2/14 Wally - decreasing even more....

Wally & Stefano

Wally & Stefano

Active Member
Prev condo:
http://www.felinediabetes.com/FDMB/...ues-in-the-last-few-days.210712/#post-2335953

This morning I decided to reduce even more to 3.5U because:

- his AMPS was lower than the last 5 days
- he didn't eat most of his night timed food
- he barely eat something at AMPS
- so maybe not much food in his stomach before shooting

Last PMPS measurement is 119

General conditions are very good. I tested ketones again and got ZERO on blood test.

I was not able to monitor during the day but again nadir was at +12 even tho we don't know what exactly happened during the day

I am tempted to give hime some different LC food to make him a bit more hungry, but I'm worried to introduce something new in this already weird condition.

Any feedback welcome!

@Sandy and Black Kitty @Marje and Gracie @Wendy&Neko @Sienne and Gabby (GA) @Bear & Lora
 
Copied and pasted from Wally's previous thread.

@Sandy and Black Kitty @Marje and Gracie @Wendy&Neko @Sienne and Gabby (GA)

Sandy since at this point Wally's situation is very different and can not be held to normal protocol in a safe manner.
Did you ever have to skip a shot to drain the Depot?
I realize that Wally has had DKA and that needs to be kept in mind with constant testing for ketones while trying to maintain a safe dose of insulin .
On the other hand in this situation weighing the margins of safety for Wally do you feel draining the Depot is an option that could be considered when a safe dose is elusive.

The only reason I am broaching this is that Stefano has shared through PM's with me the struggle he has been dealing with and like you with BK, trying to keep Wally's head above water so to speak, along with the fear of uncertainty when he has to leave Wally for long stretches of time unmonitored.
The Depot while being a positive in the regulation of a feline by the continuation of insulin becomes somewhat problematic in this rare situation.

Everyone that has joined this forum has a deep, abiding love for a feline and I have much empathy for Stefano in what has become a difficult pursuit to keep Wally safe and am trying to find more options for Wally and Stefano with no offence intended.
 
I like Laura's comments and agree that optimizing dose has to be balanced with kitty's safety and caregiver's mental/physical wellbeing.

Wally's recent BGs are wonderful and it seems (although the larger depot is probably still having an effect) that something between 3.5 u and 5.5 u will be a good dose range. If I was in Stefano's position I'd keep the 3.5 u dose for another day to have a little breather then reassess. A tired and stressed caregiver needs relief.
 
I responded to Lora's observations in the previous condo.

Stefano -- keep in mind that low carb is not the same as low calorie. If you want to change up Wally's food, that's fine but it may not have an effect on whether Wally is hungry. Most cats, as they get better regulated are not wanting to eat everything in sight. What goes along with more normal BG numbers is that the glucose that had previously been floating around in a cat's blood stream is now getting into the cells like it's supposed to. As a result, appetite decreases. This is usually a good thing.

I would suggest testing at +1. See where numbers are. If they are dropping, test at +1.5 and if they are stable or rising, test at +2. In other words, monitory carefully so you are able to see what Wally is doing and if numbers continue to drop, intervene with HC food. I'm not going to be able to stick with you. I'm at work and have a meeting coming up.
 
Not necessarily because there is still some influence from the previous higher dose depot. When Wally starts dropping, he sure is dramatic about it. All you can do is watch how this cycle goes and then act accordingly. I really wonder if he dropped lower last night than you caught and those blues today could be a bit of a bounce. I don't think any of us expected Wally to be this low tonight. He's definitely putting you through your paces but he's going in the right direction. :)
Your instincts have served you and Wally well. Let's see where he's at next test.
 
