4/17 Ivy Amps 256, +2 261, +4 257, +6 199, +9 291, Pmps 291, +2 268, +3.5 182, +9.25 55 Libre

[Staci & Ivy]

4/16/24
Amps 256
Good morning,
Got a better night sleep with no alarms going off from the Libre since Ivy surfed higher last night from her bounce.

Dose was reduced to 4.5 units last night at pm dose and again today. Trying to drain depot gently a bit. Will decide if I go down to 4.25 units maybe tomorrow.

Still trying to figure out how to structure a custom dosing approach and a proper reduction point for her.
I am trying to let her run a little higher so she’s not dropping to a Libre “Lo” for very long extended periods (like all night, overnight) and the only way I can figure out how to do that is it let her be a little bit higher than I would really like her to be. Which, of course, would be lower greens.
This is not a perfect science for sure, and there are challenges when using the Libre technology for a cat who won’t doesn’t tolerate being tested all the time.

On another note, I have to take her in on May 6 for more lab work to see how the methimazole dose is working for the thyroid.
I will be pre sedating her the night before with some gabapentin and again the morning of the appointment with more gabapentin.
It looks like we will use Torbutrol injection at the vet, so they can handle blood draw.
My question is: what is the best way to handle giving insulin and not feeding her because we want it to be a fasting blood draw?
Would I possibly give a reduced dose the night before and a full dose the morning of the blood draw?
If I give full dose in the am (my appointment is 9 am and I’m about 40 minutes away from the vet). My normal shoot time is 6:15 am, so about 3 hours prior to appointment).

And how would I handle the next dose at pm, of course hoping she will have an appetite to eat by dinner/ shot time at 6 pm. (Last time she didn’t want to eat I had to syringe feed her all night and the next morning. She doesn’t do well after all the sedations).

Not quite sure how to handle this would appreciate suggestions.

Thanks so much and I hope everyone has a great day.

 

[Mikanmama (Mikan GA)]

Good morning Staci,
Yay to a solid sleep without Libre alarm!

Good luck with the custom dosing. You have a very tricky situation there.

This is not a perfect science for sure

Yeah, it's the art side of medicine, for sure. You may have to do some trial/error things.
You are such a dedicated, caring mom. I have no doubt that you will find what's best for Ivy and you

Also good luck with the vet visit next week. Hope the test finds her thyroid doing better!
I am not sure about what to do with the fasting - a lot of people here have experience - I'll tag some experienced folks here
@Wendy&Neko @Angela & Cleo @tiffmaxee @Bandit's Mom

Hope Ivy surfs well today and you have a great day!

 

[Staci & Ivy]

Good morning Staci,
Yay to a solid sleep without Libre alarm!

Good luck with the custom dosing. You have a very tricky situation there.

Yeah, it's the art side of medicine, for sure. You may have to do some trial/error things.
You are such a dedicated, caring mom. I have no doubt that you will find what's best for Ivy and you

Also good luck with the vet visit next week. Hope the test finds her thyroid doing better!
I am not sure about what to do with the fasting - a lot of people here have experience - I'll tag some experienced folks here
@Wendy&Neko @Angela & Cleo @tiffmaxee @Bandit's Mom

Hope Ivy surfs well today and you have a great day!

Thanks, Kit, it’s a lot of factors for sure. Ivy is a complicated girl. Thank you for the support as always. We appreciate you every day.
Wishing you and Mikan a gentle surf today

 

[cecile & bella]

I don't have the answers but I am thinking of you, and hope that all will go well. You are so usd to taking care of her, I know she will be OK

 

[Staci & Ivy]

I don't have the answers but I am thinking of you, and hope that all will go well. You are so usd to taking care of her, I know she will be OK

Thank you, Cecile, that’s very sweet. I appreciate you

 

[Jason - Kona's Dad]

Goooood Morning, Staci!

I'm glad you were able to get some sleep last night. Good luck on figuring out the custom dosing.
I'm looking forward to the lab work results to how good the methimazole is working.
Did the vet give any suggestions at all on the fasting for blood work? That's a tough one...

 

[JLS12]

I'm glad to see you got some sleep!

I know nothing about your questions for May 6th. I would think your vet should provide some guidance, how many hours for fasting, best practice or even a helpful suggestion or two since they are familiar with Ivy. After all, isn't that one of the reasons why we pay them?

