consider it the first shot at that dose rather than the third, which is what it actually would be?

I think Sandy meant a fur shot...probably an autocorrection by the iPad.

 

[bambinaki]

Do you have any cerenia or ondansetron if you need it for nausea?

Yes, I have cerenia.

 

[bambinaki]

Thank you, @SingsToCats , @Bron and Sheba (GA) , @Judy and Freckles , @tiffmaxee , and @Sandy and Black Kitty

 

[Sandy and Black Kitty]

Something is changing.

Please read about becoming data ready to shoot low numbers. Lots of good info there.

I think Sandy meant a fur shot...probably an autocorrection by the iPad.

I did mean fur shot - it was the blasted auto-correct on my iPhone.

Very sound thinking.
That is why we are all hesitant in offering advice. If it was straight low numbers it would be easy. But with the acro, carbergoline, R, reduced appetite, diarrhoea in the mix we are not experienced enough

I don't think there is any one person here that has experience with all those variable moving parts. I dont have personal experience with Acro or cabergoline, however I do understand high doses and safely navigating completely uncharted high dose waters. my recommendation to skip tonight's shot is for safety sake because 1-he has a considerable depot 2- a mid green PS is a sudden change and out of pattern 3 - no data on shooting blue or green 4 - his appetite is off 5 -you have R if needed to help with any fallout.

My $0.02-
see where the numbers go on tonight's cycle. Get a +8 and shoot R according to your current scale for AM or PM (not mid cycle), hopefully that will bridge the insulin gap until lantus AM shot onset.
Then put away the R for a couple cycles while you evaluate what the current 9.25u Lantus dose is doing.

If the cabergoine is kicking in a reduction may be around the corner.
Its anybody's guess.

 

[bambinaki]

I did mean fur shot - it was the blasted auto-correct on my iPhone.

I don't think there is any one person here that has experience with all those variable moving parts. I dont have personal experience with Acro or cabergoline, however I do understand high doses and safely navigating completely uncharted high dose waters. my recommendation to skip tonight's shot is for safety sake because 1-he has a considerable depot 2- a mid green PS is a sudden change and out of pattern 3 - no data on shooting blue or green 4 - his appetite is off 5 -you have R if needed to help with any fallout.

My $0.02-
see where the numbers go on tonight's cycle. Get a +8 and shoot R according to your current scale for AM or PM (not mid cycle), hopefully that will bridge the insulin gap until lantus AM shot onset.
Then put away the R for a couple cycles while you evaluate what the current 9.25u Lantus dose is doing.

If the cabergoine is kicking in a reduction may be around the corner.
Its anybody's guess.

Thank you, Sandy

 

[Marje and Gracie]

Karen had these questions in a PM which I’m moving here.

I would still like to know about:

• The so-called BCS

• This, which you said, Marje:

Since @@Sandy and Black Kitty and @@Wendy&Neko have been helping you with the R scale, I’m going to tag them and see if they think we need to increase it as it doesn’t seem to be doing a lot. You get an occasional response but I’d like to see if we can fine-tune a little more. We have to be careful so we don’t send it the other way and cause bouncing.

• If/When I should increase cabergoline in light of what happened today

Thank you

In a nutshell for tonight, a BCS is a temporary reduced dose. For non-high dose cats, I’m personally not a fan of BCS shots in response to lower Preshot numbers due to the depot. But everyone has their own feeling about them. I never shot a BCS.

Usually the effect, if it’s going to be seen, is not until late in the cycle. I’ll let Wendy & Sandy give you their thoughts on BCS doses for high-dose cats. There can be an advantage to draining a depot on a high dose cat for specific reasons.

Wendy and Sandy will have to give you their thoughts on the R scale. IMHO, what was at play today was the dose increase with the R in the mix plus bounce clearing.

I’ve not used cabergoline so I won’t ever give advice on it. I agree with Wendy that I trust Paula (or Wendy).

 

[bambinaki]

In a nutshell for tonight, a BCS is a temporary reduced dose. For non-high dose cats, I’m personally not a fan of BCS shots in response to lower Preshot numbers due to the depot. But everyone has their own feeling about them. I never shot a BCS.

Usually the effect, if it’s going to be seen, is not until late in the cycle. I’ll let Wendy & Sandy give you their thoughts on BCS doses for high-dose cats. There can be an advantage to draining a depot on a high dose cat for specific reasons.

