4/15/19 AMPS 464, +2 HIGH, +5 HIGH / PMPS 466, +2 265, +3 182, +4 175, +5 200

Just checking in. You need to think about whether you want to follow TR or SLGS. With TR you don’t decrease until she drops under 50. Maybe that helps you relax a little about her numbers last night. :joyful: With SLGS the reduction number is under 90. As you both get used to lantus you won’t need to test as much as last night unless she’s in the 50’s. You also will stop feeding earlier and see if her numbers stay up for an hour or two without food. But that’s after you learn her patterns. Well done last night. I hope you can take a nap today. I never could. Max used to drop low at night so I had lots of pj parties. Hopefully Alice will be more considerate, lol.
 
tiffmaxee said:
Just checking in. You need to think about whether you want to follow TR or SLGS. With TR you don’t decrease until she drops under 50. Maybe that helps you relax a little about her numbers last night. :joyful: With SLGS the reduction number is under 90. As you both get used to lantus you won’t need to test as much as last night unless she’s in the 50’s. You also will stop feeding earlier and see if her numbers stay up for an hour or two without food. But that’s after you learn her patterns. Well done last night. I hope you can take a nap today. I never could. Max used to drop low at night so I had lots of pj parties. Hopefully Alice will be more considerate, lol.
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Thanks you for the deeper explanation. I needn't in learn this but I really want to try for a nap right now.

She's grooming after her meal. Alert. I feel like she acted a little "off" when she was lower before........ Even though the numbers themselves weren't as low as low should be. I have to rest. Part of that sentence garbled up.

+2 or +3?
 
Okay here's what is in the background of my brain, gnawing at me: having heard 4u is a rather large dose in the first place. I think that's what makes it sound more overwhelming.
I was getting a feel for the NPH 3x/day thing, even with the aggressive dose. It wasn't what should in theory be best for her, so the change is worth it. But it all caught up to me that I have less initial control with Lantus. And I'm running a deficit on everything now, all of myself, broke, no sleep, half nuts.

It always feels like a lot until it doesn't anymore though, and I know that! Onwards! Zzzzzzz
 
I can only imagine how totally exhausted you are. Alice is lucky to have you and you need to keep you healthy for both your sakes. I think you can go grab a couple of hours of sleep and retest Alice at +3. Lantus doesn't onset as early as the Novolin and her pre-shot is pretty high today.

You were giving Alice a lot more Novolin than Lantus and while 4u might be a higher dose than most, a cat needs the amount of insulin they need. I understand your concern about a higher dose as a Mom who was at one time shooting 16u twice daily. It's scary but 4u really isn't that high and Alice is getting some nice blues and dark greens. Right now the important thing is to keep Alice's BG as optimal as possible. Chances are her dose will decrease once she has fully recovered from the DKA.
 
The best dose for a cat is the dose the cat needs to get the numbers in a good place. It doesn't matter if the dose is 0.5u or 5.0u -- the cat needs what she needs. I'd also point out that Alice was getting a total of 10.5u on a daily basis. She's now getting 8u. In the grand scheme of things, she's getting a lot less Lantus than NPH.

Given how much you are able to test, I want to encourage you to stick with TR. It is a more aggressive approach to dosing. However, given Alice's recent DKA history, we want to be aggressive in order to prevent ketones from recurring. (@tiffmaxee ) You want to stick with the current dose until you either see a drop below 50 (with TR) or for 6 cycles at which point we reevaluate the dose. We were considering increases after 2 - 4 cycles given how much more NPH Alice had been getting but it's looking like she's responding well to Lantus and her nadirs are in a good range at this dose.
 
CassandraCatface said:
Okay here's what is in the background of my brain, gnawing at me: having heard 4u is a rather large dose in the first place. I think that's what makes it sound more overwhelming.
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As Linda said, 4 units may or may not be a high dose. My girl got to 8.75 units, we have seen some with secondary endocrine conditions that have needed over 80 units per shot, some cats do well on 0.1 units. Each cat is different. The numbers to focus on are the blood sugar numbers, the dose is just the thing that gets Alice into that good blood sugar range. And Alice is seeing some pretty nice numbers on 4 units.

Sleep well, things seem more logical after a nap.
 
That means she is bouncing. Test for ketones when you can. Then put on a pair of comfy patience pants and get some sleep. I am all too familiar with the meter greeting me “Hi”. The bounce will pass over time, it can take up to six cycles.
 
Deep breathes! There is nothing you can do but wait it out. I like Wendy's idea...... comfy pants and some sleep. This too shall pass.
 
But when do I check? I can barely nap as it is. It took me this long to start falling asleep. How long can she stay like this? I don't want to put her through more DKA and hospital.

I guess..... What can I DO? How often should I check in on her? I can't take her to bed because she's not set up and the herpes cat lives in there right now. :\
 
The likelihood that the bounce will resolve itself this cycle is next to zero. Take a nice, long nap. As annoying as bounces are, this is what you hope for if you're sleep deprived! Bounces are high numbers. Bounces breaking can put a cat in lower numbers. Typically, it takes up to 3 days for a bounce to resolve but it can also take less time as your cat gets used to lower numbers.

