? 07/18/2022 MICIO: AMPS 231 BGs keeps rising, dose increase to 10u ok?

MISSY + Simone&MICIO (GA)

MISSY + Simone&MICIO (GA)

Member Since 2021
Yesterday: AMPS 175 / 153@ +3,25 / 155@ +5.75 / 161@ +9 / PMPS 180 / 174@ +3 / 196@ +5.5
Micio seemed to be doing fine again up 'till the 15th and then, again, all of a sudden his BGs started spiking up....coincidentally after starting a new pen of insulin?!
Anyway, the swelling on his left jaw still there, keeps going up and down (yesterday it was pretty big, this morning seems much less), he's been drinking a lot more but keeps eating just fine despite Clindamycin.
I decided to increase the dose to 10u this morning, was that the right choice? @Wendy&Neko warmig up the syringe between my fingers before shot it does really make a difference ( thanks for the reminder) but still, he's feeling it. Should I wait for the infection to go down before try/ switching to Levemir? At this point not even sure if it is because the infections, acromegaly or type of insulin..? and don't know what to do :arghh:
 
MICIO&Simone said:
he's been drinking a lot more but keeps eating just fine despite Clindamycin.
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It is odd how the swelling goes up and down... happy it's down today... hopefully the trend will continue. It's great to hear how he's doing well on the Clindamycin and it's not affecting his appetite, etc. What a relief, because I think he really needs that! Looking at his spreadsheet, I think you did have some wiggle room for that increase... I know you will watch him carefully and will soon know if it is too much because you monitor him so closely. He had higher end greens on that dose. Overall, his spreadsheet looks very good. I would not stress out too much about a few higher numbers. You want to think about what your overall goal is for Micio in terms of his BG. Is it to be mostly in blue, or do you think you want to go for mostly greens. The thing that concerns me is that, as his infection clears (we pray!) that his BG will come down. But, as I said, I'm not that concerned because I know you will monitor him very closely and that you are equipped to handle any low numbers.

So does he seem happy overall? I know that Wendy will come along today at some point and will give you her perspective. I just wanted to stop by and say hello and say that you're doing a great job.
 
Suzanne & Darcy said:
It is odd how the swelling goes up and down... happy it's down today... hopefully the trend will continue. It's great to hear how he's doing well on the Clindamycin and it's not affecting his appetite, etc. What a relief, because I think he really needs that! Looking at his spreadsheet, I think you did have some wiggle room for that increase... I know you will watch him carefully and will soon know if it is too much because you monitor him so closely. He had higher end greens on that dose. Overall, his spreadsheet looks very good. I would not stress out too much about a few higher numbers. You want to think about what your overall goal is for Micio in terms of his BG. Is it to be mostly in blue, or do you think you want to go for mostly greens. The thing that concerns me is that, as his infection clears (we pray!) that his BG will come down. But, as I said, I'm not that concerned because I know you will monitor him very closely and that you are equipped to handle any low numbers.

So does he seem happy overall? I know that Wendy will come along today at some point and will give you her perspective. I just wanted to stop by and say hello and say that you're doing a great job.
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What concerns me the most is not the blue numbers but the fact that at this high dose of insuline and the .50u increases sometimes don't seem to make a difference as it used to but probably that whatever infection is the main cause...not even the specialty dentist can explain what it is exactly; that's why he wanted to get x-rays and biopsies done with this recent procedure cause he wa ssure that some foreign object or something was stuck/present on his mouth/jaw but it wasn't . They're supposed to contact me today, we'll see.
Also worry about his kidneys with higher numbers. Overall Micio seems "ok", he doesn't do anything else beside eat, drink and sleep, but he's constantly waiting for more food all day long.
Thanks again for your support!
 
Oh boy do I ever understand your concern about his kidneys! BUT, with him in mostly blue numbers, you wouldn't even need to worry about it... blues are definitely below the "kidney threshold" numbers that I have seen.... not to mention green. You have a lot on your plate with Micio, so don't worry about the occasional yellow. Those lower yellows are okay; you don't have a whole bunch of them.
 
