? 05/20 Lily AMPS 416 +5 430

[Elizabeth20]

Hi

Previous

Lily has been really high for her in the last week, up to where she was at diagnosis before insulin. Possible there's some bounce involved because she is capable of throwing a green in there - she took a really long time to give me any blues after her last reduction and now I think maybe she has got used to being pink and is bouncing even if she goes yellow. I've been studying really hard the last week or two because it's end of year so unable to get bedtime reads.

I'm basically wondering if it's worse to leave her with such horrible numbers most of the time or to have to manage the occasional low. Also wondering if maybe her pancreas is functioning worse?

I tried creeping her up the tiniest increase, only 0.05mm on the calipers, and got that green.

No ketones, 0.1 an hour ago, and she's eating and purring just not really grooming. Dandruff is back. What to do?

Thanks in advance.

Liz

 

[Bandit's Mom]

Hi Liz,

Please change the "GA" prefix to "?" in the thread title! GA stands for Guardian Angel or Gone Away and is used when our kitties pass on.

Now that I know Lily is fine, let me read what you've written!

Got a scare! LOL

 

[Elizabeth20]

Oh god sorry, I thought it meant general advice!!!!

 

[Hercule's mum]

Got a scare! LOL

me too! Glad to hear she is fine!

 

[Katherine&Ruby]

Good morning Liz,

It looks like Lily needs more insulin. Some glucose toxicity has probably built up, which means you need to be taking her dose up in order to break through it. Then hopefully she will start to see some lower numbers. I know you started following SLGS because of your work schedule and were worried that you could not monitor her lows, but with the reductions at 90 and holding doses for 7 days, it doesn't seem to be working well. Leaving her in high numbers could lead to ketones and possibly ketoacidosis, which affects more diabetic kitties than hypoglycemia. You can work against hypoglycemia with higher carb food, but the only thing that works against hyperglycemia and toxicity is more insulin.

In your last thread Sienne offered some advice regarding working full time and following TR. Here's a lively condo about it if you haven't seen this: https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/. You can also modify SLGS to take reductions at a lower number, say 70 rather than 90, to give Lily more time in greens to give her body more of a chance to get used to it. Lots of CGs on the board do this with bouncy kitties.

I hope you're able to find the right solution.

 

[Elizabeth20]

Thank you so much Katherine. That's a great relief to hear. Given her numbers I may increase her a full 0.25iu this evening rather than adjusting more incrementally as I have been doing, to get on top of things as quickly as possible.

Very handy modification hint to SLGS too. I'll read that thread now.

Thank you again. I appreciate this place so much!

 

[Katherine&Ruby]

Thank you so much Katherine. That's a great relief to hear. Given her numbers I may increase her a full 0.25iu this evening rather than adjusting more incrementally as I have been doing, to get on top of things as quickly as possible.

Very handy modification hint to SLGS too. I'll read that thread now.

Thank you again. I appreciate this place so much!

You're welcome. I've gotten so much great help and love here that it's nice to pay it forward!

I think a modified SLGS might work for you and Lily. You've been at this dance for long enough and have data to know how high and low Lily goes. Just figure out what the cut off, "take action" number would be that you're most comfortable with, and you can move that number around as you need.

I should also add that with TR, it's advised to always increase in .25 unit increments, but you can "shave" reductions if the cat is not holding full reductions well. With SLGS, I believe you must always take a .25 unit reduction if she drops below your reduction number.

 

[Elizabeth20]

You're welcome. I've gotten so much great help and love here that it's nice to pay it forward!

I think a modified SLGS might work for you and Lily. You've been at this dance for long enough and have data to know how high and low Lily goes. Just figure out what the cut off, "take action" number would be that you're most comfortable with, and you can move that number around as you need.

I should also add that with TR, it's advised to always increase in .25 unit increments, but you can "shave" reductions if the cat is not holding full reductions well. With SLGS, I believe you must always take a .25 unit reduction if she drops below your reduction number.

Yes I was wondering if I could get away with a more hybrid approach. I'll get a timer feeder I think and put some HC food in it on days I'm going to be at work or out at nadir. She's never yet had any visible hypo symptoms so I can count on her to eat if she goes low.

There's a UK Facebook page I also use that encourages holding the dose for longer when numbers are high even after a decrease, but knowing Lily and that ECID I think I'll have to learn to trust my instincts, balance the risks and manage the potential drops with food because she's a bugger for not playing by the rules! She gets comfy on high numbers so quickly and has such an efficient bounce reaction that I think glucose toxicity is her highest risk.

xx

 

[Katherine&Ruby]

Yes I was wondering if I could get away with a more hybrid approach. I'll get a timer feeder I think and put some HC food in it on days I'm going to be at work or out at nadir. She's never yet had any visible hypo symptoms so I can count on her to eat if she goes low.

There's a UK Facebook page I also use that encourages holding the dose for longer when numbers are high even after a decrease, but knowing Lily and that ECID I think I'll have to learn to trust my instincts, balance the risks and manage the potential drops with food because she's a bugger for not playing by the rules! She gets comfy on high numbers so quickly and has such an efficient bounce reaction that I think glucose toxicity is her highest risk.

xx

Sounds like you know Lily well. That's half the battle. Getting her under renal threshold (numbers somewhere around 200 and below) would be the first goal to prevent any further damage to her organs from the hyperglycemia, and then you can think more about how loosely or tightly you'd want her regulated and the associated risks involved with getting her there. Tight regulation would give her a shot at remission, but that's not in the cards for all cats or manageable for all caregivers.