4/1 Gus AMPS 147 please advise for PM

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elizabeth and gus

elizabeth and gus

Member Since 2015
Gus's BG are allover the place. Should his dose increase 0.25U or 0.5U or continue with 1U??.

I appreciate any input.

Elizabeth and Gus
 

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Hi Elizabeth,
I can't open your spreadsheet GUS SS.xisx. And your Google spreadsheet, according to Google, is "in the owner's trash". Perhaps go to the tech forum and ask for help in getting the Google SS back.

Until someone can see Gus's spreadsheet and answer your question, you can read the "stickies" at the top of the form to learn when and by how much to increase the dose. Which protocol are you following? Tight Regulation, or Start Low go Slow?

Best of luck,

Ella & Rusty
 
Elizabeth....Are you still feeding dry?

I'd stick with the 1 unit at least another cycle since you dropped back to .5 the other night

I got the message that your spreadsheet was in the trash too.
 
Hi Chris

We no longer feed dry food. Gus is finicky eater so we experimenting with different low carb wet food as well as home made raw. Gus is not impressed with my efforts.

Thank you so much for your replay. I am going to continue 1U and do curve tomorrow.

Elizabeth and Gus
 
Now it's saying we need permission to view it

Go to the top right to the blue box that says "Share". Click there and a new box will pop up. At the bottom right of that box it'll say "advanced". Click there and some new choices come up. Choose "Anyone with the link" and then "save" it
 
Chris & China said:
Elizabeth....Are you still feeding dry?

I'd stick with the 1 unit at least another cycle since you dropped back to .5 the other night

I got the message that your spreadsheet was in the trash too.
Click to expand...

Chris, I see 8 days of l unit. When did she drop back to l unit? That was March 6th from what I see and the nadirs are over 200.
 
Hello and welcome. What type of BG meter are you using? My comments are going to assume a human one as it's more common here. You might want to put the meter type in your signature.

I too would stick on one unit for now. I have a couple of recommendation on how to change your testing. It's really important to get some tests in at night, after the PMPS test. Maybe even just before you go to bed. Many cats, including mine, prefer to go lower at night. So we can't get a good picture of how the dose is doing without some of those tests. We determine how to dose Lantus, based on how low a cat will get on that dose. Also, I notice a bunch of day time tests at +6. Not all cats have their low point then on Lantus, and sometimes they can vary from cycle to cycle. you might want to experiment with moving that test around a bit, maybe from +4 to +7.

Since your signature says you are following SLGS, these are the steps you need to do to determine what to do next with the dose. It looks like you need to do a curve next, since you've been at this dose a week.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
The curve may tell you something different, but so far the spot tests have shown a low of 121 on this dose which would mean maintaining the same dose.
 
Hi Wendy and thank you so much for your replay.

Gus is not him self this morning. He didn't got up from his bed and is not purring. He is not eating and his food that I left for him overnight is unattached. BG 414. If he is not going to eat I will skip the shot and next thing trip to a vet.

I am using human meter Relion.

Elizabeth and GUS
 
A trip to the vet sounds like a good idea. Is he meatloafing? Just wondering if he gets pancreatitis. Here's a Primer on Pancreatits. Any chance you can entice him to eat, even high carb food? It'd be good to get some insulin into him. Make sure you test for ketones today.
 
Gus refused to eat anything this morning. BG 414, he wasn't even drinking. After over an hour he drunk water and went to LB just sniffed and jumped out and throw up foamy clear liquid. He repeated this twice. I didn't inject his insuline and took him to the vet.

He got fluids, Cerenia, Famotidine injections , Mirtazapine tablets and can of a/d wet food. Vet describe two most likely causes; CRF or Pancreatits. Blood and urine samples were send to the Lab (renal profile and pancreas testing (PLI). Now we have to wait. Results should be tomorrow for most but PLI will take about a week.
Vet also requested to stop insulin injestions????
We returned from the vet about two hours ago Gus drank water and just nibbled on his food. I offered him several options that he liked previously.

I have to mention that Gus had his senior checkup done week and half ago. His urine culture was negative, all other results were within normal ranges except elevated BUN and urine pH 8 and USG 1016 all results included in his SS.

Elizabeth and Gus
 
I would not stop insulin. The risk of stopping Gus' insulin is that he develops diabetic ketoacidosis. DKA results from not enough calories, not enough insulin, and an infection/inflammation. I don't think you want DKA on top of everything else.

Also, your vet should know this but there is a Snap fPLI that it like a pregnancy dipstick. It gives you an immediate result. It's not as fine tuned as sending bloodwork out but it's accurate. I also have no clue why it takes him so long to get results from an fPLI.

The elevated BUN may or may not be indicative of anything other than dehydration. His USG isn't high enough to indicated kidney problems (it would need to be above 1.03). Also, the format for your SS and labs is very hard to read. I couldn't find the specific gravity lab.
 
I also would absolutenly not stop his insulin. You've got some meds that should help with nausea and increasing his appetite. That ought to get him eating.

