3/15 - Gen, AMPS 133, PMPS 131

[Allie & Gen]

Yesterday

Augh. Gen had a slightly higher cycle last night, and silly me, I thought I'd try .75u (which is only half his "current" dose, though at this point I'm not really sure how to think of it). The result has been an unauthorized scuba diving session.

This time, I've got the blood tests to back up the Libre, too. I've done two - one at +3.5 (45) and one at +4.25 (49). I'm working on the not panicking thing.

He's still eating, but not at a pace that will counter this. I've tried a few different kinds of treats to encourage him, a little Karo, and a couple spoonfuls of HC (FF gravy lovers). The Libre currently has him at 56 (with the highest he bumped up to being 58). To say I'm not happy with this is a bit of an understatement.

Does anyone have any insight as to why this is happening? He has been getting fewer calories for days than he was before his episode of inappetence, between the limitations of syringe feeding and the fact that he's been eating, but a bit picky about it. (Since the only food he's reliably eaten has been a prescription food I'm almost out of now, and can't purchase again without a new vet approval, I have been trying not to waste it.)

I hope you're all having a much more boring and pleasant Sunday than I am! Wishing your kitties safe surfs.

 

[Elaine and Ember]

Yesterday

Augh. Gen had a slightly higher cycle last night, and silly me, I thought I'd try .75u (which is only half his "current" dose, though at this point I'm not really sure how to think of it). The result has been an unauthorized scuba diving session.

This time, I've got the blood tests to back up the Libre, too. I've done two - one at +3.5 (45) and one at +4.25 (49). I'm working on the not panicking thing.

He's still eating, but not at a pace that will counter this. I've tried a few different kinds of treats to encourage him, a little Karo, and a couple spoonfuls of HC (FF gravy lovers). The Libre currently has him at 56 (with the highest he bumped up to being 58). To say I'm not happy with this is a bit of an understatement.

Does anyone have any insight as to why this is happening? He has been getting fewer calories for days than he was before his episode of inappetence, between the limitations of syringe feeding and the fact that he's been eating, but a bit picky about it. (Since the only food he's reliably eaten has been a prescription food I'm almost out of now, and can't purchase again without a new vet approval, I have been trying not to waste it.)

I hope you're all having a much more boring and pleasant Sunday than I am! Wishing your kitties safe surfs.

I don't know about the Petsmarts near you, but the couple near me will sell prescription food with a recently-expired prescription. Last year I was able to buy a bag of Zoey's renal diet when her prescription had expired the previous month and they told me just to get a new one for next time. (I'm not sure if they were being nice or if that's a company policy. )

 

[Allie & Gen]

I don't know about the Petsmarts near you, but the couple near me will sell prescription food with a recently-expired prescription. Last year I was able to buy a bag of Zoey's renal diet when her prescription had expired the previous month and they told me just to get a new one for next time. (I'm not sure if they were being nice or if that's a company policy. )

I suspect that probably won't work if the prior prescription wasn't with them/on file with them. I generally order through Chewy.

I should be okay to order more/get fresh authorization tomorrow, and I have a couple cans, so as long as I'm not reckless about it we should be okay. Gen did eat a LITTLE FF pate today, and some of the HC food I gave him to try and bump him up. And there's always more syringe feeding (sigh).

 

[Jessica & Indy]

At least you got him above 50 again which is good! I'm sorry this has been so frustrating! At least he is eating a bit in his own. Hopefully, the vet won't hesitate to give you the authorization so you can order some new cans.

 

[Allie & Gen]

At least you got him above 50 again which is good! I'm sorry this has been so frustrating! At least he is eating a bit in his own. Hopefully, the vet won't hesitate to give you the authorization so you can order some new cans.

I doubt she'll hesitate! It's the same food she originally prescribed me, which I transitioned him away from because it's MC, after all. Sigh. Though how we'll get back to a trial elimination diet is a whole other question.

 

[Mary & Jude]

Hi Allie! Wow, those are some lows! Since Gen has been without insulin and/or receiving inconsistent doses for a few days, and since his nadirs without insulin/with inconsistent doses have been relatively low (like those lows yesterday in the 50s and 60s--so low that he doesn't warrant an increase), I would stick, at a maximum, with the .50 right now, unless something prohibits you shooting (like an even lower than normal preshot number). Especially right now while you are battling inappetence making it difficult to carb manipulate him if/when he goes lower. He seemed to be doing okay on the .50 dose, though I see those numbers climbing a bit last night. You can always go up when his nadirs get a bit higher--the nadirs are important to consider in dosing increases, not just the higher numbers in a cycle.

