12/11 Jackson AMPS 270 +2 193 +4 198 +5 144 +6 123 PMPS 270 +2 354 +4 290

Skye & Jackson

Member Since 2022
https://felinediabetes.com/FDMB/thr...-6-5-493-9-5-410-pmps-413-2-386-4-406.271699/

I really did think he was going to see yellow last night! But don’t be surprised if he bounces a bit. :( I’m glad to hear he is happy!

Well, you guys were right - I can hardly believe it after that all almost red day, but he did hit yellows! Not only that but he stayed in them through the wee hours, and I even got a yellow preshot. I’m expecting a bounce at some point, but I really hope it isn’t so much red again! That really scared me! That really is the first time since diagnosis that he had such a prolonged period in the 400s without coming down at least a bit in the middle.


IMHO, the hardest part of SLGS is the method stipulates holding the dose for a week. When a cat's in higher numbers, it's hard to hold the dose. If there's any chance you can transition Jackson to an all canned food (or raw) diet, you could switch over to TR. Even if you do so only temporarily, it will mean you can adjust the dose every 3 days/6 cycles.

When I first started this diabetes trip, I was gung-ho about TR, at least the original protocol I found on my own on the TillyDiabetes website. I had read all about remission, done all the intensive research that I throw into any new medical problem human or feline, and I truly believed I could “get there!” Unfortunately I then discovered via attempting it that I can’t really fulfill the protocol - despite the Libre’s ability to show what his sugars are doing at any point (though muchly I get that info well after the fact, is part of the issue). I realized that I can’t feed or personally monitor as often as TR requires. It’s not just a wet vs dry food thing - the dry he is on is less then 1% carb, so it actually shouldn’t make that much of a difference. It’s the scheduling.

The problem is, I work usually 8 but not uncommonly 10, and thank-God-rarely 12 hour days at a hospital. I literally cannot give him a separate measured out little feeding every four hours or whenever his glucose starts dipping low. I literally cannot hang out all day (most days, anyway) with him and make sure his sugars don’t dip too low if the protocol had me shooting aggressively for greens. And I am his only full-energy caregiver. I have trained a couple family members to be able to give a shot that I have pre-loaded in a syringe a few hours before, on the days when my shift goes over the PM shot time, and between them they are certainly willing to scan the Libre at least a couple times while I’m gone (as their workflows allow). But I have been bluntly informed that they have jobs too as well as other responsibilities (such as the elderly relative’s medical and care issues currently taking up so much of all our energies), and that nobody can sit with Jack all day. And also that no ear pricking (for accurate numbers when he’s in greens) will be attempted. I haven’t even asked about feeding small measured meals of specific carb percentages; I already know from past experiences of other kinds that I am the only one in my family with that kind of patience for detail and timing (I’ve actually been called obsessive before, as though it were a flaw, like something that would get in the way of the rough and tumble unpredictability of “real life”). Therefore free-grazing the YA kibble has become Jackson’s stand-in for those meals, to keep him safe and his ketones down.

My cousin B in particular - although she has affection for Jackson and truly loves kitties, can’t resist most hard luck cases - is unfortunately mentally quite old school about diabetes. Back in the 80’s and early 90’s, she was told to simply put a couple of cats down that developed diabetes, and those experiences hit her hard. She now seems to vacillate between being amazed and glad that insulin therapy exists now for cats, and a deep-set skepticism that it will work in the long run, which grows worse the longer and harder Jack takes to regulate. She actually told me the day before yesterday that I “may have to face reality, this could just be giving him a little more time”. I recognize that this is her way of distancing herself to try to lessen the pain and grief that she deep-down is convinced will happen again, but that attitude is not helpful. Yet at the same time, she has been the most willing to learn to give a shot despite her initial squeamishness and still nerves about it, and the most anxious - from a distance - when he’s too high or “too low” (the latter being anything below 200 in her mind, and below 100 would send her into a panic). So it’s a frustration for me, but I have to try to keep as positive-voiced as possible and work with what help I’ve got.

Don’t get me wrong, I still daydream about remission… it’s just more wistful now. I would love it to happen - but if it ever does, it must be slowly reached, without intensive hovering required. Which I know makes it less likely. I feel like I’m being realistic now in saying that seeing greens (stable higher-end since I can’t tightly monitor and react to lows) would be a joy, eventually, but that I feel a long time in yellows and then blues - if we can ever stop his rocket-ship bouncing - is probably more likely what’s going to have to happen.

