05/23 Teja AMPS >400, +4 >400

[Malia]

https://www.felinediabetes.com/FDMB/threads/05-22-teja-amps-400-8-361.290311/

Hello Everyone, I am feeling defeated. She had some good numbers on the 21st, and now she is having horrible numbers again. Is she ever going to get regulated? I am a basketcase and in tears. We are starting our second month of trying to get this handled. She seems fine right now, she just ate and is resting right now. I feel like I am failing her. She just never gets to surf the blues or yellows for very long.

 

[Staci & Ivy]

https://www.felinediabetes.com/FDMB/threads/05-22-teja-amps-400-8-361.290311/

Hello Everyone, I am feeling defeated. She had some good numbers on the 21st, and now she is having horrible numbers again. Is she ever going to get regulated? I am a basketcase and in tears. We are starting our second month of trying to get this handled. She seems fine right now, she just ate and is resting right now. I feel like I am failing her. She just never gets to surf the blues or yellows for very long.

Hi Malia, you are not failing her. You’re doing the right thing by coming here and asking questions. It’s how we all learn.
And you are very new to this process you’re only here a month.

There are so many of us that have been here a very long time. I know it feels like a long time for you but as they say around here, “this is a marathon, not a sprint” so you have to have lots and lots of patience, keep reading, keep asking…you’ll learn a lot and you’ll be able to help her. You’re Teja’s best Advocate, so keep showing up and keep doing what you’re doing and try to keep the faith.
Hope you have a great night.

 

[Bandit's Mom]

She is just bouncing from the lower numbers she saw on the 21st. Bounces can take up to 6 cycles to clear. I know it's awful to see higher numbers after good ones.

You aren't failing her at all!

 

[Malia]

Hi Malia, you are not failing her. You’re doing the right thing by coming here and asking questions. It’s how we all learn.
And you are very new to this process you’re only here a month.

There are so many of us that have been here a very long time. I know it feels like a long time for you but as they say around here, “this is a marathon, not a sprint” so you have to have lots and lots of patience, keep reading, keep asking…you’ll learn a lot and you’ll be able to help her. You’re Teja’s best Advocate, so keep showing up and keep doing what you’re doing and try to keep the faith.
Hope you have a great night.

Thank you so much for your kind words. I just don't know, this is all so new. I know every cat is different, but what is normal? Is this normal for her? I just don't know enough. Which is why I am here. Thank you so much.

 

[Malia]

She is just bouncing from the lower numbers she saw on the 21st. Bounces can take up to 6 cycles to clear. I know it's awful to see higher numbers after good ones.

You aren't failing her at all!

Thank you so much Bhooma! Okay this is exactly what I needed to know! I know you have told me before that bounces can take time to clear (6 cycles), but I forgot. My brain just isn't braining very well these days. And when my brain is like this, I go to the worst case scenario. and on top of everything, with reducing the steroid that she was on, she is having the steroid withdrawal symptoms that we have to get her through.

Thank you so much Bhooma, okay, just a little bit more time and hopefully she will come back down again. This is just not liek anythign I have ever done before.

 

[Malia]

She is just bouncing from the lower numbers she saw on the 21st. Bounces can take up to 6 cycles to clear. I know it's awful to see higher numbers after good ones.

You aren't failing her at all!

Holy cow, she is dropping now!

 

[Malia]

So my internal medicine veterinarian doesn't give value to bouncing or rebounding to low numbers. She told me that Teja dropping to 99 is normal and there shouldn't be any bouncing back up with the right dose.

She is looking at Teja's numbers and wants to increase her insulin dose to 3.5. Her method for treating feline diabetes isn't along the protocols here. Should I share with her our dosing strategies? She's been treating diabetic cats for a long time, I am not sure what's right.

 

[Bandit's Mom]

Holy cow, she is dropping now!

I don't see the drop? Still in pinks?

She is looking at Teja's numbers and wants to increase her insulin dose to 3.5. Her method for treating feline diabetes isn't along the protocols here. Should I share with her our dosing strategies? She's been treating diabetic cats for a long time, I am not sure what's right.

I would not increase to 3.5U. We recommend increases and decreases by 0.25U (or 0.5U if nadirs stay over 300). You can share our dosing methods. You could also point her to the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats was developed by laypersons from the German Diabetes-Katzen Forum. The protocol was eventually published in the Journal of Feline Medicine and Surgery.

 

[Malia]

I don't see the drop? Still in pinks?

She had her preshot meal and it went up. She is still in the pinks, but coming downish now. Maybe she will come down again tonight, coming off of the bounce. I think I better put on some coffee and find something to watch. I do have to work in the morning so this could be a long night if she does keep lowering. I am so jealous, she is sleeping so hard she is snoring. I am so tired myself.

