Panter is in trouble

Well, there he comes... at +14.5 and 22.9... more delay... I gave him the reduced amount 6.75 (2.7).
How long should I keep him on the reduced one do you think?

And today I'm a bit pessimistic I guess... with these delays... that means that we ending up medicating at night...can't do this in the long run... what do we do then?... Like now, maybe it would be better to not give him and wait for his pm shot, but then again, we will never have curve to 'trust'.... yes many thoughts...
 
I'd keep him on the reduced dose until Deb can have a look. She thought yesterday that he might be due (earn) another reduction very soon.

It looks like he's bouncing again and you need to give the new dose a few cycles & a chance to settle in.

Hold that reduced dose for now unless he earns another reduction - then you immediately reduce the dose the next cycle by .25 units (U100 .625u)
Any time Panter drops below 5 mmol/L (90 mg/dL), the dose needs to be reduced.
 
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A bit frustrating - I'm mom to a two-legged too - and my sweet two-legged just let Panter out through the patio door just now... after I closed the cat door to make sure he gets his pm shot... Things doesn't work very well right now...
 
Panters-mom said:
Puhh...to have an wild outdoor cat with diabetes is a bit complicated I have to admit...
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Yes, you and we knew this could get complicated with Panter, the mighty hunter. Especially now, there are probably lots more mice and voles around for him to eat. Plus frogs, salamanders, birds and lots of other prey that gets his hunting instincts going strong.
Panters-mom said:
and my sweet two-legged just let Panter out through the patio door just now... after I closed the cat door to make sure he gets his pm shot.
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Life happens. Young children don't understand that cats need medicine and testing sometimes.
Panters-mom said:
How long should I keep him on the reduced one do you think?
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Hold the dose for several more cycles. As Shelley said, looks like Panter is bouncing, so hold the dose steady for now. Until he earns another reduction by going below 5 mmol/L(90 mg/dL).

Panters-mom said:
with these delays... that means that we ending up medicating at night...can't do this in the long run... what do we do then?... Like now, maybe it would be better to not give him and wait for his pm shot, but then again, we will never have curve to 'trust'.
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Goeril, skip a shot to get yourself back to a normal dosing schedule. Since you have gotten so far off schedule, I'd suggest you skip a dose the next time that Panter doesn't come to you for several hours.

If you have a bag of dry treats you can maybe shake, so Panter comes to associate that sound with your calling him to come back inside to eat? Or some other sound you can make, so he comes running. I do that with my cat, make a kiss-kiss type sound and call her name, when it's time for her meals.

Yes, the 6.75U U100 dose (2.7U U40 dose) looks good for now.

Maybe @Panic has some ideas on how to get Panter to come to you, since she also has a diabetic cat that goes outside.
 
Hi Goeril :)

Sounds like Panter is a lot like my younger cats haha. I've had indoor-outdoor cats for years, some that will do anything to come inside and others that will do anything to get out. About two years ago we bought a new mobile home and put it on our current property; the cats were understandably freaked out and 4 out of 6 of them refused to come in at all. Panic was one of them that never wanted to come inside until she got sick and diagnosed with diabetes. I sort of used her rampant hunger as a way to convince her to come inside more since inside = food.

At this point, I've now successfully convinced all 6 of the cats to want to come in again and it's basically just letting them in to eat and not "trapping" them inside after. If they decided to chill a few minutes great, otherwise I let them back out. In Panic's case, I do not feed her outside hardly at all, mainly just because the other cats eat higher carb food so I feed them outside and her inside. I imagine she strongly associates the house with food/treats. She also interestingly, after 10 years, no longer associates the shaking of dry food with meal time, so she ignores it when I shake food for the others. I also have bought her little catnip mice toys and every once in a while she indulges herself into a little playtime.

I make a point to know where Panic is most of the time as well. We have a couple acres of land with lots of hide-y places. Her current fad is inside the old boat in the backyard, but recently has been switching to the carport out front since it's cooler. Sometimes she stays under the back porch. Since I test and feed often, I come outside a lot to call her and I find she's usually near the door waiting on me to let her in for another snack.

As long as you can convince Panter to come when called I wouldn't worry too much about keeping him in, especially if he doesn't like it. If possible, sometimes I just test outside wherever Panic is at rather than dragging her inside. I really don't struggle to find her at all, I just need to already know her hiding spots. There have been just a couple times where I was a few minutes late with a shot because she was out, but it was only because it was raining outside and I'm sure you know how difficult it is to convince a cat to come out in the rain. :woot:

Also noticed that Panter wears a collar - I had a very cute collar customized for me from Etsy with Panic's info and DIABETIC written on the collar itself. I bought some medical warning tags originally but figured she wouldn't appreciate them dangling on her haha.
 