And as a topper on that cake, I don’t know if I’ll be able to maintain a Libre on him long term, though I would like to. Not only the cost, but also that he’s started paying attention lately to getting them off. If he figures out how to defeat the intensive gluing that I put on this last one, we’re gonna have a problem. So I may end up down to just a couple of chances to check his BG a day, eventually - he won’t allow any more pricks than that. (I really do hope that’s not the case and I can keep the Libre on!)

To summarize all that - due to my lack of ability for intensive monitoring and feeding, SLGS has become my only realistic option.

(Although a long-timer or two here have given me a go-ahead a few times to specially do a dose increase before a week is up a couple times, when I was home a couple days and could monitor.)
 
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Nice yellows. I hope Jackson slides down today. All you can do is the best you can around your work schedule. The most important thing is how Jackson is feeling overall. It's not just about numbers. Hang in there. Jackson is lucky to have you. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Thanks, Carla. Mostly, he seems okay, though he’s definitely livelier in better numbers. And he needs to put some weight back on, again.

As for numbers… he apparently picked a heck of a time for them! After yesterday I can hardly believe it! 193 at +3. I’m delighted! -and I also wish he could have waited until tonight. I can’t stay home all day… I’m needed elsewhere… I just hope he stays blue, no attempts at greens today.

He is very purry though. :cat:
 
Skye --

FWIW, when Gabby was alive, my situation was not unlike yours. I'm on faculty at an academic medical center. My hours have always been crazy since I don't work shifts. That's the upside. The downside is that I make my own hours which currently means I'm at my office by around 7:00 and don't typically leave until 6:00. While I never lived from far the med center and if I was being paranoid about Gabby's numbers, I could run home, test (and feed if necessary) and fly back to work. I understand the demands the job places on you. Truly.

Add to the craziness of the workplace, Gabby was a diva. She had an early onset and nadir and her numbers could plummet. I adjusted my shot times so I would have a couple of hours before I left for work and was able to test. I typically had a timed feeder set up so there was food available throughout the day should Gabby's numbers drop. I didn't have anyone who could come by and check on Gabby -- I was her sole caretaker.

When I was managing Gabby's FD, there was no such thing as a continuous glucose monitor. The CGMs are a new innovation. That being the case, I wouldn't stress over having to test manually. The amount of testing doesn't really differ between SLGS and TR - you need a preshot-test and at least one test during both the AM and PM cycles. Probably the difference is that many of us who used TR (it was pretty much what everyone did when Gabby was here) were testaholics. If you look at Gabby's spreadsheet you'll see what I mean. Part of why I tested the way I did was due to how sudden Gabby's drops in numbers were. The more you learn about Jackson's patterns, the better you will be able to anticipate -- unless he's like Gabby and thought being predictable was not a species appropriate behavior.

As for the family and friends who are not terribly empathic, when you have a few minutes, read the link to Gabby's Legacy in my signature. The text I'm referring to is post #7.
 
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@Sienne and Gabby (GA) :bighug::bighug::bighug: Thanks for sharing that.

So far Jack is not particularly predictable - I will think I’ve got a pattern figured out for a few days, then he’ll totally change it. He also loves deep dives on random cycles. I do not love the deep dives. I’m hoping those will ease with time / less bouncing / more steady lower numbers…
 
A second yellow preshot in a row!!! Not going to last of course, because he’s heading up fast in the bounce now, but today was so the opposite of yesterday that it’s amazing/ridiculous/something.

At least I don’t have to be afraid that something other than a bounce was going on. Even if he’s high again tomorrow. Whew. And I’m actually glad you guys discouraged me from doing an increase just yet. His nadir was uneventful at about 110-115 from what I see on the Libre graph, and the yellows and blues were nice and long/steady. I think it may be a good dose for awhile, at least to help him settle with lower numbers - the action of the blues lasted longer than most his (typically hard-dive) encounters with green so far. Now we just have to ride the bounces out…

I did end up backing up his shot time by 30 minutes again tonight - I figured at the start of a bounce was a good safe time to get completely back on schedule. Shooting normal times again starting tomorrow morning.
 
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