3/25 Brian AMPS 385 - Follow up on vet visit yesterday.

N

Nate2021

Member Since 2021
https://www.felinediabetes.com/FDMB...hot-i-think-but-this-was-this-one-too.245103/

Went to the vet yesterday with Brian and the vet said to raise the dose by a full 1iu. Said something about the clinical signs excess drinking and hunger and numbers combined indicate it still isn't enough insulin, that it is extremely unlikely it is due to too much insulin, and that we should have started a bit higher based on his size and the first week of testing (at vets prior to me home testing). The vet also recommended raising 0.5iu every two days until his lows get to 280, then change to 0.25 increments... I'm not sure why 280 specifically. I asked the vet about the depot building and if that's enough time and stuff, and she said while he's high with clinical symptoms of drinking we can be a bit more aggressive to get it under control faster. She did say I need to do curves for today and tomorrow though. His blood work was all great other than pancreas raised.

Wanted to know what you guys think about this
 
This is interesting... most vets are very laid back, and only want to change insulin dosage after monthly blood glucose curves done at the vets.
Their proposed strategy seems much more agressive than anything I have read. I couldn't possibly say it is wrong, but I would ask for some references....

I am glad his blood work came out all good!
 
Nate2021 said:
Ty sue and Luci, hope I got it right
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Purrfect!!

So a couple of questions for you.

How much does Brian weigh?

What kind of meter are you using? Cross this one out - I saw you're using a human meter...good!

I'm rather hesitant to increase so rapidly...but I agree his numbers are too high...and you've been testing so it's easy to see that he's maintaining those higher numbers.

However, if you pass by a good dose by raising it too fast you'll just hit a really low number at some point and then he'll bounce back to the high numbers...and then the yo-yo thing starts...

You've elected to follow TR and the increases there are at minimum every 3 days - which usually gives the Lantus time to build up in the 'depot'...the ever elusive depot...

Other than that, how's Brian feeling?

How would you feel about slowing things down just a tad...and trying increasing at .25 every 3 days?
 
OK, your vet is more aggressive than we are here. If you are seeing nothing below 300 (and you saw low 200's just 5 days ago on 2 unit so that's not true), you would increase by 0.5 units. And every 6 cycles, not 4 cycles. Tight Regulation is an aggressive but safe protocol. I wouldn't want to push increases any faster than it says to do. And yes, the depot does need time to build. We do have a method for fast tracking, but again, not if you were seeing low 200's just recently.

How about holding the 3.0 unit dose for a total of six cycles? That gives the depot time to build, and then do a 0.5 unit increase if you see nothing below 300. And you'll need to make sure you get a test for every preshot, plus at least one additional one each cycle.
 
Hercule's mum said:
This is interesting... most vets are very laid back, and only want to change insulin dosage after monthly blood glucose curves done at the vets.
Their proposed strategy seems much more agressive than anything I have read. I couldn't possibly say it is wrong, but I would ask for some references....

I am glad his blood work came out all good!
Click to expand...
I hadn't read anything that aggressive either. Vet seemed confident... She was really focused on his excessive drinking being an indicator that a bigger increase was alright as long as monitored closely, I could have picked that up wrong though lol. One other thing is she seems to think the sooner his numbers come down the better and had me remove carbs immediately when first diagnosed and test him myself as often as possible. Seems like a good vet but also maybe not :/
 
Sue and Luci said:
Purrfect!!

So a couple of questions for you.

How much does Brian weigh?

What kind of meter are you using? Cross this one out - I saw you're using a human meter...good!

I'm rather hesitant to increase so rapidly...but I agree his numbers are too high...and you've been testing so it's easy to see that he's maintaining those higher numbers.

However, if you pass by a good dose by raising it too fast you'll just hit a really low number at some point and then he'll bounce back to the high numbers...and then the yo-yo thing starts...

You've elected to follow TR and the increases there are at minimum every 3 days - which usually gives the Lantus time to build up in the 'depot'...the ever elusive depot...

Other than that, how's Brian feeling?

How would you feel about slowing things down just a tad...and trying increasing at .25 every 3 days?
Click to expand...
:)

This was exactly the thing the vet had stressed, Brian is a big cat currently 7kg/15lb, and quite thin right now. At a healthy weight he should be around 9-10kg/20-22lb. I'm thinking the vet factored this into the current raise advice

He isn't doing too well, very tired and hungry and lots of drinking and peeing. Usually an outdoor cat but is staying inside and using a litter box.

