11/06 Butters AMPS 328/+3 257/+6 259/ PMPS 358

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday night (cycle 8 of current dose) Butters had a couple more mid-blues in the first half of the PM cycle: 166 @+3 and 139 @+6. Then she zoomed up to 288 @+9. I doubt I missed any action between +6 & +9, but one can never know for sure.

This morning she is back in the 300s. Given the mid-blues last night, perhaps it makes sense to hold the dose for another couple of cycles (cycles 9 & 10 today and tonight). Then I'll likely have to make a decision about whether or not to increase tomorrow morning, since I will have held the dose for 10 cycles at that point. And I'm not sure what to do.

Have a good day, all.
 
I hate to say this, but welcome to my world.

I deal with the higher/lower, roller coaster numbers all the time...it's just a way of life here. Luci is stuck in the lemon tree...and I'm usually increasing about every 6 cycles...so she has this next 24 hours to do her thang...otherwise she'll be getting an increase tomorrow...it's a constant juggling match with this one.

You may want to go ahead with an increase and help her pancreas get it's groove on again...it looks like she could use the help.

I hope she's feeling a bit better than yesterday.

Have a good day Lyla! Your weather is improving there isn't it? At least it appears to be doing pretty well in Michigan..70's predicted for this weekend...not too shabby for November in that part of the country :)
 
Good Morning :)

How is she feeling? One thing I would caution with insulin dose changes as well as with any med changes (additions, dose changes) with pancreatitis is to avoid changing more than one thing at a time.

So, if you are just starting to use the new Bupe, make that change, wait at least a few days to see how she does, including how the BGs look with the dosing, and then make your change to the insulin dose once you have that information. Otherwise, it makes it difficult, if not impossible, to figure out the cause and effect when more than one change is made at a time. There are already some variables caused by the pancreatitis that you can’t see (like inflammation) so any variables that you are able to control (insulin and med changes) is helpful.

I wouldn’t necessarily wait the typical time or follow the traditional recommendations to make changes to the insulin secondary to her pancreatitis and how it waxes and wanes. Sometimes you wait and other times based on the exacerbation or the resolutions of symptoms, insulin requirements will change. The timeframe for those changes will be guided by clinical symptoms and medication management along with the BG information.
 
Good morning. I'm glad Butters has hit the blues, at least for a short while. She will need time to heal, I'm sure. Best of luck. I try to check in when I can to see how she's doing. How are you??
Milo's attack of pancreatitis seems to be resolv(ed) (ing?) and he's eating fairly well without too much need for appetite stimulant. I hope and pray for healing for Butters too. Have a good day.
 
It's good to see those blues. Butters has been through a lot, but she will eventually get back to blues and greens. I hope she is feeling good today and you are getting some rest. Don't forget to take care of yourself too. :bighug::bighug:
 
Tomlin said:
Good Morning :)

How is she feeling? One thing I would caution with insulin dose changes as well as with any med changes (additions, dose changes) with pancreatitis is to avoid changing more than one thing at a time.

So, if you are just starting to use the new Bupe, make that change, wait at least a few days to see how she does, including how the BGs look with the dosing, and then make your change to the insulin dose once you have that information. Otherwise, it makes it difficult, if not impossible, to figure out the cause and effect when more than one change is made at a time. There are already some variables caused by the pancreatitis that you can’t see (like inflammation) so any variables that you are able to control (insulin and med changes) is helpful.

I wouldn’t necessarily wait the typical time or follow the traditional recommendations to make changes to the insulin secondary to her pancreatitis and how it waxes and wanes. Sometimes you wait and other times based on the exacerbation or the resolutions of symptoms, insulin requirements will change. The timeframe for those changes will be guided by clinical symptoms and medication management along with the BG information.
Click to expand...

This is interesting and I understand some of it. And thank you so much for your opinion and advice.:bighug:

So even though I had been using older bupe for the previous couple of days, you suggest that because I started new bupe yesterday, I should wait before adjusting her insulin? I have held her current dose for five days, so if the bupe were going to impact her BGs, do you think I would see that impact today or would have seen it even last night? Yesterday I saw mid 100s. Today, she seems stuck in mid 200s.

I'm curious if @tiffmaxee did similar? Elise, would Max's numbers always go high from a pancreatitis flare? How would you handle increasing his insulin when you were in the midst of managing a flare? Were you more cautious? I'm trying to figure out whether to increase Butters insulin or hold off. If you have time to comment, thank you:bighug:.

Butters seems to be feeling good for the past couple of days. She is still eating well and still in my lap. Could be a sign that the inflammation is waning, no? I haven't had to put her back onto cyproheptadine. She is getting Cerenia and bupe.

Maybe the blues yesterday were another sign that the inflammation is waning. Maybe the flat yellows today is a sign she is not getting enough insulin. How will I ever be able to figure it out? How will I ever know when the right time is to try to increase insulin?

