02/09 Java AMPS 374, +4 335 stuck in the pinks

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javasfambam

javasfambam

Member Since 2014
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Hi Guys

I am being patient (most of the time!), but i'm concerned that after almost 8 weeks on insulin and a wet low carb diet, we aren't making much progress getting his BG down with any sort of regularity?

He is putting on weight, and is now over his senior panel weight of 2013 (5.5kgs) at 5.7 kgs. He's back to being his playful affectionate laphog self! Is it possible that glucose toxicity is an issue here? How do i go about finding out?

C
 
Charlene, about all you can do is just keep increasing every 6 cycles until he starts getting some blues in his cycles.

Yes, it's possible that some glucose toxicity has set in, but the "cure" for that is the same....keep increasing every 6 cycles until you start to see some progress

Hang in there! At some point, hopefully it'll just "kick in" and he'll start coming back down the dose ladder!
 
Thanks Chris :)

One question re the protocol for increase - if in the previous 6 cycles, Java has one nadir in the 200-300 range we increase by .25? I know the protocol increases based on nadir...............but which one? The lowest of a group? Or the majority :)

Probably a silly question, but just wanting to understand it really well!

C
 
Hi Charlene,

I think that's an excellent question. I wish I could answer it for you, but I pretty much gave up on trying to understand the protocol. I was just confusing myself, which is easily done. ohmygod_smile I just started asking, "What do I do with the dose?" and let the experienced people tell me! :lol:

I just really wanted to stop by and offer my encouragement. It's so tough not to see immediate progress. Jersey was stuck in the pinks for what seemed like forever. Then, things just started clicking for us. One week we were seeing pinks, the next week we were seeing greens, and the next week we were in an OTJ trial. You'll find that good dose that starts clicking for Java. Just hang in there!

Shelly
 
Thanks Shelly!

We're over 3 U lantus BID now, so im hoping that sometime soon Java decides to hate on pink and make friends with blue :)

C
 
I think this might help explain

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if the majority of nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

Now personally, going by the protocol, I think you could increase by .5 each time since the majority of Java's nadirs are still greater than 300, but here's where it's not always exactly ALL about the numbers....Since Java has been in yellow on a lower dose recently, we kind of take that into consideration too

That's why the spreadsheet is so essential....while generally we concentrate on the last several days the most, we also look back for about 2 weeks to see what else has been going on.

At this point, I think I'd go ahead and do the .25 increase if Java doesn't get into the blues by the next time he's due for an increase....that would put him up to 3.5 at that time....IF after another 3 days he's still mostly in pinks and reds, maybe go up to 4 units at that time (but let's cross that bridge when we come to it)

For now, just hold the 3.25....if you don't get into blues by the end of the 6 cycles, go ahead up to 3.5 and we'll start the count again.

On another note...is there any chance Java needs a dental? A lot of times, those high numbers are caused due to inflammation or infection and lots of times that's going on inside their mouths. If he hasn't had his teeth looked at in awhile, it might be worth the visit to get it checked out. The other common reason is urinary tract infections, so if that's even a slight possibility, it should be checked into.
 
right now on 3.25u, with the 3 cycles you have so far, all of the nadirs are over 300. If you don't have something significant change by the time 6 cycles are up, I'd increase by 0.5u.

It's possible we're just not to Java's "right" dose yet. Every cat has one, but it's small in some cats and big in others. You're on the right track - just keep on plugging.

I'd suggest you get an early morning test occasionally - not every morning, but it's a lot of white space there and if you can occasionally get a test in the white areas of the ss, sometimes they can be revealing.

Let me ask a few things.

I saw you switched from caninsulin to Lantus on August 9th. Did you get it from a regular pharmacy, in other words, was it in good shape when you got it? it was refrigerated? Have you watched the video on the Info, Proper Handling & Storage that is about halfway down this page? Have you done any see-sawing of your dose back and forth between the syringe and the insulin?