I'm hoping with my current testing schedule I'll be able to spot something that will suggest it went too high with this initial jump? I think I want to slow it down and have 0.25iu increments, but I'm also wanting to see if this increase resolves the excessive drinking and clinical signs. I'm a confused because it was as if the vet thought that drinking and peeing with high numbers meant not enough insulin, high numbers without the clinical signs would mean too much insulin, but I'm 99% sure I Just couldn't keep up with what she was saying haha

The depot...is it more than 3 days to build up ever? Or will it definitely already be built up from the 2iu dosing from the past 5 days?

Cheers for your help
 
Wendy&Neko said:
OK, your vet is more aggressive than we are here. If you are seeing nothing below 300 (and you saw low 200's just 5 days ago on 2 unit so that's not true), you would increase by 0.5 units. And every 6 cycles, not 4 cycles. Tight Regulation is an aggressive but safe protocol. I wouldn't want to push increases any faster than it says to do. And yes, the depot does need time to build. We do have a method for fast tracking, but again, not if you were seeing low 200's just recently.

How about holding the 3.0 unit dose for a total of six cycles? That gives the depot time to build, and then do a 0.5 unit increase if you see nothing below 300. And you'll need to make sure you get a test for every preshot, plus at least one additional one each cycle.
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this is exactly what I questioned the vet on, because I was thinking how can it be that he got the yellow numbers then consistently high after. She explained it with something along the lines of "when we raised the dose to 2iu the pancreas can get a bump and a shift in hormones(?) causing a dip, if 2iu was enough insulin it would have gone back down again at least once at some point in the following few days and we'd see that the pancreas is getting a good amount of help. Because it's stayed raised for 4 days its safe to assume the pancreas still isn't getting enough help" she also stressed that when he hits a high enough dose its possible he'll come down fast and need lowering quite fast so I need to keep on top of the testing.

I am for sure going to hold the 3iu for 6 days just to be sure we haven't potentially missed a better lower dose
 
If a cat is underweight, TR bases the starting dose on actual weight. The formula is 0.25 units per kg of actual weight, so starting dose would have been 1.75 units for Brian.

It is true that sometimes you can see an initial drop after an increase, and then some bouncing time and then the numbers might not come back down when the bounce clears, so you need to increase. That doesn't justify 0.5 units if you are seeing any yellows or even 1 unit increases. As you said, hold the course for 3 days and get enough testing in to see if this dose is taking him lower.

The depot initially takes 5-7 days to build after starting insulin. After than 6 cycles (3 days) is enough, provided you haven't skipped, given a fur shot, smaller dose, delayed dose.
 
I would say in comparison with other vets, your seems clued up.... but perhaps a tad to agressive....

With regards to drinking.... On Deb's advice I started adding water to hercs food. I think I heard that they cannot drink enough water, and the more hydrated the better? Wendy do correct me here.... So I hope I keep him more hydrated by serving him soupy food.

Drinking water is a sign of diabetes, but doesn't seem like a reliable sign by which todose insulin.... especially when you have the BG data....

waiting 3 days versus 2 days won't make that big of a difference, but may allow you to sleep better....;)
 
Nate2021 said:
high numbers without the clinical signs would mean too much insulin
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Huh?

High numbers are high numbers - high numbers = not enough insulin...

As for the depot I think Wendy covered that...it takes time...and patience. Don't be in too big a hurry - insulin is a hormone, not a drug...takes a little time for kitties to figure things out.

Brian will start to feel better as soon as the insulin starts to take effect...the water drinking, peeing will diminish and his weight will improve...it all just takes time. Diabetes is not much fun for these kitties to deal with...but you can do it! Looks like you've got lots of love and time to help him along his journey :)
 
Wendy&Neko said:
If a cat is underweight, TR bases the starting dose on actual weight. The formula is 0.25 units per kg of actual weight, so starting dose would have been 1.75 units for Brian.

It is true that sometimes you can see an initial drop after an increase, and then some bouncing time and then the numbers might not come back down when the bounce clears, so you need to increase. That doesn't justify 0.5 units if you are seeing any yellows or even 1 unit increases. As you said, hold the course for 3 days and get enough testing in to see if this dose is taking him lower.

The depot initially takes 5-7 days to build after starting insulin. After than 6 cycles (3 days) is enough, provided you haven't skipped, given a fur shot, smaller dose, delayed dose.
Click to expand...
Awesome cheers for these specifications. Do you think I should ignore the vets advice at this stage and take the dose to 2.25iu instead of 3, like the tr protocol says?

And sorry more questions...
Doing it that way will mean 12 days before I get all the way up to what the vet says to do now, if the numbers stay high throughout, is it OK for him to be drinking all day like this for another 12 days?

I might put what you've told to my vet and see what she says, she'll likely ok it
 
Hercule's mum said:
I would say in comparison with other vets, your seems clued up.... but perhaps a tad to agressive....

