Lily AMPS 225 0ct 20

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Pretty much the same as yesterday.

When Saoirse was on Vetsulin, she'd get very sleepy after the dose was given but somewhere after +1 she'd usually perk up a bit and go to her food bowl looking for something to eat. Have you observed any similar behaviour in Lily? If yes, typically how long after the insulin dose would she typically look for more food? (Trying to see if Lily gives you some sort of visible signal that the dose is starting to kick in.)


Mogs
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Critter Mom said:
Pretty much the same as yesterday.

When Saoirse was on Vetsulin, she'd get very sleepy after the dose was given but somewhere after +1 she'd usually perk up a bit and go to her food bowl looking for something to eat. Have you observed any similar behaviour in Lily? If yes, typically how long after the insulin dose would she typically look for more food? (Trying to see if Lily gives you some sort of visible signal that the dose is starting to kick in.)


Mogs
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No, I haven’t noticed her being hungry at all. I think all the cats have gotten used to eating at 12 hours intervals. She did sleep a lot yesterday and she is just laying around now. But they all are, I have some lazy cats! LOL
 
They were put on the planet to supervise humans. It doesn't require much movement on their part. :D

I'd suggest next test at +2.5, Sally. Does that fit in with your schedule OK?


Mogs
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Sally and Lily said:
Mogs she is at 231 at +2.5.
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Looks like a mirror of yesterday, Sally. I'd suggest checking her before you go to FIL and again when you get back. If in the unlikely event that she has dropped a lot before you leave you could give her a small feed to tide her over till you get back.

I'm also wondering whether Lily might normally be getting a small bit of carryover between doses (not common with Vetsulin and not usually discernible unless insulin doses are skipped for some reason. We shall have to see...


Mogs
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Hi Sally,

Been following along on Lily's spreadsheet and I see that she's basically flat again today and I am wondering whether this might be an influence of the skipped PM doses. My best suggestion to you is to put a call in to your vet to discuss the low reading that you got for Lily the day before yesterday, that you're now wary of the dose taking her too low but that her BG levels have been running higher during the day when you've needed to skip evening doses for safety. Your vet should be able to advise you how best to proceed.

From my perspective, I don't think there's much more I can do to help you on the Vetsulin side of things for Lily because there's no way I'd suggest you give insulin if I didn't think you'd be able to keep Lily safe and, both according to FDMB dosing guidelines plus my own experience of using this insulin, going below 90 on this insulin isn't wise. The indicated dose reduction is merited but Lily's dose is so small there's nowhere to go.

My best suggestion to you is to maybe consider having a discussion with your vet about switching Lily to Lantus insulin. It has a much gentler mode of action which makes it better at providing safe, continued insulin support for cats who still need insulin but who are in an overall range too low to permit continued safe administration of the in-out insulin they are currently being treated with. With Lantus it's also possible to give insulin safely at lower preshot levels and thus keep a kitty in healthier numbers for longer (can take a little while to get the kitty to this stage, of course!).

Thoughts?


Mogs
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Critter Mom said:
Hi Sally,

Been following along on Lily's spreadsheet and I see that she's basically flat again today and I am wondering whether this might be an influence of the skipped PM doses. My best suggestion to you is to put a call in to your vet to discuss the low reading that you got for Lily the day before yesterday, that you're now wary of the dose taking her too low but that her BG levels have been running higher during the day when you've needed to skip evening doses for safety. Your vet should be able to advise you how best to proceed.

From my perspective, I don't think there's much more I can do to help you on the Vetsulin side of things for Lily because there's no way I'd suggest you give insulin if I didn't think you'd be able to keep Lily safe and, both according to FDMB dosing guidelines plus my own experience of using this insulin, going below 90 on this insulin isn't wise. The indicated dose reduction is merited but Lily's dose is so small there's nowhere to go.

My best suggestion to you is to maybe consider having a discussion with your vet about switching Lily to Lantus insulin. It has a much gentler mode of action and it is easier to dose cats who still need insulin but who are not in too high a BG range overall. With Lantus it's also possible to give insulin safely at lower preshot levels and thus keep a kitty in healthier numbers for longer (can take a little while to get the kitty to this stage, of course!).

Thoughts?


Mogs
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I agree with you Mogs. I just hope the vet will too. If we switch over to Lantus would we start at the same dosage?
 
Critter Mom said:
Hi Sally,

Been following along on Lily's spreadsheet and I see that she's basically flat again today and I am wondering whether this might be an influence of the skipped PM doses. My best suggestion to you is to put a call in to your vet to discuss the low reading that you got for Lily the day before yesterday, that you're now wary of the dose taking her too low but that her BG levels have been running higher during the day when you've needed to skip evening doses for safety. Your vet should be able to advise you how best to proceed.

From my perspective, I don't think there's much more I can do to help you on the Vetsulin side of things for Lily because there's no way I'd suggest you give insulin if I didn't think you'd be able to keep Lily safe and, both according to FDMB dosing guidelines plus my own experience of using this insulin, going below 90 on this insulin isn't wise. The indicated dose reduction is merited but Lily's dose is so small there's nowhere to go.

