? AMPS 588/PMPS 534 - Kaz

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[USER=10387]@Claire[/USER] said:
Hi Bron

Kaz's numbers are really high again today so tomorrow morning planning on starting the new dose from 2 units to 2.25 unless you tell me otherwise. I am going to test his Ketones again during next ear prick. For some reason there has not been as much blood over past couple days its weird.

Also did get the Meowspace which I set up today and have started training him I spoke to the owner of the company today and she said it could take about a week to get him used to going in with the door closed. He is goin in with door open already so that's positive. So I am hoping that within the next week I will be able to leave additional meals out for him so another step in the right direction.

Thanks as always for your help.

Claire/Kaz
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Great the Meowspace has arrived. Would love to see a photo of it with Kaz inside!
Yes, I think you are ok to increase the dose to 2.25 U
 
I have increased to 2.25 units this morning.

Some how during the night Kaz managed to get the entire adhesive ring off himself no idea how he did it as it was on his neck and I can not find it in the house either.
He also just thrown up all his food hes still hungry so I am giving him a small amount again as I have now given him the insulin (gave him the insulin before he threw up).
The adhesive ring was not in the throw up and I don't think he would be that stupid as to eat it.
 
[USER=10387]@Claire[/USER] said:
I have increased to 2.25 units this morning.

Some how during the night Kaz managed to get the entire adhesive ring off himself no idea how he did it as it was on his neck and I can not find it in the house either.
He also just thrown up all his food hes still hungry so I am giving him a small amount again as I have now given him the insulin (gave him the insulin before he threw up).
The adhesive ring was not in the throw up and I don't think he would be that stupid as to eat it.
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It’s possible that he had the adhesive ring in his mouth and I know when cats have string in their mouth, they often can’t get it out and have to swallow it because of the tiny hooks on their tongues. He might have accidentally swallowed it so I would watch his poops for it to come out the other end and also if he keeps vomiting you might need to tell the vet what could have happened. Of course it might turn up in the house as well.
 
Bron and Sheba (GA) said:
It’s possible that he had the adhesive ring in his mouth and I know when cats have string in their mouth, they often can’t get it out and have to swallow it because of the tiny hooks on their tongues. He might have accidentally swallowed it so I would watch his poops for it to come out the other end and also if he keeps vomiting you might need to tell the vet what could have happened. Of course it might turn up in the house as well.
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He hasn't thrown up since this morning and hes acting normal so hopefully he will just pass it within a couple days.
 
Bron and Sheba (GA) said:
Great the Meowspace has arrived. Would love to see a photo of it with Kaz inside!
Yes, I think you are ok to increase the dose to 2.25 U
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Hi Bron

I will be on cycle 6 this evening at 2.25 his number are still on the high side but I know some of the issue is probably not getting the regular food.
I'm working with the owner of Meowspace as there new models (which is what the sent me) does not appear to allow the cat into the box unless the magnet is actually placed on the device which the cat obviously can't do. If the device worked as it was supposed to the cat would definitely use it. I'm hoping for a fix to this issue within a few days or maybe the older model needs to be sent.

Thanks Claire
 
[USER=10387]@Claire[/USER] said:
I did contact my vet who said just to clean it with warm water and a cloth and leave it to the air to heal.
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This is the correct thing to do. Leave it open to the air. Wounds need to heal from the inside out and not seal over the top first because infection (abscess) will possibly develop underneath. That’s why when a surgeon opens up and drains a large abscess the wound will have to be “packed” (usually with a long string of material that is inserted into the wound…. to keep it open while it heals. I recommended Olive Oil. Coconut oil is also excellent although I am not sure of its antimicrobial properties.
 
[USER=10387]@Claire[/USER] said:
Hi Bron

I will be on cycle 6 this evening at 2.25 his number are still on the high side but I know some of the issue is probably not getting the regular food.
I'm working with the owner of Meowspace as there new models (which is what the sent me) does not appear to allow the cat into the box unless the magnet is actually placed on the device which the cat obviously can't do. If the device worked as it was supposed to the cat would definitely use it. I'm hoping for a fix to this issue within a few days or maybe the older model needs to be sent.

