4/11 Lord Fuzzy Bottom | AMPS 476

[Min and Lord Fuzzy Bottom]

Previous Day Condo: https://www.felinediabetes.com/FDMB/threads/4-10-lord-fuzzy-bottom-pmps-126.288625/#post-3169038

Responding to question on previous day:

Also, I’m just curious…are you priming the insulin pen before every use?

No. I know what the Lantus website states to do. I asked the vet myself. I watched them and recorded them giving a dose of insulin with the pen. They stated they never prime the pen. But in the video I made, you can hear me asking if they prime the pen and you hear the tech stating no. But they had said that a droplet starts showing after the needle is on it showing that insulin is in the needle.

This morning his numbers were below 600 even though his last shot was yesterday morning. Today is his curve so I'm weighing how much he ate this morning so far:
3g of Science Diet Adult Cat
19g of Fancy Feast Flakes (i thought this one was a pate when I bought it, found out this morning, it wasn't)

These are the things I am asking the vet today- I typed them out so I can make sure he gets it:
1. Is he still in Diabetic Ketoacidosis? It was never mentioned if he was out of it or not. I do monitor via urine strips and try to do so 1 time a day. I understand how DKA is a dangerous thing for cats and they can go downhill very quickly.

2. I am concerned that with the Glargine being a depot insulin that his PM dose skips are working off the depot that his body has created. Is this possible?

3. Would it be better to lower his insulin to perhaps 2u every 12 hours instead of 4u every 12 hours? That way the depot has a chance to build back up and give him the long stable curve that it is known for. I believe that when he was first diagnosed and I was giving the insulin, I was having user error and I don’t think he was getting his entire dose which was causing his bg to remain high. And then after I watched him get the injection and recorded it so I could look back on it I haven’t been having any errors like I did in the beginning. I am barely having any ‘leakage’ after injection, most times now his coat is dry after the shot.

 

[Min and Lord Fuzzy Bottom]

Ok Fuz is back home... here is his curve numbers from the vet these were taken with the AlphaTrack3 that the vet uses.
His preshot was 556 with the alpha trak2 and his shot was at 5am
8am - 518
10am - 413
12pm - 300
2pm - 153
4pm - 99
5pm - 96

His dose has been adjusted where he is only getting 1 shot per day. The vet said that he isn't 'behaving' how normal diabetic cats do. I was informed that he would be a Type 1 diabetic. Next Thursday I will be doing his curve at home and sharing the data with the vet. They wanted me to bring him in for another curve, I suggested I do it at home to lessen his stress and they said ok. They love my data that I am keeping.
When he went in to the vet for the DKA his weight was 7.5lbs. On the 1st it was 8.4. And today it was 7.9. Could be because he has been such a fickle eater. Today I did get a TriOak calming collar that the vet gave me for free. Said a customer donated it. I know nothing of that brand so I need to look in to it before putting it on him- so if anyone has any experience with that brand of calming collars, please let me know how they are.
He is no longer in DKA. She told me when he stops producing ketones, he is no longer in dka.
The reason he is only getting 1 shot per day is he is weird. He isn't burning through the insulin as quickly as other cats do and it is going slow in his system. Decreasing his dose wouldn't get him down to the normal numbers and as it stands right now he is only getting in the higher numbers for short periods of time. They are looking at over time his preshot morning numbers to continue to get lower- hence the curve next week.

I need to update his spreadsheet and will do that later today. I'm just gonna rest and relax for now.

 

[JL and Chip]

His dose has been adjusted where he is only getting 1 shot per day. The vet said that he isn't 'behaving' how normal diabetic cats do.

The reason he is only getting 1 shot per day is he is weird. He isn't burning through the insulin as quickly as other cats do and it is going slow in his system.

*Deep sigh*
If I had a nickel for every time I heard that in the past 19 years … well, yeah.

I highly doubt LFB is “weird” or unique. To the contrary, today’s curve seems somewhat predictable. You’ve skipped PM shots recently, which allowed the AMPS to shoot high because the depot is draining and there’s no replacement insulin coming on board.

I say this as respectfully as possible, but it appears that your vet is treating a depot insulin (Lantus) like an “in-and-out” insulin, and that’s just not how it works.

By going with only one shot a day (still same 4u dose I presume??), you’ll likely see big drops and rises in BG rather than the more gent “surfing” that shooting twice a day can provide, and for which Lantus is known.

Fresh out of DKA, this once-a-day dosing isn’t a great “experiment” to do, IMHO. And sadly the longer you fiddle around with this type of dosing, you might actually reduce the chance of remission. No guarantee one way of the other, but it’s a shame the vet isn’t on board with at least splitting the dose and trying 2u twice a day.

Decreasing his dose wouldn't get him down to the normal numbers and as it stands right now he is only getting in the higher numbers for short periods of time. They are looking at over time his preshot morning numbers to continue to get lower- hence the curve next week.

Depends on how you define “short periods of time,” I suppose. Again, DKA in the recent history matters. And those higher numbers may be unnecessary, or at least minimized, with twice-a-day dosing (and the lower dose LFB already indicated was warranted). Sometimes higher numbers are part of the process toward regulation, but it’s just a shame when they might be able to be avoided or minimized.

@Wendy&Neko any thoughts?

 

[Wendy&Neko]

I highly doubt LFB is “weird” or unique.

I second that sigh and add this . What you said @JL and Chip LFB is neither weird nor unique. His cycles look a lot like what happens when cat clear bounces (nadir much later) and/or when you skip a shot - producing action the first or second cycle after the skip. In fact, LFB has shown you the last couple of days that 1 shot per day is not good enough, as he ends up sky high 24 hours after his last shot. It is waaaaaaaaaaaay better to reduce the dose, and shoot twice per day. 2 units per cycle is probably be too little, but better than 4 units once per day.

I lost track of the times a member here has had a vet that suggested one shot per day and it didn't work,..... In fact, in my time here I don't think I've ever seen it work. It's a not uncommon suggestion. Some vets get confused because humans, with slower metabolisms, take Lantus/glargine just once per day.

With very recent DKA, though he may not longer be in DKA - he is still very much at risk of going back there. Not enough insulin, such as 1 shot per day, is courting a return date with DKA. That's an ugly date you don't want to repeat. Ketones can show up really quickly, going high in less than 24 hours. If you follow this vets advice, please test ketones each and every day, maybe more if he's in higher numbers.

Do you have any friends/family who are diabetic? Ask them what it feels like to yo-yo between really high and normal numbers every day. Not good is what I've heard. Less insulin, but twice a day will flatten him out more and make him feel better.