6/5 Max AMPS 512 +6 496 +10 459

[max&emmasmommie]

Well, it's been a hard morning since 4:30 am. I could not give Max his dose last night at 12:00 because his BG was 134. Half an hour later it was 136. I gave him some fresh food, and by +13 his BG was 156. So, I gave him the full 1.75u dose. I got up at +4.5, and his BG was 394. I woke up with a terrible headache then and at 8:30 this morning. At +10 Max's BG was 525.

I gave him 100cc of fluids at +11 which was a nightmare. I guess I'm very tired. When I turned on the juice, it started shooting out the other side of the tent. He bolted, and the needle fell out. Then he fought me when I tried twice more to put in the needle. I got a new needle, and he jerked that loose once. Four stabs of that huge needle. Finally, I got all 100 ccs into him as well as about 50cc in his fur and on the floor. He drank water twice this morning even after getting 100cc yesterday. I can't believe he let me pet him 1/2 an hour later.

After that, the baby fell down and started crying non-stop all through a diaper change and beyond. I had to carry her 20 lbs around with me everywhere. When I got ready to test Max, he disappeared after I put the sock in the microwave. I didn't find him until 12:20. Once I got him tested and shot it was 12:30.

The baby just fell asleep, but we have to leave now to pick up the Hubs at the airport.

Link to yesterday's post: viewtopic.php?f=32&t=72539

 

[BJM]

Re: 6/5 Max Worst morning so far AMPS 512

You've a lot on your plate and it can be very difficult to get everything scheduled when no one is cooperating!!! {{hugs}}

If you can test for urine ketones religiously (see Secondary Monitoring Tools in my signature), a trial dose reduction may be done for up to 3 days, to see if the tests you get go down or up. If you detect ketones, the insulin is increased back. If you can grit your teeth through it, you could go to as low as 1 unit, as it is possible he was started too high initially. Do not attempt this unless you will test for ketones daily or more often.

Good luck!

 

[max&emmasmommie]

Re: 6/5 Max Worst morning so far AMPS 512

Good idea. I've been considering starting back at 1 u for quite a while, but I didnt' have the guts to do it. Testing for ketones is no problem. In a way, really see no choice at this point as we have never had a blue number without going into the red or black thereafter. This bouncing around is terrible for his organs just as much as if I wasn't treating him at all. However, I simply cannot go through a ketone incident. I don't trust my vet, and I can't afford it.

What if I slowly reduced the dose to 1 unit, then held it there for 3 or 4 days and started back up again if necessary. Could that work? I know I'd have to test for ketones anyway, but the likelihood of having them would be less if I were inching his dose down by .25 every three days, right? Or is that wishful thinking? Any other reasons not to do that?

 

[BJM]

Re: 6/5 Max Worst morning so far AMPS 512

...What if I slowly reduced the dose to 1 unit, then held it there for 3 or 4 days and started back up again if necessary. Could that work? I know I'd have to test for ketones anyway, but the likelihood of having them would be less if I were inching his dose down by .25 every three days, right? Or is that wishful thinking? Any other reasons not to do that?

I don't know if inching it down slowly makes ketones any less likely, though they might be slower to appear at moderate levels ... and DKA can occur at any level.

Oh wait a minute

Take a look at your spreadsheet with the size reduced to about 50% - you'll get a visual overview of the color patterns which may give you clues about how insulin dose affected glucose levels. When you tested 1.5 units for a week, most of what you got were blacks and reds. As you've increased, you seem to have fewer blacks, though it is hard to tell with few mid-cycle tests during that time. This past week, you've had blues and yellows.

Some of that may be due to the constipation issues and schedule irregularities, but some of that may be the insulin. you've got about 30 points of buffer at the lowest he's ever tested.

Other finagles folks have used if continuing with Lantus and dealing swith steep curves:
1) TID dosing - giving 1/3 or the total daily dose every 8 hours. might not work with your schedule
edited to add: probably won't work with your scheduled. And next poster notwitstanding, you have to find what actually works with your cat, even if it is outside of the box.