Thanks Claire
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I would like to see the Meowspace as I had never even heard of it until you mentioned it.
 
Suzanne & Darcy said:
I would like to see the Meowspace as I had never even heard of it until you mentioned it.
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Having a few issues with Meowspace with him getting in with the magnet. The owner thinks hes on the taller side so I need to take door off and reinstall other way to make it higher. He will go in if the door is open but can not get in when closed and he tried for about 2 hours on and off last night. Hoping that when I switch it it will work but below are some pictures. WilburCat needs to take the credit for this one as I had never heard about it before. Already got women I work with ordering one for her cat with kidney issues.

The wound is also healing nicely and I have been putting coconut oil around the wound (not directly on it) to help with the itching as well as on his ear and it does seem to be helping

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Bron and Sheba (GA) said:
I’m sorry the feeder is causing a problem. I hope you can get it sorted out.
If you don’t get any blue BGs in the cycle tonight I would increase the dose tomorrow to 2.5U
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Hi Bron

Kaz jerked his head this evening when I was giving him his insulin shot I am pretty sure most of the liquid went in but some did not I am not really experiences enough yet to know what % went in and what did not. I am guessing there is nothing I can do and will have to wait till tomorrow morning but I wanted to check.

Thanks Claire
 
[USER=10387]@Claire[/USER] said:
Hi Bron

Kaz jerked his head this evening when I was giving him his insulin shot I am pretty sure most of the liquid went in but some did not I am not really experiences enough yet to know what % went in and what did not. I am guessing there is nothing I can do and will have to wait till tomorrow morning but I wanted to check.

Thanks Claire
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Hi Claire,
Nothing you can do about that, sorry. Don’t ever give any more insulin if that happens. Everyone has that happen at some point so don’t worry. He’ll get back on track.
You are doing a great job.
 
[USER=10387]@Claire[/USER] said:
Kaz jerked his head this evening when I was giving him his insulin shot I am pretty sure most of the liquid went in but some did not I am not really experiences enough yet to know what % went in and what did not. I am guessing there is nothing I can do and will have to wait till tomorrow morning but I wanted to check.
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Hi Claire, this would be good to add to the Remarks section of the spreadsheet for yesterday.

Did you get anymore tests in last night? With a drop at +2, that usually means a more active cycle. He may have even seen some blue after that but we will never know. :cool:
I would have tested again at +3 or +4 to determine if any further tests were needed after that.
You're doing a great job, Claire. I've been following along. :bighug:
 
A lot of people put PFS in their spreadsheet (for possible fur shot. ) The possible fur shot "resets" the count of cycles on a particular dose. I'm sorry he's back in black.
 
Also, did you see wetness on his fur or smell insulin on his fur? You can usually smell that insulin odor. If not, then most of the shot probably went in... if not all.
 
Suzanne & Darcy said:
Also, did you see wetness on his fur or smell insulin on his fur? You can usually smell that insulin odor. If not, then most of the shot probably went in... if not all.
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That's how I know I missed some as it was wet and I could smell it. Going to actual shave his neck area for when I am in the UK as it makes it much easier to see and with someone else giving the shots that does not give them this should help her.

I will be asking you and Bron for help with this as I am gone for three weeks which means no blood tests and no adjustments in his insulin so I need help formulating a plan on dosing so as to keep him at a consistent safe level while I am gone.

Claire
 
Bron and Sheba (GA) said:
I’m sorry the feeder is causing a problem. I hope you can get it sorted out.
If you don’t get any blue BGs in the cycle tonight I would increase the dose tomorrow to 2.5U
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Hi Bron This is 6 days now at 2.25 I think as I had the mishap with the injection I am supposed to stay at this level of insulin but please let me know if you want me to adjust again.

I would have thought by now I would be seeing lower numbers but been no real change?