Another option is increasing by half (.125u).

At what point do you think that glucose toxicity becomes more of a concern? Is there a trigger that would make you decide to increase insulin even if you had changed a med recently, for example, because BG numbers have been high for a while and glucose toxicity could come into the picture?

I hope you're all having a great day:)

Sue and Luci said:
I hate to say this, but welcome to my world.

I deal with the higher/lower, roller coaster numbers all the time...it's just a way of life here. Luci is stuck in the lemon tree...and I'm usually increasing about every 6 cycles...so she has this next 24 hours to do her thang...otherwise she'll be getting an increase tomorrow...it's a constant juggling match with this one.

You may want to go ahead with an increase and help her pancreas get it's groove on again...it looks like she could use the help.

I hope she's feeling a bit better than yesterday.

Have a good day Lyla! Your weather is improving there isn't it? At least it appears to be doing pretty well in Michigan..70's predicted for this weekend...not too shabby for November in that part of the country :)
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Weather is disconcertingly warm for November where I am, too. :(
Luci, she is a puzzle isn't she. I so wish she'd give up the lemon tree. :bighug: Thanks for the opinion, Sue. :bighug:
 
Since you’ve been using the Bupe (it was not old so it is fine) and it’s been a few days and her behavior has been consistent, I would go ahead and increase the dose. I would personally increase it by .25 :).

So long as you see consistent clinical symptoms and the meds are consistent it’s fine making a change:).
However, say things are going well and you see improvement & you decide to make a change to the Bupe (give it less often), it’s best not to be cutting the Bupe and increasing insulin at the same time. If you do one change you are then able to look for any change to the BG. Say you decreased the Bupe and you start to see BGs rising, that helps provide some potentially helpful info about pain. Again, keep in mind that as they improve, the signs are more subtle so the BGs can actually help give you some warnings that a change isn’t working well. This isn’t to say you can’t increase insulin. If you increase the insulin today, don’t change the meds, give it a few days and get a new baseline. Then if & when you change the med, you can look at the BGs and see if anything changes. Does that make sense:cool:?

The point is to try to avoid muddying the waters so that if something isn’t working or a problem develops, you have a better chance of knowing what may have led to the change. If you have too many things being added, subtracted at once, there is no way to determine the potential cause of the issue.
 
I would increase, this dose is not bringing you any joy. ie. greens. I think you said her appetite continues to be fine? As long as her appetite is good, you can do what you need if her numbers come down. You are already fighting glucose toxicity, don't make the battle any harder by holding a dose that isn't giving numbers you want.

Bupe impacted Neko's numbers not that much. Her bupe was to deal with acroarthritis pain. She was quiet and withdrawn before bupe, much more interactive and playful after it started. See her SS Jan 31, 2014 - I was battling glucose toxicity at the time too. I listed the first couple times I gave it on the SS, then it was bid for rest of her life.
 
Wendy&Neko said:
As long as her appetite is good, you can do what you need if her numbers come down. Yo
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This is the issue with pancreatitis that you absolutely have to be mindful of when managing insulin. Just because her appetite is “good” right now does not mean it will stay that way unless and until you are out of the woods & on some solid ground. This is why the advice is to be cautious with managing blood glucose because you could bring her low and she has an issue and won’t eat that pile of food you put down for her like a cat without this issue. That’s just the reality of the situation.


Wendy&Neko said:
You are already fighting glucose toxicity, don't make the battle any harder
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If only this was the only battle you were fighting that would be nice :). You could just hammer it with the insulin and fix the issue. Unfortunately, there is a lot more going on with respect to this disease. This doesn’t mean you just let the BG run out of control, yet it is just as important to be mindful of the other factors involved and make adjustments to insulin dosing as per the recommendations of the endos. There is a reason why they don’t recommend
being overly aggressive with regulation during a flare.
 
I have dealt with pancreatitis before in my cat. And an up and down appetite due to the p'titis, heart issues, GI issues. I always had some 8% carb food around if I needed to up her mail meal carbs, as well as feeding syringes and syrup. I am not recommending being overly aggressive as there is plenty of room for an increase with mid blue nadirs. This dose has already been held 9 cycles, which is on the long side, though still within the guidelines of 6-10 cycles of nadirs under 200.
 
I totally agree with an increase :)because there is plenty of room to do so...just by way of trend but to dose a cat coming out of a more serious pancreatitis episode vs a day of some mild appetite loss due to chronic pancreatitis are two different things. Dosing to the point of having to even think about putting a cat in a situation where you need to syringe feed higher carb food or honey is simply unnecessary. Risk/benefit....no gain. There is an ability to be in a range that is helpful yet also little to no risk of dropping too low. Again, I want to stress that this is not my opinion simply from having a cat with underlying issues...that is just one cat... but instead the recommendations from the experts who taught me how to manage the the challenge of a more severe form of pancreatitis along with DM.
There are a lot of cats with very mild or slightly moderate disease where the course of illness and complications just aren’t as difficult to manage.
 