 

[Staci & Ivy]

Goooood Morning, Staci!

I'm glad you were able to get some sleep last night. Good luck on figuring out the custom dosing.
I'm looking forward to the lab work results to how good the methimazole is working.
Did the vet give any suggestions at all on the fasting for blood work? That's a tough one...

Thanks, Jason. Thanks for that vote!
The vet actually thinks we should not do a fasting blood draw but I think we are getting some skewed numbers from having her eat before we go (we did that in March and her triglycerides were very high).
I think we should do a fasting blood work to see if it’s the food causing the spike or if there’s truly a problem.
Always a dilemma.
Hope you have a great day.

 

[Staci & Ivy]

I'm glad to see you got some sleep!

I know nothing about your questions for May 6th. I would think your vet should provide some guidance, how many hours for fasting, best practice or even a helpful suggestion or two since they are familiar with Ivy. After all, isn't that one of the reasons why we pay them?

Hi Janet, thank you
Yes I agree on your comment about the advice from the vet. Why do we pay such high prices??
My vet has some ideas which cause me to question some stuff. (See my reply to Jason).
Sigh. Always something.

 

[Deb and Tiger]

Hi Staci
Hope your custom dosing works well and you get more sleep!
Have a good safe night.

 

[Staci & Ivy]

Hi Staci
Hope your custom dosing works well and you get more sleep!
Have a good safe night.

Thanks, Deb. Still trying to work out some details. Have a good night, too

 

[Diane Tyler's Mom GA]

4/16/24
Amps 256
Good morning,
Got a better night sleep with no alarms going off from the Libre since Ivy surfed higher last night from her bounce.

Dose was reduced to 4.5 units last night at pm dose and again today. Trying to drain depot gently a bit. Will decide if I go down to 4.25 units maybe tomorrow.

Still trying to figure out how to structure a custom dosing approach and a proper reduction point for her.
I am trying to let her run a little higher so she’s not dropping to a Libre “Lo” for very long extended periods (like all night, overnight) and the only way I can figure out how to do that is it let her be a little bit higher than I would really like her to be. Which, of course, would be lower greens.
This is not a perfect science for sure, and there are challenges when using the Libre technology for a cat who won’t doesn’t tolerate being tested all the time.

On another note, I have to take her in on May 6 for more lab work to see how the methimazole dose is working for the thyroid.
I will be pre sedating her the night before with some gabapentin and again the morning of the appointment with more gabapentin.
It looks like we will use Torbutrol injection at the vet, so they can handle blood draw.
My question is: what is the best way to handle giving insulin and not feeding her because we want it to be a fasting blood draw?
Would I possibly give a reduced dose the night before and a full dose the morning of the blood draw?
If I give full dose in the am (my appointment is 9 am and I’m about 40 minutes away from the vet). My normal shoot time is 6:15 am, so about 3 hours prior to appointment).

And how would I handle the next dose at pm, of course hoping she will have an appetite to eat by dinner/ shot time at 6 pm. (Last time she didn’t want to eat I had to syringe feed her all night and the next morning. She doesn’t do well after all the sedations).

Not quite sure how to handle this would appreciate suggestions.

Thanks so much and I hope everyone has a great day.

Hi Staci, Man I'm glad to hear you got sleep last night.
It must have felt amazing..I'll also try tagging
@Marje and Gracie and
@Suzanne & Darcy

 

[Diane Tyler's Mom GA]

Good morning Staci,
Yay to a solid sleep without Libre alarm!

Good luck with the custom dosing. You have a very tricky situation there.

Yeah, it's the art side of medicine, for sure. You may have to do some trial/error things.
You are such a dedicated, caring mom. I have no doubt that you will find what's best for Ivy and you

Also good luck with the vet visit next week. Hope the test finds her thyroid doing better!
I am not sure about what to do with the fasting - a lot of people here have experience - I'll tag some experienced folks here
@Wendy&Neko @Angela & Cleo @tiffmaxee @Bandit's Mom

Hope Ivy surfs well today and you have a great day!