He's holding steady albeit with the higher carb food so I don't think you need any bigger weapons just now.
Do you have any honey, pancake syrup or corn syrup in the house? How about ice cream? I used to keep sugar donuts in my fridge because Menace would only eat one flavour of LC food but she loved sugar donuts (found out due to her pilfering!:woot:)
 
The larger depot can influence 4-6 cycles after a reduction, more with larger depots. It’s likely the 7.5 unit dose has an impact on this cycle, and the 5.5 unit one definitely does. With larger dose kitties, it can be helpful to do a one time half or two thirds dose after a reduction is earned, in order to help drain the depot, before returning to the new dose.

Good news on the negative ketones.

Up a bit now Wally please.
 
+5.5: 63.... i served again 28% to see if he moves a bit up
I timed some more MC at +7 and +9 and I'm heading to bed now.... I hope you forgive me, but tomorrow i will have to wake up at 6.30!!!

Hope he behaves well... food is around also on his bowl so he should be able to manage it :)

Good night and thank you all!!
 
Moving discussion from yesterday’s condo to today’s:

Bear & Lora said:
Look at Wally's SS in remarks, he is logging his Carbs and times.
Stefano has been steering at times with 28% and the outcomes depending on where Wally is in his cycle have held his BG steady with little to no movement.
Click to expand...
Yes, I saw some but he doesn’t log the % carbs every day or every cycle and it’s just been since 2/8.

Bear & Lora said:
The real issue here is how long can a human being stay at home to test their Kitty when they have to leave home to work and are getting little sleep and are feeling a lot of anxiety when food is doing minimal steering of the BG.
This has continued for 6 days now with a decrease of 5 units.
Click to expand...
Food is doing minimal steering because of the feeding times. Not every diabetic cat, but most of them do better with timed feedings which work with the curve of the insulin to manage it. We typically manage the curve with food for cats that are divers and bouncers but, certainly, most cats can benefit from managing the curve with food. For cats that are running lower where you want to bring the nadir up, it works great as well. If you haven’t seen those “teaching lessons” on managing the curve with food, please let me know and I’ll post one of them. Jill has written one and I’ve written a few and there might be others.

But managing the curve with food to prevent those lower dips has to be consistent in timing and also in the % calories from carbs used. Right now, Stefano is responding to the lows; the goal would be to anticipate them so Wally has enough food on board before he onsets and before nadir so the insulin can work with the food. Does that make sense?

Having said that, there are times when cats rush down the dosing ladder, especially if IAA breaks or an acro tumor wanes or the liver snaps and bouncing stops, when the CG has a grueling time. I can think of many over the years and it’s never easy.
 
Yes, I have been practicing feeding the curve.
Wendy had suggested it for reducing Bears bounces.
I have had some success.
The problem with that is you have to be home with your Kitty to test and adjust carbs.
Stefano has an autofeeder that he is using but added to the problem that Stefano can't continue to stay at home is that Wally's appetite has greatly decreased.
 
Bear & Lora said:
Yes, I have been practicing feeding the curve.
Wendy had suggested it for reducing Bears bounces.
I have had some success.
The problem with that is you have to be home with your Kitty to test and adjust carbs.
Stefano has an autofeeder that he is using but added to the problem that Stefano can't continue to stay at home is that Wally's appetite has greatly decreased.
Click to expand...
If you are managing the curve with food, you are often feeding a higher LC food consistently....depending on the carb sensitivity of the cat.

Yes, I do understand that Wally is not eating well and that’s a whole different scenario. That’s why feeding him a higher LC food when he’s home and leaving it in the auto feeder can help. If Wally will eat a higher LC food while Stefano is there or if Stefano can assist feed him when he’s there and leave some out that Wally might just eat a little, it might help.

But, there’s a balancing act here because of the DKA. That balancing is reducing the dose for safety from low numbers but not so much that it puts Wally at risk for DKA. That’s also why Stefano making sure Wally eats higher calorie food with higher LCs when he’s home is important and leaving it in the auto feeder.

