02/13 Mumf AMPS 329 +5 281 +7 281 PMPS 346 +3 265

reviewing my spreadsheet of the last few weeks and can’t help but wonder: my cat’s BG was better (i.e. below 300) when he was on 1.25 and now we’re going up and his numbers seem to be stagnant or even getting higher.
 
Hi Jana, what you are seeing is "Glucose Toxicity" from holding doses too long. The term sounds a lot worse than it is. When a cat stays in high numbers for too long, its body gets used to higher numbers and treats them as normal. It then requires much more insulin to break through to lower numbers.

I saw that Marje recommended that you try TR and I was going to do the same thing. If you can work your shooting schedule around you work schedule so that you can get at least one test before you leave for work and a test before bed, you could try TR. It will help you get to a good dose faster. Once you break through to better numbers, you can switch back to SLGS.

IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!
 
See, that’s the thing. I absolutely cannot get at least one test in before I leave for work. I shoot and I run out to go to work. I have a 1 1/2 hour commute, it’s just not possible. I’ve only been testing so much because I’ve been home with my broken foot. That changes next week (or the week after next at the very latest).. then I will be back to only pre-shot readings and a before-bed reading. I’m pretty sure that’s not enough. Normally I cannot take time off work or run home during the day, I work with mentally ill people in crisis.

But I am consulting with a new vet more experienced with feline diabetes (just have one on call just in case if emergency, right?) and I will definitely also ask her about tight regulation.
Thanks!!
 
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I also wanted to add that I saw several posts about how he was doing better on a dose earlier. Sorry that no one clarified before this...but a cat's insulin needs go up and down and our job is to take the dose up and down along with their numbers. What was a good dose last week can be too much or too little this week :-)

I saw that you are gone 12 hours and cannot do TR. When next week do you start the job? Monday?
 
You have held the 1.75U dose for 6 cycles now and it's clear it's not enough. I would increase him to 2U tonight.
Then we can see what we can with only night time tests.
 
Bandit's Mom said:
I also wanted to add that I saw several posts about how he was doing better on a dose earlier. Sorry that no one clarified before this...but a cat's insulin needs go up and down and our job is to take the dose up and down along with their numbers. What was a good dose last week can be too much or too little this week :)

I saw that you are gone 12 hours and cannot do TR. When next week do you start the job? Monday?
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Thank you so much for clarifying this. That is exactly what I’ve been wondering about! My vet made it sound like there’s one perfect dose and then you’re set. But that’s obviously not the case. Due to the fact that I kept thinking there’s one correct dose I’ve constantly been hesitant to increase his dose because I thought I would be doing something wrong or hurting him. Wow.. sometimes a little extra information really goes a long way. Thank you, Bhooma!

I have tomorrow off and I’m seeing my doctor to see if I go back to work on Tuesday or get one last week at home. So I would like to increase his dose tomorrow morning, that way I can be home without anxiety. I don’t like doing those increases at night. I get too antsy.
 
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Something I’ve been wondering about: Mumf has quite a bit of chin acne and also a really red spot right where his whiskers are, probably from rubbing his face on things. This has been there for a bit, on and off.
He’s probably itchy because he’s allergic to something. I switched out the dish in the automatic feeder so that at least the inside that he eats from is not made out of plastic.

I know it can take a while for allergies to clear. I’m trying to figure out if it could be anything else as well. It seems like an allergy like that would also raise his blood sugar, so I’m wondering if I should try cutting out allergens in food before I increase his dose? Or am I thinking in the wrong direction here.
 
While any kind of infection and inflammation can elevate blood sugar, I would not wait to raise his dose. He is already spending most of the time above the renal threshold and that's hard on his kidneys. Plus, the glucose toxicity will make it hard for you to bring his numbers down. Even if you resolve any issues that are elevating his blood suagr,

I would increase his dose to 2U tonight so to that you have enough number of cycles at the new dose to see how he is doing on it before you start work on Tuesday.
 
