Leo 12/17 AMPS 569 +2.5 595 +5 HI PMPS 577 +3 523 +4.5 460

[La-La Leo (GA)]

Oh, dear.
I'm concerned about our diabetic kitty, Leo... it looks like he has become insulin resistant as his blood glucose numbers are so high, even after his insulin shot with a new generic Glargine pen. I thought maybe the previous pen had gone bad, but maybe not. The vet we go to has not insisted on a rabies shot since his orig December 2021 diagnosis, but after last appointment and lab results, she said he would have to get the rabies vax going forward. This is not a well kitty.

I haven't kept up with his spreadsheet due to so much happening here with taking care of Leo; DH was recently found with cognitive impairment, plus has low iron and sodium; step-mom in hospital (and she definitely has cognitive impairment... probably stage 6, and my 88yr father takes care of her on his own). Those are the biggies.

Meanwhile, I'll try to get some of Leo's numbers in the spreadsheet.

@Bandit's Mom
I'm way off track. Will you straighten me/us out, please?

The question is in a later post, but editing this post with the question.
>>BIGQUESTION: What if the vet won't see Leo because of the rabies vax she already told me will be required going forward after the Glargine script was renewed, 10/27?.... it's TX state law. I maintain he is not healthy.

 

[Marje and Gracie]

Oh, dear.
I'm concerned about our diabetic kitty, Leo... it looks like he has become insulin resistant as his blood glucose numbers are so high, even after his insulin shot with a new generic Glargine pen. I thought maybe the previous pen had gone bad, but maybe not. The vet we go to has not insisted on a rabies shot since his orig December 2021 diagnosis, but after last appointment and lab results, she said he would have to get the rabies vax going forward. This is not a well kitty.

I haven't kept up with his spreadsheet due to so much happening here with taking care of Leo; DH was recently found with cognitive impairment, plus has low iron and sodium; step-mom in hospital (and she definitely has cognitive impairment... probably stage 6, and my 88yr father takes care of her on his own). Those are the biggies.

Meanwhile, I'll try to get some of Leo's numbers in the spreadsheet.

@Bandit's Mom
I'm way off track. Will you straighten me/us out, please?

I’ll take care of the SS @Bandit's Mom.

I’ll be back shortly to address Leo’s issues as soon as I study his SS.

 

[La-La Leo (GA)]

I’ll take care of the SS @Bandit's Mom.

I’ll be back shortly to address Leo’s issues as soon as I study his SS.

Thank you

 

[Marje and Gracie]

One question before I delve into all this: does Leo go outside? If he doesn’t, why would you give a rabies shot? I live in AZ and while it’s a state law, my cats don’t ever ever go out, they never come in contact with a pet that does go out (like a dog), and I choose to not vaccinate them for anything (they had their kitten respiratory series but nothing since and one is 13-1/2). Of course, it’s your decision but if you don’t want him vaccinated and he’s totally indoors and not exposed to another animal that goes outdoors, then it should be your decision and not because your vet insists.

Here is what I’m seeing for his BG.

I won’t bang the drum on not getting data for all those weeks except to say not getting a PS is really putting him at danger for a hypo. Please, no matter what is going on personally, get a PS test every single time before you give insulin.

On to what’s been going on since you started testing again.

--on 10/20 he was at 1.5u and you reduced the dose at the 72 which TR would not have indicated be done. Under TR, we reduce the dose when the BG drops below 40 for a long-term diabetic like Leo. When he went low that night, you reduced again the next morning even though he didn’t earn a reduction that night either. He really should have been on 1.5u on 10/21; not 1u.
--the two increases on 10/22 were too soon; remember these long-duration insulins with depots should not be dose-hopped and he was clearly bouncing which can last six cycles so unless he would have dropped below 40, the dose should have stayed at 1.5u.
--dose changed again on 10/23 but should have still been 1.5u.
--more dose changes continue.

Bottom line: his dose should not have been dropped between 10/20-10/30.

Moving forward:
--dose dropped from 1.5u on 12/10 but no reduction earned
--dose raised back up to 1.5u for one cycle pm 12/11 but then dropped but no reduction earned
--dose fattened by a smidge on 12/14; just as a note, until cats get closer to remission, you want to try and always increase and decrease by 0.25u. That really works best.
--then two fast increases to 1.5u and then 2u and then a reduction to 1.25u with no reason to do so

I don’t think his pen was bad; and I don’t mean this critically but honestly his BG looks like it does because of all the dose hopping. I would urge you to reread the TR protocol and stick to it. Ask questions if you don’t know if you should reduce or increase. But it’s as if you are making those decisions on the pre shots and that’s not how we use this insulin.

I’d like to see you leave him at 1.25u for four cycles unless he drops below 40. After four cycles, if he’s still high, we might need to increase him but the amount will depend on what his BG has been. Please post and ask so we can help you get him back on track.

I’m very sorry about your family health issues. I know it can be very challenging to deal with those and a diabetic cat. It’s so common here among members and we are all empathetic but I don’t to see Leo added to that list because he has DKA. Please be sure and check his urine ketones daily.

Let us know if you have questions on the above.

