6/26 Ruby AMPS 185/+3 298/+8 234/PMPS 240/+3 204

[Katherine&Ruby]

Yesterday on Ruby, Only Ruby.

Purrs n' biscuits alarm this morning.
No more runny poop.

That's about all the good news I have to report. Her BGs are running higher and she's not eating very much. Have written to Ruby's IM about getting some priority on the waitlist to see the oncologist. Paws crossed.

Have a great Caturday, everyone.

 

[Tomlin]

Love the comic ! Always a great start to the day when there are purrs and biscuits (and of course, solid BM!). Hoping the IM helps you out given the recent issues.

 

[Katherine&Ruby]

+3 = 298. Trying to stay calm here. I know I need to hold the dose but I'm very worried. Ruby did finally eat most of her breakfast this morning, but these numbers are bad. I need to start checking for ketones again.

 

[Marina & Chico]

+3 = 298. Trying to stay calm here. I know I need to hold the dose but I'm very worried. Ruby did finally eat most of her breakfast this morning, but these numbers are bad. I need to start checking for ketones again.

Ohhh, Ruby sweetie, go slowly back down, there is nothing nice waiting that high

Katherine you are doing a great job at adapting the insulin dose, unfortunately this is a new game you have to play, i really hope you will get good results from pred as soon as possible

do you give the same pred dose since you started?

 

[tiffmaxee]

Prayers. No runny poop is a good thing.

 

[mosi_yazhi]

Ruby, you're supposed to go DOWN, not UP

I know ***sometimes*** special circumstances require people to give two different insulins at two shots - might this call for that? A shorter acting insulin during the AM cycle only when the pred is at play?

(I'm honestly talking out my ass, and just thinking outside the box)

Prayers that her ketones stay at bay

 

[Our Dolly Girl (GA)]

+3 = 298. Trying to stay calm here. I know I need to hold the dose but I'm very worried. Ruby did finally eat most of her breakfast this morning, but these numbers are bad. I need to start checking for ketones again.

Hi Katherine, I know how upsetting this must be. You are doing what you need to for Ruby and giving it your very best as always. I hope and pray those numbers start reacting to the new dose. Hugs to all

 

[tiffmaxee]

Ruby, you're supposed to go DOWN, not UP

I know ***sometimes*** special circumstances require people to give two different insulins at two shots - might this call for that? A shorter acting insulin during the AM cycle only when the pred is at play?

(I'm honestly talking out my ass, and just thinking outside the box)

Prayers that her ketones stay at bay

She’s not so high to try R in my opinion.

 

[Katherine&Ruby]

Thanks, everyone. I don't know where I'd be without you all chiming in and supporting me.

Different AM/PM dosing to offset the pred would probably be best, but I'm in a terrible vet limbo here. Ruby's regular vets don't want to deal with her diabetes, wishing to defer to IMs, and unless I make an appointment 4-6 weeks out it's impossible for me to get an appointment with an IM at AMC. Her current IM doesn't respond to my emails--I have to aggressively follow up with any communication. I also know that in about two weeks her steroid dosage might change and there will be the added variable of the chlorambucil, so I don't want to embark on any unfamiliar dosing strategy right now unless I am guided by a vet proficient in feline diabetes. I am actively in search of an endocrinologist at the moment. The only thing I can do is increase the insulin as soon as it's safe to do so. I'm also going to be starting an intense new job in a little over a week that will take up a lot of my mental space and physical energy, not to mention the fact that it will take me away from Ruby Monday thru Friday, therefore losing the flexibility I have had to bring her to appointments as necessary. I'm in a bind and so very worried for her.

I am going take up her dose again to .5 tonight. Going forward I will not reduce unless she drops under 50 three times. I need to stay ahead of this somehow because I am worried about DKA while keeping in mind that this might be a temporary flare. Ruby will tell me if it's too much for her.

 

[Ann & Sister]

Wish you were in the Los Angeles area. I would run Ruby to the vet for you. I am retired.

 

[Katherine&Ruby]

Wish you were in the Los Angeles area. I would run Ruby to the vet for you. I am retired.

That's so kind of you!

 

[Tina Marie (GA) and Jan]

I know ***sometimes*** special circumstances require people to give two different insulins at two shots - might this call for that? A shorter acting insulin during the AM cycle only when the pred is at play?

(I'm honestly talking out my ass, and just thinking outside the box)

Very good thinking, even though it might be premature in this case (I trust Elise's @tiffmaxee thinking and experience), plus adding a lot of stress for Katherine during her transition to working outside the home again. As a long term T1 diabetic, I use fast acting insulin all the time (for carbs and to bring down higher BG), and keep the same lantus dose almost all the time. However, our cats are more like T2s, and can go into "remission" with the right diet, etc.