I would not increase to 3.5U. We recommend increases and decreases by 0.25U (or 0.5U if nadirs stay over 300). You can share our dosing methods. You could also point her to the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats was developed by laypersons from the German Diabetes-Katzen Forum. The protocol was eventually published in the Journal of Feline Medicine and Surgery.

Is it safe to increase the dose every 3 days like my vet is wanting to do? If the increase is .25? The next increase would be 3 units. Teja seems to have nadirs mostly over 300 with these bounces. I am going to share this with my vet tomorrow, thank you. I just spent some time looking for something on bouncing. Is there a sticky that I can share with her regarding bouncing?

 

[Bandit's Mom]

She had her preshot meal and it went up. She is still in the pinks, but coming downish now. Maybe she will come down again tonight, coming off of the bounce. I think I better put on some coffee and find something to watch. I do have to work in the morning so this could be a long night if she does keep lowering. I am so jealous, she is sleeping so hard she is snoring. I am so tired myself.

Be guided by the +2. Unless she is much lower, do not stay up. You can always set an alarm to test at +8 or +9. You need to get rest or you will not be able in no shape for this marathon.

Is it safe to increase the dose every 3 days like my vet is wanting to do? If the increase is .25? The next increase would be 3 units.

With TR, you increase every 3 days if nadirs are over 200. Once you start seeing green nadirs (like Teja is seeing on this dose), you hold a dose for 5 days. Ignore the bounces. Dosing is based on nadirs and not on preshots or bounces. We don't change doses every day/every cycle based on highs. Lantus is a depot insulin.

Teja seems to have nadirs mostly over 300 with these bounces. I am going to share this with my vet tomorrow, thank you. I just spent some time looking for something on bouncing. Is there a sticky that I can share with her regarding bouncing?

Yes. Numbers can be flat and high during bounces. As her body gets used to lower numbers, the bouncing will reduce.

"Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". Usually, a bounce will clear kitty's system within 3 days (6 cycles)."

https://www.felinediabetes.com/FDMB...-ndw-and-failed-reductions.46012/#post-642819

 

[Malia]

Be guided by the +2. Unless she is much lower, do not stay up. You can always set an alarm to test at +8 or +9. You need to get rest or you will not be able in no shape for this marathon.

But it is so hard!! I have such anxiety about drops! I don't think I will have to worry about it tonight. She hasn't dropped below 350. Thank you for reminding me of this. I do need to sleep and take care of myself, so I can care for her through this marathon.

With TR, you increase every 3 days if nadirs are over 200. Once you start seeing green nadirs (like Teja is seeing on this dose), you hold a dose for 5 days. Ignore the bounces. Dosing is based on nadirs and not on preshots or bounces. We don't change doses every day/every cycle based on highs. Lantus is a depot insulin.

I was reading the PubMed article and it is great. I can't wait to get it over to my vet. I wish my vet understood this, to ignore the bounce and define the dosing based on nadirs. Thank you, you are really teaching me a lot.

Yes. Numbers can be flat and high during bounces. As her body gets used to lower numbers, the bouncing will reduce.

"Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". Usually, a bounce will clear kitty's system within 3 days (6 cycles)."

https://www.felinediabetes.com/FDMB...-ndw-and-failed-reductions.46012/#post-642819

Thank you for this! I remember reading this article but for some reason, I couldn't find it. Probably because I am tired, lol. I wish I could convince my vet of these things. Hopefully with these articles, I can at least get heard when discussing treatment plans.

I am so grateful for your help Bhooma. I hate not knowing, I feel so insecure when I don't know. I have read through the forums and with what you have taught me, I am starting to feel more secure. But this is still so hard.

Thank you for everything

 

[Bandit's Mom]

But it is so hard!! I have such anxiety about drops! I don't think I will have to worry about it tonight. She hasn't dropped below 350. Thank you for reminding me of this. I do need to sleep and take care of myself, so I can care for her through this marathon.

Continuing to bounce. So don't worry and get some sleep

I wish my vet understood this, to ignore the bounce and define the dosing based on nadirs.

I wish I could convince my vet of these things. Hopefully with these articles, I can at least get heard when discussing treatment plans.

Vey few vets know very much about feline diabetes besides prescription food and (very often) the wrong insulin and/or incorrect dosing. So it's nothing new. Many of us have navigated FD without any help from our vet - we just used the FDMB dosing methods and looked to the vets only for a prescription for insulin! The mantra here is just smile and nod at what the vet says and then come home and do what you think is working!

I hate not knowing, I feel so insecure when I don't know. I have read through the forums and with what you have taught me, I am starting to feel more secure. But this is still so hard.

FD is not simple or linear and is a lot of work even without all the other conditions you are dealing with.