04/27 Shen AMPS 207 +0.5 229

[Nimi S]

Hello!
This is my first post on the L/L/B ISG.

Shen's pre-shots on 1U glargine have been between 350-420.
Increased his dose to 1.25U from yesterday's PM shot.

His BG at the vet's 30 mins before today's AM shot was 235 (11:45 am) and dropped to 207 (12:02 pm) once we were back home, and 229 after 30 mins of waiting (12:32 pm)
Last snack was at 6:30 am.

Do I shoot 1.25U and observe?

The sticky says :

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

But it's been only one cycle since his dose was increased.

Tagging @Bandit's Mom and @Bron and Sheba (GA) for inputs.

Link to previous thread, if relevant: https://felinediabetes.com/FDMB/thr...sample-for-urine-culture.276776/#post-3066627

 

[Bandit's Mom]

Sorry Nimi, only just seeing this. Did you shoot? Can you monitor if you shoot? If yes, go ahead and shoot.

ETA: He is also slightly higher after stalling

 

[Bandit's Mom]

Glargine is very good at giving flat cycles when you shoot low. In fact, you can shoot as low as 50 with TR and 90 with SLGS if you can monitor.
I would shoot and get a test at +2.

 

[Nimi S]

I just shot after checking again - it was 246 at 1:10 pm.
I think I have shot a little less than 1.25U (image attached).

He's eaten well, so I'll keep an eye out for his BG every couple of hours today.
Couldn't catch his BG properly in the night after his first 1.25U.

 

[Bandit's Mom]

I think I have shot a little less than 1.25U (image attached).

Looks okay to me.

Responding to some of your questions in your previous post in the Main forum:

I've stopped going to vets for diabetes and CKD. It's amazing how little vets know about them. And most of them are more used to dogs than cats. I follow the felinecrf website and they also have a great support group that you can join. There's also a good support CKD support group on FB (https://www.facebook.com/groups/felinecrf).

Don't be discouraged by Shen's kidney values. His BUN and creatinine are good. I was not able to figure out why Budge's phosphorus is elevated so I just manage it with a phos binder. Once Shen's diabetes is regulated, that will take the pressure off his kidneys.

If you are in the western suburbs, I've heard good things about Happy Tails in Khar. There is also a Crown Vet in Khar and a Top Dog in Andheri but I'm not sure how Top Dog is. I've been to Crown Vet in Worli. The good thing about these places is that it's a one-stop shop - so you can get everything done without carting Shen here and there. Bloodwork, Xrays, Ultrasound etc etc. It's possible that Shen has dental issues which is what is affecting his appetite and causing the drooling and gagging. I've had Bandit's dental done and it's not like she is regulated. Her numbers are all over the place.

The blood could be because of the loose stools. Did I tell you that I use Darolac capsules for S. Boulardii? I wonder if he has a tummy bug and needs meds for it. @Bron and Sheba (GA)

You can apply the spot-on for the ear mites. Ear mites can also cause BG to be elevated. What do you use? I use Selamec spot-on for cats (Selamectin). And you can also deworm him. Maybe worms are giving him diarrhea?

As for following TR, it's good you increased. He will feel better if you get him regulated and it's also less strain on his kidneys.

 

[Nimi S]

I've stopped going to vets for diabetes and CKD. It's amazing how little vets know about them. And most of them are more used to dogs than cats. I follow the felinecrf website and they also have a great support group that you can join. There's also a good support CKD support group on FB (https://www.facebook.com/groups/felinecrf).

I know I must sound overly paranoid. I lost a cat less than 2 months back, after a major surgery didn't work out for him. He was a paraplegic, incontinent cat prone to bed sores and UTIs, so he was relatively high maintenance. I used to co-parent him with a friend. For the entire 1.5 years we had him, he was a frequent visitor to the vets. Now that I'm reading about kidney disease, I'm realizing that there are so many small things we could have done right for him had we known what and how we were supposed to do them. Just like now, Google was my friend then too but it still wasn't enough relevant information. It feels ridiculous that none of this information comes from the vets who see our cats regularly - no tips whatsoever on nutrition, warning signs, symptoms, susceptibilities
Had the vets bothered with an ultrasound before the first surgery, they'd have known it wouldn't have helped and we wouldn't have put him through 2 surgeries.
Hence I have this constant feeling of dread of missing out on some detail or doing things wrong (the way I was feeding Shen less when we started the insulin).

I agree that dogs somehow have more resources than cats, for nearly everything.

I'll also join the crf group soon. But currently I'm so overwhelmed and the last 3 weeks of reading and research have been burning me out - have to set alarms for everything.

Don't be discouraged by Shen's kidney values. His BUN and creatinine are good. I was not able to figure out why Budge's phosphorus is elevated so I just manage it with a phos binder. Once Shen's diabetes is regulated, that will take the pressure off his kidneys.

I've got the Phos binder yesterday. Do I wait for his KFT results from today's blood-work, before starting the binder?

If you are in the western suburbs, I've heard good things about Happy Tails in Khar. There is also a Crown Vet in Khar and a Top Dog in Andheri but I'm not sure how Top Dog is. I've been to Crown Vet in Worli. The good thing about these places is that it's a one-stop shop - so you can get everything done without carting Shen here and there. Bloodwork, Xrays, Ultrasound etc etc. It's possible that Shen has dental issues which is what is affecting his appetite and causing the drooling and gagging. I've had Bandit's dental done and it's not like she is regulated. Her numbers are all over the place.

