08/05 Grandpa AMPS 520, ate a small breakfast

[Beck and Philly]

Yesterday

He woke me up meowing for breakfast and went to his favorite eating spot so I was really hopeful. I wanted to cry when I saw the 520 number. I had such hopes for Lantus, but these numbers are higher than ever. I don't know if it's the worms, the low starting dose, the masses, or the wrong insulin for him.

We went to a store yesterday that sells a huge assortment of the supposed better quality can foods. We bought about 20 cans or so of different flavors and brands from the approved food list. I tried a Hound and Gatos pate first. He ignored it so I offered some Friskies. He sniffed at that and took a few small bites of the original offering. I kept coaxing, stirring, making little mounds of food, etc and he would take a bite or two each time. He left after 10 bites or so. I opened a can of Rawz for our allergic to everything boy, and Grandpa was curious enough to come back an try some of that along with JJ.

Grandpa only has about five teeth, and we know one isn't in good shape. All vets have advised leaving it alone with all else he has going on. I noticed he ate with his head at a different angle than usual so now I wonder if the tooth is also bothering him when he chews. He definitely gravitated to the softest choices this morning.

The specialty food store owner is recommending goat milk in his food. She gave us a pint yesterday. Has anyone tried it?

 

[Kris & Teasel]

I'd address the Lantus dose along with the worm treatment. You're doing TR so you can increase more frequently.

 

[Sue and Luci]

I'd address the Lantus dose along with the worm treatment. You're doing TR so you can increase more frequently.

I agree...give it a little more time...then an increase...wait for other expert to chime in. Poor little fella... Sorry he's having such a time of it. He sure likes his high numbers doesn't he? Hope you'll see some improvement soon...we're all cheering for him...

 

[Sienne and Gabby (GA)]

I have a couple of thoughts....

When you switched insulin, you weren't seeing much movement with your previous insulin and you were giving Grandpa double the amount of what you're dosing with Lantus. With most other insulin, you can start your dose at the same amount of Lantus as the insulin you were switching from. In other words, it's not surprising that you're not seeing much movement with the current dose.

If you look at the information on TR, if nadirs are over 300, you can increase the dose by 0.5u. Given how frequently you're testing, this should be a safe option.

Anything that stresses your cat's system, causes their body to release stress hormones (aka "steroids"). The bad tooth (dental problems are notorious for raising BG number) and the worms are stresses on Grandpa's system. Even if his numbers were wonderful before dental and worm issues, there's a good chance they would drive his numbers up.

On a positive note, you are seeing some "break through" better numbers. It's very likely that Grandpa's numbers will bounce upward after a lower number which makes it harder to see his progress.

 

[Beck and Philly]

Thanks all. I want to get him back up to at least 2U as quickly as it is safe to do so. The vet that prescribed Vetsulin in the first place told us that we were to give Lantus in a smaller dose and specified 1U. I wish we had started higher now. Today is day 3 at 1.25. Tomorrow we will go to 1.5.

 

[Beck and Philly]

We just learned that his worm med is processed through the liver. His liver is compromised enough that he is jaundiced so adding a harsh drug wouldn't help. Aaaagh.

We're thinking of giving some subQ fluids and Bg 12 to maybe give a boost. He drank some goats milk.

 

[Marje and Gracie]

I left some detailed dosing advice/suggestions on his 8/3 condo and I’ll move it here for you. It’s always important to go back to the previous day’s condo and read through to be sure you saw everything. If someone wants to post something to you and you haven’t done the current day’s condo yet, they’ll put it on the previous day’s condo.

By “taking into consideration” the dose of the non-L insulin one is switching from, it means, in a nutshell, one wants to consider if that dose was getting him into good numbers? If it was and you have an idea of how low that dose was taking him, you might want to back off the Lantus starting dose a bit from the other insulin dose. If that dose was not doing much for him, then you wouldn’t want to back off the starting dose of the Lantus very much at all as long as you could test (safety first).

We’ve seen some instances where the dose on the previous insulin was doing nothing....numbers were still very high. In that instance, it didn’t make any sense to lower the Lantus starting dose and leave the kitty in high numbers.

Dosing by weight is the place to start when you first start insulin and there is no information as to how a kitty is responding to any insulin.

Please keep in mind that my comments are not offered as criticism but as a teaching opportunity since we have a lot of members who read but don’t post. Also, if you are in the position of helping someone in the future as they switch from a non L insulin to Lantus or Levemir (or one of their generic forms), you can offer good advice.

It’s important to note that when switching between the L insulins, we do it differently than above. In general, we reduce the starting dose by 30%. However, having said that, if a cat on Lantus, for instance, was hanging out in black and red numbers and we knew that was as low as it was getting, for the switch, I’d consider not dropping the Levemir insulin dose back.

Where to go from here with Grandpa? Typically, following the TR protocol, with nadirs over 300, one would increase the dose by 0.5u after six cycles. However, in this instance where you have switched to Lantus from another insulin and the dose was dropped back, with his nadirs where they are (other than the one blue number he had), I would consider increasing the dose by 0.25u after just four cycles to try and fast track him a little towards his previous dose on Vetsulin.

