5/23 Tessa AMPS 299 +3 283 +6 287 +9 274 PMPS 270 +2 272

[tessa's mom]

Previous: https://www.felinediabetes.com/FDMB/threads/5-21-tessa-amps-269-3-286-6-278.290259/

Really kicking myself for not setting an alarm to get up around PM +6 on 5/21 so I could see how low the dose took her. With the frequent increases and her only seeming to get low numbers overnight I am getting frustrated and feel like I'm just shooting in the dark so to speak.

I have some stressful family issues going on and I'm not sleeping very well already so I'm exhausted and overwhelmed but I'm going to try to get some PM spot checks in over the weekend and try to make up the sleep with a nap during the day. My husband said he could try to get some too but Tessa tends to run from him (she seems to be afraid of men) so I might have to get up anyway.

 

[tessa's mom]

Absolutely, I think you'll need to increase as fast as possible that the TR protocol lets you do. Her turnaround dose last time on insulin was 2 units. As I mentioned in the post where you were looking for suggestions on dose, kitties coming out of remission tend to need to get up to or even just above how high they got the first time on insulin. With a 12 lb kitty, assuming that's her ideal weight, if she was newly diagnosed she would start at 1.25 units. The sooner you can get her back in the greens, the better the odds for remission again.

Just to clarify, do you mean I should ignore potential bouncing and new dose wonkiness and just increase every 3 days unless her numbers get down to greens?

And that means I should increase to 1u tomorrow, right?

 

[Bandit's Mom]

See what Wendy says but I think you're good for an increase tomorrow. In fact, you want to increase every 6 cycles till you start seeing low blues or greens.

 

[tessa's mom]

See what Wendy says but I think you're good for an increase tomorrow. In fact, you want to increase every 6 cycles till you start seeing low blues or greens.

Thanks, I think what's getting me is just not knowing what her overnight nadirs are. I suspect she's hit low blues overnight but I am not 100% sure.

 

[Bandit's Mom]

I suspect she's hit low blues overnight but I am not 100% sure.

I'm not so sure that she is. I could be wrong, but I suspect her PM cycles might be similar to the AM cycles you saw on 5/16, 5/17 and 5/18. Later nadirs but not significantly lower than +3.

 

[Wendy&Neko]

I agree with Bhooma, I think you are good to go to 1.0 units tomorrow morning, unless you see green or really low blues before then. Our goal is to get her in good green numbers ASAP (and safely) to try to increase the chance of a second remission.

do you mean I should ignore potential bouncing and new dose wonkiness and just increase every 3 days unless her numbers get down to greens?

Correct. Bouncing isn't a factor in when you increase, other than, if possible, drying to avoid increasing on the same cycle they break the bounce. NDW is over in the first few cycles after an increase. If you wait 6 cycle to increase, it's long gone.

 

[tessa's mom]

I agree with Bhooma, I think you are good to go to 1.0 units tomorrow morning, unless you see green or really low blues before then. Our goal is to get her in good green numbers ASAP (and safely) to try to increase the chance of a second remission.

Correct. Bouncing isn't a factor in when you increase, other than, if possible, drying to avoid increasing on the same cycle they break the bounce. NDW is over in the first few cycles after an increase. If you wait 6 cycle to increase, it's long gone.

Am I reading this wrong then?

Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours.

https://felinediabetes.com/FDMB/threads/new-dose-wonkiness-ndw-and-failed-reductions.46012/

Because if it can happen in the first 3 days and last up to 24 hours then theoretically it could take 4 days to truly see what a dose can do. Increasing every 3 days doesn't give any time for things to settle.

I'm NOT arguing that I want to keep her at her current dose, just curious if this is just a case of outdated info still being in the stickies or something.

 

[tessa's mom]

I'm not so sure that she is. I could be wrong, but I suspect her PM cycles might be similar to the AM cycles you saw on 5/16, 5/17 and 5/18. Later nadirs but not significantly lower than +3.

Okay, I'm probably wrong then. My logic was that if she was getting a 75-100 point drop during the day then a 75-100 point drop at night would bring her to low blues. But I'm probably wrong, I often am lol.

 

[Wendy&Neko]

Also from that Sticky Note: NDW usually lasts for less than 24 hours and is usually seen in the second day following a dose increase.

More information in post #17 of this post about bounces and when to increase: Protocols: Myths Debunked

 

[tessa's mom]

Also from that Sticky Note: NDW usually lasts for less than 24 hours and is usually seen in the second day following a dose increase.

More information in post #17 of this post about bounces and when to increase: Protocols: Myths Debunked

I have read that and that's where more confusion is coming in for me because it says Day 4-6 could be bouncing. We increased on day 5 so we will never know if she was bouncing or not.

I know that people think I'm stupid for starting her back on 0.5u but I am going through some personal issues and I am thankful to have the training wheels for the first week or so. I looked at some sheets for cats who came back from remission and about half of the ones I looked at that started back on 1 unit or higher had a number under 50 within the first week. I cannot handle that right now. Maybe I'm ruining everything and dooming her to a life of insulin instead of a chance of a second remission but I'll have to beat myself up for that later. I'm just trying to get through each day right now.

 

[Wendy&Neko]

It's fine that you started at a lower dose. Some cats will show stronger initial reactions when starting insulin, then it fades away. We also hold the initial dose 5-7 days, so increasing after 5 was also OK. When you increase next is up to you and your individual situation. Bhooma and I are just telling you it's safe to increase tomorrow, barring good numbers tonight, should that be what you decide to do.

How is Tessa feeling/acting these days? Her numbers are mostly higher yellows, just wondering if that means she's peeing more. Also wondering how she's doing in general. Cats are a lot more than just their numbers.

 

[tessa's mom]

It's fine that you started at a lower dose. Some cats will show stronger initial reactions when starting insulin, then it fades away. We also hold the initial dose 5-7 days, so increasing after 5 was also OK. When you increase next is up to you and your individual situation. Bhooma and I are just telling you it's safe to increase tomorrow, barring good numbers tonight, should that be what you decide to do.

How is Tessa feeling/acting these days? Her numbers are mostly higher yellows, just wondering if that means she's peeing more. Also wondering how she's doing in general. Cats are a lot more than just their numbers.

She is doing pretty well. No increased urine output or drinking. She mostly hangs out with me in my office all day so I'd know if she was leaving to pee or drink a lot and she's not. My husband scoops the boxes and he said that everything looks normal there too. Activity levels are pretty normal for her. If it weren't for her high BG, you'd have no idea that she's out of remission.

I am still a bit worried about her mouth though and am considering another follow up to have them recheck her mouth. She is still showing some signs of pain, or at least I think she looks like these are signs of pain. I'll add videos I took and you can tell me if I'm just being silly.

This video was 2 days ago:

She gets that wide eyed look almost every time you touch her face in that area and that's where she had multiple premolars removed. And as you can see, no wide eyed look when touching the other side of her face even with some good scritching.

This video is from today:

Kind of hard to see but her jaw quivers a little bit and then she pulls away. I added a slowed down version of the clip right after but I think it's actually easier to see in the normal speed part.

Her bottom jaw on that side feels different, almost like there's a divot where the teeth used to be. I'm not sure if that's normal or not because I have read that cat's jaws are basically held together by the teeth so it might be completely normal.

I requested x-ray copies from the vet clinic that did the extractions but they said they're having computer issues. I hope that they're telling the truth and not trying to hide something from me.