Thank you Deb, Shelly and Elisabeth - thank you for all the encouragement and you made me smile/laugh! That felt good!:-) I'm so glad you understand. And yes, Panic sounds like Panter! He even has the same hiding spots:-) - unfortunately he has the bigger forest as well (he was basically more or less living in the forest his first 7 years until he came to us) as well as maybe the most difficult one - and of course his favoritt - under the roof where we can´t get hold of him. That's the place he will lay and sleep and ignore me - if he is not hungry though:) I know this because suddenly he pops out of there stretching and purring and like 'I've heard nothing'- after me calling him for an hour or two..:) But like you say, the problem comes when I lock him in - like to test in his nadir time or something - and absolutely worse - at night time - he goes nuts... So I'm hoping we will find his insulin level - as the matter of fact is that - so far - when he feel free, he even comes on time, sometimes he just comes like a clock... but again, soon as he feels some things up and that he might be locked in... nope - don't like that...
I'm thinking, could it be better to keep him a bit high, like in yellow/top blue in nadir time - then its not this big panic of him dropping too low and all the close monitoring that is then needed - what's your thoughts about this?

As we speak he just bumped down from the roof...

Another one - as mentioned, we are far of schedule - the insulin time today is 1 o'clock and pretty hopeless. Should I just skip this one today and than start a new one at 7 as before? (as you mention Deb). And if I should catch up on time, will one hour at the time be too much - if the BG is around 17-21 as it normally is at +11?

Have a great day you all! :-)
 
Also, can I ask, what feeding schedule do you use? Panter eats about six times a day - more than 600g of wet food. He was very skinny, no I will say a bit less than normal. The idea of often feeding is to make him come home often - and it has worked very good - well up to now... And he would likely be more and more outdoors as it gets warmer - so should I feed him more less times.... just some thoughts in process...:-)
 
I skipped the am shot and I'm starting over at 7 pm. Thinking - I will try to give him a 85g bag/box at +12 after shooting, then a big meal 150g just before nadir closing in +5 - the idea is that he will have some food in his stomach when nadir 'kicks in'), then put out a snack 50g daytime (maybe 100g at night as he is more active) +8, maybe even from +7 (6/7 is the nadir) ...but not too much food here though, then he want show up for his shots... Does this sound like an idea?
 
I can't offer any suggestions about feeding and/or feeding times. My diabetic kitty was diagnosed as 'likely' IBD (definite sensitive stomach issues) and I feed smaller more frequent meals.

I'm sure others will chime in about feeding suggestions & I'll be keeping an eye out for any updates on You & Panter. :)
 
I love cats but sometimes I have to scowl at them when I know they've been purposefully ignoring me LOL.
We are surrounded by woods as well (we may have a couple acres but most of it is still covered in pine trees!) but luckily the cats don't go past the tree line often, unless they've spotted a rodent of course!
I'd recommend either making that "under the roof" spot accessible to yourself (ladder perhaps?) so you can pop up there to say hello/offer treats or if not, blockade it. Do take some extra time to go out often and say hello and leave him be, he may start associating you with food more.

I've mainly based Panic's feeding schedule off her onset/nadir, so she gets mini meals at +2, +4, and +5, both daytime and nighttime. She gets snacks of chicken or cheese at test time usually, and I usually end up giving her small bites of her wet food after nadir if she asks. She was eating probably double of what she eats now at first, but she was down to 4 lbs at the time.

Does Panter get fed inside/outside/both? Does he have any high value treats he really loves?

Panters-mom said:
I'm thinking, could it be better to keep him a bit high, like in yellow/top blue in nadir time - then its not this big panic of him dropping too low and all the close monitoring that is then needed - what's your thoughts about this?
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I'd say the tricky thing about insulin is you can't always gauge where to keep him BG-wise ... a perfect dose can suddenly nosedive into hypoglycemia for no reason, and you alternately wouldn't want him running too high. It's very inconvenient. I will say that when we were still using Prozinc there were days where I couldn't monitor at all and Panic would throw a lower-than-average number, I'd either lower the dose for the day or skip entirely.
 
Panic said:
I'd recommend either making that "under the roof" spot accessible to yourself (ladder perhaps?) so you can pop up there to say hello/offer treats or if not, blockade it.
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Yes, been thinking about this...probably a good idea!

Panic said:
Does Panter get fed inside/outside/both? Does he have any high value treats he really loves?
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Always inside. Always same routine. First up on the table. Wrap a towel just lightly around his neck, fast BG test, dry his eyes that runs, cuddle and look for tics - and he loves it :cat: - so he jumps up at the table by himself. Then food. He is actually amazing - except from the few times (but probably will be more) when he doesn't show up.

Tonight at pm shot he was 20.5 and that was +18 - thats a change - I thought he would be higher. That's positive right? :-)
 
Hi Goeril,

Good to hear you skipped a shot, to get yourself back on schedule and back to your normal sleeping and awake times.

Panters-mom said:
I'm thinking, could it be better to keep him a bit high, like in yellow/top blue in nadir time - then its not this big panic of him dropping too low and all the close monitoring that is then needed - what's your thoughts about this?
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Ideally, you don't really want Panter's nadir BG to be above renal threshold, where excess glucose is dumped into the urine. That can result in frequent UTI's (urinary tract infections) but more importantly there will be slow but steady damage to his other organs.