Suzanne & Darcy said:
Oh boy do I ever understand your concern about his kidneys! BUT, with him in mostly blue numbers, you wouldn't even need to worry about it... blues are definitely below the "kidney threshold" numbers that I have seen.... not to mention green. You have a lot on your plat with Micio, so don't worry about the occasional yellow. Those lower yellows are okay; you don't have a whole bunch of them.
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Thank you for reminding me, may need to go through the diabetes basics again...feel better now about his numbers. Still don't understand why vets are ok with yellow numbers though...most of the vets I've seen believe that higher blues and yellow are good (my vet actually told me that he can't get to lower his customers cats BG's under 300! He said that care givers don't test their pets and they'll increase, decrease or even skip the dose based on how much the cat drinks?! THAT IS CRAZY! I almost cried hearing that, poor cats. He believes on the Libre device but people still don't know what they're doing and how to care and control diabetes, neither are willing to spend extra time to try to understand it...so sad.
 
We have a lot of people here who join and say that they were increasing and decreasing based on how much their cat drinks! Of course, they take their cat to the vet every few weeks for a fructosamine test :banghead::banghead: I do feel sorry for these cats as well. I think most vets are just trying to keep the cats from going hypo so they give this bad advice instead of encouraging people to learn how to test their cats at home and keep track of their numbers. A few vets seem to be getting on board with home monitoring now that there are Libre sensors (I am sure that the people who make the Libre sensors have done a good job of marketing these to veterinarians too!) so maybe that's a positive thing. A lot of people start with a Libre and then learn how to home test. Once they see the value of it, they get hooked.
 
The increase was fine. The nadirs were mostly blues with the odd higher greens. Rising insulin needs would not be caused by the type of insulin, but infection or a pulsing acro tumour can do it. As could IAA if he had been diagnosed with that - it's a common enough pairing with acro.

Are you testing periodically for ketones? No reason to wait for the infection to go down before switching insulin if you want to do so. The one caveat being presence of ketones as you start Lev on 70% of the Lantus dose. If ketones then you don't want a sudden drop in insulin dose.

Depending on the cat, high blues might not be below kidney threshold. Have you ever used Ketodiastix to see when he pees excess sugar? I figured it out by testing Neko every time before she went into vet for urinalysis. But I also wouldn't worry about the occasional yellow or higher blue. It's prolonged time in higher numbers that is more damaging.

As for not seeing any reaction to 0.5 unit increases, you can move to 1.0 unit ones at 10 units total dose.
 
Wendy&Neko said:
The increase was fine. The nadirs were mostly blues with the odd higher greens. Rising insulin needs would not be caused by the type of insulin, but infection or a pulsing acro tumour can do it. As could IAA if he had been diagnosed with that - it's a common enough pairing with acro.

Are you testing periodically for ketones? No reason to wait for the infection to go down before switching insulin if you want to do so. The one caveat being presence of ketones as you start Lev on 70% of the Lantus dose. If ketones then you don't want a sudden drop in insulin dose.

Depending on the cat, high blues might not be below kidney threshold. Have you ever used Ketodiastix to see when he pees excess sugar? I figured it out by testing Neko every time before she went into vet for urinalysis. But I also wouldn't worry about the occasional yellow or higher blue. It's prolonged time in higher numbers that is more damaging.

As for not seeing any reaction to 0.5 unit increases, you can move to 1.0 unit ones at 10 units total dose.
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I test for ketones and usually report the results on the SS notes when I remember...I always used the Relion ketones strips and always been negative but wasn't aware of the Bayer Ketodiastix, I will try those.Thanks again.
 
As for not seeing any reaction to 0.5 unit increases, you can move to 1.0 unit ones at 10 units total dose.[/QUOTE]
Forgot to ask: when moving to 1u increase, would 1u be also the reduction if ever needed? What are the numbers that would call for a reduction in this case?
 
To start, take the same size decreases as increases. Over time you may find that may or may not work for Micio. When Neko's numbers weren't changing a lot, I found smaller decreases worked better. But ECID. Try it and experiment what is best for your cat.

Per TR, reductions are if they go below 50. If you can has undergone treatment (SRT, cabergoline) and it's actively working with frequent reductions, then some people will raise that reduction point a bit.
 
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