It’s your choice but what I wouldn’t do right now, unless you are seeing ketones, is raise him by 0.5u after four cycles. I’d do one or the other of these options if nadirs continue over 300:
—Increase by 0.5u after six consecutive cycles or
—Increase by 0.25u after four consecutive cycles

And before increasing any dose, it’s important that you know how low the current dose is taking him so spot checks each cycle are important. When he’s this high, that doesn’t mean get up from a sound sleep to test but grab a +2 at night and a before bed test. If he’s headed down quickly, it might be smart to then grab a later test.

And with these high numbers, with the combination of his lower dose and him being off food, I’d be staying on top of the urine ketone testing.

I had such hopes for Lantus, but these numbers are higher than ever.

When using Lantus/Levemir, it’s good to give it at least six months to work. There might be other things at play but I’d give it a little bit of time before deciding it isn’t the right insulin. On of our age-old adages here is “FD is a marathon, not a sprint”. Lantus cannot yank numbers down like Vetsulin and some of the other shorter acting insulins but it can give nice, long duration once you find the correct dose. It takes patience to get there.

 

[Wendy&Neko]

As per Marje, if you don't see below 300 tonight, you can increase to 1.75 units tomorrow. That'll get you there a little faster.

 

[Beck and Philly]

I left some detailed dosing advice/suggestions on his 8/3 condo and I’ll move it here for you. It’s always important to go back to the previous day’s condo and read through to be sure you saw everything. If someone wants to post something to you and you haven’t done the current day’s condo yet, they’ll put it on the previous day’s

I did read your post on 8/3 as well as all of the subsequent comments on all of my past threads. I believe what I proposed above is in line with what you wrote as well all the guidance I've received here. It has been more than the four cycles you mention and tomorrow will be more than the three days in the protocol for TR increases. We are currently at 1.25 and I proposed increasing to 1.5 tomorrow. Some have recommended going from 1.25 up to 1.75, but unless I misunderstood, you recommended a .25 increase. I wasn't willing to increase his dose yesterday with very little food in him and him obviously sick, but I think it will be ok tomorrow.

Unfortunately Grandpa likely doesn't have six months or even six weeks left to adjust to Lantus. I can hope and pray for longer, but every day is borrowed time. Whole most people are looking at long term remission, we are looking at helping him live his last days as happy as possible.

As always, thanks for all of the input.

 

[Marje and Gracie]

I did read your post on 8/3 as well as all of the subsequent comments on all of my past threads. I believe what I proposed above is in line with what you wrote as well all the guidance I've received here. It has been more than the four cycles you mention and tomorrow will be more than the three days in the protocol for TR increases. We are currently at 1.25 and I proposed increasing to 1.5 tomorrow. Some have recommended going from 1.25 up to 1.75, but unless I misunderstood, you recommended a .25 increase. I wasn't willing to increase his dose yesterday with very little food in him and him obviously sick, but I think it will be ok tomorrow.

Unfortunately Grandpa likely doesn't have six months or even six weeks left to adjust to Lantus. I can hope and pray for longer, but every day is borrowed time. Whole most people are looking at long term remission, we are looking at helping him live his last days as happy as possible.

As always, thanks for all of the input.

I do need to clarify because I think you did misunderstand. What I recommended was bumping him up by 0.25u to 1.5u after four consecutive cycles at 1.25u or up by 0.5u to 1.75u after six consecutive cycles. However, you are past four cycles at 1.25u so now the other option, which is per the TR protocol, is to raise him by 0.5u after six consecutive cycles so your new dose would be 1.75u.

When it comes to increases and whether they are eating, you have to look at how high the numbers are. His BG was high enough that even without eating, a small increase would have been fine. By not getting him towards a better dose, you risk DKA if he’s got any infection going on that you aren’t aware of. DKA is caused by infection + not enough insulin + not enough food/water. So I see a red flag when you have a cat that clearly doesn’t have enough insulin and is not eating.

Every single member’s goal should be regulation, not remission. I understand that if he has pancreatic masses, you are doing a lot of palliative care. But helping him with the correct dose, regardless of how much time he has, will help him feel better in terms of the diabetes. Unregulated diabetes can make the kitty feel bad.

Sending him many vines.

 

[Beth 73]

Sending many prayers to you and dear Grandpa , Beck

 

[Susan&Felix(GA)]

The specialty food store owner is recommending goat milk in his food. She gave us a pint yesterday. Has anyone tried it?

I haven't tried more than the ice-cube sample she gave me, but our specialty food store owner recommends goat milk, too. I'm glad Grandpa enjoyed his.

We just learned that his worm med is processed through the liver. His liver is compromised enough that he is jaundiced so adding a harsh drug wouldn't help. Aaaagh.

Do I understand correctly that Drontal is just one dose, and then they don't need more if they have a negative stool sample a few weeks later? Hope so. It does seem that once those things are out of his system, his appetite may very well perk up. Sending lots of vines for that.

 

[Beck and Philly]

With kittens Drontal is recommended as a 3-dose series. I think adults can stop at one if, as you say, they test negative. My original plan was to do a repeat dose with Grandpa to be sure, but now there's no way.

On a good note, he ate well tonight. Now the prayer is that he keeps it down. He vomited his mid- day snack.

 

[Beck and Philly]

Goodnight from Grandpa. Thanks for your help.