Thanks Claire
 
Hi Claire
Would you mind putting DKA in the signature please as it’s important that people helping you know that history…thanks.
Also in the Ss can you put TR as the dosing method please…..you aren’t feeding any dry food are you?
I would go up to the next dose of 2.5 units tomorrow morning.


[USER=10387]@Claire[/USER] said:
I will be asking you and Bron for help with this as I am gone for three weeks which means no blood tests and no adjustments in his insulin so I need help formulating a plan on dosing so as to keep him at a consistent safe level while I am gone.
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When will you be going away and who is minding him?
Will they be able to test for ketones?
Do you think he will eat well for them when you are gone?
 
Bron and Sheba (GA) said:
Hi Claire
Would you mind putting DKA in the signature please as it’s important that people helping you know that history…thanks.
Also in the Ss can you put TR as the dosing method please…..you aren’t feeding any dry food are you?
I would go up to the next dose of 2.5 units tomorrow morning.



When will you be going away and who is minding him?
Will they be able to test for ketones?
Do you think he will eat well for them when you are gone?
Click to expand...


I'll have to figure out about the signature someone else kindly set up the spreadsheet so I have never had to touch it.
Still don't know what TR is assuming you want me to put it in the comment section.

99% is wet food. I have been giving him a few morsels of dry vs treats when I do insulin shots and potassium tablets and ear pricks. I was going through a canister of treats every 2-3 days so I switched to this method as its more affordable. He now only gets treats at insulin time.

I'm gone from June 18/19th through July 5th.

No the women looking after will not be doing any kind of tests only thing she has agreed to do beyond the normal day to day is the insulin shots. This is the best option I have as there is NO ONE ELSE. There is no medical boarding and no one licensed in this kind of work. I am extremely lucky to have gotten anyone to administer shots at all. If this goes bad she will not do it again and them I am going to have huge issue in December when I travel again. I have said this over and over that there is no one and I am on my own. This is the best and ONLY option available lucky to have it.

Please do not make me feel guilty about this as I searched and searched I sent out well over 100 emails called every place within 50 miles of me and got NOTHING. As I have said over and over I have to travel twice a year these are set trips that will NEVER change until my mother passes.

As far as eating goes I have the appetite stimulant and I was planning on having her use it whilst I was gone as she is not going to wait around for him to eat and this is going to be my best option.

I will increase to 2.5 tomorrow.

Claire
 
[USER=10387]@Claire[/USER] said:
I'll have to figure out about the signature someone else kindly set up the spreadsheet so I have never had to touch it.
Still don't know what TR is assuming you want me to put it in the comment section.

99% is wet food. I have been giving him a few morsels of dry vs treats when I do insulin shots and potassium tablets and ear pricks. I was going through a canister of treats every 2-3 days so I switched to this method as its more affordable. He now only gets treats at insulin time.

I'm gone from June 18/19th through July 5th.

No the women looking after will not be doing any kind of tests only thing she has agreed to do beyond the normal day to day is the insulin shots. This is the best option I have as there is NO ONE ELSE. There is no medical boarding and no one licensed in this kind of work. I am extremely lucky to have gotten anyone to administer shots at all. If this goes bad she will not do it again and them I am going to have huge issue in December when I travel again. I have said this over and over that there is no one and I am on my own. This is the best and ONLY option available lucky to have it.

Please do not make me feel guilty about this as I searched and searched I sent out well over 100 emails called every place within 50 miles of me and got NOTHING. As I have said over and over I have to travel twice a year these are set trips that will NEVER change until my mother passes.

As far as eating goes I have the appetite stimulant and I was planning on having her use it whilst I was gone as she is not going to wait around for him to eat and this is going to be my best option.

I will increase to 2.5 tomorrow.

Claire
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Sorry just looked up dates

Fly out on June 16th (late flight) So Laurie is looking after Kaz from June 17th through July 5th (19 days) hoping to have a Libre button put on on the 16th but as we all know this could last one day or two weeks.
 