I hope that someone with more experience will weigh in on what do with tonight's dose--much will depend on the preshot, of course--and you've earned a dose reduction back to .50 with today's lower numbers--is it best to short tonight's dose and drain the depot a bit? I'm not sure; that would be my question.

@Bandit's Mom @tiffmaxee @Christie & Maverick

 

[Allie & Gen]

Hi Allie! Wow, those are some lows! Since Gen has been without insulin and/or receiving inconsistent doses for a few days, and since his nadirs without insulin/with inconsistent doses have been relatively low (like those lows yesterday in the 50s and 60s--so low that he doesn't warrant an increase), I would stick, at a maximum, with the .50 right now, unless something prohibits you shooting (like an even lower than normal preshot number). Especially right now while you are battling inappetence making it difficult to carb manipulate him if/when he goes lower. He seemed to be doing okay on the .50 dose, though I see those numbers climbing a bit last night. You can always go up when his nadirs get a bit higher--the nadirs are important to consider in dosing increases, not just the higher numbers in a cycle.

Yeah, I feel stupid. I think part of my confusion here is that his dose was 1.5u (up until the day I took him to the hospital), and then has been inconsistent/often withheld because of inappetence/total lack of food intake apart from what I could do with syringe feeding.

I guess I just am not sure where anything should be right now (insulin dose, caloric intake, etc), or when/how it should change! But I suppose that he's definitionally not back to his prior normal with food, so I shouldn't be trying to get back there with insulin either. I wasn't really sure it was anything like a 1:1 correlation.

 

[Mary & Jude]

Yeah, I feel stupid. I think part of my confusion here is that his dose was 1.5u (up until the day I took him to the hospital), and then has been inconsistent/often withheld because of inappetence/total lack of food intake apart from what I could do with syringe feeding.

I guess I just am not sure where anything should be right now (insulin dose, caloric intake, etc), or when/how it should change! But I suppose that he's definitionally not back to his prior normal with food, so I shouldn't be trying to get back there with insulin either. I wasn't really sure it was anything like a 1:1 correlation.

It's a logical conclusion that he was on a dose and should go back to that. Insulin, though, is a hormone and not a medication, so his needs for insulin are going to shift, which complicates things. And he's super-complicated anyway right now!! The stress of FD is enough not to mention all the other added ups and downs he's been experiencing. You're doing a very good job trying to manage all of this.

I actually find these shifts fascinating (but, granted, also very annoying). Why is it that Jude experienced inappetence and an FIC flare (etc., etc.), and his insulin needs have increased while Gen goes through his issues and his needs decrease? It's so weird.

 

[Staci & Ivy]

I agree with Mary, Allie. I wouldn’t give him more than 0.50 units.
Less insulin seems to be just fine right now.

When Ivy had pancreatitis last year I had to keep reducing her insulin suddenly.
So my only experience was that when something outside of diabetes was going on, she was diving and I had to reduce again and again.

So just let the numbers tell you, and if he’s too low at preshot, skip it.
He seems to be fine even with the skip the other day.

Sending lots of vines to both of you. Eat sweet Gen! We are over here rooting for you, can you hear us?

 

[Allie & Gen]

@Mary & Jude @Staci & Ivy Thank you both so much for your input and encouragement. It all makes a lot of sense. I wish I hadn't increased this morning, but I suppose we live and learn.

I'm taking advantage of the fact that I'm uncomfortable leaving him alone today (I had planned an outing to do some bird photography originally) to do some of the research I've been planning on current diabetes treatment recommendations and studies, etc. Which is certainly interesting! I may make a separate post about some of it on the "main" forum later, depending.

Gen has been napping on my feet for a couple of hours now. He wasn't inclined to eat last time I woke him up, and unless he dives again I figure I'll leave well enough alone until his usual dinnertime. He'll get his normal meds (currently ondansetron, gabapentin, cerenia and liquid mirtazapine) a little ahead of that.

