12/18/24 Raven AMPS 305 PMPS 315 - Numbers high due to infection

Hi all,

I haven't posted since 2023 and all my prior posts and information have disappeared from my profile. My foster care Raven (in my care since February 2023 when my rescue pulled him from a Baltimore county shelter where he was scheduled for euthanasia due to new diabetes diagnose -- after being surrendered by owner). Since I got him, Raven has been on Lantus and for the last year almost exclusive in green numbers for AMPS and PMPS on a stable dose of 2.25u. He also has been on an exclusive novel protein diet (mostly raw rabbit) due to IBD. He was doing very well and I did not realize that I would need to continue monitoring his mid-cycle numbers/ or reduce his dose until I was just alerted to this in Facebook group. I will be doing this going forward as far as possible with my very stressful job that requires me to commute 3.5-4 hours a day 3-4 times a day and will likely not be able to follow TR, but mostly SLGS or a hybrid between the two when it comes to reductions.

In any case, Raven recently got a skin infection (from scratching near his ears) and as a result was prescribed Apoquel allergy meds (1/2 tablet twice daily for 14 days, then once daily), topical Animax (twice daily for 7 days, then once daily), and Clavamox 62.5 mg (1.5 tablet every 12 hours for 14 days). He is very large (~18 lbs). The vet suspects allergy to be the reason. No steroid was administered due to IBD and no blood work was done to be mindful of rescue budget and since vet diagnose a bacterial skin infection. No other symptoms were noted and no fleas or mites were detected by vet or in household. He is an indoor only cat. We are considering further vet visits and blood work if symptoms don't improve.

As a result -- either of the infection, the medication, or both -- his AMPS and PMPS skyrocketed in the following days. The rescue organization which recently had a similar case recommended to increase his insulin dose from 2.25 to 3 per vet recommendation in prior case (I have been told this was too much and have now increased by 0.5 only to 2.75). Still his numbers remain high. This is what got me back to the Facebook group, where I was encouraged to post again here. I have been keeping BG numbers on paper for all of 2024, but just started a new spreadsheet and repopulated numbers since Thanksgiving in there for reference.

I realize now that I should have checked for midcycle numbers. I also have been told that Raven may very well have qualified for reductions. I feel terrible that I didn't realize this. I will do better now that I know. Apart from this I have been taking really good care of Raven and he has been doing very well. We love him and, even though he is a foster, we treat him like our own and spare no expense.

(@Margaret (and Pearl) - thanks for suggesting I post. I am very rusty and so busy with work. I cannot find any one by tag of @Bhooma -- could you tag them if you see this? Somehow I've lost all my old records.)
 
Hi there! Very nicely written post, I’m sorry you have to deal with FD on top of that work situation…

I can’t offer advice, but it’s said here a lot that a cat is more than their numbers. So it’s great that Raven did well all that time.

Here’s Bhooma’s tag @Bandit's Mom.
 
Hi Sophie
Is Raven eating well?
It would be good if you can fit some mid cycle tests in as that will help us with doing.
With the infection and rise in BGs I would suggest you get a bottle of Ketostix from a pharmacy and test Ravens urine for ketones. Hopefully there will be none but it is a very good thing to eliminate.
 
Animax contains triamcinolone which is a corticosteroid. Not the best option for a diabetic cat. They can still absorb the steroids through the skin. Is he finished getting it now?
will likely not be able to follow TR, but mostly SLGS or a hybrid between the two when it comes to reductions.
We don't recommend mixing and matching the two dosing methods, for safety. Each dosing method has it's own safety mechanisms built in, which have years of testing for them for that particular dosing method.

As far as mid cycle tests go, getting a test in the middle is ideal, but if you can get a test a couple hours after the shot as you head out that door, or before you go to bed, that would also provide us a lot of information about what is happening in that cycle and for that dose. A curve if you have a day off during the week will also help.

With such a large dose increase and resulting higher preshots but no mid cycle data, I can say for sure that he needs either more or less insulin. We dose based on nadirs for both dosing methods, hence the interest in what is happening mid cycle.
 
Animax contains triamcinolone which is a corticosteroid. Not the best option for a diabetic cat. They can still absorb the steroids through the skin. Is he finished getting it now?
We don't recommend mixing and matching the two dosing methods, for safety. Each dosing method has it's own safety mechanisms built in, which have years of testing for them for that particular dosing method.

As far as mid cycle tests go, getting a test in the middle is ideal, but if you can get a test a couple hours after the shot as you head out that door, or before you go to bed, that would also provide us a lot of information about what is happening in that cycle and for that dose. A curve if you have a day off during the week will also help.

With such a large dose increase and resulting higher preshots but no mid cycle data, I can say for sure that he needs either more or less insulin. We dose based on nadirs for both dosing methods, hence the interest in what is happening mid cycle.

Thanks so much to your and others input. I really appreciate it. He is still on the animax for 5 more days - but only once daily vs twice since yesterday. His numbers were in mid 200s today so perhaps the reduction in Animax is already having an effect?

Yes, I will be mostly home for the holidays starting tomorrow and will get more midcycle data to get to the bottom if it.
 
Hi Sophie
Is Raven eating well?
It would be good if you can fit some mid cycle tests in as that will help us with doing.
With the infection and rise in BGs I would suggest you get a bottle of Ketostix from a pharmacy and test Ravens urine for ketones. Hopefully there will be none but it is a very good thing to eliminate.
Thank you! He is eating very well. Yes, I need to get new Keto strips. I have some that expired this summer but my main issue is collecting the urin to test.
 
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