@Marje and Gracie and
@Suzanne & Darcy

 

[Staci & Ivy]

Hi Staci, Man I'm glad to hear you got sleep last night.
It must have felt amazing..I'll also try tagging
@Marje and Gracie and
@Suzanne & Darcy

Thanks, sweet Diane. It was wonderful to get more than 2 hours of interrupted sleep

 

[Marje and Gracie]

4/16/24
Amps 256
Good morning,
Got a better night sleep with no alarms going off from the Libre since Ivy surfed higher last night from her bounce.

Dose was reduced to 4.5 units last night at pm dose and again today. Trying to drain depot gently a bit. Will decide if I go down to 4.25 units maybe tomorrow.

Still trying to figure out how to structure a custom dosing approach and a proper reduction point for her.
I am trying to let her run a little higher so she’s not dropping to a Libre “Lo” for very long extended periods (like all night, overnight) and the only way I can figure out how to do that is it let her be a little bit higher than I would really like her to be. Which, of course, would be lower greens.
This is not a perfect science for sure, and there are challenges when using the Libre technology for a cat who won’t doesn’t tolerate being tested all the time.

On another note, I have to take her in on May 6 for more lab work to see how the methimazole dose is working for the thyroid.
I will be pre sedating her the night before with some gabapentin and again the morning of the appointment with more gabapentin.
It looks like we will use Torbutrol injection at the vet, so they can handle blood draw.
My question is: what is the best way to handle giving insulin and not feeding her because we want it to be a fasting blood draw?
Would I possibly give a reduced dose the night before and a full dose the morning of the blood draw?
If I give full dose in the am (my appointment is 9 am and I’m about 40 minutes away from the vet). My normal shoot time is 6:15 am, so about 3 hours prior to appointment).

And how would I handle the next dose at pm, of course hoping she will have an appetite to eat by dinner/ shot time at 6 pm. (Last time she didn’t want to eat I had to syringe feed her all night and the next morning. She doesn’t do well after all the sedations).

Not quite sure how to handle this would appreciate suggestions.

Thanks so much and I hope everyone has a great day.

For the vet visit, I’d suggest shooting a half dose the night before to drain the depot a bit. Then I’d delay her morning shot until 8 am and give a full dose. That way, she won’t onset until about 10 am and that gives you two hours to get food into her. I’d try and get them to draw blood as close to 9 am as possible. I think I remember it takes about 30 mins for the Torbutrol to take effect. Hopefully with a reduced dose the night before and a late shot the morning of, she’ll be high.

That evening, check her at your normal shot time. If she’s high, try to feed her and then shoot which would be two hours early. There’s no since in letting her stay at high numbers longer than she needs to.

Sound like a plan? Questions?

 

[Karolina & Nestle]

Glad to hear you finally got some well deserved sleep. Hopefully tonight goes just as well and she stays out of LOW territory on Libre.
Have a good night

 

[Staci & Ivy]

For the vet visit, I’d suggest shooting a half dose the night before to drain the depot a bit. Then I’d delay her morning shot until 8 am and give a full dose. That way, she won’t onset until about 10 am and that gives you two hours to get food into her. I’d try and get them to draw blood as close to 9 am as possible. I think I remember it takes about 30 mins for the Torbutrol to take effect. Hopefully with a reduced dose the night before and a late shot the morning of, she’ll be high.

That evening, check her at your normal shot time. If she’s high, try to feed her and then shoot which would be two hours early. There’s no since in letting her stay at high numbers longer than she needs to.

Sound like a plan? Questions?

Thanks for the suggestion Marje. They won’t draw labs at 9 am precisely.
The vet will examine her briefly first, discuss the plan with me and updates. Then they will inject with Torbutrol, wait at least 30 minutes. I’d bet it’s past 9:45 at the least (probably closer till 10 am) till they draw labs.
So I’d think it’s not until after 10 am (maybe closer to 10:30 am) I would have her back in a room where I could attempt to put some food in front of her (she’s in a very sedated state) and maybe get her to take a few licks (since I would think we want to introduce food slowly after the sedation).
Do you think if I could get a tiny bit of food into her would suffice to combat the insulin onset? (What if she won’t eat?)

Would I then give small amounts of food (how much/often) to try to get food In her system that early in the cycle?