My best suggestion to you is to maybe consider having a discussion with your vet about switching Lily to Lantus insulin. It has a much gentler mode of action which makes it better at providing safe, continued insulin support for cats who still need insulin but who are in an overall range too low to permit continued safe administration of the in-out insulin they are currently being treated with. With Lantus it's also possible to give insulin safely at lower preshot levels and thus keep a kitty in healthier numbers for longer (can take a little while to get the kitty to this stage, of course!).

Thoughts?


Mogs
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I left a message for the veterinarian to call me when she comes in tomorrow and I emailed Lily’s spreadsheet. Hopefully she will be receptive. In the meantime, should I skip the evening dose?
 
Sally and Lily said:
I agree with you Mogs. I just hope the vet will too. If we switch over to Lantus would we start at the same dosage?
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For a newly diagnosed cat, the starting dose is based on ideal weight (for cats at ideal weight or overweight) or current weight if they are under their ideal weight. However, for cats who've already been treated with another insulin the previous insulin dose is considered.

I'm going to ask Elise (@tiffmaxee) if she can pop onto this thread next time she's online and ask her whether she can give you a little more information on determining starting dose for a kitty making the switch to Lantus. (It's an area that always gives me the wibbles! :nailbiting:). One thing I can say with confidence is that I think Lily would only need a very small dose of Lantus to start with. It can always be adjusted in small increments thereafter if required.


Mogs
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Sally and Lily said:
I left a message for the veterinarian to call me when she comes in tomorrow and I emailed Lily’s spreadsheet. Hopefully she will be receptive. In the meantime, should I skip the evening dose?
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As per last night, because of that drop below 90 on this dose I think it's too risky. It's one thing to give a dose that's taking BG numbers right to the limit of what's considered a safe nadir for a given insulin when one is awake and able to test and intervene with food at any point if numbers drop a bit low, but it's a very different scenario to give that same dose when monitoring/intervening isn't possible. As I said to you last night, if it was my cat in this situation I wouldn't give insulin tonight.

While things are in flux - and purely as a general safety precaution - I'd suggest doing a daily check for ketones until you can return to regular administration of insulin again.

I hope things go well with your vet. Be sure to give a shout for any help you need. :)


Mogs
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Critter Mom said:
As per last night, because of that drop below 90 on this dose I think it's too risky. It's one thing to give a dose that's taking BG numbers right to the limit of what's considered a safe nadir for a given insulin when one is awake and able to test and intervene with food at any point if numbers drop a bit low, but it's a very different scenario to give that same dose when monitoring/intervening isn't possible. As I said to you last night, if it was my cat in this situation I wouldn't give insulin tonight.

While things are in flux - and purely as a general safety precaution - I'd suggest doing a daily check for ketones until you can return to regular administration of insulin again.

I hope things go well with your vet. Be sure to give a shout for any help you need. :)


Mogs
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Thanks so much Mogs, I will let you know the outcome. This is the same vet that told me to give her 2 units and didn’t mention testing and going back in a month for a curve. :arghh:
 
Sally and Lily said:
Thanks so much Mogs, I will let you know the outcome. This is the same vet that told me to give her 2 units and didn’t mention testing and going back in a month for a curve. :arghh:
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Oh dear... :(

We'll still be here to help with any questions you have, Sally, and we'll do all we can to support yourself and Lily going forward. :)


Mogs
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PS: You certainly wouldn't look to start Lily on 2IU Lantus every 12 hours! IIRC last time you reviewed Lily's progress with the vet they were pleased with how she's been doing on the small dose of Vetsulin so hopefully any dosing suggestions they might make for Lantus would be a tad more conservative now there's a record of how Lily responds to her insulin treatment. :)


Mogs
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Just seen Lily's +7! That was a good catch from you, Sally. Wonder where she'll be at PMPS tonight? (NB: Just wondering whether she might still be under 200 because that could potentially give a clue to why her AM numbers have been flatter yesterday and today. For clarity, I still think it's not safe to give her insulin tonight.)


Mogs
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Critter Mom said:
Just seen Lily's +7! That was a good catch from you, Sally. Wonder where she'll be at PMPS tonight? (NB: Just wondering whether she might still be under 200 because that could potentially give a clue to why her AM numbers have been flatter yesterday and today. For clarity, I still think it's not safe to give her insulin tonight.)


Mogs
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Yes I was glad to see it going down too. I won’t give her insulin tonight. Thanks for checking on us!!!:bighug:
 
I know exactly what you mean about the alone feeling, Sally. I can't tell you how grateful I was to find FDMB and for all the help I have received here. We all need a lot of 'technical support' with the nuts and bolts of managing feline diabetes ('cause it's overwhelming!) but the bit of moral and emotional support is very much needed too ('cause sometimes it can be very scary and exhausting). :bighug:


Mogs
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Critter Mom said:
I know exactly what you mean about the alone feeling, Sally. I can't tell you how grateful I was to find FDMB and for all the help I have received here. We all need a lot of 'technical support' with the nuts and bolts of managing feline diabetes ('cause it's overwhelming!) but the bit of moral and emotional support is very much needed too ('cause sometimes it can be very scary and exhausting). :bighug:


Mogs
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Lily is 149 at +9. Is this good or bad?
 