The other thing I’ve done for my cats who eat a raw diet so I can’t leave it in an auto feeder, is have a friend or neighbor feed them if I cannot be here. It doesn’t happen often but perhaps Stefano has a friend, relative, or neighbor who can help. This might have been discussed and my apologies if I missed it and am being redundant.
 
@Marje and Gracie

I really do appreciate your advice and have seen that you are a kind and smart lady. :bighug:

I just don't think everyone is getting the full picture of Stefano and Wally's situation.
Sandy and Black Kitty described her situation as an uncommon occurrence and looking at the dramatic drops in Black Kitty's BG is very similar to what Wally is doing.
I am inexperienced by far to most that are posting so I can't come close to having read as many SS, and threads but this seems uncommon .

When I first joined the forum in the stickys on protocol it stated that their are situations that caregivers have to adapt ECID.
I just don't see much adapting on advice when it is obvious from 6 days of fighting to keep Wally from going below 50BG, with it being apparent Wally is not carb sensitive and has been decreased 5 units that Stefano and Wally need more ideas to keep Wally safe while unattended and Stefano from dropping.
DKA should definitely be considered in Wally's safety but my mind sees this as a lesser danger than a hypo with no one at home to attend.

I know you addressed some of the things I have been writing about but I will leave them in instead of editing for convenience of time. :)
I will say that Stefano is his own person and I wouldn't have reduced as dramatically but apparently Stefano knows Wally well and has kept him safe with his decisions.
 
Bear & Lora said:
@Marje and Gracie

I really do appreciate your advice and have seen that you are a kind and smart lady. :bighug:

I just don't think everyone is getting the full picture of Stefano and Wally's situation.
Sandy and Black Kitty described her situation as an uncommon occurrence and looking at the dramatic drops in Black Kitty's BG is very similar to what Wally is doing.
I am inexperienced by far to most that are posting so I can't come close to having read as many SS, and threads but this seems uncommon .

When I first joined the forum in the stickys on protocol it stated that their are situations that caregivers have to adapt ECID.
I just don't see much adapting on advice when it is obvious from 6 days of fighting to keep Wally from going below 50BG, with it being apparent Wally is not carb sensitive and has been decreased 5 units that Stefano and Wally need more ideas to keep Wally safe while unattended and Stefano from dropping.
DKA should definitely be considered in Wally's safety but my mind sees this as a lesser danger than a hypo with no one at home to attend.

I know you addressed some of the things I have been writing about but I will leave them in instead of editing for convenience of time. :)
I will say that Stefano is his own person and I wouldn't have reduced as dramatically but apparently Stefano knows Wally well and has kept him safe with his decisions.
Click to expand...

Thank you for your comments. :bighug::bighug::bighug:

Actually, we are getting it. This isn’t our first rodeo with cats on a high dose coming down the dosing scale quickly. It just isn’t. Sandy’s occurrence was uncommon at that time. It was a long time ago and since then, there have been many others over the years and those of us commenting have been here a very long time and seen a lot of situations.

Yes, CGs do need to adapt and Stefano is doing that. He has dropped the dose back to where he feels comfortable because he’s dealing with a very large depot and a cat that isn’t eating as he normally would. There are only so many things you can do in this situation and we’ve offered them:
  • reduce the dose but watch just skipping due to the potential for DKA esp if Wally is not eating; if he was eating normally, a skipped shot to drain the depot a bit is worth considering but a reduced dose is much better. See Wendy’s post 20 above; she is our most experienced high dose member having had a high dose kitty and also one that was sick
  • feed higher carb food and incorporate more feeding times every single cycle in the hopes that Wally will eat out of his feeder
  • see if neighbors, friends, or relatives can help with feeding times to see if Wally will eat if someone is with him
Is it possible he reduced too much? Perhaps but with a depot that large, you have to start somewhere and we’ve reduced other high dose cats by half. You have to give the depot time to drain and see where the numbers land and take the dose up, if necessary. I’m not sure there are many members around even from the last few years that understand how fast a large depot can get ahead of you and those kinds of low numbers can last a long time.

