2nd September: Felix and his persistently high numbers...

Astra&Purrfect

Astra&Purrfect

Member
Hello everybody!
This is my first post with Felix on the.com Forum since posting about his brother Purrfect around 8 years ago. Previous posts about Felix on the interim .org Forum include the following:​
17th August. Felix and trying to get his numbers under control.
Fur shot on Felix, bring back time of injection?

Firstly, the good news is that: Felix has regained his appetite overall (apart from a few odd iffy days) since starting B12 Cobalaplex and Omega 3 on the 5th of August. He has no vomiting or diarrhea. He has no ketones in his urine. Following the insulin therapy and now a renewed deworming and flea treatment, his fur has regained lustre (although a bit thin). He is purring more.

However, we are disappointed to see his numbers so persistently high. We thought we were making progress at 2.25 units but ever since we skipped a shot on the 14th August due to numbers in the 180s and then unfortunately a fur shot 3 days later, we've seen persistently high numbers and the 'Hi' reading on the human glucometer pre-shot, even though we're being stricter now and stopping him eat 2-3 hours pre-shot (perhaps adding to stress and bg?). Before then, we'd not had a Hi reading on Prozinc.
Perhaps his body is still in flux due to this instability, so did we actually give him long enough to stabilise after the skipped doses before going up to 2.5 units on the 23rd of August? Now I find out that apparently it could have taken up to 2 weeks to stabilise after the 2 missed shots.​
Or coincidentally, could he have more background inflammation causing higher BG?

I know the “Every Cat Is Different” slogan, but has any other owner experienced this problem?

This is what worries me: if Felix was making progress on 2.25 units even down to the 100s, is increasing his dose actually the right thing to do now? Or will he come crashing down at some point?

Any thoughts or ideas would be most welcome - thanking you in advance.​
Astra & Felix.
Felix-taking-it-easy.jpg
 
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This forum is really acting up on me right now. I was trying to quote and reply to what you said about whether this is the right time to increase. I would not hold doses any longer than 7 days. If you hold doses too long you risk glucose toxicity where hos body again becomes too accustomed to higher numbers— it makes it harder to shift them out of it. I think it’s pretty risky for a number of reasons to leave him in these really high numbers. That’s terribly hard on his organs.
 
Astra&Purrfect said:
This is what worries me: if Felix was making progress on 2.25 units even down to the 100s, is increasing his dose actually the right thing to do now? Or will he come crashing down at some point?
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I don’t even see a green number on Felix’s spreadsheet- ever. I can’t see him come crashing down, since he’s never done it before. I understand your worry, but you test enough and monitor enough to keep him safe. He’s only ever had a couple of blues. Also, it’s not uncommon for a cat’s insulin requirements to change. Some cats go up and down in dose quite a bit while others stay at one dose for quite a while. Since cats are living beings with many factors influencing their insulin needs, things can fluctuate. Felix has had a lot going on so his dose requirement could fluctuate. You need to keep on top of the increases as well as the reductions.
 
You would not need to do a curve, of course, because you do enough testing that we can see his nadirs. It’s just that it’s best to stay on top of the need for increases as well as reductions.
 
Hello, Suzanne!

Many thanks for your posts and for reminding me of the SLGS protocol. That was what we needed and so, we’ve gone up to 2.75 units straightaway this morning. We shall monitor him at +3 and +5 hours. Good news is that upon weighing Felix this morning he has put on 200g (7 ounces) in the last 10 days since the 2.5 dose.
We’re hoping to get him out of those pesky ‘Hi’ numbers soon.

Purrfect was a beautiful sandy herringbone tabby tomcat and perhaps we should have had him neutered at the time we found out about his diabetes. But we got him to live indoors and go for regular walks outside. He got away once but had come back. Everything was ticking over nicely when our neighbour came down to give us a little 3-week old black kitten who was rather noisy who became our Roxanne. Purrfect was so annoyed by the arrival of the kitten that all he wanted to do was get away. Finally, he found some way to escape by getting into the loft and out. Unfortunately, despite searching and calling him in the countryside and asking people for several kilometres around, we couldn’t find him and he never came back. Oh, well. It was sad to lose Purrfect. We have Felix, his brother, who eventually developed the same ailment.

