? 4 Nov Methos increased vetoryl —predicting bounce breaking 409@ AMPS

[SmallestSparrow]

It takes a village…please help me anticipate disasters as I have no idea how to estimate bounces or bounces breaking and there’s a lot of moving parts going on here for the next few days.

He’s never been regulated (tightly or otherwise) —guidelines for diabetic dogs *starting* vetoryl is monitor for hypoglycemia and be ready to reduce dose rapidly. I’ve been wavering between 3.0 and 3.25 as I’ve wavered on increasing his vetoryl. For better or worse i decided on 3.25 since his carbs increase with the extra pill pocket (so that was probably the wrong decision) and increased his AM vetoryl this morning to 15 mg from 10 mg. This is a 50% increase of his AM dose (overall a 25% increase in daily dose)

if anyone can tell if he’s bouncing…and especially if you can predict a bounce breaking please let me know. I’d like to anticipate the need for a decrease if possible and stay ahead of big drops
Thank you!

 

[Angela & Cleo]

Hi Colleen, I know that Methos is a complicated cat. I think that you're seeing high numbers. There's no real way to predict how the increase in vetoryl will impact his bgs especially since you just raised the dose of vetoryl.

I think what might help is if you have a plan. What is your goal for nadirs?
What is your "reduction" BG number? Answering those questions might help take away the "guessing" and anxiousness.

Fwiw, when I've had to give Cleo any meds, I also use pill pockets. I tend to give the pill pocket right before/at onset of insulin. The extra carbs on board right at onset would help deter a large drop in BG.

Wishing you and Methos the best of luck today

 

[Staci & Ivy]

Hi Colleen, I just want to send you support and huge admiration for your incredible work to keep Methos safe. (I wish I had answers and expertise to help guide you)

You’re doing such a great job taking care of your sweet boy.

 

[SmallestSparrow]

Hi Colleen, I know that Methos is a complicated cat. I think that you're seeing high numbers. There's no real way to predict how the increase in vetoryl will impact his bgs especially since you just raised the dose of vetoryl.

I think what might help is if you have a plan. What is your goal for nadirs?
What is your "reduction" BG number? Answering those questions might help take away the "guessing" and anxiousness.

Fwiw, when I've had to give Cleo any meds, I also use pill pockets. I tend to give the pill pocket right before/at onset of insulin. The extra carbs on board right at onset would help deter a large drop in BG.

Wishing you and Methos the best of luck today

Thanks! His reduction is 80 but he’s been up and down through several doses that have given him that …several times …some members have commented before that they could tell he was bouncing or that a bounce would break (idk how to tell difference between numbers are high bc bounce vs numbers are high bc needs more insulin …and no clue how to predict a bounce breaking)

his nadir goal for my vet i believe is between 100-150. I’m a happy camper at 200 if that means no AMPS of 75. He hasn’t been at a dose that consistently give that, he tends to have nadirs mid 200-mid300 for a few cycles then a decent cycle then a surprise 80 or below, rinse and repeat. I was really hopeful at 2.5 (and my vet was starting to agree he might not be a 3U cat) when he became hyperkalemic, meds got shuffled and now it all a mess.

I like your pill pocket approach but will need to look at his feeding schedule and vet office hours since the pp also contain his Vetoryl, spiranolactone, and potassium and those all need to be with food and be timed so he can get blood tests 5 hours after he gets them. I remember wanting to do it before (when a delay on his insulin for a low amps got insulin separated from his food with his pills but couldn’t do it for some reason. Probably the blood test but I’m not sure I want to do any more stim tests anyway—they were hard before but a nightmare with him on insulin

 

[SmallestSparrow]

Hi Colleen, I just want to send you support and huge admiration for your incredible work to keep Methos safe. (I wish I had answers and expertise to help guide you)

You’re doing such a great job taking care of your sweet boy.

Thanks Staci! It’s just so hard popping a vteoryl capsule (now two) out of the blister pack labeled “warning do not give with sprianolactone or other meds that increase potassium” and pushing it into a pp *with* spiranolactone and potassium and saying “here baby, mom has something yummy for you”…then injecting insulin and wondering how much *that* will decrease his potassium…if I could just anticipate any big BG drops it would be so helpful but I don’t know how others have predicted a break before

 

[Staci & Ivy]

Thanks Staci! It’s just so hard popping a vteoryl capsule (now two) out of the blister pack labeled “warning do not give with sprianolactone or other meds that increase potassium” and pushing it into a pp *with* spiranolactone and potassium and saying “here baby, mom has something yummy for you”…then injecting insulin and wondering how much *that* will decrease his potassium…if I could just anticipate any big BG drops it would be so helpful but I don’t know how others have predicted a break before

I know you must be so worried, Colleen. I can't imagine, how you feel.

I can only relate however, with the meds I have to give for her hyperthyroid (which others refer to as "poison", so that's totally comforting).
This is all VERY VERY hard on us

 

[Heike & BInie]

Hi Colleen,

oh my, that is so complicated with the different meds and how they influcence each other and you are really a hero, to manage all this. I never had to give Binie nearly as much meds but I know how my head was spinning to give her something which can either help her or have side-effects. It's a nightmare. So I send you all my hugs and positive thoughts!