2) continuing with a basal dose (a stable dose on consistent schedule) and then using supplemental R or N when there are spikes. Initially, you start with a VERY small amount (0.25 units) and then test over its duration to see how it works. R lasts about 4 hours so you'd want to test around +2 of the R dose.

Edited to add: very, very tiny dose - when I tried it with spitzer, he was pulling huge reds and blacks a lot of the time, so 0.25 helped. I'd not seen a written protocol on this website other than in response to other posts.

 

[Blue]

Re: 6/5 Max Worst morning so far AMPS 512

...What if I slowly reduced the dose to 1 unit, then held it there for 3 or 4 days and started back up again if necessary. Could that work? I know I'd have to test for ketones anyway, but the likelihood of having them would be less if I were inching his dose down by .25 every three days, right? Or is that wishful thinking? Any other reasons not to do that?

I don't know if inching it down slowly makes ketones any less likely, though they might be slower to appear at moderate levels ... and DKA can occur at any level.

Oh wait a minute

Take a look at your spreadsheet with the size reduced to about 50% - you'll get a visual overview of the color patterns which may give you clues about how insulin dose affected glucose levels. When you tested 1.5 units for a week, most of what you got were blacks and reds. As you've increased, you seem to have fewer blacks, though it is hard to tell with few mid-cycle tests during that time. This past week, you've had blues and yellows.

Some of that may be due to the constipation issues and schedule irregularities, but some of that may be the insulin. you've got about 30 points of buffer at the lowest he's ever tested.

Other finagles folks have used if continuing with Lantus and dealing swith steep curves:
1) TID dosing - giving 1/3 or the total daily dose every 8 hours. might not work with your schedule

2) continuing with a basal dose (a stable dose on consistent schedule) and then using supplemental R or N when there are spikes. Initially, you start with a VERY small amount (0.25 units) and then test over its duration to see how it works. R lasts about 4 hours so you'd want to test around +2 of the R dose.

OK first point, do NOT go with TID dosing on Lantus... do not do that... a suggestion to dose Lantus TID is dangerous! Even if you are doing some extreme testing, you need to know when your cat's nadir is so that you don't have a clash of the nadirs nitemare. .... horrible suggestion.

Next point, the use of R. Do NOT try using R without an experienced R user around to help and guide you. The initial dose in any R trial is 0.1u.... that's one drop. You can practice measuring with water to the .5u mark and see how many drops you can squeeze out. Your first dose would be 0.1u and you would test every hour for five hours on that initial shot. On your next shots of R, you will do the same thing: test every hour for five hours.
Using R has its uses, but it's very labor intensive upfront until you learn how sensitive YOUR cat is to R, when the R nadir is falling, and how long the R lasts in your cat. Waiting until +2 to test with R and you may find your cat has dropped 250 points by then.

The recipe for ketones is not enough food + not enough insulin + brewing infection. Some cats are very prone to developing ketones, and they dont' need to have high BG numbers for them to crop up. Know your cat and if you have had any ketones register in the past, be very cautious when it comes to big drops in dosing because you may be inviting ketones to happen.

 

[max&emmasmommie]

Re: 6/5 Max AMPS 512 +6 496 +10 459 So sad.

Thanks BJM and Gayle. Thank you both for your posts. It really helps to see supportive people here even if I'm not brave enough to bite the bullet and go with the advice right away. I've had Max since he was about 6-8 weeks old when I took him, his mother, and his whole litter into my home 16 years ago last month. I've held onto him through 9 moves, and through a "benign" cancer. That required me to give him shots in his muscles to counteract a crazy immune response that was going to kill him. We had to opt for the surgical removal of his thymus to save his life. He's so precious to me.

The good news is he has gained weight and his neuropathy is much better. He walks almost normal most of the time. He goes outside to sit in the sun and eliminate, and he sits by the pond which isn't very close to the house. This shows a confidence in his own well-being that I didn't see before I starting treating him for diabetes. We have lived here a year and a half, and I've been treating him for 4 months. To have him feel safe here is important to me.