Tomlin said:
Good Morning :)

How is she feeling? One thing I would caution with insulin dose changes as well as with any med changes (additions, dose changes) with pancreatitis is to avoid changing more than one thing at a time

I wouldn’t necessarily wait the typical time or follow the traditional recommendations to make changes to the insulin secondary to her pancreatitis and how it waxes and wanes. Sometimes you wait and other times based on the exacerbation or the resolutions of symptoms, insulin requirements will change. The timeframe for those changes will be guided by clinical symptoms and medication management along with the BG information.
Click to expand...

I agree about making one medication change at a time as we have discussed before. That way you can figure out what works and what doesn’t. With the insulin I would not hold the dose more than 10 cycles because of glucose toxicity. I agree with Wendy.
 
Tomlin said:
vs a day of some mild appetite loss due to chronic pancreatitis
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Would have been nice if I had been dealing with just a day of mild appetite loss. A troubled heart and chemo for lymphoma as well meant more than a day of some mild appetite loss. Neko's appetite was unpredictable for a long time her last year. So my motto was "always be prepared". I also was not aiming for a dose that earned dose reductions - as I've mentioned on Butters condo before. Deliberately aiming to earn reductions is meaningless with an acrocat. Plus I still had the after effects of radiation therapy impacting her dosing needs at the time. If a dose looked at all like she was getting near a reduction, I shied away. Being under renal threshold as much as possible was my goal.

Getting rid of pink on Butter's SS is a good goal.
 
Amen to the get rid of the very high numbers but being safe :bighug:.

I think we are all on the same page with the exception of “cycle counts”. So many of these “guidelines” are from the protocol that was written for the paper trying to achieve remission and never were extended, studied or clinically shown to be the way to manage DM beyond that. So, when I see them being applied that way it is concerning....especially with cats recovering from a significant illness.
 
You must be mentally and emotionally exhausted trying to deal with so much at the same time. My heart goes out to you, and Butters. Hopefully soon there will be light at the end of the tunnel, and she can get back on track with her BG. Until then, your doing an amazing job with her. :bighug:
 
I'm not going to be on the board much or at all tonight. I just wanted to stop by to thank you all, and to let you know I read everything and I decided to increase. :bighug::bighug::bighug:And FWIW a couple of quick comments.

tiffmaxee said:
I agree about making one medication change at a time as we have discussed before. That way you can figure out what works and what doesn’t. With the insulin I would not hold the dose more than 10 cycles because of glucose toxicity. I agree with Wendy.
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We have discussed this and I followed it. I started by adjusting the cyproheptadine (eliminated now), and then it was couple of days later when I changed her from gabapentin to bupe.

Tomlin said:
Dosing to the point of having to even think about putting a cat in a situation where you need to syringe feed higher carb food or honey is simply unnecessary. Risk/benefit....no gain. There is an ability to be in a range that is helpful yet also little to no risk of dropping too low. Again, I want to stress that this is not my opinion simply from having a cat with underlying issues...that is just one cat... but instead the recommendations from the experts who taught me how to manage the the challenge of a more severe form of pancreatitis along with DM.
There are a lot of cats with very mild or slightly moderate disease where the course of illness and complications just aren’t as difficult to manage.
Click to expand...

I don't ever want to be in that situation if I can help it. But I feel like one can never know for sure, given what I have learned about the cat pancreas. I do have syringes and would be prepared to do it if I had to, even though I'll be actively working to avoid it. I don't see myself trying to purposely get Butters to earn reductions. Like Wendy with Neko. I have firmly put that chapter of Butters' and my FD journey behind us and I am very happy and confident with my decision.

Wendy&Neko said:
Getting rid of pink on Butter's SS is a good goal.
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I really like having goals. I agree this is a good goal and what I'm going to work toward. I remember @thebigfuzz saying on Butters' condo once that her goal is happy and healthy. Ultimately, that's what I am aiming for with Butters.

I plan to go back and read everything again; there is much to think about. I hope others will, too. :) The back and forth, debating of ideas, discussion of research, and sharing what you've learned from your experience with your own cats is one of my favourite things about the board. I have learned so much from these conversations and I continue to learn. And of course it helps so many others as well.
 
Cheryl & Jazzy said:
You must be mentally and emotionally exhausted trying to deal with so much at the same time. My heart goes out to you, and Butters. Hopefully soon there will be light at the end of the tunnel, and she can get back on track with her BG. Until then, your doing an amazing job with her. :bighug:
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I am kind of. But it's okay. I know a lot of other people are, too, though, and I feel for them. But that said, I'm going to call it a night. :bighug:
 
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