I got a Happy Tails reference yesterday while I was asking around. I'm going to give them a shot.
I'm hoping that I don't have to take Shen to the vets as frequently as I have been doing, since he's starting to become wary of me, every time he sees me dressed up

The vet I took him to today saw his X-ray and said it shows a lot of tooth damage/decay and his teeth will probably need to be removed but that she'd wait for the BG to be under control first.

Just got his culture report on email - Klebsiella oxytoca was the organism detected O_O
Will upload the report to the SS.

The blood could be because of the loose stools. Did I tell you that I use Darolac capsules for S. Boulardii? I wonder if he has a tummy bug and needs meds for it.
You can apply the spot-on for the ear mites. Ear mites can also cause BG to be elevated. What do you use? I use Selamec spot-on for cats (Selamectin).

I'll try the Darolac capsules. I was confused about which ones to give because I was trying to get ones with only S boulardii in them.
I've tried Selamec (15 Feb & 01 Mar) but it didn't seem to work that well. So was advised to try Advocate (22 Mar) but I feel he needs a reapplication.

And you can also deworm him. Maybe worms are giving him diarrhea?

I think it's mostly due to the wet food. Shen used to have the best poop in the house, even I used to envy him Probably all the fiber in the Farmina Obesity helped with that - saw that it has Psyllium Husk as one of the ingredients.
Does Ondem cause constipation? Shen is going once every 2 days since I started adding it - though today's stool was better than the last one week's.

 

[Bandit's Mom]

So sorry to hear you lost a cat. And I know what you mean about feeling let down by vets. You don't sound overly paranoid at all, but you might burn out if you don't take care of yourself
Give Shen also a break from vets for a bit. See what antibiotic the vet prescribes for the infection. Hopefully taking care of the infection and getting him to a good dose will get him regulated and then you can take him for a dental soon.

Let's see what the KFT says and then start the binder.
http://www.felinecrf.org/phosphorus_binders.htm#dosage

Ondansetron does constipate. Has it reduced his lip-licking and improved his appetite? You can always add a little psyllium husk (isabgol) to his food. Start with 1/8th tsp once a day.
http://felinecrf.org/appetite_loss_nausea_vomiting.htm#ondansetron_interactions_side_effects

Did you get a test after the shot?

 

[Nimi S]

The lip licking hasn't improved noticeably so. But he's been eating well, at times asking for food by himself. Other times I have to bring his meals to him.
His appetite is better than it was when we'd just started the insulin.

I took a BG reading too soon (alarm went off as per his original shot timing) - it was 250 at +1.5 (from 246 at AMPS) and now 134 at +3
Should I be checking every hour now since he's dropped kind of low before his usual nadir? Too many pokes today already
He just got his +3 snack.

 

[Bandit's Mom]

What is his feeding schedule? Don't feed him a large meal with the shot. You want him hungry enough to eat a little after each test. What you could do to flatten his curve is to feed a little at +2. In active cycles like today you also want to feed a little after each test to slow the drop.

Got a test after the +4? Testing does not hurt them. Do you feel like it does?

Sorry for the delayed reply. Was out and only just saw this.

BTW, since you've shot, please change the thread title to take off "lower than normal, shoot or wait?". Thanks

 

[Nimi S]

I feed him around 3.5-4 pouches of whiskas throughout the day.
1 pouch each before the AM & PM shots and around 1-2 spoons for every snack.
Snacks are usually at +3, +5/+6 and then +7/+8 depending on whether I've to wake him up or he's asking for it.

I test at these times and then give the snack. Haven't been able to keep up in the PMs especially after the change in his shot schedule.

Today I've been testing and giving snacks more often since he's dropped low even before +6.

His readings today have been:
AMPS - 246
+1.5 - 250
+3 - 134 (and snack)
+4.5 - 85 (and snack)
+5.5 - 89 (and snack)

He's due for another snack at +6.

I'll try to even out the feedings including his pre-shot meals.
I'd read that it's preferable to not feed after the nadir. But Shen usually comes around at +8 - +10 looking for food.


Edited the title. Thanks!

 

[Nimi S]

Got a test after the +4? Testing does not hurt them. Do you feel like it does?

I don't think it must hurt much since Shen doesn't flinch or run away when being poked.
But his ears are a bit bruised and some spots have been slower to recover.

 

[Bandit's Mom]

His readings today have been:
AMPS - 246
+1.5 - 250
+3 - 134 (and snack)
+4.5 - 85 (and snack)
+5.5 - 89 (and snack)

Nice green surf. Sharp drops also cause bouncing, so if you add a snack at +1.5 or +2, that might reduce the dive at onset.

I test at these times and then give the snack. Haven't been able to keep up in the PMs especially after the change in his shot schedule.

Do you want to slowly move his shot time so you don't have to be up at night? You can advance his shot time by 30 mins per day.

But his ears are a bit bruised and some spots have been slower to recover.

I guess you can see the bruises more clearly because his ears are white!

 

[Nimi S]

Nice green surf. Sharp drops also cause bouncing, so if you add a snack at +1.5 or +2, that might reduce the dive at onset.

Do you want to slowly move his shot time so you don't have to be up at night? You can advance his shot time by 30 mins per day.

The greens make me more anxious..Been on my toes all day

I did want to advance his time but all his vet visits are between 11 am- 1 pm, so I keep hovering around 12 pm.
Hoping to go back to 8/9 by next week.

The vet called to inform me that Shen's other kidney labs are normal, but I'm waiting to receive a soft copy from the vet.
He has an ultrasound scheduled for Saturday, to clear up any of my remaining concerns.

Hoping that clearing up the UTI helps with his overall response to the treatment.