1/11 Buddy AMPS 355 - Need Help

[lbeachstace]

We are very concerned about Buddy.

He's had a couple of bouts of constipation. This past weekend he was taken to the vet for an enema.

He's on cisapride now and finally went on his own last night for the first time in a while.

But we can't get his numbers regulated at all. We should have gone up to 6 units but did a .25 increment because of his constipation issue.

He's really out of it this morning. He only ate a little bit - appetite has not been an issue at all lately. This is the first time.

What do we do? Do we go to 6.5 for his morning shot?

Is the Lantus not working for him?

Any time we see his numbers start to go down, they bounce again. How do we get him regulated?

Last thread
https://www.felinediabetes.com/FDMB...-amps-402-7-246-pmps-179.272637/#post-3032039

 

[lbeachmike]

Additional note that on 1/4/23 it looked like he was starting to regulate in the upper 100s on 5.5 units, but we unfortunately had a fur shot and it seems he's not been able to get back on track since then.

 

[tiffmaxee]

I think glucose toxicity set in from being high for so long. Has he been tested for IAA and ACRO? Increases need to be in .50 increments given his dose. Tagging Wendy for input. @Wendy&Neko

 

[lbeachmike]

Increases need to be in .50 increments given his dose.

We are aware of this. Last time he had constipation and it was relieved, he came down a couple hundred points so we took a more conservative approach for that one point in time while he was constipated given the unknown it was introducing - also knowing that he was previously very responsive at 6 units (though erratic.)

 

[Wendy&Neko]

Going forward, I would only do increases of 0.5 units, unless you are tweaking a dose that is already showing some green. The nice thing about the last 0.25 unit increase is it left you on the syringe line. Unfortunately, at that size dose it's not enough of an increase to show a significant change in numbers. With larger doses, the increases need to be larger to be significant.

What do we do? Do we go to 6.5 for his morning shot?

Is the Lantus not working for him?

Any time we see his numbers start to go down, they bounce again. How do we get him regulated?

You hold this dose for six cycles. Sometimes cats take until the 4th or 5th cycle at a dose to show what the dose can do. Provided you don't see low blues or greens by the AM of the 13th, you can increase then to 6.5 units.

As for Lantus, it is lowering his blood sugar, so it is working. You just haven't gotten to a good dose for Buddy yet. Bouncing is a very common thing with diabetic cats. And probably the number one complaint from diabetic cat caregivers. It's a sign that his body is working to protect him from numbers he's not used to. One thing to remember, insulin is a hormone, not a drug. It's not like adding a bit more gives a bit better numbers. You just have to keep increasing per the protocol until you get to that fitting dose.

Some cats need more insulin than others. Some cats have secondary conditions that cause insulin resistance. My girl had two such conditions. One called acromegaly (more properly hypersomatotropism) which is a benign tumour in the pituitary gland. The tumour sends out excess growth hormone and in turn causes the diabetes. The other condition is IAA or insulin auto antibodies, which you can think of like an allergy to the injected insulin. There are blood tests that can test for these. Other conditions causing insulin resistance include pancreatitis, kidney or heart conditions, hyperthyroidism and others. Regardless, a cat with insulin resistance can need more insulin than average. We have yet to see a cat here that did not eventually get some form of regulation. Not all get tightly regulated but at least somewhat regulated. However, the nature of some of these forms of insulin resistance is that you can see some good numbers, then they go away, and you have to keep increasing to chase after those good numbers. Just keep increasing, and you will get there.

 

[lbeachmike]

Thanks Wendy. I notice today that Buddy has appetite loss and it looks to me like he is probably feeling nauseous. To your knowledge, are these common symptoms seen in an unregulated diabetic cat with high BG numbers? Or more likely due to some secondary ailment that the unregulated diabetes is causing?

 

[Wendy&Neko]

Usually unregulated cats are hungry. Nausea is not something I'd expect from being unregulated. It could be a secondary condition, but completely unrelated to the diabetes. It's possible to have two different conditions at once. Has Buddy been tested recently for pancreatitis? It's possible to have chronic pancreatitis that comes and goes. I've seen some cats here have p'titis episodes set off by vet visits. Do you have any antinausea medications to give him? I find ondansetron is the best.

 

[lbeachmike]

I have not yet heard of ondansetron but we'll ask our new vet about it. We have been using cerenia (prescribed by the previous vet), but have scarcely needed it since early last year when we were aware of him having pancreatitis.

He did go to the vet three days ago on 1/8 for an enema and didn't like that experience at all. You can see his BG numbers rocketed with that vet visit. But he had a monster appetite just yesterday, and normal BM at home (he's now on cisapride for bowel motility, so that is also a new variable.)

Another thing he has been doing as of the last few weeks, and seemingly more so when not feeling well, is he sort of stands there dazed and then sort of stumbles around in circles. We have not been able to learn anything about this, and I'm not sure what it is telling us : (

 

[Wendy&Neko]

Ondansetron is the generic name of the drug Zofran. The generic is a lot cheaper. Have you tried giving Cerenia today to see if it helps his appetite?

 

[lbeachmike]

Buddy seemed to be feeling a little better this evening, so no extra drugs just yet. He also pulled a much better BG.

One other variable we're trying to decipher is: Stacey just went from full remote to four days/week back in the office. I know he misses her during the day (I'm not good enough) - not sure if that impacts his well-being.