5/17 Mr. Sluggo AMPS:129, 107@3.0, 98@5.0, 122@6.25, PMPS:139, 89@3.0, 110@6.0

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Very very flat today. Barely within TR territory. But there. Finally broke below 100 at +5.0.

At least this kitty seems to defend himself very well against hypo episodes, so I feel I can leave for work confidently after dosing. Very safe.

Will do one more check at 6.0 to see if I can nail the nadir then give it a rest til dinner time.
 
Just as soon as you nail the nadir, I am sure he will change it on you :)

If you take into account the meter variance, the 129 could easily be in the normal range....regardless, his numbers seem excellent and under renal threshold....
 
As the cats get to lower curves, some will have a little blue "bounce" off of those 50s. Sly has loved to do that to us. Every time ChrisFarley went up to blue, I'd say he was climbing up to the diving board 'cause he'd find a new low soon after. Give Sluggo a little time to settle and see what he does then. Their little pancreases are sputtering at this stage, there will be bumps. Some run down quickly, some like to two-step it. We can't control it or predict it, just dance along.
 
Thanks Melanie! Let me ask you... I count basically Day #5 of TR on Sluggo's SS. Would you be thinking about a wean after day #7 at this point if he keeps going like this?
 
I would wait and see what the next two days bring you :D Since Sluggo is a second timer on insulin, you really want to make sure he is finding remission that will stick so I would probably start recounting. But if he dropped back down and ran all normal numbers so that the 137 was a single blip, then I might consider discounting it and calling it a 7 day run.
 
Regarding yesterday's 137...somewhere on the site it says that absorption can vary by as nuch as 50% from one shot to the next.

sometimes cats will have a day where they run higher with no obvious reason. since your dose decisions are made by the lowest numbers over the past 3-5 days, to some degree you can ignore the higher numbers.

I feel your despair. Hang in there and know you can lean on us for support. We get it. This can be a hard thing to cope with even if all is well with the vet. I hope you can find another vet to work with. Do you have any university vet school nearby?
 
I was just reading over in Oren's condo...
I want to reassure you that you are doing great with Mr. Sluggo.

I'm the one that used to live in Raymondville, 30 + years ago. I remember there being lots of vets, all over the valley.
Harlingen had quite a few....

I think you interview a few and try to present yourself as calm and demure as you can. Tell them you need help with the other issues
besides diabetes.... wanting to keep tabs on b/w.... etc..., and don't volunteer the difficulties you had with this previous vet. They don't need to know that, it makes them leery of you.


I am in the same shoes with the ibd/lymphoma issue. I don't know which one I'm dealing with as I don't want to put mine thru more surgeries.
Having to start prednisolone is what knocked her out of remission altho' she's doing pretty good with her numbers just the same.
I started dealing with these new issues on March 2
that's when I saw a very current internist who ran a new test ( not proven yet) but it sure made me feel better.
Ibd kitties can last a long time with treatment .
I know I'm not likely to keep her around for many more years but her qol is better now than it was.
I don't know if it would help you to read thru my condo since March 2.... lots of input on the ibd/lymphoma .

any cat who comes out of remission.... generally needs a bit more aggressive so I think you should stay with the TR.
Remissions are stronger when you stay the course and earn those reductions, so I would not taper down yet.
Maybe start footnoting what was eaten , and when, perhaps something you fed tends to spike numbers.... for that 137.
There have been a few who react to some foods even tho' they are low carb.
Ibd usually means some food is an irritant/allergen and you might be getting a pain response .
I sure hate dealing with food allergies since they are really hard to determine with a picky cat already.
 
Thanks much. Tonight a repeat performance though a bit earlier with a pre-shot 139. I'm afraid this isn't just a blip. I tried rotating the injection site (after reading Julie's note above) to side of abdomen as recommended here. I'd always used scruff of neck. Yesterday, I did vary the routine a bit by following a routine I'd used when sluggo had that abscessed tooth. I put the canned stuff in a nutribullet and threw the fortiflora in as well. Never could get him to eat it with the fortiflora on top. He always likes the food better that way & winds up eating more canned stuff. Today back to just putting out the canned and he's only eaten half as much (hoping he went more with the YA zero carb). It's also been 3 days since his last mirtazapine which certainly spikes his appetite for at least a day or so after. Still, numbers are all pretty much the same. No matter how you slice it now, I really see a fixed 1.75U with no reason now or in near future (barring a surprise) for a reduction. And I see no way I can safely increase the dose either. Protocol itself says aim for 50 to 200, and only increase when over 200. As "bad" as his regulation the past couple days has been, he's moved from completely normal numbers by all of 20 points max. That's no reason for even thinking of a dose increase. Nothing I can do. It ain't perfect, but there's nothing to "fix". Oh well. If this keeps up a few days, I think I could even go into a vet and just say, "he's on 1.75 U BID lantus insulin for diabetes (end of story)" with a very straight face. :p
 
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Those higher numbers since last night make me wonder if Mr Sluggo had a teeny, tiny dip just under 50 at some point during the yesterday AM cycle and is reacting to that. Or he might just be being a cat - I always found with Rosa that I'd get the occasional day or two where she'd run slightly higher numbers for no apparent reason, then she'd get back to business and start giving me some mostly green cycles again.