Thanks for the answers.
@Marje and Gracie

 

[Staci & Ivy]

Glad to hear you finally got some well deserved sleep. Hopefully tonight goes just as well and she stays out of LOW territory on Libre.
Have a good night

Thanks, Karolina

 

[Staci & Ivy]

At +9.25 dropped to 55 on Libre. (Alarm woke me up) Fed 2 tsp 6%.
Late nadir and yellow bounce break I suppose.

 

[Marje and Gracie]

Thanks for the suggestion Marje. They won’t draw labs at 9 am precisely.
The vet will examine her briefly first, discuss the plan with me and updates. Then they will inject with Torbutrol, wait at least 30 minutes. I’d bet it’s past 9:45 at the least (probably closer till 10 am) till they draw labs.
So I’d think it’s not until after 10 am (maybe closer to 10:30 am) I would have her back in a room where I could attempt to put some food in front of her (she’s in a very sedated state) and maybe get her to take a few licks (since I would think we want to introduce food slowly after the sedation).
Do you think if I could get a tiny bit of food into her would suffice to combat the insulin onset? (What if she won’t eat?)

Would I then give small amounts of food (how much/often) to try to get food In her system that early in the cycle?

Thanks for the answers.
@Marje and Gracie

I’m wondering if they will let you bring her in at 8:30 and a tech give the injection so she’s calm by 9. I’m not really sure why the vet has to examine her, discuss a plan, etc when you’ve just had her in and she’s done all that and you’ve beeen emailing her. Quite honestly, at my clinic, to just do a blood draw, I don’t even need to see my vet. Perhaps you should ask them about that…bring her in at 8:30, a tech (or the vet) gives her the torbutrol, wait 30, tech draws blood.

 

[Staci & Ivy]

I’m wondering if they will let you bring her in at 8:30 and a tech give the injection so she’s calm by 9. I’m not really sure why the vet has to examine her, discuss a plan, etc when you’ve just had her in and she’s done all that and you’ve beeen emailing her. Quite honestly, at my clinic, to just do a blood draw, I don’t even need to see my vet. Perhaps you should ask them about that…bring her in at 8:30, a tech (or the vet) gives her the torbutrol, wait 30, tech draws blood.

Unfortunately, given that it's Ivy with her awful, fractious temperament, the vet herself needs to give the shot of Torbutrol AND draw the blood (vet techs couldn't do it last time and vet herself is more successful at the blood draw). And I am ok with seeing the vet first since I want to MAKE SURE we are on the same page of what labs are being drawn ( I don't trust the techs to get it right, especially since we are sending the T4 panel to Hemopet). The techs have proven they are incapable of handling her.

I wonder if I give her insulin when I arrive at the clinic at 9 am is a better move? (might be a better timeline with onset) What do you think, or it that just getting too late to shoot?

 

[Marje and Gracie]

Unfortunately, given that it's Ivy with her awful, fractious temperament, the vet herself needs to give the shot of Torbutrol AND draw the blood (vet techs couldn't do it last time and vet herself is more successful at the blood draw). And I am ok with seeing the vet first since I want to MAKE SURE we are on the same page of what labs are being drawn ( I don't trust the techs to get it right, especially since we are sending the T4 panel to Hemopet). The techs have proven they are incapable of handling her.

I wonder if I give her insulin when I arrive at the clinic at 9 am is a better move? (might be a better timeline with onset) What do you think, or it that just getting too late to shoot?

The main reason we don’t shoot more than two hours late is just because it’s harder to make up the time. You could shoot at 9 but I wouldn’t shoot three hours early if she’s high at PMPS. Two hours….yeah, that’s fine but three is pushing it. That would mean if you shoot at 9 am, you could shoot at 7 pm if her BG is upper 200s or above. If she’s not high at 7 pm, you’ll have to walk back the shot time a little each day. While you can do 15 mins a cycle, I find it much easier to do 30 mins once a day. Since you are up and can see the Libre, any time she’s higher at pre-shot, you could shoot early to get her back on schedule as long as it’s not more than two hours. But be sure it’s on a day when you’ll be home.