Would you get ketone urine dipsticks (any pharmacy or drug store) and check him at least once a day until he's back to normal? Not glucose dipsticks - you want the ones that measure ketones. The ketones that Sienne mentioned are a risk for a cat in a situation like Gus is in right now, so it's very important to check for them. You can check one dipstick yourself to figure out how to read it - timing is very important.

For Gus, you can either stick the dipstick in his urine stream, put a spoon/ladle under him to catch enough to test, or use an alternative box with something non-absorbent in it like aquarium gravel. I slipped a paper box lid (from a case of photocopy paper) into a plastic garbage bag filled with non-absorbent something, then shut punkin in the laundry room with his watered down dinner and that box. And me. Once Gus pees, tip the box to one side and you can test the puddle.

There is a post on the bottom of the New to the Group? sticky that has suggestions on getting a cat to eat. Look here and click on the NTG? link. Then scroll down.

by the way, you might have better luck just starting a new spreadsheet instead of trying to fix the xl page you've got. Leave the old one linked and start a new one. There are directions for that on the New to the Group? sticky also.
 
I just noticed that Gus went to the litter box and was straining but there was no pee. I am very concerned that he is not urinating. Usually at this time of the day he would pee four times. He keeps drinking water and mostly leaks food not so much eating.

I am going to ask the vet about Snap fPLI test.

Thank you for you replay and I am sorry for ss formatting. At the moment I don't have in me to correct it.

Elizabeth and Gus
 
don't worry about the ss at the moment.

could he be blocked, like with urinary stones? I don't know much about it but straining to go and not being able to can be an emergency. I'd phone the vet.

Sending healing vines to little gus. I hope he feels better.
 
Julie

I have ketone sticks and I test his urine regularly. As of 5:00 am gus did't urinate except vet's office and they tested for ketones - neg. This is very unusual for Gus and I sow him straining in the LB.

Elizabeth
 
Based on the examination this morning and previous Lab results vet didn't think it is blockage or stone. I am going to watch him for while longer and call the vet.
 
I just talked to the vet:

He assured me that Gus can pee and he did a lot in the vets office - watch him and call tomorrow morning.
The SnapfPLI they only have for dogs and he is not sure if it will work for cats.

Minutes after I finished talking to the vet. Gus went and peed in LB. Now I am going to try feed him and pray.

Thank you all for your support.

Elizabeth and Gus
 
There is a SNAP test for cats. The fact that they don't have it makes me wonder if this is more a dog practice. It's okay because between you and me I don't like that test. I prefer the Spec fPL. I get the results back the next day. My vet uses Antech but the fPL is sent to IDEXX, My Max has chronic pancreatitis. It can be painful and it makes him inappetent. I give him ondnasetron for it but others use cerenia.I hope you were sent home with cerenia because it only lasts for 24 hours. I'm so sorry Gus is going through this but glad you went to the vet and know that he is not blocked. Max waent through that once and a vet pierced his bladder or it burst from the pressure. Not something I would wish on anyone.

Do you have any all meat baby food, like Gerber's 2nd ham, chicken or turkey? Sometimes they will eat that when they won't eat anything else. Beechnut is another brand. You just want 100% meat without any garlic or onion.:bighug::bighug:
 
When you get the lab results, you can load them into the lab tab on the SS so we can look at them for you and give you some ideas. Be aware that the limits on the lab tab are for Antech so if your vet uses IDEXX, you'll have to adjust them.
You might want to read the info in this Primer on Pancreatitis.

Sending prayers and vines for Gus.
 
Good morning

Vet just called to let me know that Gus's Lab is all negative for CFD his BUN - 36 , CREA - 1.6. Based on the results cancer is not likely. Now we waiting for fPLI results. The appetite is good today. I am just going to watch him, wait for the results and continue with 1/4 tab Mirtazapine every 24 hours. In day or two we are going to asses need for fluids. I didn't stop insulin.

Vet was honest with me and admitted that he really don't know what is going on. This is a third vet within 6 weeks and only one that is allowing me to control Gus's diabetes based on the guidance from FDMB.

Please keep prayers and fingers crossed for my old (16 years ) sweet Gus

Extremely grateful for your support

Elizabeth and Gus
 
I believe that mirtazapine dose is too frequent. Here is a reference for mirtz from Tanya's site, which is fairly reliable. Punkin took mirtz and it was prescribed for once every 3rd day. Tanya's has recent info that says as often as every other day. I've never seen someone give it daily. Some cats react to it with agitation - i'd stick with not more often than every other day if Gus was mine. There is more on the site and it's worth reading, but here is the most relevant part:

A commonly used dose in CKD cats was â…› to ÂĽ of a 15 mg tablet every 3 days. However, a study at Colorado State University, The pharmacokinetics of mirtazapine in cats with chronic kidney disease and in age-matched control cats (2011) Quimby JM, Gustafson DL & Lunn KF Journal of Veterinary Internal Medicine 25(5) pp985-9, found that the half life of the drug (the time it takes to leave the body after taking it) is shorter than originally thought. The Veterinary Teaching Hospital at Colorado State University therefore considers it safe to give mirtazapine every other day, but always start with â…› of a 15mg tablet. It usually takes effect pretty quickly, within a few hours, though it works more quickly for some cats.