I read your posts on Megan's thread and I've got to say I think you're doing a great job with him. I find it incredible that a vet would fire you when it has to be obvious to them from your spreadsheet that you're not taking risks with Mr Sluggo's health and that you're doing everything you can to keep him as close to normal numbers as possible while still dealing with low numbers quickly. Whether they completely agree with the protocol or not, the data you're getting should speak for itself. It doesn't have to be something they would do with their cat, but I don't think it's unreasonable of you to expect that they will allow you to provide care as you see fit for your cat. It amazes me that any vet would think that any of us caregivers would arbitrarily choose a protocol that is so intensive for the caregiver as well as the cat if we didn't have evidence that it works - why would any of us choose sleepless nights and long days if there wasn't documented evidence that it really does help a lot of cats achieve remission? I really hope you can find a vet who will at least tolerate what you're doing even if they don't 100% agree with it so that you can get the other tests done that are needed when you need them.
 
Not yet. But I'm going to give them a call tomorrow. I have the day off, so if they'll meet with me and they seem good, I'll go up there & talk with them, at least.

I don't want sluggo anywhere near a vet right now. The sorts of blood sugar spikes I've witnessed when he goes won't play well with my attempts at TR.

And incidentally, BJM, thank you very much for all you do around here, from teaching me how to use the spread sheet to this. Very glad you're around!
 
Flat is actually good, especially with those kinds of numbers. Even if they technically aren't in the "normal" range, they are still healing and healthy numbers. Remember that "normal" on a human meter is 50-120, so anything that is just a hair above that (and don't forget about meter variance, too) is nothing to worry about at all.

Also keep in mind that nadir isn't always necessarily at +6. It can vary from cat to cat, and can vary within one cat. They like to keep us guessing, and unfortunately FD is just not a "fits in this box perfectly" kinda disease. Despite that, Mr Sluggo is doing awesome.
 
Subtle changes for the better clinically. Sluggo hasn't had classic DM signs I could spot at least for the past month (Polyuria, polydipsia, polyphagia, etc.). But since the switchover to the new protocol/insulin his coat is nicer. His dandruff which had been pretty severe is completely gone.

Ain't much, but it is for the better. Hopefully it's symptomatic of deeper changes for the better.
 
Actually, there are times when a person will want to increase the dose even with green nadirs (under 100). The guidelines are here:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
One thing that people do if they are just fine-tuning a dose, in other words, the nadirs are pretty good but maybe the cycle overall isn't perfect, is to fatten the dose and while doing that, give carbs as the midcycle approaches in order to prevent the cat from going below 50. As long as it is easy to keep the cat over 50, say with a bite or two of low carb, it's fine to do that. It becomes risky and the threat of overdosing your cat exists doing this if you are working to keep a cat's blood sugar over 50, if it takes multiple feedings or high carbs, then it's time to reduce the dose. We call this manipulating the curve with food in order to get a little more insulin in. There is a link to an explanation of it on the Where Can I Find? post - look at the bottom section under "feeding the curve."

I'm not suggesting you do that at this point. I think I'd give Mr. Sluggo a little bit longer to see if he will settle in. Yes he has 10 cycles at this dose, but he got into the 50's yesterday - and your dosing decisions are made primarily on the low numbers, not the random highs. I'm just mentioning it because you said that there were no options. And don't think that increasing a dose is a failure - it's a routine part of this dance. It's normal to have to go up in dose in order to bring down the BGs. The success comes from Mr. Sluggo spending lots of time in normal numbers. The more time he spends there the better. I wouldn't worry at all about the 129 or 139 today.

Remember too that meters have a 20% variance - so his 130 might be (130 - 20%) 104 or it could be (130 + 20%) 156. You're looking at overall trends from the past several days, not just one cycle or a test or two. It's the big picture of the past 3-5 days that determines whether or not one should try increasing the dose. I'd encourage you to post with "dose advice?" in your subject line and let one of us with experience take a look if you are thinking you want to increase the dose. We can help you sort out if you should increase or if you should continue to hold it a little longer.

By the way, Fortiflora doesn't increase blood sugar - at least I've never seen that happen. It was fine that you blended his food with it. That shouldn't affect his blood sugar.

 
An Ok final number. Looks like he is making the turn before 6 hours, though.

Thanks for all the advice! Sleep well, all.
 
manxcat419 said:
I find it incredible that a vet would fire you when it has to be obvious to them from your spreadsheet that you're not taking risks with Mr Sluggo's health and that you're doing everything you can to keep him as close to normal numbers as possible while still dealing with low numbers quickly. Whether they completely agree with the protocol or not, the data you're getting should speak for itself.
Click to expand...

Payback's a b*tch

Nolana_Review
 
Nice work! I just gave you a "useful" vote on that one too - figure the more people who know about that sort of thing the better!
 
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