 

[Staci & Ivy]

The main reason we don’t shoot more than two hours late is just because it’s harder to make up the time. You could shoot at 9 but I wouldn’t shoot three hours early if she’s high at PMPS. Two hours….yeah, that’s fine but three is pushing it. That would mean if you shoot at 9 am, you could shoot at 7 pm if her BG is upper 200s or above. If she’s not high at 7 pm, you’ll have to walk back the shot time a little each day. While you can do 15 mins a cycle, I find it much easier to do 30 mins once a day. Since you are up and can see the Libre, any time she’s higher at pre-shot, you could shoot early to get her back on schedule as long as it’s not more than two hours. But be sure it’s on a day when you’ll be home.

So let me confirm...I could shoot at 9 am at my appointment and IF she's upper 200s or above shoot at 7 pm.
If she's NOT high, shoot 1/2 hours early early (at 8:30 pm that night, then the next night 8 pm, then next night 7:30 pm etc until back to normal schedule). This would mean the am cycle next day would be 8:30 am, 8 am next day, 7:30 am next day, till back to normal?)

And are you saying I could shoot early in a given cycle IF she's high before any preshot time to try to make up the time factor (does it matter am or pm??). (And what about the fact that she seems to have these late nadirs, which could happen AFTER I shot a high number early?)

Am I still confused or does any of this make sense?

 

[Staci & Ivy]

The main reason we don’t shoot more than two hours late is just because it’s harder to make up the time. You could shoot at 9 but I wouldn’t shoot three hours early if she’s high at PMPS. Two hours….yeah, that’s fine but three is pushing it. That would mean if you shoot at 9 am, you could shoot at 7 pm if her BG is upper 200s or above. If she’s not high at 7 pm, you’ll have to walk back the shot time a little each day. While you can do 15 mins a cycle, I find it much easier to do 30 mins once a day. Since you are up and can see the Libre, any time she’s higher at pre-shot, you could shoot early to get her back on schedule as long as it’s not more than two hours. But be sure it’s on a day when you’ll be home.

Or….maybe I just give a 1/2 dose at regular time 6:15 am (or... 2 hours late, 8:15 am) and don’t feed.
Then at pm dose stay on schedule if she’s high enough either at regular time 6:15 pm (or at +12?)

(maybe another 1/2 dose night before to drain the depot, or not necessary??)

 

[Heike & BInie]

4/16/24
Amps 256
Good morning,
Got a better night sleep with no alarms going off from the Libre since Ivy surfed higher last night from her bounce.

Dose was reduced to 4.5 units last night at pm dose and again today. Trying to drain depot gently a bit. Will decide if I go down to 4.25 units maybe tomorrow.

Still trying to figure out how to structure a custom dosing approach and a proper reduction point for her.
I am trying to let her run a little higher so she’s not dropping to a Libre “Lo” for very long extended periods (like all night, overnight) and the only way I can figure out how to do that is it let her be a little bit higher than I would really like her to be. Which, of course, would be lower greens.
This is not a perfect science for sure, and there are challenges when using the Libre technology for a cat who won’t doesn’t tolerate being tested all the time.

On another note, I have to take her in on May 6 for more lab work to see how the methimazole dose is working for the thyroid.
I will be pre sedating her the night before with some gabapentin and again the morning of the appointment with more gabapentin.
It looks like we will use Torbutrol injection at the vet, so they can handle blood draw.
My question is: what is the best way to handle giving insulin and not feeding her because we want it to be a fasting blood draw?
Would I possibly give a reduced dose the night before and a full dose the morning of the blood draw?
If I give full dose in the am (my appointment is 9 am and I’m about 40 minutes away from the vet). My normal shoot time is 6:15 am, so about 3 hours prior to appointment).

And how would I handle the next dose at pm, of course hoping she will have an appetite to eat by dinner/ shot time at 6 pm. (Last time she didn’t want to eat I had to syringe feed her all night and the next morning. She doesn’t do well after all the sedations).

Not quite sure how to handle this would appreciate suggestions.

Thanks so much and I hope everyone has a great day.

Oh Staci, I am sorry to hear taking blood is such an issue for Ivy! It must be nerve wrecking for you as well! Binie used to be like that and before we came to our vet ten years ago, it was impossible to draw blood without sedation. The vet we have now works with the purrito-technique and it works so well for Binie. The vet wraps her in a soft blanket which was scented with pheromones. Binie is tucked in the blanket like a little loaf and the procedure can be done without any fighting and screaming. When she was in the clinic for the Iodine treamtment they tried it "the normal way" and it was impossible to draw blood. They sent her home without the final blood test and a letter, that it was too dangerous for the staff to handel her. I felt like a parents whos kid was sent home from school with a complaint letter.