Wendy and Sandy will have to give you their thoughts on the R scale. IMHO, what was at play today was the dose increase with the R in the mix plus bounce clearing.

I’ve not used cabergoline so I won’t ever give advice on it. I agree with Wendy that I trust Paula (or Wendy).

Thank you, Marje

 

[Wendy&Neko]

Sorry I was away from the board today during the excitement. Love to hear Maxi was doing yoga with you. Since this was the second time seeing green, and such a long stretch of it, he probably felt off because of it. First time Neko saw a stretch of green she hid under the bed.

I think I gave a BCS twice, maybe three times with Neko. All three times were when there was downward pressure on her insulin dose, due to one or a combination of her IAA breaking and SRT working and causing the tumour to shrink, hence less growth hormone being output. Anyway, I never shot a BCS because of a low preshot value, but rather to drain an overfull depot. I think two of the BCS might have been the cycles after seeing BG in the 20's. An overful depot means you can be battling low numbers for a long time. The third time was when I knew she was about to ask for a reduction (I was right), and her appetite was off, and it was a night time cycle and I was tired.

One other thing, whether you give a BCS really depends on the cat. After Neko's first SRT, she was still extremely bouncy. I never gave a BCS then because I knew she'd bounce to the moon for a while after a reduction and be safe. After she learned to tone down the bouncing, I had to be more careful. The amount you reduce the dose is also ECID. Some people start with a half dose. I found taking just 1/3 off was enough to deplete the depot enough. Again, it's about learning what works for your cat.

From what I've observed, cats taking cabergoline don't seem to have a highly predictable pattern in how or if it will impact them. It's ranged from a sudden roller coaster ride down the dosing scale, to a very slow walk down, to no impact. Uncertainty means caution is key in decision making about giving insulin. I would much rather deal with higher numbers for a few cycles than be fighting to bring up an inappetant cat when I'd rather be sleeping.

I think someone told me cabergoline has to be tapered off, so I'm not sure if it's ok for him not to get it tonight. I've also heard cabergoline can cause stomach upset.

Don't worry about him missing part of a cabergoline dose for tonight. We had at least one person have to do every other day for a period of time until their cabergoline refill got shipped. Cabergoline can cause stomach upset, but I remember seeing people have that issue early on, not after 4 weeks of taking it.

And Sandy suggested, let's see where he ends up with his Lantus dose, without R in the mix, before figuring out if the R scale needs tweaking.

 

[bambinaki]

Sorry I was away from the board today during the excitement. Love to hear Maxi was doing yoga with you. Since this was the second time seeing green, and such a long stretch of it, he probably felt off because of it. First time Neko saw a stretch of green she hid under the bed.

I think I gave a BCS twice, maybe three times with Neko. All three times were when there was downward pressure on her insulin dose, due to one or a combination of her IAA breaking and SRT working and causing the tumour to shrink, hence less growth hormone being output. Anyway, I never shot a BCS because of a low preshot value, but rather to drain an overfull depot. I think two of the BCS might have been the cycles after seeing BG in the 20's. An overful depot means you can be battling low numbers for a long time. The third time was when I knew she was about to ask for a reduction (I was right), and her appetite was off, and it was a night time cycle and I was tired.

One other thing, whether you give a BCS really depends on the cat. After Neko's first SRT, she was still extremely bouncy. I never gave a BCS then because I knew she'd bounce to the moon for a while after a reduction and be safe. After she learned to tone down the bouncing, I had to be more careful. The amount you reduce the dose is also ECID. Some people start with a half dose. I found taking just 1/3 off was enough to deplete the depot enough. Again, it's about learning what works for your cat.

From what I've observed, cats taking cabergoline don't seem to have a highly predictable pattern in how or if it will impact them. It's ranged from a sudden roller coaster ride down the dosing scale, to a very slow walk down, to no impact. Uncertainty means caution is key in decision making about giving insulin. I would much rather deal with higher numbers for a few cycles than be fighting to bring up an inappetant cat when I'd rather be sleeping.
Don't worry about him missing part of a cabergoline dose for tonight. We had at least one person have to do every other day for a period of time until their cabergoline refill got shipped. Cabergoline can cause stomach upset, but I remember seeing people have that issue early on, not after 4 weeks of taking it.

And Sandy suggested, let's see where he ends up with his Lantus dose, without R in the mix, before figuring out if the R scale needs tweaking.

Thank you, Wendy.