Neither DKA nor hypo are issues we want any member to deal with. Both can have very bad outcomes. If Wally had never been DKA or was eating heartily, we’d have more latitude because a cat that is eating well is not going to go into DKA. The only other thing we can offer for Stefano to keep Wally safe is either take him to work or try and take time off while Wally is going through this. Not ideal situations for Stefano, I’m sure. Perhaps he can hire a vet tech to come in and test and feed Wally but that gets expensive.

We all want to help but I’m not sure what you are looking for. We understand the situation immensely. You state you think the dose has been dropped back too much but that is counter to your concern about Stefano having ways to keep Wally safe while he’s gone. I think it is wonderful that you’ve been so supportive to Stefano and I feel at a loss that I’m not understanding exactly what it is you wish us to do when we’ve made suggestions based on our years and years of experience.
 
Sudden drops in insulin needs in a cat with a higher dose can occur for a number of reasons. First is acromegaly, which is actually relatively common, since one in four diabetic cats has it. There are many reasons acrocats can suddenly require less insulin. They are the tumour pulsing or the effects of treatments such as radiation therapy, hypophysectomy, or cabergoline or other reasons not specific to acros. Kitties with IAA can have sudden changes in insulin needs when the IAA breaks. Some acros can also have IAA, as my girl did. IAA is less common than acromegaly. When Sandy’s kitty was diagnosed with IAA, he was the first here, so obviously rare at the time. Kitties with Cushings can also suddenly change their insulin needs as a the tumour pulses or as a result of treatment. There hasn’t been much research on how common Cushings is in cats. All of the above kitties can have glucose toxicity if in high numbers for a while. Breaking through that can also mean rapid changes is dose needs, but again more common as low dose cats have that happen too. And finally, we have also seen the odd high dose cat with cancer, some types of which thrive on carbs.

Time will tell if the large reduction in dose is too much. We have seen many cases of larger reductions than the protocol suggests, often the caregiver had to go back up in dose, but sometimes not. It is for these latter cases, especially with a large depot in play, that we suggest waiting to see what happens when the depot stabilizes again, and continued testing for ketones, especially in ketone prone cats.
 
One other thing I thought of, but I’d like @Wendy&Neko and @Sandy and Black Kitty to offer their thoughts is perhaps shooting an 18 hour schedule if this fast roll down the dosing scale continues.

My thought was that it might allow you to get a little less insulin in him than a dose that causes him to stay low but a dose that is not so low as to endanger him in regard to DKA. Shooting an 18 hour schedule just for even two times, if possible with your work schedule (and it might not be), might drain the really full depot without you having to skip or drastically reduce the dose.

Again....just a thought and it might not work for many reasons including ones that don’t work for Stefano or also issues that Wendy and Sandy might identify. I was just trying to brainstorm this a bit and think of other strategies.

I have to be honest that I’m not aware that we’ve used that strategy for this kind of situation before but, admittedly, I’m not on the board every day so Wendy might know if it’s something she’s recommended before and whether it worked or not. I’d suggest letting at least Wendy weigh in (I don’t know how available Sandy is) before you try this.
 
Marje and Gracie said:
We all want to help but I’m not sure what you are looking for.
Click to expand...

Once I posted a thread that had a very narrow point of view. After learning more facts I had a different perspective. I asked Jill & Alex if she would Delete my thread.
This was her response:
The thread you're asking me to delete already has 17 replies after your original post. Deleting an entire thread is something we rarely do. Even though you've changed your stance, others have contributed and shared their thoughts also. To delete the thread at this point is a disservice to the community because there's much to be learned from the discussion.

What she said stroke a cord with me and I was really impressed with her ideals for community/Forum, open and free to share their thoughts in order to benefit others.

What I am looking for is as many options for this situation I can find whether in the box or out of the box.
The more options a person has raises the percentage of better choices that might fit the situation.
If the outlook is narrow the options will be limited.

