? 06/02 Teja PMPS 167, +8 101, +9 76, +10 98

[Malia]

Yesterday's post: https://www.felinediabetes.com/FDMB/threads/06-01-teja-amps-177-3-121.290676/

Hello Everyone, I am in need of help. I am worried that I have the insulin gestapo after Teja. I have been struggling this morning with Teja and her BG. She has been lower than she has ever been. And while 76 and 98 aren't bad, we are coming up on time for her insulin and I am worried about shooting this low, especially if I shoot what I have been shooting, 4 units.

She isn't eating that much and I am worried about that. I met with her vet on 05/30 and we made some changes. We recently reduced her dose of prednisolone to 1mg once daily, down from 1mg twice daily. We also increased her dose to 4 units, up from 3.5 units. Teja's internal medicine vet felt that she could handle 4 units. So on 05/31 I increased her insulin dose to 4 units. On that first day, her numbers were great, and she was eating. Then with the better numbers, she just lost interest in eating as much and turns her nose up at the food she was once eating. She will take a few licks and then turn her head away like she is done. She is such a cat!

I have a message in to her vet about reducing her dose and am waiting for a response. I am pretty sure she will tell me to stay the course with the 4 units.

Since we went below 90 this morning, I will be reducing her dose to 3.75 units. This is correct for the SLGS, right?

I know I didn't follow the protocol for increasing doses when I upped the dose to 4 units. That was me, caving to me vet, thinking she knew better than me. I have been so tired lately and not getting the best sleep so my brain isn't braining very well.

And when she was low this morning, she would lick at her food just a bit, but not enough to do anything to her glucose. I ended up syringe feeding her 30 mLs of her d/d (higher calorie) and water. That was at that +10 marker, as she was ranging between 90s and 80s. I know these are normal values, but I wanted to get her glucose up for her insulin shot as it wasn't exactly going up on its own.

I was also recommended by Wendy to up Teja's dose of cerenia to help with nausea, but that will be later this afternoon when she usually gets her cerenia (around 5pm Pacific).

Maybe she shouldn't be off of the steroid as it increases her appetite. But we have been working to get her off of the prednisolone for a month now, reducing, then letting her adjust.

I will also be giving her some mirataz this afternoon to help get her appetite up, while she adjusts to the steroid change. I am probably going to do it for the next 3 days.

What are your thoughts? Any suggestions and help would be greatly appreciated.

 

[tiffmaxee]

It’s hard having to work with custom dosing by a vet and trying to follow one of our methods. Changing the dose like you have lately does not work well with a depot insulin as it confuses things. Then the Libre often reads low when an ear prick shows a higher bg. Upping the dose by .50 missed what might have missed a good dose.

I would definitely reduce to 3.75 but I think 3.5 is what I would do. Hopefully Wendy will give her opinion.

 

[Malia]

It’s hard having to work with custom dosing by a vet and trying to follow one of our methods. Changing the dose like you have lately does not work well with a depot insulin as it confuses things. Then the Libre often reads low when an ear prick shows a higher bg. Upping the dose by .50 missed what might have missed a good dose.

I would definitely reduce to 3.75 but I think 3.5 is what I would do. Hopefully Wendy will give her opinion.

Thank you. And I know I shouldn't have changed her dose so significantly. I caved to Teja's vet and I was desperate. I honestly thought we would never get her managed and was losing hope. Teja's internist sounded so genuine and renewed my hope. So I did it and screwed up my protocol.

 

[Wendy&Neko]

You asked yesterday about Mirataz, and yes, it is safe for diabetic kitties. If that's what you need to give. I'm a strong believer in making sure there is no nausea first, to improve the appetite. Nothing worse than giving an appetite stimulant to a cat that is nauseous. It can cause food aversion too.

As far as dose goes, there's been a lot of jumping around. It's hard to say what size the depot thinks it is, and for us to say what dose actually caused that 76 last night. When following SLGS, you hold the dose for 7 days, unless they go under 90. Even with TR doses are held a minimum of 6 cycles. You could go with either 3.75 or 3.5 units. It's easier on you to start lower and work your way up. Looks like you shot 3.75 units this morning?

 

[Malia]

You asked yesterday about Mirataz, and yes, it is safe for diabetic kitties. If that's what you need to give. I'm a strong believer in making sure there is no nausea first, to improve the appetite. Nothing worse than giving an appetite stimulant to a cat that is nauseous. It can cause food aversion too.