We certainly don’t want to make you feel guilty but we do need to ask these questions so we can decide what the best dose will be.
Im sure you have looked everywhere for help looking after him. I know how hard it can be. I’m so glad you have found someone.
Will you have an automatic feeder set up for him while you are away?
I’m heading to bed now so will talk to you tomorrow :)
 
Bron and Sheba (GA) said:
We certainly don’t want to make you feel guilty but we do need to ask these questions so we can decide what the best dose will be.
Im sure you have looked everywhere for help looking after him. I know how hard it can be. I’m so glad you have found someone.
Will you have an automatic feeder set up for him while you are away?
I’m heading to bed now so will talk to you tomorrow :)
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Thanks goodnight

We are still working on the Meowspace I am praying that he will have figured it out by then as this helps me too as I want him to have a couple smaller meals during the day.
 
No. We don’t want to make you feel guilty. That’s not our goal. Our goal is to help you keep Kaz safe. Since there’s to be no testing, I think you need to have a Libre sensor put on him so that the pet sitter can at least scan it before shooting insulin to make sure it is safe to shoot.
 
Suzanne & Darcy said:
Where do you live Claire? What state? Are you in a rural area? I wish I could just take care of him for you.
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I am planning on having a Libre button put on I already have the button but again this may work 14 days or just one day. Can't rely on this and there is no way she is going to remove the button and put another on. I had issues getting the button off poor thing was bleeding with nasty wound.

I live in Allston Massachusetts (suburb of Boston)
 
Diane Tyler's Mom said:
Hi Bron I see Claire is feeding some dry , see post #72 maybe she would ADC to her signature food combo?
@Bron and Sheba (GA)
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Not feeding him any dry he simply gets a few bits of kibble as treats. Not get a bowl of it he can't or he will block. Very careful about this and switch between treats and kibble. This is why he is on Prazosin.
I also add water to his food even though he drinks a lot to counter this.
 
[USER=10387]@Claire[/USER] said:
Not feeding him any dry he simply gets a few bits of kibble as treats. Not get a bowl of it he can't or he will block. Very careful about this and switch between treats and kibble. This is why he is on Prazosin.
I also add water to his food even though he drinks a lot to counter this.
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Okey Dokey I just want to check with Bron if it's still OK to follow TR Protocol even if Kaz is only getting a few kibble. Whatever method you follow you will add that to your spreadsheet up top where it says Dosing Method(SLGS or TR) above where you have the meter you are using
@Bron and Sheba (GA)
 
I will say that I fed my diabetic cat little bits of Dr. Elsey’s Clean Protein - like five pieces sometimes for a treat or a food topper. That is one of the very few low-carb kibble available that I am aware of. At first, I only gave Pure Bites 100 percent meat treats. Boiled chicken is a good option.
 
Somebody needs to explain acronyms on this site or send me a link as to where to find my answers I have asked at least three times what TR is and had no response.


I also now have a more general question regarding feeding.

Kaz is getting way, way more food than normal. Before I was ok with this as he was so under weight but now he is back to 12 lbs and is now over this amount at 12.4 lbs. If I keep feeding him this way he is going to be extremely obese which has its own health issues.

I need to understand feeding schedule and how much he should be getting in between the two main meals.

Thanks Claire
 
I am sorry. I didn’t see that question. TR stands for tight regulation and it is a dosing method/protocol. Let me send you a link, in case we haven't done that yet. Sorry for the frustration!
 
[USER=10387]@Claire[/USER] said:
I am planning on having a Libre button put on I already have the button but again this may work 14 days or just one day. Can't rely on this and there is no way she is going to remove the button and put another on. I had issues getting the button off poor thing was bleeding with nasty wound.