Thank you for your clarity that Wally's sudden need for less insulin is not an uncommon occurrence and also laying out all the options that have been talked about on this thread all on one post which is very helpful.

Marje and Gracie said:
You state you think the dose has been dropped back too much but that is counter to your concern
Click to expand...

This is a misunderstanding: Looking at the situation as a bystander I wouldn't have dropped the dose as much which is different than a caregiver who really knows the kitty-attitude, actions, demeanor etc.
As a bystander my choice would have been wrong.
Stefano knows Wally and made good decisions based on years of being his caregiver and knowledge of the cat.
 
Bear & Lora said:
Once I posted a thread that had a very narrow point of view. After learning more facts I had a different perspective. I asked Jill & Alex if she would Delete my thread.
This was her response:
The thread you're asking me to delete already has 17 replies after your original post. Deleting an entire thread is something we rarely do. Even though you've changed your stance, others have contributed and shared their thoughts also. To delete the thread at this point is a disservice to the community because there's much to be learned from the discussion.

What she said stroke a cord with me and I was really impressed with her ideals for community/Forum, open and free to share their thoughts in order to benefit others.

What I am looking for is as many options for this situation I can find whether in the box or out of the box.
The more options a person has raises the percentage of better choices that might fit the situation.
If the outlook is narrow the options will be limited.

Thank you for your clarity that Wally's sudden need for less insulin is not an uncommon occurrence and also laying out all the options that have been talked about on this thread all on one post which is very helpful.
This is a misunderstanding: Looking at the situation as a bystander I wouldn't have dropped the dose as much which is different than a caregiver who really knows the kitty-attitude, actions, demeanor etc.
As a bystander my choice would have been wrong.
Stefano knows Wally and made good decisions based on years of being his caregiver and knowledge of the cat.
Click to expand...

Thank you for sharing. Jill is wise and we are all lucky she’s been here so long.

It is important for us to have open discussions and brainstorm options. That’s vital for the well-being of our kitties.

I believe those of us who have been around a while and have posted in Wally’s condos are out-of-the-box thinkers but we also deal in the reality that some situations have limitations and we have to brainstorm within those confines.

You’re welcome; laying options out lets all of us see what has been discussed or suggested. It might lead to further ideas.

One thing I’ve learned here is that we can never discount the importance of a CG knowing their cat or their intuition. It’s easy to think, “I would have made a different choice for my cat”. I don’t always agree with what CGs decide here for their cat but I have to remind myself that it isn’t my cat and as long as they are deciding on the side of safety, there’s no judgement.
 
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Wow, just catching up and my head is spinning.
Since it’s 4am and I really should be asleep I just want to say few things that are front of mind.

First of all I’m glad ketones are negative. I recommend testing for ketones once each cycle (AM and PM) don’t let 24 hours pass without a ketone check.

are you feeding, and is he consuming, enough calories to maintain ideal weight ?

Did he lose weight during his DKA episode?
Could his appetite decrease be due to him reaching
ideal weight?

BK was down to 7.5 pounds following his second DKA episode. When he started recovering, he would eat 16 to 20 ounces of wet food per day. When he gained back his weight and strength he started eating less and less I did freak out Until I saw he was well and this was just the new normal.
Bear & Lora said:
Sandy since at this point Wally's situation is very different and can not be held to normal protocol in a safe manner.
Did you ever have to skip a shot to drain the Depot?
Click to expand...
See February 13-16 2009 on BKs ss for one example of my trying to keep things steady (hmmm...same time of year-funny). It was like trying to rein in wild horses. I don’t believe the concept of intentionally draining the depot had been put into practice back then. Due to lack of any precedent we were flying by the seat of our pants.
Do a search of BKs ss using the terms ‘no shot’ and ‘bcs’ for more scenarios.