I've held off on the budesonide, but I have it on hand now. Since it doesn't need to be given with food, I'm probably going to wait until after feeding and shot times to decide whether to start tonight; I'd rather make sure he's not too off from his norms before I go introducing it. Probably. Open to input!

 

[squeem3]

Where were you planning to go bird viewing? Do you do photography as a fun hobby?

Eat, Gen! Eat!

 

[Allie & Gen]

Where were you planning to go bird viewing? Do you do photography as a fun hobby?

Eat, Gen! Eat!

I go all over the area (there are a surprising number of parks, preserves, etc within cycling range of me); today I was originally planning to head up to the Mystic Lakes to check in on the nesting eagles and a variet of winter waterfowl congregating over there. It's a pretty long bike ride, so then I was considering just going to the Arboretum, but alas. Didn't even manage a walk in my own neighborhood (plenty of standard backyard birds, there's a nesting pair of red-tailed hawks back for at least their third year in a tree one street over, and an eastern screech-owl sometimes roosts a little further on).

I do the photography as somewhere between a hobby and citizen science stuff? I've generally been teaching myself bird and plant ID (and to a lesser extent, other kinds of animals and fungi) for some years now - I've done some related volunteer work and would really like to move my science communication/writing skills over to a more ecology-centric organization some day (instead of the tech focus of my current job). I make art based on the photos sometimes, too.

Gen is eating, though in his gradual way. I gave him a FF pate just now and he had a little, which tells me he'll probably continue to eat it (not nauseous). I'll add another flavor in a bit, and/or a small amount of the Hill's m/d, but I wanted to take away the Hill's for a bit to discourage holding out for it/see if he would eat something else (which seems to have worked).

We're a little past +11, and his BG is around 118 (theoretically, since "realtime" values are frequently revised by the Libre, and I tend to recheck any I record at least 20-30 minutes later just in case). We'll see where it goes from here.

 

[Bandit's Mom]

Wow! He does seem to have flipped a switch. I agree with staying with 0.5U.

While Budesonide is not supposed to affect BG like Pred does, I've heard a few CGs say that it does. I have no experience with IBD, but Wendy does and can advise on that.

 

[Allie & Gen]

Wow! He does seem to have flipped a switch. I agree with staying with 0.5U.

While Budesonide is not supposed to affect BG like Pred does, I've heard a few CGs say that it does. I have no experience with IBD, but Wendy does and can advise on that.

Thanks, Bhooma! That's what I did, and it's good to have confirmation from one of our "official" veterans.

I'm not clear how much the (unplanned/unintentional on my part) reduction in overall caloric intake may square with the flipped switch/apparently heightened insulin sensitivity. Gen is eating better and a little more inclusively, and may continue to progress in that direction, so I guess time may tell. (I have been trying to get him back up to his prediabetic weight, with partial success, and I hope not to lose that progress but we'll see about that, too.)

What little research I've managed to do suggests that it's a risk, but in balance it seems like a reasonable one for now, especially as his enteropathy symptoms are more acute than those of his diabetes at present. That said, I am always open to input and collecting more data. I know of one cat for whom it does affect BG, and several for whom it does/did not.

 

[squeem3]

Budesonide does affect Leroy's bgs

Check out Mt. Auburn. I know they have programs for bird watching and photography and other nature stuff. I think they still have their citizen science program too. There's info on the web site.

The river as you head west into the suburbs will have tons of birds and wildlife.

 

[Allie & Gen]

Budesonide does affect Leroy's bgs

Yeah, he's the one cat I referenced.

Check out Mt. Auburn. I know they have programs for bird watching and photography and other nature stuff. I think they still have their citizen science program too. There's info on the web site.

The river as you head west into the suburbs will have tons of birds and wildlife.

I spend a bunch of time at Mt. Auburn - it's definitely the most popular birding spot around here. I've never looked into citizen science stuff there, though, so ta for that idea! I've kind of scaled back on some of those activities while Gen's been sick, but here's hoping I'll have a little more space/flexibility in my schedule in the future.

Some of my favorite spots are on the river in Watertown and Newton. I'd like to get further west more often, where there are the big state preserves, but that works better if I can go with a friend who has a car or take the train and make a day of it (time constraints again).