I live in Allston Massachusetts (suburb of Boston)
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Yes. I remember now about the problems with the button. :-(
 
This is a link to the Sticky Note (located at the top of the Lantus/Levemir/Biosimilars forum) that describes how Start Low Go Slow (SLGS) and Tight Regulation (TR) works. The TR method allows you to do increases more rapidly, if enough testing is done (the two pre-shot tests, plus at least one mid-cycle test if the minimum requirement for following TR.) It's just that Kaz's numbers are so high that it would be good if he could follow the TR protocol and get into better numbers more quickly - instead of holding the doses for so long. Here it is:

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Suzanne & Darcy said:
This is a link to the Sticky Note (located at the top of the Lantus/Levemir/Biosimilars forum) that describes how Start Low Go Slow (SLGS) and Tight Regulation (TR) works. The TR method allows you to do increases more rapidly, if enough testing is done (the two pre-shot tests, plus at least one mid-cycle test if the minimum requirement for following TR.) It's just that Kaz's numbers are so high that it would be good if he could follow the TR protocol and get into better numbers more quickly - instead of holding the doses for so long. Here it is:

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
Click to expand...


Ok thanks so it basically means that I am adjusting the dosage based on hi BG levels verse keeping it at the same dosage every day.
 
[USER=10387]@Claire[/USER] said:
Ok thanks so it basically means that I am adjusting the dosage based on hi BG levels verse keeping it at the same dosage every day.
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Well, all doses are based on nadirs (the lowest BG number that a cat has on a dose,) regardless of which method you are using that is true. Doses are always based upon the nadirs. The main difference between the two methods is that with Tight Regulation (TR) more testing is required in order for the dose to be increased as often as every six cycles (three days). This, of course, depends on the cat's numbers and if it is necessary to do that. There are rules about holding the dose depending on nadirs (if you are seeing blue nadirs or if you are seeing green nadirs, for example, the doses are held for a longer time.) So these are general principals. There are exceptions always, such as if your cat is bouncing, you usually want to wait until he's cleared the bounce and is back down into his more usual numbers before increasing. The reason for that is that the cat will drop back down during a bounce and you don't really want to increase insulin at the same time as the cat is dropping down on his own after "clearing the bounce" -- because you will have downward momentum from that at the same time an increase in insulin can also cause your cat to go lower in BG. I hope this helps a little. There are quite a few subtleties to the methods, but that Sticky Note covers a lot of it very well.
 
[USER=10387]@Claire[/USER] said:
so it basically means that I am adjusting the dosage based on hi BG levels verse keeping it at the same dosage every day.
Click to expand...
I'm re-reading the question and want to make sure that you understand... you will not adjust the dose on a daily basis (except when reduction is required for safety.) Doses are typically held for 6 cycles on TR and longer on SLGS - even if BG goes high (and a lot of times with new cats it will due to bouncing.)
 
[USER=10387]@Claire[/USER] said:
I am planning on having a Libre button put on I already have the button but again this may work 14 days or just one day. Can't rely on this and there is no way she is going to remove the button and put another on. I had issues getting the button off poor thing was bleeding with nasty wound.

I live in Allston Massachusetts (suburb of Boston)
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I live in Georgia. I wish I was closer because I really would not mind taking care of him while you were away. I totally understand about you needing to go and see your mother. I know this must be really stressful for you, too.
 
Suzanne & Darcy said:
Does he have Feline Lower Urinary Tract Disease (FLUTD?)
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Well he's on Prazosin and I have syringes filled with buprenorphine in case he gets blocked. Vet never used the term lower urinary Tract disease. I just know for at least 10 years now that if he eats a bowl of dry food for a couple days straight he will start going in and out the litter box then if it does not clear up on its own I have to start giving him the syringe medication once a day till it passes. If that does not work its catheter at the hospital. They refer to it as a blockage related to crystal formation which is a type of urinary tract infection.
I am very careful with this and its been 4+ years since he has had to have buprenorphine. The vet replaces it every time I go to the UK as there have been a couple times in the past that he got really stressed with me not being here and the symptoms started in both cases they subsided very quickly after my return.
 