Your bouncing questions: I am far from being an expert but I try to explain how I understood it and hope someone will correct me, if I talk nonsense: I think if it is a bounce or not enough insulin you only know by looking at the cycles before. If there was an unusual low cycle, some cats may bounce for up to six cycles. Could be, that Methos is bouncing from the blue numbers he saw on Saturday but it is not clear to me.

Breaking a bounce: If Binie is breaking a bounce, she has a high cycle with the nadir before her shot. Just have a look at her am cycle today. We started in red numbers and during the day she went down in pink numbers and her PMPS was the lowest. That's when I knew, that she might goes lower tonight and I am prepared. But it seems that this is only one variation.

I hope you get some experts advice on that and all paws and fingers are crossed everything goes well!

 

[SmallestSparrow]

Hi Colleen,

oh my, that is so complicated with the different meds and how they influcence each other and you are really a hero, to manage all this. I never had to give Binie nearly as much meds but I know how my head was spinning to give her something which can either help her or have side-effects. It's a nightmare. So I send you all my hugs and positive thoughts!

Your bouncing questions: I am far from being an expert but I try to explain how I understood it and hope someone will correct me, if I talk nonsense: I think if it is a bounce or not enough insulin you only know by looking at the cycles before. If there was an unusual low cycle, some cats may bounce for up to six cycles. Could be, that Methos is bouncing from the blue numbers he saw on Saturday but it is not clear to me.

Breaking a bounce: If Binie is breaking a bounce, she has a high cycle with the nadir before her shot. Just have a look at her am cycle today. We started in red numbers and during the day she went down in pink numbers and her PMPS was the lowest. That's when I knew, that she might goes lower tonight and I am prepared. But it seems that this is only one variation.

I hope you get some experts advice on that and all paws and fingers are crossed everything goes well!

Thank you so much!! Many of his cycles have the nadir +11 or PS…perhaps he is in perpetual bounce

I wondered if that was how you knew…I noticed the pattern when you said Binie was breaking her bounce. Then I thought “oh no, methos may be breaking AND he got more vetoryl AND my vet and I decided to let him stay at 3.25 rather than reduce for the increased vetoryl since he’s been so high with ketones.

of course I screwed up, looked at the wrong clock and instead of testing him at +2 then feeding him a snack (a big one because of the ketones) I accidentally tested at +1 and fed him. No wonder he wasn’t interested in the food at first. So now I have to test him more often tonight bad cat mom

 

[SmallestSparrow]

Of course I’m trying to rearrange my pantry while my stomach is in knots over screwing up the testing, and him starting the increased meds…anxiously staring at him every 5 minutes

 

[SmallestSparrow]

He otoh is pretty bored

 

[Heike & BInie]

Thank you so much!! Many of his cycles have the nadir +11 or PS…perhaps he is in perpetual bounce

I wondered if that was how you knew…I noticed the pattern when you said Binie was breaking her bounce. Then I thought “oh no, methos may be breaking AND he got more vetoryl AND my vet and I decided to let him stay at 3.25 rather than reduce for the increased vetoryl since he’s been so high with ketones.

of course I screwed up, looked at the wrong clock and instead of testing him at +2 then feeding him a snack (a big one because of the ketones) I accidentally tested at +1 and fed him. No wonder he wasn’t interested in the food at first. So now I have to test him more often tonight bad cat mom

Oh Colleen, I am sorry if my explanations made it more scary for you. I think there are different patterns and what applys to Binie might not be right for Methos. Especially in this situation with all the meds. You are such a great mom to keep him so safe in all this! I keep all my fingers crossed, things get more balanced again. He looks quite happy on the pic! I send you a big, big hug and healing vibes for Methos!

 

[SmallestSparrow]

Oh Colleen, I am sorry if my explanations made it more scary for you. I think there are different patterns and what applys to Binie might not be right for Methos. Especially in this situation with all the meds. You are such a great mom to keep him so safe in all this! I keep all my fingers crossed, things get more balanced again. He looks quite happy on the pic! I send you a big, big hug and healing vibes for Methos!

Please don’t be sorry, your explanation was very helpful. Unfortunately I don’t think he was “breaking” his bounce. I’m a little hopeful, since there’s a very tiny downward trend, that the increased Vetoryl is doing something. Maybe I will be very lucky and he will start having the reactions of a normal diabetic cat. I actually got two naps today!

 

[Heike & BInie]

Please don’t be sorry, your explanation was very helpful. Unfortunately I don’t think he was “breaking” his bounce. I’m a little hopeful, since there’s a very tiny downward trend, that the increased Vetoryl is doing something. Maybe I will be very lucky and he will start having the reactions of a normal diabetic cat. I actually got two naps today!

Hi Colleen,

I see Methos is coming down to yellow numbers. So great! And two naps sounds wonderful. I would say both of you are doing really well! Hope Tammuz is also better!

Hugs for you and belly rubs for the boys!