1/28 - Sami - PMPS 477;

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Tina & Sammy

Tina & Sammy

Member Since 2010
Good morning all,

Sami had a nice little drop last night. I am not sure if it had to do with the fluids or the new insulin. She is back up to 455 this morning, but I was sort of expecting that. Like I mentioned yesterday, I a guessing it will take her a bit longer to come down since she has been high for so long. I am very hopeful that I will get her back to the Falls very soon.

I am extremely grateful for this group. Whenever someone tells me that their cat was diagnosed with diabetes I send them here. Everyone is so helpful and encouraging.

We will see how today goes. I will try to get home from work for lunch to get a +6 today, but I am not worried about her going too low at this point, but mostly just to have the data. I am also very tempted to give fluids again tonight, just maybe not 100 ml, but maybe about 50 ml. Any suggestion would be helpful. I know it won't hurt her to give her fluids, and if it is helping her come down from the high I will definitely consider it.


Yesterday's Condo: http://www.felinediabetes.com/FDMB/threads/1-27-sami-pmps-470.132126/#post-1360717
 
I was hopeful that Sami would stay down after her 300's last night, but again this afternoon at +6 AMPS she is at 502. I don't know when the last time she ate was. There was food in the feeder when I stopped by the house at lunch to do a quick test. She will have food available to her until +8.5 AMPS, and then the food will be removed in preparation for PMPS.

I still have at least two more cycles before I would be allowed, per protocol, to increase her dose, but I am wondering since I have been following a strict protocol should I hold for a couple extra cycles before increasing just in case she is bouncing?
 
Does anyone feed Dry food for their HC? I haven't needed it yet, but I have some Kitten Chow on hand, and Sami loves it, and I know if she goes low she would probably eat as much as I give her. Suggestions Please?
 
Tina:

Per the protocol used by the German Lantus forum, if numbers are this high and flat, you can increase as soon as after 4 cycles. In fact, you could increase by as much at 0.5u since the nadirs have all been above 300.

Remind me -- have you taken Sami to the vet to make sure that numbers this high aren't due to a medical problem? If this is food allergy, did the vet recommend novel proteins?
 
Any changes in fluids should probably be discussed with your vet.

I agree with Sienne on the increase. I wouldn't worry about the bouncing at this point, Sami just isn't getting enough insulin. Check out the post on Lantus: Myths Debunked and Bouncing. On entry #17, Libby has a great explanation on increasing during a bounce.

We don't usually use dry food for HC. Dry food takes longer to metabolize and get into the blood stream. When a cat is low, you want to bring her up quickly and HC wet food, karo, honey or syrup will impact the blood sugar much faster.
 
Sienne and Gabby said:
Tina:

Per the protocol used by the German Lantus forum, if numbers are this high and flat, you can increase as soon as after 4 cycles. In fact, you could increase by as much at 0.5u since the nadirs have all been above 300.

Remind me -- have you taken Sami to the vet to make sure that numbers this high aren't due to a medical problem? If this is food allergy, did the vet recommend novel proteins?
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Sienne,

Sami was at the vet earlier this month, the vet did recommend a hypoallergenic diet, but only because she suspected pancreatitis. What are Novel Proteins? Would that be something like hypoallergenic diet? Sami is a very picky eater so we haven't tried the hypoallergenic diet yet because it is SO expensive, but it is not out of the question if she will eat it. Would you recommend this course of action?

I am just not sure if these high flat numbers are due to the change in doses over the last several days, and if I should just hold for now.
 
Wendy&Neko said:
Any changes in fluids should probably be discussed with your vet.

I agree with Sienne on the increase. I wouldn't worry about the bouncing at this point, Sami just isn't getting enough insulin. Check out the post on Lantus: Myths Debunked and Bouncing. On entry #17, Libby has a great explanation on increasing during a bounce.

We don't usually use dry food for HC. Dry food takes longer to metabolize and get into the blood stream. When a cat is low, you want to bring her up quickly and HC wet food, karo, honey or syrup will impact the blood sugar much faster.
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Thank you for pointing out that DRY food takes longer to get in to the system. I will stop and get some HC and MC food tonight.

So I am assuming you are both suggesting that I increase Sami's insulin to 1 unit tonight? Is that correct? Because since she has been on .5 unit for the last 4 cycles she hasn't gone under 300. is that right.

At one point Sami was getting 100 ml fluids every day. We have only backed off recently to ever other day or every couple of days. Maybe I will just wait to see how she does tonight and then give fluids tomorrow.
 
