04/23 Shmee AMPS 277, +2 207, vacation dosing

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Amanda & Shmee

Amanda & Shmee

Member Since 2018
Previous condo: http://www.felinediabetes.com/FDMB/threads/04-20-shmee-amps-197-2-192.194426/#post-2175366

Good morning,

I had an alarm set last night for a +5 and I don't even remember waking up again to turn off the alarm :(, so mad at myself, I need to change it to a louder more obnoxious alarm. I leave to go to Minnesota to visit my grandma on Wednesday bright and early, so DH will be taking care of him then. From prior conversations I was thinking Shmee could get a reduced dose while I am away, but I am thinking he should stay at 4.5. What do you think? I am thinking that because he should be getting an increase tomorrow to 4.75, so instead of the increase I think I will just keep him at 4.5. This also gives DH a line on the syringe which he would be much more comfortable with, instead of doing the reduction to 4.25. He is going to be home all day and night while I am gone, so he can test as necessary. Shmee also hasn't been doing the greatest on this dose... more pinks (except last night dangit!), which also makes me more comfortable leaving him at 4.5 while I am away. He also could have gone a little lower on Saturday, maybe the high number that night was a bounce? I was gone all day so I could not test. Thoughts? Thank you so much in advance.

Update ** see email from vet below and my response.
 
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Looking at the ss leaving him at 4.5u while you are away, sounds reasonable. I don't think I'd want to take him all the way back to 4u to leave DH with an on the line dose.

Has DH tested before? Might be an idea to have him get some practice in with you there for moral support if hasn't done it before. George is always great about being tested, however, if it isn't me doing the testing he does try it on:rolleyes:

You might want to think about a giving DH a no shot number.
Will he have access to the board to ask for help if he should need it?
Make sure you leave him written instructions so he knows what to do in case he is faced with low numbers. Also leave a needle full of a colour liquid with the dose required, we've had a number of kitties who've ended up overdosed when a temporary CG has been in charge. Worse case I remember is kitty being given 10 instead of 1 u:eek:
 
Have a wonderful time visiting your grand mom! I agree with Gill that the 4.5 dose is probably safe with the numbers you've been getting and your reasoning is sound. Tell Shmee to be good for Daddy.
 
I appreciate all of your responses, I will be keeping him at 4.5 while I am away since everyone is in agreement that would be ok.

Gill & George said:
Has DH tested before? Might be an idea to have him get some practice in with you there for moral support if hasn't done it before. George is always great about being tested, however, if it isn't me doing the testing he does try it on:rolleyes:

You might want to think about a giving DH a no shot number.
Will he have access to the board to ask for help if he should need it?
Make sure you leave him written instructions so he knows what to do in case he is faced with low numbers. Also leave a needle full of a colour liquid with the dose required, we've had a number of kitties who've ended up overdosed when a temporary CG has been in charge. Worse case I remember is kitty being given 10 instead of 1 u:eek:
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I started "training" DH over the weekend, and today he started doing it himself. He did great, and was able to get blood for the BG test first try.
Wow that colored liquid syringe is a great idea, thank you! He does have access to the board, and I will be available full time, so he will be calling me for any questions, and I have my laptop so I will hop on here myself if there are any questions/issues. I told him to call me for any number under 100, and if there is an emergency like a number under 50 and he is acting funny to give him a little bit of honey and get him to the emergency vet. But you are right I should definitely have written instructions for more specifics just in case he cannot get ahold of me. I have added that to my "to do" list.

Stacy & Asia said:
Happens to all of us! There is even a phrase for it: “abducted by aliens” :joyful:

I saw it on a SS once and asked what that was about, I think it’s brilliant and then you can laugh it off a bit instead of beat yourself up. It’s in my SS a couple of times. ;)
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Haha I love that! I was telling DH this morning that I need to put the phone on my dresser so I have to physically get up in order to turn it off. So hopefully the aliens don't come visiting in the future!! My vet gets copies of my updated SS when I go to the vet, so I can only imagine her reaction to reading "ubducted by aliens"!!


Bobbie And Bubba said:
Have a wonderful time visiting your grand mom! I agree with Gill that the 4.5 dose is probably safe with the numbers you've been getting and your reasoning is sound. Tell Shmee to be good for Daddy.
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Thank you I haven't seen her in a few years, I am looking forward to it :)
 
Amanda & Shmee said:
My vet gets copies of my updated SS when I go to the vet, so I can only imagine her reaction to reading "ubducted by aliens"
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Well, it’s a quick way to find out if your vet has a sense of humor, which would only make her a better vet IMO! ;)

Putting the phone somewhere that you have to physically get up to stop it is a great idea. I also have alarms preprogrammed for every half hour so it’s easy to select what I want. I make all the alarms ring different so I don’t get used to one alarm sound and ignore it. :p Despite all this, sometimes my body just says sleep is happening, I don’t care about all of your rules, and I’m a sleeping zombie that doesn’t budge. :rolleyes:
 
Another update: I emailed my vet this morning with an update about Shmee, and she is concerned since he is back to high numbers, after being in the greens at 4 units. This is the email from her, and my response. I totally forgot to update the SS and you guys this morning that he didn't eat well yesterday :(. This morning he ate well though, so I am hoping he will continue to eat well throughout the day.

Vet's email to me:
"How has Shmee's appetite been? Have you needed to give any mirtazapine? How is he acting? Any excessive drinking or urinating? Have you been able to weigh him at home? I am a bit concerned that at 4 and 4.25 units he was in the 100s and even under 100 frequently and now at 4.5 units he's back in the 200s - this is not looking like a true Symogyi effect but I am worried he could be getting too much insulin vs not enough. Can you do a full curve checking every 2 hrs (for a long as you area able to that day) either tomorrow before you leave or when you get back, keeping him at 4.5 units? If he gets below 100 check hourly until it starts to increase. He is on a pretty high amount of Lantus to still be running in the 300s.