We've not yet seen a cat go into "shock" as a result of a bounce. The biggest risk could be ketones but you're monitoring. You feed your cat as you would ordinarily do -- bouncing requires nothing special.
 
Cassandra, as Wendy said, Alice is bouncing. It's a normal frustrating phenomenon that we've all been through and it can take several cycles to break. No she is not going to go too low. The "roller coaster" is unfortunately something we all had to get used to.

If you feel uncomfortable leaving Alice, can you curl up on the sofa or wherever Alice likes to hang out for your own peace of mind? You really do have to make sure you get some rest while Alice is running high and doesn't need excessive monitoring. :bighug::bighug::bighug:
 
Here is a tip about Lantus. The +2 test can often tell you a bit about how the cycle will play out. If it’s around the same as the preshot number, you will have a typical Lantus cycle with some downward movement. If it’s quite a bit lower, you will have a more active cycle needing more monitoring. That was last night. If the +2 is higher, it will be a quiet cycle. Those are good times to catch up on sleep, shopping, housework or pampering you. Seriously, treat as a permission slip to do something for you. With a bounce like you are seeing, you don’t need another test unless you are just trying to gather data. And yes, I relate to hard hard it is stop being a helicopter for a bit. :bighug:
 
Great timing, she peed!

I checked twice, not really sure on ketones. These colors are hard for me for some reason???
 

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I timed them. Both pics are 15-17 seconds in. 15 is the view time. Thanks.

@MrWorfMen's Mom unfortunately I can't curl up with her easily. She's in the bathroom for now for several reasons. :\ Maybe I'll curl in the floor with a blanket later like her.

Nap attempt now. Thanks again!!!!!!
 
Wendy&Neko said:
That’s why I said not to test until preshot time. No chance she was going into the danger zone this cycle.

Down please Alice.
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Thanks. I'm kind of catching on now. It's just so close to the DKA. I'm so worn out it's difficult to regulate my panic alarms. Arg. :b

What are the long term risks and damage from this level of dysregulation? Kidney effects and neuropathy and other things...?

I'm going to do a little self-care and I may have just found a local resource that offers caregiver support of some kind. A local vet started up something. Going to call.... :)

What is typical (if there is a typical) after a bounce like this? What can I reasonably expect?

Thank you all. :)
 
Self care is an excellent idea. Some people do yoga, go for walks, I do rowing, pick something that works for you.

I asked Neko's internal medicine vet about the long term effects of high numbers, and he said as long as the spikes are short term, it's OK. Neko did a lot of black and Hi her first six months, took her over a year to ditch red from her spreadsheet. :rolleyes: She also had acromegaly, but still lived 5 years on insulin. She did get CKD, but acromegaly is also hard on kidneys.

Do keep testing for ketones. If anything changes in that regards, there may be other things we can do. Fluids if OK by the vet, and plenty of water to help flush her out in the mean time. Also keep an eye on her appetite and let us know if that changes or she becomes lethargic.

Bounces typically start out taking around six cycles to resolve. Numbers will wobble around during that time, but will come down afterwards, possibly back even to those lovely blues and greens. Once a cat gets more used to normal numbers, the length and height of bounces diminishes. ECID how long that takes.
 
@Wendy&Neko , thank you for responding! Your signature actually got me poking around to learn about acromegaly in cats last night. It's a haze in my brain because of the tired, but it sounds... Like a lot. Also I like the name. I took Japanese in college. :) Alice is a calico cat and the kanji for it literally means three color cat. /off topic chat.

It has been suggested that Alice will need someone in internal medicine. One of the ER vets suggested the mass that appeared on her belly that seems like a swollen nipple that has been there for months may be a mammary tumor? But I don't have those kinds of funds. Any info I can gather up to help me understand what is happening with her will help me get her whatever help she needs.

It's comforting to know Neko made it through those rough six months, then. Alice was probably getting sicker awhile before DX, so she's been far too unregulated for far too long. I'd like to be able to hope I can nurse her back to something closer to her previous level of health and energy.

Finally understanding that she isn't in a complete immediate danger zone right now has helped me back my anxiety down. I hope she's stable enough for me to crash some time tonight.

I will be looking for advice again as I get her numbers later. :)
 
Does she look like she's standing a little low? I wouldn't blame her. She has so little muscle right now. :'(
 

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Got a urine sample. I don't understand why they never look like they match the colors? So I think this is between mild and moderate. Pic was taken at 15-17 seconds. Thoughts?

PMPS in 15 min. She's thirsty and hungry.
 

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I don't think that strip is significantly different from the earlier ones but again, I am not sure the colour translates well in pictures. I agree it doesn't seem to really match any colour on the vial but it certainly doesn't appear to be taking on a reddish tone to me. Negative to trace would be my guess.
As for the thread, one per day so just stay here and either add PMPS or change title and remove the earlier reading and retitle with PMPS.
 
Chris & China (GA) said:
Did you get some fluids to administer sub-q?

As long as she's eating well, she's probably not working towards DKA but keep your eyes on it
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No I did not get fluids. But then there's an issue there... Supply costs. I was too out of it today with the stress and tired to focus. I'll try again tomorrow.

Here's hoping tonight is an easy low-moderate safe zone. I'll test at +2 then decide from there? I'm desperate for a real rest.
 
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