Does Java have any signs of possible infection? Does his breath smell bad - not just like cat food, but bad? Can you see visible tartar on his teeth? Any signs of bladder infection - peeing outside the box, for example?

I saw your mention on the ss that he swiped mac & cheese from a covered container. :lol: very creative, java! hehe. Is that typical of him? do you feed him and he is never satisfied and wants more? How big is he - both his overall size and his weight?

When do you feed him in relation to his shots? Does he eat only in the first half of the cycle, or does he eat all day?

You want to just keep on increasing every 6ish cycles - at least re-evaluate the dose every 6 cycles, until he starts to move.
 
Thanks Chris - that is perfectly logical! Ill belt up my patience pants and ride it out :)

Java definitely needs his teeth done - his breath smells like he's a cannibalistic grave robber! We just need to recoup from the DKA stay, tests and other costs before we give him a teeth clean :) Its next on the list though for sure - for all our sakes!

C
 
Hey Julie! Got some answers here for ya :)

I can definitely pop in some later tests, more likely to be a +6 and a +8.

When we switched from Caninuslin to Lantus we got it from a regular pharmacy on script from the vet. Definitley in good shape, and nice and cool. Went straight home and popped it on a shelf in the fridge, not the door - the pens are in the box, in a plastic box. The pen in use is in a little plastic box with a cotton pad on the bottom so its a little cushioned (overkill much?!) we don't roll it, and it comes out, is drawn, then goes away. We do this while Java is eating, then shoot 'im up as he is finishing. The insulin was pretty pricey, so we are looking after it! We started with new needles and a pen at the same time. We are almost through 1 pen (overdraw to get out the airbubbles and still getting used to the new syringes) and its still within its un-refrigerated shelf life. Nice and clear :)

Java's breath smells terrible. Vet checked his teeth and said he needs a clean, but appears that there are no holes or bad teeth, so she was happy for us to recoup a little after the initial hospital stay (he was bad DKA when diagnosed) and outlay. Next pit stop though. No signs of any infection - happy, healthy, playful and purry.

The food stealing is typical - its our fault as we have spoilt him rotten and tended to feed him whenever he was hungry. But had gotten worse just before DKA. He is a bit of a food thief, always has been - it was nice to see he ate his veges along with the cheese. He loves cheese - he's a little piggy. We feed him quite a bit during the day now - he is heavier now than his checkup in 2013! Its good, as at DX he was 4.8 kgs, and now hovering around 5.6kgs. He eats 4 times a day. 50/50 mis of ziwi peak and friskies pate at am shot, a forkful of raw beef at noon (or a chicken neck if we have them), 50/50 ziwi/friskie mix at PM shot, and another forkful of beef before Tom comes to bed - this means he will wake us at 5.55am for his morning test and shot :) He always wants more immediately after - but he is a scarfer, and im assuming by the time he finishes his little head has registered he's had food :) Right now, he is happy with a nice full tum, sleeping on a rug in the sun, and we both ate lunch next to him - he wasn't interested, sniffed and went to lie back down. He is a bigger cat according to the vet, and she would like to see him around the 5.8 mark - and he is putting on weight nicely. Don't know how it will go when we have to stop the weight gain diet! lol Right now, we can no longer feel prominent bones, backbone or ribs. Of course, if we poke they are there, but that's normal i'm thinking.

C
 
ah - thanks for clarifying on the eating. that all sounds pretty normal. Sometimes if cats eat a lot in the second half of the cycle it can really increase the blood sugar, but it doesn't sound like that's Java's situation.

his size sounds fine, his meals sound fine, you're doing a great job with the insulin - those are the most obvious things to look at first.

i'm going to point to the teeth as likely being a problem. if his breath smells that bad (what an image!) :shock: :lol: , there are cooties in there and cooties can raise blood sugar. i'd get them cleaned as soon as possible - vets can't really get a good look or cleaning without the cat being under anesthesia. that can make a difference.

Beyond that, it sounds like you're doing everything right, so it's just going to be a matter of getting him to the right dose, moving methodically. Some cats just need more. :-D
 
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