A later study, Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: a masked placebo-controlled crossover clinical trial(2013) Quimby JM & Lunn KF Veterinary Journal pii S1090-0233 found that "the oral administration of 1.88 mg [â…› of a 15mg tablet] of mirtazapine every other day for 3 weeks to cats with CKD resulted in significantly increased appetite. Additionally, significant weight gain, increased activity and decreased vomiting were demonstrated."
​
Really glad he's peeing and not blocked. that's a relief.
 
Julie

I was very uncomfortable with the dose recommended by my vet (1/4 pill every 24 hours) since most people at Tanya's CKD support group (that I joined) were dosing every third day. It just proves that I need to question everything vet recommends. Looks like I have more research to do. I am going to dose him every third. Hopefully his fPLI results come back soon and we have proper diagnosis. Today vet ruled out CKD or any kidney issues. I had not see copy of the results but vet stated that renal panel results are great and he doesn't understand how Gus's BUN now is within normal range. He was convinced that bases for Gus's lack of appetite was CKD but now Lab results don't supported this diagnoses.

Thank you so much for caring and guiding me trough this journey.

Elizabeth and Gus
 
Vet just called to let me know that Gus's fPLI test was 6.7 so it is pancreatitis. Since Gus is showing no symptoms of discomfort (diarrhea, throwing up, etc) at this time vet offered no treatment. I just have to make sure that he eats, drinks and control his BG. He still has poor appetite but with the all you can eat buffet he is able to eat and with BG being lower it appears to help. In last couple days finally we were able to get his BG in 200 range.

I would like to try to use supportive supplement therapy like PetAlive Pancreas Booster Capsules? or ??? I wondering if any of you had luck with something like this?

I am lost, any suggestions will be greatly appreciated.

Elizabeth and Gus
 
Hi Elizabeth. I was just wondering if there was a reason why you lowered Gus' dose this morning?
Pancreatitis can be very painful. My cat J.D. had it and he got buprenex for pain. My step mom has it and she keeps needing to be hospitalized it is so painful at times. Does Gus sit in a meatloaf position? That can be a sign that his tummy hurts.
Also, how is he eating? Often cats with pancreatitis will not want to eat because of feeling nausea. They will sometimes go to food and then either only eat a couple bites or lick their lips or just sniff it, and then walk away. I used Ondansetron to help J.D. with his nausea. Have you had a chance to read the Primer on Pancreatitis that Marge linked above?
I have never tried any of the supplements you mentioned, sorry.
 
Hi Dyana

The lower dose this morning was panic reaction to his AMPS BG 210. Now I realize that it should be increased because his nadirs are > 150.
Gus doesn't sit in meatloaf position and except morning 3/25 when he wasn't him self, not eating and throw-up twice that morning he appears fine. Eating is a problem since he eat dray food for 16 years and we are having tough transition to wet food. He will eat something and next day not. He likes to nibble on different foods every three hours or so and on days that his BG is lower he eats better. It did't seem to that 1/4 pill Mirtzapine made any difference in his appetite I am going to start recording his food intake in SS.

Yes I read and printed Primer on Pancreatitis and thinking that I should review this with his vet. Do you think that I should press vet to prescribe meds??

Thank you so much for the replay
Elizabeth and Gus
 
I think tryng Ondansetron might help. I would get a prescription and go fill it at Costco Pharmacy (I didn't have to be a member to use their pharmacy) as it was $0.33 per pill, when at my local pharmacy they wanted $3.33 per pill. Ask your vet. A lot of vets seem to be of the mind that nausea = the act of throwing up. Nausea is more than that, I think, it is the feeling of a queasy tummy, so they don't want to eat. JMO
 
Thank you. I am going to call vet tomorrow and request Ondansetron script. This vet is not good with writing prescriptions he wants me to get meds from him. Is 1/4 of a 4mg tablet twice daily to control nausea sounds about right??

Thank you so much. I appreciate your guidance.

Elizabeth and Gus
 
Sending feel better vines to Gus. Punkin had one round of acute pancreatitis, but the vet said he'd probably had some chronic pancreatitis too. I think pain relief and anti-nausea meds are both helpful and important.
 
Julie
This is what vet said today that it was acute pancreatitis and chronic is very likely. I will have consultation tomorrow.

Thank you so much.
 
Can you print out the information on pancreatitis and take it with you to the vet? A lot of vets will palpate the cats tummy and then say that cat is not in pain (that's what happened with J.D.), but cats are notorious for hiding their pain.
Pancreatitis is very painful.
 
This morning AMPS 147 I am going to skip insulin ???? or not? will check little bit later. If PS is < 200 should we skip shot?

Elizabeth and Gus
 
147 is a nice AMPS, if you ask me, as long as you will be around to test and have all the supplies you need.
Have you fed him yet? Why don't you do another test and see where he's at?
 
Hi, Elizabeth.

Just as an FYI, we try to start a new thread (aka "condo") each day. Otherwise, the thread gets too long and too confusing.
 
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