Plus, our diabetic cats rarely cooperate on keeping their BG levels up at nadir. If only they would be so accommodating!:)

So somewhere above 180-250 mg/dL ( 10-13.8 mmol/L) is too high, above renal threshold for most cats. Each cat is different, and they do not have the same renal threshold. But it takes time to get cats BG's down lower. So don't worry too much about that at this point in time.

I think you have to let Panter be Panter. And not worry too much about his BG levels and what might happen one day in the future. Panter is being a typical cat, and you have to go along with what he is doing.

If he feels trapped, when you try to keep him inside, you'll simply have to let him indulge his wanderlust tendencies. So sometimes you don't get those tests. So sometimes his BG might drop lower at mid-cycle than is ideal. Many cats will naturally seek out food, when they feel their bodies blood glucose drop lower. Panter may come home for a bite to eat when that happens. Panter is too much of a free spirit to keep confined, especially now that late spring is here and summer is just around the corner. Let him wander to his heart's content, and love him when he comes home for those "pick the ticks off" sessions.

You'll probably get off schedule with the shots again. But now you know what to do next time.

Panters-mom said:
I skipped the am shot and I'm starting over at 7 pm. Thinking - I will try to give him a 85g bag/box at +12 after shooting, then a big meal 150g just before nadir closing in +5 - the idea is that he will have some food in his stomach when nadir 'kicks in'), then put out a snack 50g daytime (maybe 100g at night as he is more active) +8, maybe even from +7 (6/7 is the nadir) ...but not too much food here though, then he want show up for his shots... Does this sound like an idea?
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Your plan sounds reasonable Goeril.

You know he is going to catch more mice, and dine out at his favorite restaurant on his catches. You do what is possible for you and Panter, not some idealized feeding schedule, such as feeding only every 12 hours, that many vets suggest. I fed Wink 4 times a day, 2 breakfasts, 2 dinners, but he was strictly an indoor cat.

I haven't had a diabetic cat in 3+ years, since Wink died. So no suggestions from me on changes to your suggested feeding schedule.
 
Deb & Wink said:
Ideally, you don't really want Panter's nadir BG to be above renal threshold, where excess glucose is dumped into the urine. That can result in frequent UTI's (urinary tract infections) but more importantly there will be slow but steady damage to his other organs.
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Got it! I treated my CKD ill cat for three years. That was hard, though amazing what you adopt to. But I don't hope to do that again...

Deb & Wink said:
I think you have to let Panter be Panter. And not worry too much about his BG levels and what might happen one day in the future. Panter is being a typical cat, and you have to go along with what he is doing.
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Yes, I think you're right. I'm thinking, I will give him the best possible life the years he has left and that means I will have to give him his freedom and space to be in his chosen environment - the outdoors - with the extras of having a family to come home to. Then he is happy.:cat:

Deb & Wink said:
You'll probably get off schedule with the shots again. But now you know what to do next time.
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Yes, probably. Thanks for all the advises. Very valuable. Feels less stressful now.

To mention, today has worked good. He has been on schedule and hanging around, BG okay, and life is good!;)

Thanks again!! Have a great evening - night time here.
 
Panter is showing up for his shots in good spirit. But two mornings he has been very low 10.7 at +12 and 6.4 at +10 - that probably means far too low at nadir... He also hasn't been eating his night food the last three nights - that is two meals he is missing - can look like this is a new habit for the time. Was thinking - could it be an idea to lower his insulin only at night? I did reduced the insulin tiny bit this morning... but only from 2.7 to 2.6 (6.75 to 6.5 100u syringe).
 
Panters-mom said:
But two mornings he has been very low 10.7 at +12 and 6.4 at +10 - that probably means far too low at nadir...
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Goeril, This is one of those "almost impossible to tell" what Panter is doing at nadir. But you are probably right.

Panters-mom said:
He also hasn't been eating his night food the last three nights - that is two meals he is missing - can look like this is a new habit for the time.
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His not eating food at night would most likely cause the BG numbers to be lower in the morning. Since there isn't food to keep the BG levels up higher.

If you look back at Panter's SS, you can see when he dropped into the blues and yellows at pre-shots, he drops much lower at nadir.

I think I'd shave or reduce Panter's dose down even a bit more. Down by a full 0.25U (U40 measurement) instead of only the tiny adjustments you make. So from 2.7 down to 2.4 (6.75U to 6U in the U100 syringe). Recommend this mainly because of his change in appetite. Same dose both cycles, AM and PM. Insulins like consistency.

Dose yesterday AM and PM cycle was what? 09/05/2020 in your date format. Nothing on the SS for dose. If you skipped the dose, please enter 0 in the units column.

p.s. Please start a new thread, and link this only one at the top for history and continuity. This one has gotten very, very long.
 
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