6-24 Zed AMPS 628!! Need advice ASAP

[Bree&ZeddyBoy]

Can an admin please look at Zed's SS - Is he having a rough time with this higher dose and does it need to be reduced or should we stay the course or increase?? I hate seeing these black numbers. If anyone can let me know what is going on in medical terms, I would be grateful. @Wendy&Neko @tiffmaxee

 

[Bron and Sheba (GA)]

Can you get any tests in the PM cycle that are later than +3? Just to see if he's dropping lower some nights?
Those black numbers are most likely from bouncing .
I think he needs an increase in dose up to 1.75 units.
Are you giving some small snacks during the cycles and well as the preshot times?

 

[Frogster]

Just wanted to say I feel you.
I did not make a SS here yet, but we are struggling with bouncing (I s'pose). Her numbers are getting higher and higher every day and with every dose changing and they never come back. Her best were a couple of weeks ago at around 270 and we were not even on any injections then.
Since we started Lantus (and now we are trying Levemir) her numbers started to rise and are skyrocketing right now. She was at 478 +6 today (428 preshot and 327 +3), and now I'm simply afraid to make more tests, because I have no idea how to last for 3 hours till her next shot.

 

[Bree&ZeddyBoy]

Can you get any tests in the PM cycle that are later than +3? Just to see if he's dropping lower some nights?
Those black numbers are most likely from bouncing .
I think he needs an increase in dose up to 1.75 units.
Are you giving some small snacks during the cycles and well as the preshot times?

I can certainly try to get more PM tests - we do free feed but pull food 2 hours before pre-shot tests. Should we be giving him something during that time to help with bouncing?

 

[Bree&ZeddyBoy]

Just wanted to say I feel you.
I did not make a SS here yet, but we are struggling with bouncing (I s'pose). Her numbers are getting higher and higher every day and with every dose changing and they never come back. Her best were a couple of weeks ago at around 270 and we were not even on any injections then.
Since we started Lantus (and now we are trying Levemir) her numbers started to rise and are skyrocketing right now. She was at 478 +6 today (428 preshot and 327 +3), and now I'm simply afraid to make more tests, because I have no idea how to last for 3 hours till her next shot.

@Frogster - it is so frustrating and confusing...what is her insulin dose now?

 

[Frogster]

@Frogster - it is so frustrating and confusing...what is her insulin dose now?

We were on Lantus 1.25 for three days, her numbers kept rising, I tried to reduce to 1, and it kinda worked for the next two circles, but then the numbers just went wild. Today is our first day on Levemir, I started with 1, and... well...
+1 they raised, +2 it seems they started to fall, because she looked afraid and tried to hide, +3 they were significantly lower then at +1, and at +6 - here we go - she is skyrocketing.
She's been sick since february, and I'm emotionally and physically exhausted.
(sorry, English is not my first language)

 

[Bree&ZeddyBoy]

Can an admin please look at Zed's SS - Is he having a rough time with this higher dose and does it need to be reduced or should we stay the course or increase?? I hate seeing these black numbers. If anyone can let me know what is going on in medical terms, I would be grateful. @Wendy&Neko @tiffmaxee

Ok everyone - I just realized that my husband changed the code on the meter last night to test himself with a human strip. Sheesh. Just tested with the proper code and got a +5 at 448. Still high but not CRAZY. Can someone take a look at his spreadsheet and let me know if we should increase the dose or hold for a few more days?? @Wendy&Neko @tiffmaxee

 

[tiffmaxee]

I do think an increase is needed BUT is it possible to set an alarm any time between +5-7 just to see if he’s dropping and bouncing?
I’m glad the meter issue was figured out.

 

[Beck and Philly]

Just wanted to say I feel you.
I did not make a SS here yet, but we are struggling with bouncing (I s'pose). Her numbers are getting higher and higher every day and with every dose changing and they never come back. Her best were a couple of weeks ago at around 270 and we were not even on any injections then.
Since we started Lantus (and now we are trying Levemir) her numbers started to rise and are skyrocketing right now. She was at 478 +6 today (428 preshot and 327 +3), and now I'm simply afraid to make more tests, because I have no idea how to last for 3 hours till her next shot.

I'm far from being an expert, but I think if you set up a spreadsheet and start your own thread in this forum, the people here can probably help you get into a routine that helps your cat. It's important to be consistent with the dose and the insulin type long enough to see how it will work. Let these experienced folks help.

 

[Bree&ZeddyBoy]

I do think an increase is needed BUT is it possible to set an alarm any time between +5-7 just to see if he’s dropping and bouncing?
I’m glad the meter issue was figured out.

Hey @tiffmaxee - we got a +5 last night and he was sitting in the low 400's and based on that and the other PM data, I don't think he's a night bouncer, plus he has dinner left overs that I think carry him. Going to 1.75 this am and see what that does. Sheesh, that meter situation....OMG.

