? 6/20 Charlie AMPS 297, PMPS 411??! Dosing help

Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
Dosing question:
After his ketosis episode, the vet told me to keep increasing Charlie's insulin if his nadir is below 200. I've been trying that but...All I see is bouncing, even when his nadir is only in the low 200s. He has done this before, even when he isn't really dropping into the blues and greens, he will bounce. Twitchy liver.
He had been relatively flat but high. Now he looks like a rubber ball.

What is the best approach keep pushing the higher dose and those 400's will eventually come down? With his ketone history, I am not a huge fan of numbers like that. Or back off?

I still find TR overwhelming, I just can't test that much. We could get a Libre back on him, though I just find them so inaccurate at the high and low ends.

Some other updates
1) Oncologist did not find a mass on ultrasound to do a fine needle aspiration on... so the LCL diagnosis remains ??? But said yep, pancreatitis, which seems to be the only thing everyone is in agreement about.
2) Have called twice to get a referral to the VCA in Omaha to see an internist vet and... crickets. Oncologist wrote in her letter to please get him a referral to an internist.
3) I've demanded Zofran and sub-Q fluids from the vet and got those. She refused to give him pain meds.
4) I am testing ketones (have not tested today), he's been anywhere from 0-0.6 in the morning, and have given him fluids and he comes back down... Saturday he threw up his breakfast but I managed to stay calm and get little bits of his raw food mixed with water in him 1 TBSP at a time in a syringe until I could give his second dose of Zofran, and fluids. His ketones came down and he went back to eating on his own. He's been a little lethargic this afternoon, but eating well and grooming himself.

Previous posts
https://www.felinediabetes.com/FDMB/threads/6-16-charlie-amps-353-dosing-tr-switch.278627/
https://www.felinediabetes.com/FDMB/posts/3078679/
 
You make it sound like bounces are bad things. Annoying to us yes, but it shows his body is still working to protect itself what what it perceives to be lows. Which could be the 200's if that's as low as he's been lately.

With TR, you have to get at least two tests per cycle, the preshot and one other. I don't see any the last night or the one two before. Don't assume a red preshot means no action. Neko earned her first reduction starting at 430 and even did it from higher numbers. I've even seen cats start over 500 earn a reduction that cycle. When he woke you up in the middle of the night, maybe he wanted food cause he was low? Take the opportunity to test.

With yellow nadirs, TR says to increase the dose every 6 cycles by 0.25 units. Unfortunately, we don't have data to know exactly how low he's going on this dose because of the missing tests. If lower than yellow, you could hold the dose longer. Can you get at least a +2 tonight? The night of the 18th, he had done quite a large drop to +2, which can be a signal to an active cycle that either needs more testing, or leaving lots of food out for him to keep himself safe. The red the following day was an indicator either of the rapid drop, or lower numbers that night causing a bounce.

Good news the oncologist didn't see a mass, and kudos to whoever suggested you see an oncologist. Would the oncologist prescribe pain meds for the pancreatitis? Good to hear he is eating well.
 
Bouncing seems not great since it's resulting in numbers in the 400s. He seems to bounce without hitting numbers that would warrant a reduction. I feel like I saw somewhere that ketones are more likely with a bounce high vs. just being high all the time. But that seemed anecdotal more than data based.

Testing at night is hard, which is one reason I was like TR is not going to work for us. Even during the day is not always feasible. Tomorrow, I have meetings straight from 9 am to 2 pm... Testing late enough to give a sense of his nightly nadir is frankly not going to happen often. I have a mental health issues that makes it the transition between asleep and awake difficult and renders me useless if I don't get enough sleep. I'm still up now, I can get a plus 3 but I should have been in bed an hour ago so I can be functional at 9.

He wakes me up for food all the time, regardless of numbers so that's not a great metric. I can put a Libre on him tomorrow, but that's the only way to get readings consistently after 10 pm.
 
The oncologist was basically like bye, thanks for wasting my time. 0/10 for her. The IBD and Lymphoma FB groups suggested I go to an oncologist and they all seemed happy to book an appointment without a referral. The VCA won't get us in with the internist. I really don't want to drive to Kansas, three and a half hours each way. He was soooo stressed out and giving fluids in the back of a parked car in a Target parking lot is also a 0/10. Especially after the cat has peed on himself
 
Cats bounce when they see numbers they aren't used to (which could be in the 200's) or if they drop quickly. I found the latter sometimes produced the worst bounces. Also, Charlie hasn't seen many good numbers for a while. Ketones can be a risk factor for DKA, and not enough insulin is part of that formula too. Ketones can also happen in cats in lower numbers.

You don't need a nadir test at night, but a +2 or before bed test would be good. Regardless of dosing method being followed.
 
Definitely, Charlie had ketones when he was in the 200s! It's just hard to now see 400s.

His +3 was 298, so a drop of 118. I would assume he'll keep going down, but that's still high. At least during the day, he hasn't dropped wildly below where he was.
 
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