I think I'll stay away from BCSs since I don't really know what I'm doing -- I don't get how giving more insulin depletes an insulin depot.

Maxi's +6 just now was 188, so it doesn't look like it will be high enough at +8 to give R as Sandy suggested.

I'm happy that he ate his +6 small meal with gusto.

Do you think I should go ahead and double his dose of cabergoline tomorrow?

Paula, in light of what happened today, do you think I should double the dose tomorrow? At first you suggested going up a little (from 30 mgc to 35) but then you said go ahead and double it (to 60). @Olive & Paula

 

[bambinaki]

The post that Judy found seems to indicate a BCS dose would be something like 2.5 but the appetite and diarrhea concern me too.

As to shooting tonight can you be off schedule tomorrow?

Sorry, Elise, I missed this earlier and didn't reply. I guess it's moot now...

 

[bambinaki]

I've read these:
http://www.felinediabetes.com/FDMB/...y-to-shoot-handle-lower-pre-shot-numbers.147/
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

I'm still unsure of what to do tomorrow morning (4 hours from now). Please advise: under what conditions to shoot and how much to shoot?

Thank you


@Wendy&Neko @Sandy and Black Kitty @Marje and Gracie

 

[bambinaki]

OK, I think I understand now about the BCS. I had understood it to be an additional shot between normal shot times while it is actually a lower dose at a normal shot time. Right?

 

[bambinaki]

Well, I guess the +10 awful number of 370 indicates I'll be giving Maxi 9.25 units of Lantus in 2 hours.

I feel like I should give him R now, but Sandy said at +8 and didn't say anything about +10, so I won't give R. I hope not giving R now is the right thing to do. (This is an example of why advice ahead of time for multiple scenarios is helpful.)

His number will probably be sky high in 2 hours at his AMPS, but per advice, I won't give R at AMPS.

An added treat to all this is my annual evaluation with my boss is today.

 

[bambinaki]

AMPS: 460

 

[Judy and Freckles]

OK, I think I understand now about the BCS. I had understood it to be an additional shot between normal shot times while it is actually a lower dose at a normal shot time. Right?

Yes that's correct. A lower shot at normal shot time.

 

[Judy and Freckles]

An added treat to all this is my annual evaluation with my boss is today.

Good luck with the review. Time to shine and show how resilient you are!

 

[Olive & Paula]

@bambinaki how did I miss all the excitement. Well my phone battery AND tablet battery died at same time.I

Maxi certainly is work in progress. I don't think there is any 1 person who has done Lantus, R, and cabergoline at the same time. Certainly more things at play.

Initially, I said slow increases so Maxi system wasn't shocked by it since his dose is half what it should be. However, when people start using it, they start at dose scripted which was higher than yours. Now Your vet says to increase by 2.5 ml. That would put Maxi at 75 mcg which appears to be common dose of the capsule used. Suspension seems to be at 60 mcg. It's just how it comes in those forms.

There are no guidelines I know about for working with cabergoline. I do know pharmacist who makes ours suggested it and vet agreed. And common sense that no one dose for any medication fits all.

My thought here is 2 options; 1. Give 60 mcg and if increases are needed until ACRO symptoms are under control, 2. Give the 75 mcg the more common dose.

Ollie started at 60 and we ended up over the 75. I have not read anywhere about ones who started at 75 and went higher.

Skipping a dose is no big deal. If stopping permanently then it's best to taper off over a couple of weeks time.

There will be times you will have wild days with glucoses falling rapidly. And times where you go back up the dosing scale to where you were or higher. but the caber dose doesn't change. Some of that is because the tumor secretions are being interrupted, but you do not change cabergoline dose because of that, it's what you want it to do (does that make sense ?).

I can certainly attest to there are no patterns at least with Ollie. Her other issues can throw her glucoses off at the drop of a dime. However, her acro symptoms mainly the stridor, unsure walking, headaches, pot belly are gone and that's because of the caber. Her glucoses we just deal with.

Now maybe @Pamela & Amethyst is at a higher dose of caber for 3 yrs now and Amethyst is on high dose of insulin but pretty stable. Flat blues which I would love. Maybe she can shed some light.

 

[bambinaki]

Good luck with the review. Time to shine and show how resilient you are!

I just saw your kind message, Judy. Thank you! Because of what was (is) going on with Maxi, I postponed it. It's May 6 (I think), so a few more days of being on pins and needles. But those pins and needles are nothing compared to the ones I'm on over Maxi.