I’ll keep you posted about Felix on this thread, Suzanne. One thing I’d like to ask in advance just to be more genned up (is that a purely British English expression? To have as much info as poss): if he were to fall within blue numbers again pre-shot, we would test - without feeding I presume - every 40 mins or so until it was considered safe to shoot. Would a reduction of dose be in order at that time and if so, would it be maybe half or three quarters a dose?

Thank you so much for your help, Suzanne. Have a great Wednesday.
Astra & Felix.
 
It’s wonderful to hear how much better Felix is doing with weight gain and appetite.

If he has a higher blue preshot like he did back in August (in the 180s) I would not stall very long. I would not wait longer than 30 minutes just to see if he is relatively stable or rising. I would shoot only a slightly reduced dose of about 2.25 units— no less than 2 — as long as you will be available to monitor and feed and intervene with carbs as needed. If you are testing and feeding then you are in control of the cycle. I definitely would not skip.

Let’s hope that that he will go down gradually and not throw you too many surprises. ProZinc can occasionally throw you an odd low number too.
 
Thanks, Suzanne! Yes, it is good news about his weight gain.
Just did a PM test at 1 in the morning, 3h45 post shot. He's still high at 410, a drop of around 70. Gosh, hope to see some lower numbers soon. I don't know what those 2 missed shots did but it's only since then that we've had black readings preshot on Prozinc.
Thanks again and bonne soirée.
Astra & Felix.
 
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Hello, Suzanne. Yes, it's frustrating when it looked like progress was being made. Still, such are the vagaries of feline diabetes, it would seem and one day can vary greatly from another. I last tested his pee late yesterday evening and he had no ketones. And a great appetite today, thankfully. I hope he'll have a better day tomorrow. Thank you kindly, Suzanne, and bonne nuit ! 🌃
 
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It’s likely that his body could be reacting to lower numbers by releasing adrenaline, cortisol, glucagons and growth hormone all of which create insulin resistance and can keep numbers high for up to six cycles (the bounce). I see cats bounce from any numbers they’re no longer accustomed to since becoming diabetic (even pink numbers and very frequently from yellow numbers.)

We also don’t know what kind of night time numbers he’s getting. He could be dropping even into yellow at night but we just don’t know it, and, subsequently, in the morning he is high and we just assume it’s the insulin that has worn off. We can’t really count how many cycles his bounces last because one could end and another one could begin… but we missed it. That’s not a criticism by the way, I am just trying to think through everything as I look at his spreadsheet and tell you what I am seeing.

Since he doesn’t have ketones (so wonderful!) you can hold the dose for the full 14 cycles/7 days before increasing by .25 units. If anything changes, please post here. Have a peaceful night.
 
Thank you so much for this explanation, Suzanne. Yes indeed, it could be Feel himself (as we often call him) rebelling so we'll hope he'll get used to the lower numbers soon. 😺
 
I’m sorry to read about Felix having problems after escaping outdoors. I know you are syringe feeding him. I hope he will be eating on his own again soon. He needs an increase in insulin to 3 units as soon as he is eating at least relatively normally. You have tons of room for a .25 increase because his “nadirs” such as they are, are so very high (even on his best day with mid to high yellow nadirs there’s lots of room for an increase.) I only mention this because it’s so unhealthy for him to continue to be in these high numbers. Love to Felix.
 
Suzanne & Darcy said:
I’m sorry to read about Felix having problems after escaping outdoors. I know you are syringe feeding him. I hope he will be eating on his own again soon. He needs an increase in insulin to 3 units as soon as he is eating at least relatively normally. You have tons of room for a .25 increase because his “nadirs” such as they are, are so very high (even on his best day with mid to high yellow nadirs there’s lots of room for an increase.) I only mention this because it’s so unhealthy for him to continue to be in these high numbers. Love to Felix.
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Hello, Suzanne. Thank you for your post and advice. Felix is showing some glimmers of appetite as I head for bed now and I hope this continues so that stability will be provided for a dose increase. I agree his numbers are far too high - his nadirs in the late yellow should practically be the starting point before a shot. Today, he completed his 5th day on 2.75 so a mini-curve could be for Tuesday but we're out that day so cannot do either a curve or raise the dose and monitor. However, rather than waiting to Wednesday for a curve and then raising the dose on Thursday, we could potentially do a mini-curve on Monday and then raise the dose on Wednesday as long as that has left him the time to adjust properly.
Have a serene night.
Astra & Felix.​
 
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