Bandit's Mom said:
While any kind of infection and inflammation can elevate blood sugar, I would not wait to raise his dose. He is already spending most of the time above the renal threshold and that's hard on his kidneys. Plus, the glucose toxicity will make it hard for you to bring his numbers down. Even if you resolve any issues that are elevating his blood suagr,

I would increase his dose to 2U tonight so to that you have enough number of cycles at the new dose to see how he is doing on it before you start work on Tuesday.
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I just talked to my physical therapist and she advised me to stay home for another week, and so I will ask my doc for a note tomorrow- thank goodness for the large number of sick days we get in Germany.

So we do have one more week of me being able to monitor him! I would like to try out some different foods (to see if maybe chicken really is the culprit), but I will also start him on two units bright and early tomorrow morning.. i’ll be here to monitor and see how he does.
 
I suggest you follow TR for a week till you can resume work. Since you can monitor, let us increase his dose aggressively but safely per the TR protocol, so that we can get him to a good dose before you have to go back to work.

I would even be as aggressive as to increase his dose by 0.5U tomorrow since he is largely over 300. Let us see how he does tonight.
 
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of course now I’m super anxious but let’s push through. I will be posting his numbers per usual tonight and then tomorrow pre-shot to make a dosing decision.

Also waiting for a call back from the vet next week but I will try not to let that influence me because I’m pretty sure it’s not going to be helpful (sorry not sorry, lol).


Bandit's Mom said:
I suggest you follow TR for a week till you can resume work. Since you can monitor, let us increase his dose aggressivel but safely per the TR protocol, so that we can get him to a good dose before you have to go back to work.

I would even be as aggressive as to increase his dose by 0.5U tomorrow since he is largely over 300. Let us see how he does tonight.
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I would like to go up 2 units tomorrow, hold the dose for 48 hours, evaluate and then go up another .25 on Wednesday if necessary (I know it most likely will be necessary). That’s a solution I would feel most confident about in terms of controlling anxiety.
Do you think that’s feasible?
 
These are the TR guidelines:

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.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
I would want to make the most use of the extra week you have got to monitor him to get him to a good dose. I understand your anxiety and you are not the first person to feel anxious about lower numbers. But as long as you can monitor (test and feed), you have the tools to keep him safe. Like our cats bodies, we also get too comfortable in higher numbers. Even numbers below 200-250 spook us. But you have to remember that a cat's normal numbers are 50-100 on a human meter. Every day he stays high is a strain on his kidneys and that much more effort to bring down his numbers in terms of glucose toxicity.
 
Alright. 2.25 IE tomorrow? I mean, I’m not alone, I have the message board .. so I have a support system if I get weird.

how long does it generally take for a dose increase to show? Does it take a day or more or can it also show after the first dose? I’m never clear on that.

ETA
he did have a couple of nadirs below 300 these past few days, we are very proud of that :P
 
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MumfsFriend said:
I mean, I’m not alone, I have the message board .. so I have a support system if I get weird.
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Yes. Someone is always around. We have people in the US and Australia and I'm in India so we have you covered! :bighug:

MumfsFriend said:
how long does it generally take for a dose increase to show? Does it take a day or more or can it also show after the first dose? I’m never clear on that.
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It varies from cat to cat. Some cats react in the very first cycle.
 
OK, thank you so much, Bhooma! We will be here tomorrow for an early shot of 2.25 units ;)

I know it’s late in your part of the world so I hope you have a wonderful night and thank you so much for being around.
 
And it’s a good routine, it gives me time to make some coffee in between, to brush my teeth, put on some makeup and then shoot and head out about 20 minutes later. That way I won’t be too sweaty, hectic and out of it. So I don’t mind sleeping 30 minutes less and starting into my day with less stress
 
Well, this is interesting: Mumf just threw a 265 at +3... like he heard the talk of dosing and he’s willing to do his part, haha.
 
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