What Wally and Stefano are going through now is temporary. In two weeks it’s likely to be ancient history. its important to remember this.

Treating FD is a dance. It’s a dynamic, not static.
The sugar kitty is leading the dance, always.
 
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I don’e see a post yet for today, so am commenting here. I see Wally is starting his drift up as the depot wears off. That means 3.5 units was too low a dose, much less the 3.0 units you reduced to today. As the weekend starts, you may want to incease back up.

Answering @Marje and Gracie question about 18 hour cycles. Crista has tried it with Ming, but not sure how well it worked. I havrn’t seen many others try it, unless for some reason the timing of doing a 12 hour shot wasn’t working. For example, kitty was too low for comfort at preshot and the caregiver was not going to be around to monitor if they shot. In my experience, the temporary BCS doses worked better. Full disclosures, Neko twice tumbled down dose quickly after radiation therapy. I think I did a BCS maybe a couple times only, and one of them was when she had given me a number in the 20’s, showing that the depotnwas really too full. But I or DH could monitor most of the time.
 
From looking at Wally's SS it would seem that his issue with too much insulin is close to being resolved.
Stefano, I am so happy things are not so dangerous for Wally. :)
 
Wendy&Neko said:
I don’e see a post yet for today, so am commenting here. I see Wally is starting his drift up as the depot wears off. That means 3.5 units was too low a dose, much less the 3.0 units you reduced to today. As the weekend starts, you may want to incease back up.
Click to expand...

I'm hoping PMPS is not as high as +6.... I am sorry his run downward stopped. :(

In case he's still high the question is now how much increase
 
Don't be sorry! You did what you needed to do to keep Wally safe and allow you to get at least some sleep. He really has had you jumping these past few days. This is not a "common" situation so there is no right or wrong answer to handling it. Safety first. Since Wally has been a little unpredictable of late, it might be better to hold off on making dosing decisions until a little closer to PMPS. He's leading this dance....all you can do is follow his lead. :)
 
I think 3.5u to 4.0u units would be ideal to try at this point. I think the 3.5u will prove to be a bit low but it's a good place to start raising too if that makes you comfortable. It might also give you more of an opportunity to catch up on some much needed rest.
 
MrWorfMen's Mom said:
I think 3.5u to 4.0u units would be ideal to try at this point. I think the 3.5u will prove to be a bit low but it's a good place to start raising too if that makes you comfortable. It might also give you more of an opportunity to catch up on some much needed rest.
Click to expand...

I did shot 3.5u ...let's see the guy reaction! He usually loves to keep me awake on weekends
:kiss:
 
Wendy&Neko said:
I don’e see a post yet for today, so am commenting here. I see Wally is starting his drift up as the depot wears off. That means 3.5 units was too low a dose, much less the 3.0 units you reduced to today. As the weekend starts, you may want to incease back up.

Answering @Marje and Gracie question about 18 hour cycles. Crista has tried it with Ming, but not sure how well it worked. I havrn’t seen many others try it, unless for some reason the timing of doing a 12 hour shot wasn’t working. For example, kitty was too low for comfort at preshot and the caregiver was not going to be around to monitor if they shot. In my experience, the temporary BCS doses worked better. Full disclosures, Neko twice tumbled down dose quickly after radiation therapy. I think I did a BCS maybe a couple times only, and one of them was when she had given me a number in the 20’s, showing that the depotnwas really too full. But I or DH could monitor most of the time.
Click to expand...
Thank you for responding, Wendy, with your astute observations. Typically, I would agree on the temporary BCS doses. I just was trying to come up with some other avenue for Stefano due to his schedule but I’m also not a huge fan of 18 hour cycles unless the timing issues for 12 hours exist as you mentioned.
 
It looks like you shot the 3.5u. I would have done the same. It's very likely those pinks are the result of a bounce. One thing to look for is how quickly Wally clears the bounce.

@Bear & Lora -- no worries. The messages were flying fast and furious.
 
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