 

[Katherine&Ruby]

Ruby, you're supposed to go DOWN, not UP

I know ***sometimes*** special circumstances require people to give two different insulins at two shots - might this call for that? A shorter acting insulin during the AM cycle only when the pred is at play?

(I'm honestly talking out my ass, and just thinking outside the box)

Prayers that her ketones stay at bay

Very good thinking, even though it might be premature in this case (I trust Elise's @tiffmaxee thinking and experience), plus adding a lot of stress for Katherine during her transition to working outside the home again. As a long term T1 diabetic, I use fast acting insulin all the time (for carbs and to bring down higher BG), and keep the same lantus dose almost all the time.k Then, our cats are more like T2s, and can go into "remission" with the right diet, etc.

@mosi_yazhi Yeah, there are a few acro/IAA kitties here who use the fast acting insulin, like Oberon, Darcy, and Minnie, to fight against insulin resistance but the kitties usually get up to high doses of insulin before it's even prescribed. The pred is definitely creating insulin resistance with Ruby right now, but R would be too strong and it's not needed. Different AM/PM dosing is more likely the road I might take.

 

[carfurby (GA)]

Sending prayers.

 

[tiffmaxee]

I have a suggestion. Would you please put prednisolone on your ss when you give it unless it’s day and if so when are you giving it? I remember Patty/Blue was giving it but not every day and she did skip doses when low. With scl I believe you won’t be giving it forever. At some point it won’t be needed or might be tapered or budesonide used. @Wendy&Neko what are your thoughts?

 

[Katherine&Ruby]

I have a suggestion. Would you please put prednisolone on your ss when you give it unless it’s day and if so when are you giving it? I remember Patty/Blue was giving it but not every day and she did skip doses when low. With scl I believe you won’t be giving it forever. At some point it won’t be needed or might be tapered or budesonide used. @Wendy&Neko what are your thoughts?

Hi Elise, I have it in my signature and there's a band going across her spreadsheet when I started it saying I give it at AMPS but it's getting pretty high up there now so I can put it into each column everyday.

 

[tiffmaxee]

Hi Elise, I have it in my signature and there's a band going across her spreadsheet when I started it saying I give it at AMPS but it's getting pretty high up there now so I can put it into each column everyday.

Ok. I see that now that I am on my iPad. What time?

 

[Katherine&Ruby]

Ok. I see that now that I am on my iPad. What time?

8 AM.

 

[tiffmaxee]

My bad. No reason to keep putting it on your ss every day.

 

[Librarianista]

Aww Ruby! Feel better, baby girl.

 

[Katherine&Ruby]

My bad. No reason to keep putting it on your ss every day.

No worries, happy to put the info everywhere to make it easy for anyone to understand what they're looking at when they see Ruby's SS.

 

[FrostD]

What made you decide on 8am?

I know long term use in humans showed partial beta cell recovery over time, not sure if it's the same in cats.

I almost think I see a shifting nadir, and then the pred occasionally kicking in/wearing off at bad times.

 

[Katherine&Ruby]

What made you decide on 8am?

I know long term use in humans showed partial beta cell recovery over time, not sure if it's the same in cats.

I almost think I see a shifting nadir, and then the pred occasionally kicking in/wearing off at bad times.

I want to give the pred when the insulin is strongest against its effects, so it’s either AMPS or PMPS. Since I am more able to test and see the effects in the day rather than the evenings, it’s better for me.

It’s interesting that you see a shifting nadir. Ruby always nadirs around +3 to +5; now all I see is the waning of the pred, and its duration is getting longer and having more of a pronounced effect on her insulin resistance.

I hope you’re right about beta cell recovery. Right now Ruby’s dose isn’t very high but who knows how high we will have to go to keep the numbers from rising.

 

[FrostD]

It’s interesting that you see a shifting nadir. Ruby always nadirs around +3 to +5; now all I see is the waning of the pred, and its duration is getting longer and having more of a pronounced effect on her insulin resistance.

I hope you’re right about beta cell recovery. Right now Ruby’s dose isn’t very high but who knows how high we will have to go to keep the numbers from rising.

I'm curious why you say +2 to +3...yes, she did, historically before the pred. From my own experience though with IAA and acro, nadir is shifting all the time. Some days I see it at PS, some days +6, +9. So in some cases, I actually think you may be seeing a nadir at +12 or +14. Look at 6/21-6/24. It's like the preshots are the middle/end of the cycle. She comes up more than I'd expect from food alone, especially raw fed, then starts to come back down.

So is pred supposed to kick in right away and then fade out? Or is it a little delayed?