Yes, you can increase to 1.0U tonight.

Have you read the Primer on Pancreatitis? We don't see hypoallergenic diets recommended for pancreatitis, but rather for allergies or IBD. Novel proteins are meats that she's not eaten before. For example, if she has been eating chicken or turkey, then try venison, lamb, rabbit, pork, or duck (as examples). Most veterinary hypoallergenic diets are high in carbs and not suitable for a diabetic. There are a number of off the shelf pet foods that have low carb different proteins.
 
Wendy&Neko said:
Yes, you can increase to 1.0U tonight.

Have you read the Primer on Pancreatitis? We don't see hypoallergenic diets recommended for pancreatitis, but rather for allergies or IBD. Novel proteins are meats that she's not eaten before. For example, if she has been eating chicken or turkey, then try venison, lamb, rabbit, pork, or duck (as examples). Most veterinary hypoallergenic diets are high in carbs and not suitable for a diabetic. There are a number of off the shelf pet foods that have low carb different proteins.
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Hi Wendy,

I just read the Primer on Pancreatitis. Although Sami had been tested in the past for Pancreatitis we think it was due to an infection. She isn't showing ANY of the signs of pancreatitis. As I have previously mentioned she has been on antibiotic twice in the last few month, and once before in September 2013. I believe it was Sept 2013 when she had the pancreatitis. We did not send out to have the FPL test done again. The doctor just assumes that she might be having a flare up. I have gone through Janet & Blinky's Cat food lists and tried to find foods that have a phosphorous around 200, carbs under 10 and fat between 50-60. I understand that high fat diets could cause issues with the pancreas also. Sami has slightly elevated kidney values which, is as I understand it, phosphorous could make worse. And then there is the sugar factor. Now to see if I can get her to eat that food. I added in a bit of one of the foods last night and so far it is going over well. The doctor does recommend to try to limit the variety, at least until we can determine if it is an allergy, or just the stress of losing another family member.

I will look into getting a different protein to see if that helps as well. But she was on a similar diet before when one of my other cats had IBD. She was on a limited ingredient diet. But when he passed we went back to regular food and she has been fine on that, unless she isn't fine on it any longer. LOL!

I have a call in to the vet, but I agree that I think Sami should be increased.
 
Wendy&Neko said:
The newer food list we use is this one on www.catinfo.org. Ann's Tess also has early stage kidney disease and Ann has put a short cut list of low carb/low phos foods on Tess's SS here.

What were the antibiotics for?
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Thanks for the updated list. The antibiotics were for a possible infection.

Sami was 464 when I got home today at +10, and 544 at +11. I am very much inclined to start the 1 unit tonight, but I am very nervous about where she might be in the morning and whether or not I will feel comfortable about shooting 1 unit when I can't be home to test her. I will more than likely be able to get home at least once tomorrow during lunch around +6, but I can't be sure I could do it more than that. I am waiting to hear the doctors feed back before I make a final decision.
 
The vet hasn't been able to get back to me and I need to give Sami her shot in the next 20 minutes. I really don't know what to do. I want to give the unit, but I am also nervous about her going too low tomorrow when I can't test often.

Should I go for the full unit or maybe just increase to .75? If I go with .75 and she isn't getting down into the 200's would she earn another dose increase by Friday night or Saturday morning. I would feel more comfortable doing a full unit when I am home all day and can check her often.

Advice please.
 
there's no clear cut answer to your question. some cats respond immediately to a dose increase, some take a few cycles.

if you are nervous about increasing by 0.5u, of course you can go to 0.75u instead. we don't really have enough data on her to know if she'll respond immediately or if she's a cat that takes a couple of cycles to show what the dose will do.

i think it's your choice. what i wouldn't do is continue to hold this dose, only because she is so high and it's clearly not getting her into a good range.

as far as the fluids - another one of those ECID (every cat is different) things. I have wondered if it has mor to do with whether or not the cat is dehydrated. the first time i gave them to punkin his blood sugar plummeted. but never after that. so . . .
 
julie & punkin (ga) said:
there's no clear cut answer to your question. some cats respond immediately to a dose increase, some take a few cycles.

if you are nervous about increasing by 0.5u, of course you can go to 0.75u instead. we don't really have enough data on her to know if she'll respond immediately or if she's a cat that takes a couple of cycles to show what the dose will do.

i think it's your choice. what i wouldn't do is continue to hold this dose, only because she is so high and it's clearly not getting her into a good range.

as far as the fluids - another one of those ECID (every cat is different) things. I have wondered if it has mor to do with whether or not the cat is dehydrated. the first time i gave them to punkin his blood sugar plummeted. but never after that. so . . .
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So are you saying to hold the .5 or to hold the .75 once I start giving that?
 
i'm saying it looks like she needs more insulin. you could go to 1.0u, or if that makes you nervous, you could choose to go to 0.75u. Once you increase, i'd stick with whatever dose you choose until it settles in and we can see if she's going to get into better #s with it - a very minimum of 4 cycles, more likely 6 cycles.
 