Back to you.

You've probably been reading about bouncing here and there on the board. It's where the body reacts to a number it perceives to be too low and dumps extra glucose into the bloodstream to compensate. In some cases the BG may indeed be too low (below 50 on a human meter) but with a diabetic the body will have become accustomed to running in too-high BG numbers and if BG falls to a lower, perfectly safe but unfamiliar level the defence mechanism gets triggered as well. It can take up to 3 days for the effect of a bounce to clear.

In addition to the potential carryover from a previous dose that I've discussed before, I have been wondering whether Lily's flat cycle yesterday might have been influenced by a bounce triggered by her drop to 87 on yesterday's AM cycle. It can be trickier to spot bounces with Vetsulin because of its ability to yank high numbers down. (Lantus is better at keeping already low numbers down.)

When a bounce starts clearing you usually see numbers coming down into a better range, often at an unexpected time in the cycle. When Lily's BG finally started heading into blues at +7 today it made me wonder more whether her earlier numbers were a bit 'bouncy'. That her BG levels have dropped a little lower again at +9 - very late to see a fall in a Vetsulin cycle - makes today's cycle look a little more like a bounce that's clearing, rather than an issue with lack of dose carryover from the skipped dose. This is a practical demonstration of why I said that it was too risky to keep giving the current dose when Lily's not being closely monitored. If yesterday's numbers were indeed bounce-influenced, insulin had been given last night based on her numbers not having budged much during the day but then a bounce cleared during the night, what looked like a safe dose in the morning cycle could potentially have dropped Lily's numbers too low during the PM cycle (and a lot of cats naturally run lower at night).

I hope I've explained the above OK. Tonight, I'd strongly recommend that you get the PMPS test to be sure nothing weird is going on. By then this morning's dose should be spent, but as well to double-check.

Overall, Lily's doing really well - and you're doing a great job with her. :)


Mogs
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Critter Mom said:
Back to you.

You've probably been reading about bouncing here and there on the board. It's where the body reacts to a number it perceives to be too low and dumps extra glucose into the bloodstream to compensate. In some cases the BG may indeed be too low (below 50 on a human meter) but with a diabetic the body will have become accustomed to running in too-high BG numbers and if BG falls to a lower, perfectly safe but unfamiliar level the defence mechanism gets triggered. It can take up to 3 days for the effect of a bounce to clear.

In addition to the potential carryover from a previous dose that I've discussed before, I have been wondering whether Lily's flat cycle yesterday might have been influenced by a bounce triggered by her drop to 87 on yesterday's AM cycle. It can be trickier to spot bounces with Vetsulin. (Lantus is better at keeping already low numbers down.)

When a bounce starts clearing you usually see numbers coming down into a better range, often at an unexpected time in the cycle. When Lily's BG finally started heading into blues at +7 today it made me wonder more whether her earlier numbers were a bit 'bouncy'. That her BG levels have dropped a little lower again at +9 - very late to see a fall in a Vetsulin cycle - makes today's cycle look a little more like a bounce that's clearing, rather than an issue with lack of dose carryover from the skipped dose. This is a practical demonstration of why I said that it was too risky to keep giving the current dose when Lily's not being closely monitored. If yesterday's numbers were indeed bounce-influenced, insulin had been given last night based on her numbers not having budged much during the day but then a bounce cleared during the night, what looked like a safe dose in the morning cycle could potentially have dropped Lily's numbers too low during the PM cycle (and a lot of cats naturally run lower at night).

I hope I've explained the above OK. Tonight, I'd strongly recommend that you get the PMPS test to be sure nothing weird is going on. By then this morning's dose should be spent, but as well to double-check.

Overall, Lily's doing really well - and you're doing a great job with her. :)


Mogs
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Thanks for all the explanations Mogs, you are awesome!!!:)
 
Great, Sally.

When you're posting the result is there any chance you could start a new thread, please? This one's got a bit long (and apparently it's better for the server if threads stay under 50 posts). Will look out for it. :)

Lily is doing so well (anti-jinx!). I hope the vet gives the OK for Lantus later. My hope is that it would help you get her into lower numbers safely, and that would increase chances of achieving remission. Was Lily on steroids at all before she was diagnosed as a diabetic? (Sorry if you've posted this info before. PTSD affects my memory. :rolleyes: )


Mogs
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Critter Mom said:
Great, Sally.

When you're posting the result is there any chance you could start a new thread, please? This one's got a bit long (and apparently it's better for the server if threads stay under 50 posts). Will look out for it. :)

Lily is doing so well (anti-jinx!). I hope the vet gives the OK for Lantus later. My hope is that it would help you get her into lower numbers safely, and that would increase chances of achieving remission. Was Lily on steroids at all before she was diagnosed as a diabetic? (Sorry if you've posted this info before. PTSD affects my memory. :rolleyes: )


Mogs
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No, she has never been on steroids to my knowledge. I got her when she was 3 and she is 5 now. Was in excellent health until this.
 
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