2/16 Tonka - AMPS 101, +1 90 , +4.5 50 - Question for today

[jmalasiuk]

Yesterday's post: http://www.felinediabetes.com/FDMB/threads/2-15-tonka-amsp-126-61-3-5-59-4-5-45-at-6.133169/

Tonka appears to be on the descent today (he dropped a bit after his morning meal, rather than spiking). It doesn't really look like he rebounded yesterday, but it could have been a wee one, I suppose... (I lowered his dose back to 1.5 units as of last night)

last night's PMPS = 160
+2 = 142
+4 = 90
+6 = 99
+8 = 119
Today's AMPS = 101
+1 = 90

Here's the question, since this is still early after the reduction: if he decides to drop below 50 again today (which looks like it could happen), does the protocol (and peoples' experience) count that as an automatic reduction, or should I wait it out another couple cycles to see what happens as the depot drains? Or does it depend on how much he drops? I honestly don't know if I can keep just waiting for him to crash. It's a bit unnerving, especially since I'll be back at work tomorrow.

Any advice would be appreciated.

 

[rhiannon and shadow (GA)]

given your situation.... if he goes low again today.... imho, I would take the reduction. It looks like he's hit his turn around dose.... and may start working his way down.....which is fantastic
and nerve wracking.
If it's too much at once, you can always go back up ....


but since you need some sanity tomorrow.... that's what I would do.

 

[jmalasiuk]

I have another late night ahead of me tonight anyway (deadline for report is tomorrow), so I could give it three cycles, at least. But depending on what he does today/tonight, I doubt I'd have the nerve to leave him if he was still coming down too far. So I like your humble opinion

It would be fantastic if he was healing, but something sent him spiking up back in January and it's possible that it's just working it's way out of his system (maybe those antibiotics his vet prescribed him as a "lets see what happens" measure actually helped, or maybe something else was going on. He's not telling!) He was on a lower dose than this before and dropping just as far or farther some days. He was just rebounding so much that I couldn't keep him at the normal numbers.

Of course, in a week he gets to go back on antibiotics in preparation for his dental next Wednesday, so that could screw up his nice trend of staying in the healthy range. But time will fix that if he does spike up again, right? I'm just hoping that there's enough time left this winter to get him nice and stable before I have to start abandoning him regularly with only twice daily check-ins from their sitter.

 

[Sienne and Gabby (GA)]

It can take several cycles for the insulin depot to catch up with a dose reduction. I would try to use some LC food to prop up his numbers if you need to.

If Tonka is going to need antibiotics after the dental, make sure that if it's a liquid, that the antibiotic isn't in a syrup base.

 

[jmalasiuk]

Thanks for that advice - I'll have to see how far he drops to decide what I'm going to do for certain. I'd go the food route happily enough if I was going to be home to monitor, but I'm gone for 12 hours most days and once he's decided that it is nap time, he can't be trusted to remember that he does have food available until he hits the desperate level

They usually give the cats a pill type antibiotic at this clinic (vs liquid). The pills shouldn't have any extra sugar in them, but I will check. When Teeger had half his teeth extracted a couple years ago, they shot him up with an injectable antibiotic and then gave me the AntiCLAV that we seem to get most of the time. I expect that if Tonka can't eat solid food right away, I'd just grind the pill up and add it to water and inject that into the back of his mouth with a needless syringe. That was how we used to give our family's hyperthyroid cat his pills - any other way and they'd just get spit out.

 

[Wendy&Neko]

Some cats just decide at some point to have all green cycles. It doesn't mean a reduction pending, just that their liver/pancreas aren't bouncing anymore. It addition to earning reductions when kitty goes below 50, going seven days in all normal numbers also earns a reduction. Take a look at Davidson SS, and also Rhiannon's Shadow as examples of cats who earned reductions this way.

When Neko had her dental last month, she had clindamycin for antibiotics after the extraction. I was given the option of pill or liquid and found liquid easier to get in. The liquid (called Antirobe) had no sugar in it.

 

[jmalasiuk]

It addition to earning reductions when kitty goes below 50, going seven days in all normal numbers also earns a reduction

I hadn't seen that before - thanks for letting me know. Does that mean all normal numbers (i.e. 50-130), which includes green and lower blues, or all green numbers above 50? I'd have thought that if they are in the normal range, that would be where you'd want to stay, wouldn't it? Or is this the test to see if their pancreas is taking up slack again?

When Neko had her dental last month, she had clindamycin for antibiotics after the extraction. I was given the option of pill or liquid and found liquid easier to get in. The liquid (called Antirobe) had no sugar in it.

I've always like the liquids too, but they don;t offer them often, for some reason. Since he's probably going to have a sore mouth, maybe I can get them to give me the liquid this time (I'll ask for one without sugars). He's gotten awfully good at eating the pill pocket right off the pill and depositing said pill on the floor

 

[Wendy&Neko]

I've highlighted the bit from the protocol on reductions after a week of normal numbers.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

The odd lower blue would be allowed. Rhiannon's Shadow liked to throw those in. The ideal is to have them in normal numbers all the time, but if the goal is remission, then you also want those reductions to see if the pancreas is starting back to work.

 

[jmalasiuk]

Okay - got it (I think).
He must have been rebounding a tiny bit yesterday, since he's been steadily coming down today. Just hit 2.8 (50) at +4.5 I picked up sleepy head and moved him to his food (to which I added a smidge of the Friskies chunks in gravy that we opened yesterday), at which point he happily slurped up another few tablespoons of his breakfast. This is what I mean about him not noticing that he really ought to eat when he's in nap mode - he really likes his "naps". More like a daily hibernation in his case. This is not a diabetic symptom for him, he just REALLY likes to sleep. Always has. I literally got grumbled at today (not growled - just grumbled) when I picked him up to test yet again. It was actually kind of amusing)