I wonder if you can make an exception to increase more quickly, Wendy would know best. Because the higher she starts to creep, it might be harder to catch and bring back down. But I know you start work soon so it's a balancing act. I feel you! Just hopefully you don't get up to 12U

 

[Katherine&Ruby]

I'm curious why you say +2 to +3...yes, she did, historically before the pred. From my own experience though with IAA and acro, nadir is shifting all the time. Some days I see it at PS, some days +6, +9. So in some cases, I actually think you may be seeing a nadir at +12 or +14. Look at 6/21-6/24. It's like the preshots are the middle/end of the cycle. She comes up more than I'd expect from food alone, especially raw fed, then starts to come back down.

So is pred supposed to kick in right away and then fade out? Or is it a little delayed?

I wonder if you can make an exception to increase more quickly, Wendy would know best. Because the higher she starts to creep, it might be harder to catch and bring back down. But I know you start work soon so it's a balancing act. I feel you! Just hopefully you don't get up to 12U

I guess we're talking about two different things: I only see the effect of the pred on patterns that I've observed for a while, whereas you have enough distance to see actual nadirs from the insulin! I find that the pred sometimes kicks in early, at +2, so what looks like a food bump is actually the pred. Ruby rarely ever showed food bumps before and there is basically zeros carbs in what I feed her.

I'd increase doses more aggressively if I knew where the pred would take Ruby, but I'm distrustful. This is why I am trying to find a good time to put a Libre on her so I can see these trends a little better over a week long period and maybe figure out a different/better time to give the pred.

 

[FrostD]

I guess we're talking about two different things: I only see the effect of the pred on patterns that I've observed for a while, whereas you have enough distance to see actual nadirs from the insulin! I find that the pred sometimes kicks in early, at +2, so what looks like a food bump is actually the pred. Ruby rarely ever showed food bumps before and there is basically zeros carbs in what I feed her.

I'd increase doses more aggressively if I knew where the pred would take Ruby, but I'm distrustful. This is why I am trying to find a good time to put a Libre on her so I can see these trends a little better over a week long period and maybe figure out a different/better time to give the pred.

Oh I see what you mean, yep! Libre would be very helpful and less stressful, if she'll keep it on. Has she had one before?

 

[Katherine&Ruby]

Oh I see what you mean, yep! Libre would be very helpful and less stressful, if she'll keep it on. Has she had one before?

She has and she hated it. But I’m equipped to put it on her myself now rather than doing it at the vet and want to put it on a different spot than before, specifically her neck, to see if she tolerates it better.

 

[mosi_yazhi]

I'm positive you're going to do great at putting it on yourself.

I do, however, fear for your mortal soul, as you have to first shave down a spot on her using the electric clippers. God speed and good luck.

 

[Our Dolly Girl (GA)]

I have a suggestion. Would you please put prednisolone on your ss when you give it unless it’s day and if so when are you giving it? I remember Patty/Blue was giving it but not every day and she did skip doses when low. With scl I believe you won’t be giving it forever. At some point it won’t be needed or might be tapered or budesonide used. @Wendy&Neko what are your thoughts?

I'm positive you're going to do great at putting it on yourself.

I do, however, fear for your mortal soul, as you have to first shave down a spot on her using the electric clippers. Good luck.

 

[FrostD]

I'm positive you're going to do great at putting it on yourself.

I do, however, fear for your mortal soul, as you have to first shave down a spot on her using the electric clippers. God speed and good luck.

Ha! I forgot about that part. Whenever Mr Kitty gets shaved I hear the growling and hissing from wherever I am inside the building. And without fail, a slightly disheveled tech comes back out and describes him as "spicy".

Katherine, what she said ^ good luck.

 

[Katherine&Ruby]

Ha! I forgot about that part. Whenever Mr Kitty gets shaved I hear the growling and hissing from wherever I am inside the building. And without fail, a slightly disheveled tech comes back out and describes him as "spicy".

Katherine, what she said ^ good luck.

I love the word spicy! I have a plan to catch her mid-nap so she’s sleepy and acquiescent. Ruby’s pretty chill generally, sometimes sassy but rarely spicy!

 

[Wendy&Neko]

Sorry for the late reply. Another use for R is in ketone prone kitties, which is the case in a couple of the R kitties that were mentioned. But R requires more monitoring, no less, so I agree with you that it’s not a good time to be adding it into the mix. Plus it’d be a bit of a sledgehammer in this case, not my first choice.

As for increasing faster, no to that either. You got a 46 just four days ago on 0.5 units. Going to multiple drops for reductions is definitely worth trying though.

I think once you have chlorambucil starting to do it’s thing, you should consider tapering it and trying budesonide, to see if you get impact on her blood sugars.