Last time you increased to 1.0U, she just got into upper blue. I think it would be OK to do that. Whatever dose you do tonight, .75U or 1.0U, you would have to hold it at least 4 cycles, maybe 6.

Most people stop asking the vets for advice on dose, one of the reasons being that they are not as available as some one here.
 
Wendy&Neko said:
Last time you increased to 1.0U, she just got into upper blue. I think it would be OK to do that. Whatever dose you do tonight, .75U or 1.0U, you would have to hold it at least 4 cycles, maybe 6.

Most people stop asking the vets for advice on dose, one of the reasons being that they are not as available as some one here.
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Yes, I totally agree that the vet isn't just on call for Sami and I, but she is usually pretty good about getting back to me quickly.

I was just about to draw the insulin when the vet called me back, and talked me off the ledge. She took the time to look at Sami's Spreadsheet and highly suggested that I stick with the .5 unit for a few more cycles. She didn't think it was a good idea to take her up to 1 unit because after just one dose at 1 unit she was getting into the blue and she was concerned that prolonged 1 unit doses would bottom her out. As I mentioned before I was really nervous about the 1 unit and being able to hold it for at least a few cycles, when I couldn't monitor heavily. So I asked her about doing .75 unit. She was okay with that, but she really didn't feel like we have given Sami enough time on the .5 dose to know if it will start to work.

We made an agreement that we would stick with .5 unit for now, and if the numbers are not coming down by Friday evening I will start doing .75 unit on Friday evening dose. This way I can monitor her throughout the weekend and see how she does.

She also gave the go ahead to give Sami 50 ml of fluid every day if I felt the need.

The only thing I am nervous about is Ketones. I haven't been testing because I don't have any strips. The last time Sami had High BG for longer than a couple of days I tested regularly and she never had Ketones. Is this something I should be worried about. Should I get some strips? The last time I got the strips from the vet, but can I purchase them at the pharmacy? I need to stop and get more testing strips on Friday so I could pick up some Ketone Strips then if necessary.
 
If Sami is going to stay in high number with 0.5U dose, then yes you should be testing for ketones, daily if possible. You should be able to get Ketostix at almost any pharmacy. I believe Walmart has their own brand. I wouldn't wait on that, especially since Sami had a history of possible infection. The recipe for ketones is infection + not enough insulin + not enough food. Anything above trace on the ketone test means a visit to the vet. Giving her fluids does help.

It's our experience with kitties that are returning from remission that you have to be a bit more aggressive to give them a chance to get back into remission. Most vets don't have many if any clients that test at home. So for them, a dose that gets cats into the blues is as far as they want to go for safety's sake. Neko's vet had us stop increasing when we got to mid blue nadirs. Eventually I stopped listening to her for dosing advice.
 
Wendy&Neko said:
If Sami is going to stay in high number with 0.5U dose, then yes you should be testing for ketones, daily if possible. You should be able to get Ketostix at almost any pharmacy. I believe Walmart has their own brand. I wouldn't wait on that, especially since Sami had a history of possible infection. The recipe for ketones is infection + not enough insulin + not enough food. Anything above trace on the ketone test means a visit to the vet. Giving her fluids does help.

It's our experience with kitties that are returning from remission that you have to be a bit more aggressive to give them a chance to get back into remission. Most vets don't have many if any clients that test at home. So for them, a dose that gets cats into the blues is as far as they want to go for safety's sake. Neko's vet had us stop increasing when we got to mid blue nadirs. Eventually I stopped listening to her for dosing advice.
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Hi Wendy, I am sure that I will get to that point as well, where I rely more on this group than the vet. I just felt really uncomfortable tonight about increasing so for my own sanity I decided to keep it at .5 units. I will see how tomorrow goes and make a decision on Friday. If she is over 400 on Friday morning at AMPS I don't see a problem giving a .75 or even 1 unit shot Friday morning, because even if I can't monitor as heavily during the day I will be able to monitory heavily over the weekend. I figure it is just a couple more cycles to get me to a time when I would be home and more comfortable to shot low numbers.
 
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