 

[tiffmaxee]

So now you know. It helps figure this out. . Don’t hold this dose too long. With nadirs this high you might want to consider a .50 increase next time. I hope this increase helps get better numbers. I’d still get a +3 or before bed test as if there’s a drop it means it could be an active cycle.

 

[Bree&ZeddyBoy]

So now you know. It helps figure this out. . Don’t hold this dose too long. With nadirs this high you might want to consider a .50 increase next time. I hope this increase helps get better numbers. I’d still get a +3 or before bed test as if there’s a drop it means it could be an active cycle.

@tiffmaxee Thanks so much for your responses - I was contemplating going to 2U with what I have read on the forum. We will definitely get the +3 tonight. Could we go to 2U tomorrow morning? We will be home to test.

Have you heard of a dose reduction causing a reduction in BG??

 

[tiffmaxee]

A dose reduction doesn’t cause a reduction in bg unless a cat was given way to much insulin causing the cats body to send out insulin to protect it from a hypo, a bounce. Some vets start cats on way too high a dose and when they come here they have to restart the whole process. In that case those cats see better bg numbers. That’s not the case with Zed thank goodness as the risk of a deadly hypo is possible in way too high a dose. My boy was tightly controlled but it took a year. I wasn’t going to test at first so my vet started him on a low dose. When we got a good nadir in his office we stopped for three weeks as he though possible remission. Big mistake. Max never went into remission. It could have been due to his chronic pancreatitis or the way we treated him at first. Follow the protocol and you will get the best results possible for Zed. As to increasing again tomorrow let’s see what happens today and tonight. Hang in there. For most of us it’s a marathon and when we think we have it figured out they often throw us a curveball.

 

[tiffmaxee]

Please do start a condo on the Lantus/lev board. The most experienced Lantus people are there so more eyes in your kitty. I for one have only been looking on health because I’m home a lot more due to the Covid virus limiting where it’s safe to go.

 

[Bree&ZeddyBoy]

@tiffmaxee - I can't thank you enough for sharing and pow-wowing with me on Zed. He is my son and I am willing to do whatever it takes to help him. Our vet prescribed 3U of Lantus to start which totally freaked me out which is why we started with 1U. We had some good initial numbers. I was hopeful. We got some different advice on dropping...wish I stayed the course and wasn't such a scaredy cat about hypos but feel more confident now. Thanks for sharing your insight with Max. I also lost my first fur child to gastric lymphoma...rough. Appreciate you. We will hold the dose tonight and see what tomorrow brings.

 

[Bree&ZeddyBoy]

Please do start a condo on the Lantus/lev board. The most experienced Lantus people are there so more eyes in your kitty. I for one have only been looking on health because I’m home a lot more due to the Covid virus limiting where it’s safe to go.

I will keep posting for sure. Any way to get more eyes on his info?

 

[tiffmaxee]

Yes. I’ll tag a few people. @Marje and Gracie @Wendy&Neko Hi Wendy and Marje. Would you have a look at Zed’s ss please. Thanks.

 

[Bree&ZeddyBoy]

Yes. I’ll tag a few people. @Marje and Gracie @Wendy&Neko Hi Wendy and Marje. Would you have a look at Zed’s ss please. Thanks.

Thanks all! Sorry to be a PIA, just a concerned parent...he made it through multiple blockages, Cutaneous Mass Cell Tumor disease and the loss of his sister unexpectedly a few years back, so now we are just focused on trying to keep him alive and healthy. To be honest, our vet here in our new small town isn't the best, so your advice is critical.

 

[Marje and Gracie]

Thanks all! Sorry to be a PIA, just a concerned parent...he made it through multiple blockages, Cutaneous Mass Cell Tumor disease and the loss of his sister unexpectedly a few years back, so now we are just focused on trying to keep him alive and healthy. To be honest, our vet here in our new small town isn't the best, so your advice is critical.

I looked back to see if you ever gave any history on Zed; for example, do you have an idea of how long he might have been diabetic before you started insulin? I’ve seen many members remark that, looking back, there were signs but they didn’t think about diabetes. Also, how was his starting dose determined and what is his ideal weight? Is he underweight and, if so, what is his weight? Depending on his weight, your vet might have been right about the 3u but I’d need to know his weight first. If that was the correct starting dose, then you are likely dealing with some glucose toxicity and insulin resistance.

He does not appear to be overdosed even though you have gaps in testing which has already been discussed. It’s really important that, going forward, you know how low a dose is taking him before you increase. To do that, you will need a couple tests at night like a +2 and a before bed.

You want to be sure that you don’t hold onto doses too long when you’ve got data. I would not have left him at 1.5u for such a long time. Not a criticism....just an observation.

I’m glad you increased to 1.75u but I would not change the dose again immediately. What you can do, if all you see is BG above 300 is increase by 0.25u after four cycles or by 0.5u after six cycles at the 1.75u dose.

And you aren’t a “PIA”. No one likes to see their kitty in higher numbers. Pls tag me if you have questions.