I know he has to die someday, but I want to hang on to him as long as I can if he's not suffering. As I've told my husband, testing him and giving him fluids are things he hates. He even hates the shots, and his quality of life may be lower in some ways because of all these stabs, but my only alternative is to give up and euthanize him. I can't do that, and I certainly can't let him walk around dehydrated, starving to death and feeling miserable. Maybe keeping him in the 300s and 400s is all I can do, and he'll die just as early as if he wasn't treated at all due to organ failure, but at least he won't feel as bad while he's alive. He doesn't seem to be suffering at all. I suffer when I see his numbers; I know what they mean and how any day could be my last with him, but he seems oblivious. Thank goodness for that.

I'm going to take him in for the pancreatitis test and maybe a few others for things that mess up BGs like thyroid, etc.

I'll keep testing him for another 3 days and keep giving him fluids as BJM suggested. That could make all the difference although he really, really will be miserable about that. I don't know what else to do. How can I raise the dose when he scored an 84 at +3 the other day? The only thing I could do is lower the dose. Barring ketones, which he has never had despite high BG for months, lowering the dose is unlikely to hurt him more than what's happening now. He didn't even seem to act any different or better while he was in the greens yesterday. His behavior never really changes unless he's constipated, and I seem to have that under control.

Hopefully, once I have enough data people will start chiming in, and I'll get some more advice to consider along with BJM's and Gayle's. Mabye someone will see something that makes sense to him/her that I can't see and don't even understand. I've been hoping he would eventually stop bouncing, and I would get something that I could understand, but oh, well.

 

[BJM]

Re: 6/5 Max Worst morning so far AMPS 512

[quote="BJM]
Oh wait a minute

Take a look at your spreadsheet with the size reduced to about 50% - you'll get a visual overview of the color patterns which may give you clues about how insulin dose affected glucose levels. When you tested 1.5 units for a week, most of what you got were blacks and reds. As you've increased, you seem to have fewer blacks, though it is hard to tell with few mid-cycle tests during that time. This past week, you've had blues and yellows....[/quote]

In other words, I think you ARE making progress!

Right now, I think your focus should be on consistency, not changing the dose.

Try giving a low carb treat every time you have to test or pill or give subQ fluids. That may help with his resistance.

Also, a bit of Neosporin Ointment with pain relief applied to the area a few minutes before any injection, then wiped off, may reduce any discomfort.

And Pill Pockets are a wonderful invention, for anything that can be fit into them. Even bits of pred go down better encapsulated in Pill Pockets.

 

[max&emmasmommie]

BJM,

Oh, I wasn't sure exactly what you were seeing in the spreadsheet. If you think I'm making progress, that is so good to hear.

I have noticed that the bounces sometimes clear more quickly. It is hard to tell for sure because of the fiasco after his May 12th yellows, but on April 24th he went to 135, and I gave him the dose, 2.5u, without realizing that that was not a good idea, but he didn't hypo. He went into the black meaning his liver did the right thing for him. He seemed to be high for the next 5 days until he scored a 231 at AMPS on April 30.

Then, we get the 137 on May 6th, and at that point I knew not to give him a full dose. He bounced into the black but came right back down the next day. For the next four days I gave him his dose on time – 8 cycles. He went into the yellow on May 12 for both AMPS and PMPS, then bounced into the black. I so hoped that he was going to clear that bounce fast, and I continued to give him his dose on time, but that was when I was making the mistake with the end of the pen and getting air instead of insulin. Then, I missed the dose on the 18th in the morning! Then, the constipation, then a missed dose on the 27th, then a dose an hour late on the first of June. If 2.75 is right for him, the shed must have been less than full.

I should be grateful that I know he will bounce because maybe that means I can “shoot through” these lows, and test him all day to keep him safe, but still give this 2.75 a chance to prove it's right if that's the case.

All right, holding the course! Thank you!