I was going to increase her cerenia today when I give it to her. She gets it at about 5pm. When you shared that yesterday, I had already given her the med.

As far as dose goes, there's been a lot of jumping around. It's hard to say what size the depot thinks it is, and for us to say what dose actually caused that 76 last night. When following SLGS, you hold the dose for 7 days, unless they go under 90. Even with TR doses are held a minimum of 6 cycles. You could go with either 3.75 or 3.5 units. It's easier on you to start lower and work your way up. Looks like you shot 3.75 units this morning?

Yes, I did 3.75 units. With all of the changes that I have done, would I be able to go back to 3.5 units? Ugh, I wish I had done 3.5 units.

I've been going through the site and looking for something that explains the depot a bit better. I think I did read something that explained it, but I cannot find it again.

I heard from my vet, and she says that the numbers she saw this morning were normal numbers and that I should stay the course with the 4 units. My vet won't reduce the dose unless Teja drops below 50. That terrifies me.

Her numbers are already a bit low today and I have already broken out the higher carb food for the day. Luckily she absolutely loves the high carb food and she ate that without issue. But this is too low too early, her new dose of insulin hasn't even started for the day. Is there something that I can do to keep her from getting lower? Obviously the dose I gave was too high for her. Should I take her to the ER vet?

 

[tiffmaxee]

You are seeing some influence from the 4.0 dose. She’s not so low that an ER is needed. Just feed a little higher carb food and recheck in a bout 30 minutes. The carbs will prevent a hypo. With TR long term diabetics need to drop under 40 for a reduction. I know she’s not long term and just bring this up to let you know 84 is safe. Feeding her will keep her safe and out of the ER.

 

[Wendy&Neko]

My vet won't reduce the dose unless Teja drops below 50. That terrifies me.

You hold the syringe, you are the one loading it and doing the injections. The vet is dosing as if you were following TR, but with high carb food in the diet you can't follow TR safely.

Do as Elise said and she will be safe. Let's see what the high carb food did for her.

 

[Malia]

You are seeing some influence from the 4.0 dose. She’s not so low that an ER is needed. Just feed a little higher carb food and recheck in a bout 30 minutes. The carbs will prevent a hypo. With TR long term diabetics need to drop under 40 for a reduction. I know she’s not long term and just bring this up to let you know 84 is safe. Feeding her will keep her safe and out of the ER.

The high carb foods shot her up like crazy, wow! But she did eat like a champ. So I really think she is just tired of what she is eating. But I am not going to give her the k/d unless she is closer to 50, because this jump in BG was huge.

In 30 minutes she 89. 30 minutes after that she was 157.

Even though 84 is normal, it was terrifying for me. We had just had 2 days of blues so this is all new for me.

 

[Malia]

You hold the syringe, you are the one loading it and doing the injections. The vet is dosing as if you were following TR, but with high carb food in the diet you can't follow TR safely.

Do as Elise said and she will be safe. Let's see what the high carb food did for her.

The high carb food really brought her up into yellows. She did eat a lot, so I think she is really tired of her food. We actually fell asleep. I haven't been sleeping much due to these new numbers. The green numbers, though they are normal, scare me. And the sensor alarm was going off when she would drop under 90. I have adjusted it if it drops under 80 now.

We are working with a nutritional vet who has created a recipe for Teja. We are waiting to get that recipe started until we get a little more regulated with Teja. This recipe will allow us to slowly introduce more fats into her diet and reduce the carbs that she has. She had her galbladder removed, so we have to teach her body what to do with fats coming into the body now that she doesn't have a galbladder. So right now, her foods that she is eating are higher in carbs. We also have to keep in check her protein because of her kidneys.

And with her age, we have to work slowly to do everything. From changing her diet to reducing the steroid, I have to take steps and measures to minimize the harm in making that change.

 

[Malia]

You are seeing some influence from the 4.0 dose.

Is this due to the deposit of insulin? I am still not sure I understand this concept. I have been looking, but can't find anything. Could you point me in the right direction for the proper reading material?

Also, my apologies for the delay in responding. When her BG started going up, we both took a nap. I haven't been sleeping with these low numbers and her not wanting to eat her food.