 

[La-La Leo (GA)]

@Marje and Gracie

What is a PS?

 

[La-La Leo (GA)]

I think you mean a BG test before the shot. Always! I just haven't the time to enter into the spreadsheet all the data written down for each day. Every AM, PM and + BGs are all in the planner.

 

[La-La Leo (GA)]

Leo does not go outside, but that's not to say never. We've had him for limited time with us on the side porch, but not in the last year.

Sorry for the piece-meal reply.

 

[La-La Leo (GA)]

I’d like to see you leave him at 1.25u for four cycles unless he drops below 40. After four cycles, if he’s still high, we might need to increase him but the amount will depend on what his BG has been. Please post and ask so we can help you get him back on track.

Will do! I did get awry with the TR protocol, especially with not posting daily. I felt I was getting long of tooth for the Admins here and I should know better after a year.

Leo is actually eating a little, and I hate to stop him, but it is close the kitchen time for the 2-hr BG before shot time.

 

[Marje and Gracie]

Will do! I did get awry with the TR protocol, especially with not posting daily. I felt I was getting long of tooth for the Admins here and I should know better after a year.

Leo is actually eating a little, and I hate to stop him, but it is close the kitchen time for the 2-hr BG before shot time.

We’ve had members here for a very long time and we are always happy to help. We do need to help you get Leo back on track.

 

[Marje and Gracie]

@Marje and Gracie

What is a PS?

Preshot.

 

[La-La Leo (GA)]

Please be sure and check his urine ketones daily.

Leo finally used the temporary box while I rebounded for 10 min, so tested and it shows as negative to a slight trace. I used two just to compare and verify the findings.

Because we have two kitties, it would be difficult to be able to catch just Leo's output. This was a messy method after the fact, if anyone has any advice for this.
Leo now hanging out under the kitchen table and chair. After last chance food, he usually naps until it's time to test/feed/shoot.

RE: 10 min rebounding on my behalf. Oddly enough,
after rebounding 10 min, to improve my balance (MS issues), I fell, twice...
1) while pulling out rug from the 1/2 bath & rolling it up, I lost my balance while crouched down for the task.... didn't fall too far or while standing all the way up, but ow.
2) Right after that, I sat down on the master bedroom bench at foot of our bed, but the plentiful blankets on the bench didn't allow a firm sit as I sat... and immediately fell on the floor on the right side. Ouch.. Right upper leg and right elbow. [Crying face emoji]

Meanwhile, I sent an email to the vet's office with a link to Leo's spreadsheet. She knows things were getting crazy around here with my husband, losing his step-mom (last of all DH's family), and his own crazy low iron and sodium, plus memory issues, there's my own issues due to MS. We are a mess. Used to be smooth sailing. I could go on with my step-mom recent hospitalization, my aunt passing in her sleep, age 83 (she's my Dad's younger sister). Blah blah blah....

>>BIG QUESTION: What if the vet won't see Leo because of the rabies vax she already told me will be required going forward after the Glargine script was renewed, 10/27?.... it's TX state law. I maintain he is not healthy.

 

[La-La Leo (GA)]

PMPS 577 +3 523,
So reduced by 54.

He only locked the tuna soaked water that had a few bites of tuna. He wouldn't touch his usual pate, even with nutritional yeast added. (It's the natural form that does not add synthetic vitamins.) I'll try the beef liver powder next. He is very lethargic, though I did spot a few tail taps.... probably mad. I don't blame him.

 

[La-La Leo (GA)]

I'm usually concerned to go to sleep for potential low BGs, but now it's high BGs.

 

[La-La Leo (GA)]

What does this mean?
460 +4.5, so total down from PMPS is 117.

Why does this happen?

 

[Marje and Gracie]

Because we have two kitties, it would be difficult to be able to catch just Leo's output. This was a messy method after the fact, if anyone has any advice for this.

Glad you got a ketone test. If there are trace ketones, please check him again first per tomorrow. Please be sure he eats and gets fluids. His BG has really shot up. Is he giving any indication of an infection such as peeing often or mouth issues? We just want to be sure he’s not got ketones/DKA developing due to some infection and not enough insulin, food, water.

The easiest way to catch urine for a test is to get a larger-headed spoon and slip it under his bum as he squats so he pees in it. There are other methods but that always worked for me and I do that now for my non-FD cats to free catch urine for their annual tests.

>BIG QUESTION: What if the vet won't see Leo because of the rabies vax she already told me will be required going forward after the Glargine script was renewed, 10/27?.... it's TX state law. I maintain he is not healthy.

If he goes outside or sneaks outside, then you probably want to bite the bullet and get the shot. If you are positive he won’t get out & you have no other non-vaccinated pets that go out, you can try ignoring her request. If she’s persistent, then either get the vaccine or find a new vet. He’s your cat! I’m originally from TX and never had a vet withhold treatment if I didn’t want to vaccinate my indoor cats.

What does this mean?
460 +4.5, so total down from PMPS is 117.

Why does this happen?

He’s just high and flat. As I said earlier, we need to stabilize his dose but if he has four cycles of high BGs, we will need to increase the dose.