 

[Bree&ZeddyBoy]

I looked back to see if you ever gave any history on Zed; for example, do you have an idea of how long he might have been diabetic before you started insulin? I’ve seen many members remark that, looking back, there were signs but they didn’t think about diabetes. Also, how was his starting dose determined and what is his ideal weight? Is he underweight and, if so, what is his weight? Depending on his weight, your vet might have been right about the 3u but I’d need to know his weight first. If that was the correct starting dose, then you are likely dealing with some glucose toxicity and insulin resistance.

He does not appear to be overdosed even though you have gaps in testing which has already been discussed. It’s really important that, going forward, you know how low a dose is taking him before you increase. To do that, you will need a couple tests at night like a +2 and a before bed.

You want to be sure that you don’t hold onto doses too long when you’ve got data. I would not have left him at 1.5u for such a long time. Not a criticism....just an observation.

I’m glad you increased to 1.75u but I would not change the dose again immediately. What you can do, if all you see is BS above 300 is increase by 0.25u after four cycles or by 0.5u after six cycles at the 1.75u dose.

And you aren’t a “PIA”. No one likes to see their kitty in higher numbers. Pls tag me if you have questions.

HI @@Marje and Gracie - thanks for the thorough response. The vet thinks it is possible that Zed has been diabetic for some time. When we spoke at his diagnosis after I noticed a huge uptick in drinking and urinating, she mentioned he was at 162 2 years ago, but she never mentioned that this was something we needed to look out for. As you said, I can say with certainty, he has been walking on his front hocks for some time - I just didn't know it as neuropathy until this diagnosis and my research. :-( We had just been focused on Mast Cell Disease for so long...He is 21lbs and a very long cat. We immediately eliminated dry food (he always ate both) for a week before starting insulin. My decision on the starting dose was made after consulting 2 Facebook groups - one connected to the board, one that seems to err on the side of dose reductions. We held the dose at 1.5 after consulting here. I decided to increase it today. I recently read about glucose toxicity and insulin resistance and I am beside myself that I have screwed him up. I will absolutely work to get more PM tests and will follow the dosing guidance after the mentioned cycles.

Feeling like a failure. I really appreciate your insight and your kindness.

 

[tiffmaxee]

Please don’t feel like a failure. We all were newbies at one time. My cat was always high at my vet’s office and it was attributed to stress. Maybe it was. Maybe not. He had chronic pancreatitis and I was on a board for that when I noticed lots of cats becoming diabetic so I bought glucose urine test strips and that’s how I diagnosed him. He had started urinating more which I thought was kidney disease but it wasn’t. You are here now and treating him so he will get the help needed. This is the best place to be with a diabetic cat.

 

[Marje and Gracie]

HI @@Marje and Gracie - thanks for the thorough response. The vet thinks it is possible that Zed has been diabetic for some time. When we spoke at his diagnosis after I noticed a huge uptick in drinking and urinating, she mentioned he was at 162 2 years ago, but she never mentioned that this was something we needed to look out for. As you said, I can say with certainty, he has been walking on his front hocks for some time - I just didn't know it as neuropathy until this diagnosis and my research. :-( We had just been focused on Mast Cell Disease for so long...He is 21lbs and a very long cat. We immediately eliminated dry food (he always ate both) for a week before starting insulin. My decision on the starting dose was made after consulting 2 Facebook groups - one connected to the board, one that seems to err on the side of dose reductions. We held the dose at 1.5 after consulting here. I decided to increase it today. I recently read about glucose toxicity and insulin resistance and I am beside myself that I have screwed him up. I will absolutely work to get more PM tests and will follow the dosing guidance after the mentioned cycles.

Feeling like a failure. I really appreciate your insight and your kindness.

You’re very welcome and please don’t feel like a failure. I would be very rich if I had a dime for every member here that has said that. It’s always hard to see the forest for the trees.

His starting dose under TR is calculated at 2.3u every 12 hours (21/2.2 x 0.25) if 21 lbs is his ideal weight; I usually round down in that case instead of up so I would have suggested, based on TR starting doses, that you start at 2u. You can see we are a bit behind the power curve right now and I would suspect you might have to take the dose up beyond 2u to see some movement. Let’s hope my crystal ball is fuzzy.

One word about the FB groups just for others reading this. The one that is associated with this site is not supposed to be giving any dosing advice and so I hope they haven’t fallen back into that. There are two other groups whose admins used to be members here. One of those groups is notorious (I suspect this is the one you were in) for not following starting dose guidelines and believes most cats will do well with low doses. This isn’t true. There are many cats that need to go up to 3u or even 4u and I’ve seen ones with glucose toxicity need more (I’m not addressing high dose conditions here). There is a long history to all of that which we don’t need to revisit here. I’m just glad you worked your way over here.

So we will all put on our patience pants and take the dose up according to the TR protocol and keep our fingers crossed. It’s important that you cut yourself some slack because we all know how that “wish I had done” feeling goes and the thing is....you are here now and you are working hard to help Zed!