I am sure you already tried so many things... I keep all my fingers crossed it works as smooth as possible and the results show an improvement.

 

[Staci & Ivy]

Oh Staci, I am sorry to hear taking blood is such an issue for Ivy! It must be nerve wrecking for you as well! Binie used to be like that and before we came to our vet ten years ago, it was impossible to draw blood without sedation. The vet we have now works with the purrito-technique and it works so well for Binie. The vet wraps her in a soft blanket which was scented with pheromones. Binie is tucked in the blanket like a little loaf and the procedure can be done without any fighting and screaming. When she was in the clinic for the Iodine treamtment they tried it "the normal way" and it was impossible to draw blood. They sent her home without the final blood test and a letter, that it was too dangerous for the staff to handel her. I felt like a parents whos kid was sent home from school with a complaint letter.

I am sure you already tried so many things... I keep all my fingers crossed it works as smooth as possible and the results show an improvement.

Hi Heike, thanks so much for sharing that with me. I am so glad Binie is now easily handled. I wish someone could figure out a good plan for Ivy. It just gets more complicated the more stuff she has going on

 

[Heike & BInie]

Hi Heike, thanks so much for sharing that with me. I am so glad Binie is now easily handled. I wish someone could figure out a good plan for Ivy. It just gets more complicated the more stuff she has going on

I wish from my heart, it gets easier for you two. Sometimes I wish we could talk to them and explain.

 

[Diane Tyler's Mom GA]

So let me confirm...I could shoot at 9 am at my appointment and IF she's upper 200s or above shoot at 7 pm.
If she's NOT high, shoot 1/2 hours early early (at 8:30 pm that night, then the next night 8 pm, then next night 7:30 pm etc until back to normal schedule). This would mean the am cycle next day would be 8:30 am, 8 am next day, 7:30 am next day, till back to normal?)

And are you saying I could shoot early in a given cycle IF she's high before any preshot time to try to make up the time factor (does it matter am or pm??). (And what about the fact that she seems to have these late nadirs, which could happen AFTER I shot a high number early?)

Am I still confused or does any of this make sense?

@Marje and Gracie

 

[Diane Tyler's Mom GA]

Or….maybe I just give a 1/2 dose at regular time 6:15 am (or... 2 hours late, 8:15 am) and don’t feed.
Then at pm dose stay on schedule if she’s high enough either at regular time 6:15 pm (or at +12?)

(maybe another 1/2 dose night before to drain the depot, or not necessary??)

@Marje and Gracie

 

[Marje and Gracie]

So let me confirm...I could shoot at 9 am at my appointment and IF she's upper 200s or above shoot at 7 pm.
If she's NOT high, shoot 1/2 hours early early (at 8:30 pm that night, then the next night 8 pm, then next night 7:30 pm etc until back to normal schedule). This would mean the am cycle next day would be 8:30 am, 8 am next day, 7:30 am next day, till back to normal?)

Correct.

And are you saying I could shoot early in a given cycle IF she's high before any preshot time to try to make up the time factor (does it matter am or pm??). (And what about the fact that she seems to have these late nadirs, which could happen AFTER I shot a high number early?)

Am I still confused or does any of this make sense?

As long as you haven’t already shot early to make up time the same day, then yes. I don’t think you will see much change in a cycle from shooting early.

It doesn’t sound like you are confused

 

[Marje and Gracie]

Or….maybe I just give a 1/2 dose at regular time 6:15 am (or... 2 hours late, 8:15 am) and don’t feed.
Then at pm dose stay on schedule if she’s high enough either at regular time 6:15 pm (or at +12?)

(maybe another 1/2 dose night before to drain the depot, or not necessary??)

Remember that because of the depot, shooting a reduced dose or skipping is not likely to affect the cycle until later in it. That’s why I suggested shooting a reduced dose the night before so you drain the depot a bit. You can shoot 1/2 dose again the morning of the procedure on time. We don’t know how her BG will look when she onsets. That’s why I suggested shooting late. You could also skip, not worry about the high numbers, and shoot on time that night with a full dose.