(second email)
So I missed the comment section - I don't seen any notation about him getting mirtazapine but want to double check. Also the differences in the values could have something to do with you having to put the Denamarin in various foods. It really doesn't matter what you use (pill pockets are fine), what matters more is consistency, so if you are using chicken one day, cheese the next, etc. it will have an effect. He very well could be fine off the Denamarin if all the values were increased due to his diabetes, since he is better regulated now. If he's getting that bad about taking it and you cannot directly pill him, we could try stopping it and rechecking his liver values to see if they go back up, as long as he is still eating and acting fine off of it."

I am starting to write up a reply now, thoughts?
 
My thoughts are you’ve increased systematically since 2 units, he is not getting too much insulin, he hasn’t reached a working dose yet, he needs more insulin. Sometimes in the beginning you will get string of blues and greens and then they disappear, it happens, you can see it on so many other SSs if you go back to before a breakthrough dose was found. Somogyi has largely been disproven since continuous glucose monitors were invented. I wouldn’t even go there with your vet, they are drilled on Somogyi in vet school and many cling to it for some reason.

If Shmee was having a nocturnal hypoglycemic episode which would indicate he has too much insulin, you test enough that you would have caught it, it didn’t happen. Going away and leaving this dose might create a bit more glucose toxicity, but it’s nothing that can’t be addressed when you return. The reason the numbers have stayed up IMO is because you have held some doses for too long and he settles in those higher numbers and thinks that’s normal, makes it harder to get them down with the next increase. We can fix it when you get back.

I didn’t know he was having some appetite issues, do you test for ketones? Please make sure that you do, especially with higher numbers, and any signs of not wanting to eat or acting ill.
 
My response to my vet:

"His appetite has been great and I have not had to give him the appetite stimulant. He usually eats three cans of Fancy Feast Classics a day, but not yesterday. I totally forgot to update the spreadsheet about his appetite yesterday – I just updated it. He barely ate two cans yesterday. I wanted to see how he ate today before I give him the appetite stimulant. This morning he ate very well, ate a whole can by noon, so I hope the rest of the day follows suit.. He is acting great overall, playing and seems fine, but then again, yesterday he was not. Yesterday he moped and laid around. Today though, he seems to be better, he was playing already this morning and was watching the birds out the window. I have not bought the scale to weigh him at home, I have been coming to the office to weigh him there. 03/23, 04/04 and 04/16 he was 15.5 pounds. I swear there was one in the middle of 04/04 and 04/16 – they said they would make a note of his weight in your system every time I came in, I may be missing one. Since he is due to be weighed again, I will be sure to bring him in today or tomorrow. I am really hoping that the dental work will help regulate him better, and hopefully he wont need as high of a dose after that. From what I have read from other people’s experiences, the inflammation and possible infection from legions and gingivitis can cause some cats to not be able to stay regulated. So I am really looking forward to getting those teeth out to see if he does better, and I will be sure to be cautious with his dose around that time since he might not need as much insulin (I was also planning on getting your recommendation about what his dose should be around the time of the procedure – maybe give him half of what he normally gets?). I am going to do a full curve for you today. And as for the Denamarin, it's been so frustrating. He ate it in chicken for a while, then started to spit the pill out, and then wouldn’t eat it at all. Then I tried the cheese, wouldn’t eat all four of the pill pieces every day, more like one or two.. and then eventually not at all. So as of last night, I started him back on the pill pockets because that what has worked best for him, and this morning he ate the entire pill so that was good. I just got a new box of the Denamarin so I think I will finish off this box and then we can try to do a test after that and see how his liver is doing."
 
Stacy & Asia said:
My thoughts are you’ve increased systematically since 2 units, he is not getting too much insulin, he hasn’t reached a working dose yet, he needs more insulin. Sometimes in the beginning you will get string of blues and greens and then they disappear, it happens, you can see it on so many other SSs if you go back to before a breakthrough dose was found. Somogyi has largely been disproven since continuous glucose monitors were invented. I wouldn’t even go there with your vet, they are drilled on Somogyi in vet school and many cling to it for some reason.

If Shmee was having a nocturnal hypoglycemic episode which would indicate he has too much insulin, you test enough that you would have caught it, it didn’t happen. Going away and leaving this dose might create a bit more glucose toxicity, but it’s nothing that can’t be addressed when you return. The reason the numbers have stayed up IMO is because you have held some doses for too long and he settles in those higher numbers and thinks that’s normal, makes it harder to get them down with the next increase. We can fix it when you get back.

I didn’t know he was having some appetite issues, do you test for ketones? Please make sure that you do, especially with higher numbers, and any signs of not wanting to eat or acting ill.
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This makes me feel better, thank you. And I switched from increasing him every 3 days to every 5 days because someone on here said that when they start to go below 200, the dose needs to be kept for 5 days (this was when he was on 4U, so I kept that for 5 days). But then he started getting pinks.. So I only kept the 4.25 dose for 4 days. I know she is really stuck on the Som. effect.. I mostly nod along when she talks about that, haha. His appetite issues used to be worse, but he has not had to have the appetite stimulant since 03/22. It only was yesterday that he started to not eat very well again (of course, right when I am about to leave for a few days!). He usually eats 3 cans a day, and ate about 2 yesterday. So not too bad, but a definite difference. I do test for keytones, the latest test was documented on the SS, although I have forgotten to document some other keytone tests on the SS - I have tested him about 8-10 times since Dx, and they have all been negative. I will try to get one today.
 
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