With regards to drinking.... On Deb's advice I started adding water to hercs food. I think I heard that they cannot drink enough water, and the more hydrated the better? Wendy do correct me here.... So I hope I keep him more hydrated by serving him soupy food.

Drinking water is a sign of diabetes, but doesn't seem like a reliable sign by which todose insulin.... especially when you have the BG data....

waiting 3 days versus 2 days won't make that big of a difference, but may allow you to sleep better....;)
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Awesome cheers. I usually add water anyway because he prefers it like that. At the moment he is drinking for long periods, and is sleeping next to the water bowl, waking only to drinking, I'm not sure he could drink anymore than he is right now! Thanks! I really just am in a hurry for him to feel better, but if he's ok as he is now I can be patient :)
 
The extra water isn't going to hurt him...the high blood glucoses are much harder on him than a bit of extra water intake/outflow....

Until you've endured a hypo situation which will make you very gun-shy of raising the dose too fast, it's harder to be patient.

However, the safest way to increase is slowly and steadily...

The diabetes didn't happen overnight and it won't be fixed by fast-tracking insulin...give it a few days to see if the slow but steady increases are having an impact...

There are cats who need way way more insulin that that - but it's so much safer to take it slow and easy to determine how much they need.
 
Nate2021 said:
Awesome cheers. I usually add water anyway because he prefers it like that. At the moment he is drinking for long periods, and is sleeping next to the water bowl, waking only to drinking, I'm not sure he could drink anymore than he is right now! Thanks! I really just am in a hurry for him to feel better, but if he's ok as he is now I can be patient :)
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Happy to hear that! Otherwise we'll have to find you a pair of patience pants :)
 
Sue and Luci said:
Huh?

High numbers are high numbers - high numbers = not enough insulin...

As for the depot I think Wendy covered that...it takes time...and patience. Don't be in too big a hurry - insulin is a hormone, not a drug...takes a little time for kitties to figure things out.

Brian will start to feel better as soon as the insulin starts to take effect...the water drinking, peeing will diminish and his weight will improve...it all just takes time. Diabetes is not much fun for these kitties to deal with...but you can do it! Looks like you've got lots of love and time to help him along his journey :)
Click to expand...
Yeah idk if I just picked that up wrong maybe. I think because she was concerned he isn't leaving his water and is drinking so much that is why she's factoring it in, (his chin never gets a chance to dry from having it in the water so often for long periods)

I am working from home but so deprived of sleep and behind with work because of this lol.

Cheers for the advice I'll bring the dose back and relax a little!
 
Nate2021 said:
Do you think I should ignore the vets advice at this stage and take the dose to 2.25iu instead of 3, like the tr protocol says?
Click to expand...
TR protocol says you can increase by 0.5 units if seeing nadirs above 300, which is what you are seeing at this dose so far. I would stick with 3.0 units unless proven otherwise. You've already got 2 out of 6 doses in.
 
Wendy&Neko said:
TR protocol says you can increase by 0.5 units if seeing nadirs above 300, which is what you are seeing at this dose so far. I would stick with 3.0 units unless proven otherwise. You've already got 2 out of 6 doses in.
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Thnx! I asked my vet and she agreed with you, but said all things considered it should be ok for me to try the jump to 3iu, and that we will see bounces if it's too high of a dose. BUT that your approach is very reasonable and potentially better, so either option is no problem as long as I test consistently. I've decided I might hold the 3iu for 3 days like you say, and I'll post here after that to see what you think. Vet also praised the advice given by you guys so thnx for the free advice!
 
Nate2021 said:
and that we will see bounces if it's too high of a dose
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Not true, cats don't "bounce" because the dose is too high. They bounce. because they see a number lower than they are used to, or from fast drops. However, as long as you are testing enough, you will catch the drop to low numbers that would tell you the dose is too high.
 
Wendy&Neko said:
Not true, cats don't "bounce" because the dose is too high. They bounce. because they see a number lower than they are used to, or from fast drops. However, as long as you are testing enough, you will catch the drop to low numbers that would tell you the dose is too high.
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Yeah that makes sense. She said bouncing around values, not sure that she even knew "bounce" in the context of what I've read here tbh. I'm finding her a bit hard to follow she speaks in terms along the lines of "post hypoglycemic secretion variability" and too technical for me to know what she's on about sometimes. Cheers for all of your help
 
Nate2021 said:
Vet also praised the advice given by you guys so thnx for the free advice!
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Vet envy! I like my vet but to have a vet praising this advice is such a gift because it removes the internal second guessing! Good luck to you and Brian, I'll be keeping tabs on your progress :)
 
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