Suzanne & Darcy said:
I'm re-reading the question and want to make sure that you understand... you will not adjust the dose on a daily basis (except when reduction is required for safety.) Doses are typically held for 6 cycles on TR and longer on SLGS - even if BG goes high (and a lot of times with new cats it will due to bouncing.)
Click to expand...
\
What is SLGS?

I know I am supposed to increase the dose to 2.5 tomorrow. Bron has been kind enough to tell me what dose to give and when to change it. Really relying on her have not even told my vet I'm doing this as I am not sure how he will take it.
 
This just really surprises me that there are no vets around the Boston area (Allston, Cambridge) that do boarding of cats. But maybe they're not staffed at the right hours for giving shots 12 hours apart? That's been a problem for another one of our members. I wish there was a pet sitter around there who was more flexible. How many cats do you have, Claire? Obviously more than one or your wouldn't have needed the MeowSpace. Did you get that MeowSpace worked out?
 
[USER=10387]@Claire[/USER] said:
\
What is SLGS?

I know I am supposed to increase the dose to 2.5 tomorrow. Bron has been kind enough to tell me what dose to give and when to change it. Really relying on her have not even told my vet I'm doing this as I am not sure how he will take it.
Click to expand...
Yes. The doses that Bron has been recommending are based upon the dosing protocol guidelines that are explained in that Sticky Note I sent you. She also takes into condsideration things like Kaz's history (DKA), etc.
 
Suzanne & Darcy said:
Well, all doses are based on nadirs (the lowest BG number that a cat has on a dose,) regardless of which method you are using that is true. Doses are always based upon the nadirs. The main difference between the two methods is that with Tight Regulation (TR) more testing is required in order for the dose to be increased as often as every six cycles (three days). This, of course, depends on the cat's numbers and if it is necessary to do that. There are rules about holding the dose depending on nadirs (if you are seeing blue nadirs or if you are seeing green nadirs, for example, the doses are held for a longer time.) So these are general principals. There are exceptions always, such as if your cat is bouncing, you usually want to wait until he's cleared the bounce and is back down into his more usual numbers before increasing. The reason for that is that the cat will drop back down during a bounce and you don't really want to increase insulin at the same time as the cat is dropping down on his own after "clearing the bounce" -- because you will have downward momentum from that at the same time an increase in insulin can also cause your cat to go lower in BG. I hope this helps a little. There are quite a few subtleties to the methods, but that Sticky Note covers a lot of it very well.
Click to expand...


Going to see if I understand this correctly.
All doses are based on nadir which is the lowest point (during the 11 hour cycles you are looking at what the lowest BG reading is). Then based off these BG readings you will then make the decision as to whether or not to increase/decrease or hold at the same level.

So if this is correct unless you get multiple readings (curve) you would not be able to make an accurate prediction of what the true levels are. Then you have curveballs. If the BG is high I feed Kaz 0% carb food (Tiki) if his BG is dropping faster than I think it should I have been switching the next meal to Wernuva at 2-3% and I stopped with the DM as he was going off it and the 10% seemed high. However I was going to have Laurie use this just one can a day split evenly in the morning and evening as one of the extra meals to try and keep the BG at an even rate while I was gone and to keep the higher dosage safer. If this makes sense.

I was waiting till it was a bit closer to travel time to get an exact schedule of what I was to have her do.
 
Suzanne & Darcy said:
This just really surprises me that there are no vets around the Boston area (Allston, Cambridge) that do boarding of cats. But maybe they're not staffed at the right hours for giving shots 12 hours apart? That's been a problem for another one of our members. I wish there was a pet sitter around there who was more flexible. How many cats do you have, Claire? Obviously more than one or your wouldn't have needed the MeowSpace. Did you get that MeowSpace worked out?
Click to expand...

Since COVID no one will board medical cats. Have no problem boarding the other one. Angel just had a whole new wing built and they have a hospital attached and they will not take medical boarding right now. Hoping this changes at some point but they have even said this makes it hard for people in my shoes to get any help.
 
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