? 6/8 Jessi, +6.25 256, +8 328, +11 380, PMPS 410, +3 246, dose increase soon, help please

Stefania S

Active Member
https://www.felinediabetes.com/FDMB...pped-skin-ulcer-bleeding.278259/#post-3077623

We're back. Just tested her for the first time in days.

After the sensor quit, we had the ulcer burst at 3am, rush to the clinic, back home by 5am, the whole thing through me for a loop. I needed some down time. Maybe I took too much time. I knew here numbers were high. At the clinic they tested and got 279 at +7. But I already knew they were high from before the sensor died and from observing her. She was clearly behaving as she does when she is hyperglycemic. They tested for ketones: zero, June 5.

She was still shell shocked from that night and that thing on her shoulder looks pretty bad. They tell me it isn't painful but, I find that very hard to believe. I know it affects her movement, her entire leg which shakes when she is using it to rub her face. Maybe superficially it doesn't have much sensation, but internally I'm sure it is causing problems and discomfort for her.

I'm extremely hesitant to to go down the path of surgeries, treatments, many visits and much stress for Jessi and for me....and I just don't think her little body and mind can handle all of that in addition to the rest. But it may be necessary.

Today I took her to an new vet hoping this would be a better experience for us. BIG MISTAKE! what a disaster. She ferociously cleaned the growth. She kept saying I should have it removed and that it was a quick simple thing. She kept squeezing and touching it for like a half hour before finally getting to the sensor which was what we had come for. And that is when I discovered the hard way that she had almost no experience doing this. It was a botched job, if it stays on 3 days we'll be lucky. She didn't use any glue. I should have stopped her and just taken Jessi to another place, but I just couldn't bring myself to do it.

I have a big problem now. Every vet I go see tells me to see the Endocrinologist. This last vet was saying she would write to him herself. She kept asking me about what he was telling me to do. She said he treated her dog and swore by him as so many others here do. If I have to keep going to his team to have the sensor put on because they are the only competent ones in all of Bologna, I won't be able to keep doing my own thing with the insulin. They will find out and they could refuse to work with me. As it is I am on thin ice with them.

I'm in a tight spot and it adds that extra layer of stress. I also have to find someone to test and/or remove this growth who I can trust. Every vet wants to know and needs to know about the diabetes and the insulin therapy. I will have to tell the truth or it could put her in danger. But if they know I am not doing what Fracassi's office says, they may not work with me.

This is a VERY small city, more like a big town, and the Veterinary community is miniscule. I don't know what I'm going to do.

But for now, the first step is to get Jessi on a better dose. Half a unit is not cutting it. Now that I know back to back reductions can cause big dips in BG, I will be much more cautious about that. I also know that I am not going to reduce unless the dip is more significant.

I wonder why there is no middle ground between TR and SLGS. They seem too polar. Hasn't someone come up with an intermediate method? Or is that where you make your own customized version that works best for your cat, your health, lifestyle, etc.?

One thing that was very apparent in these last 5 days of no monitoring on a low dose, is that my wellbeing and Jessi's are competing. I already knew this since even before I started the insulin, but it increased exponentially when we started the shots.

With her on a low dose for the first time in 2 months, and not monitoring for the first time in weeks, I had time to breathe. I had time to do some more things for myself, to sleep a little more, to put my attention on other things. To take a little better care of myself.

How messed up is that? Basically I have to let Jessi be mildly to moderately hyperglycemic for me to be able to take proper care of myself. This is a big problem, and I'm not sure how to resolve it. But I can't let her stay like this, she is clearly slipping back.

So, op we go again. Hoping the sensor lasts long enough to be able to safely do an increase. And I hope it doesn't take too long to fill that depot again and get her numbers down into better levels. I have to admit that after this experience I don't have a lot of trust in SLGS as a method. My feeling was that .75 was as low as we should go at that time, and the 81, which was really more like 91 on the sensor, was not cause enough to reduce again, but as a newbie I just did what the protocol tells and hoped for the best.

My sense now is that I will probably have to find a middle ground between following the protocol and following what feels right, but since I'm still learning all this, I should and will continue to follow what senior members are suggesting until I feel more confident about making my own choices. Exceptions may be when something clearly doesn't or does feel like the right choice even though it doesn't adhere to the protocol. Then, I hope members will work with me to take the best next steps.

It does take courage to go your own way. It means you are now fully responsible. It's another reason it can be scary to disobey the doctors.

Right now, the most important question is how many days of monitoring do I need before I can increase? I'm ready to do it asap as soon as tomorrow, allowing for one or two cycles at most of reads. I don't want to make her wait much longer to get her feeling a little better.
 
Last edited:
the reads are even higher than I thought! I thought between 200s and 300s but the nadir is mid 200 with most BGs in the 300s. PMPS 410 Can I get some feedback please? Dose increase in the AM ok?
 
Thanks @Deb and Sylvester! I haven't done any tagging since joining the forum. Is that something that's ok to do as a new member? I noticed a note about not tagging too often because it could lead to something not so good, but I don't remember what it was. :p
 
Thanks @Deb and Sylvester! I haven't done any tagging since joining the forum. Is that something that's ok to do as a new member? I noticed a note about not tagging too often because it could lead to something not so good, but I don't remember what it was. :p

There is only a certain amount of times that a member can be tagged in a day where they will get a notification. In your case, though, you guys are new and you're seeking guidance. Perfectly acceptable.

What you don't want to do is continually tag someone in the same condo.

There should be more members coming on to look at the board soon. :)
 
Tagging is fine. You just need to realize that not all of the people you tag may be around exactly when you want them. For example, Bron and Bandit's Mom both are outside of the US (Australia and India) and tend to be around during the late night/early AM (US time). Likewise, everyone has their jobs, stresses, etc. and we do our best to be available.

To answer your question about dosing methods, TR was developed as part of a research protocol with what was then a new form of insulin, Lantus (glargine) and by extension, Levemir. The original research has been published and there have been several follow-up studies. SLGS is a generic method of dosing that was developed here. We encourage new members to follow the guidelines laid out in SLGS because you really don't know what you're doing. It takes several months to understand how your cat responds to insulin and be confident in your ability to manage your cat's diabetes. In addition, if you personalize treatment, the experienced members may not really know what it is you're doing and it would be difficult to offer any input. Once you have a solid grasp on the process, it makes more sense to attempt to personalize what you're doing. I will say, though, for many of the spreadsheets I've seen where members have been doing their own thing, the spreadsheets don't look that great.

My suggestion is to increase the dose back up to 0.75u.
 
There is only a certain amount of times that a member can be tagged in a day where they will get a notification. In your case, though, you guys are new and you're seeking guidance. Perfectly acceptable.

What you don't want to do is continually tag someone in the same condo.

There should be more members coming on to look at the board soon. :)

Got it, thanks!:)

Tagging is fine. You just need to realize that not all of the people you tag may be around exactly when you want them. For example, Bron and Bandit's Mom both are outside of the US (Australia and India) and tend to be around during the late night/early AM (US time). Likewise, everyone has their jobs, stresses, etc. and we do our best to be available.

To answer your question about dosing methods, TR was developed as part of a research protocol with what was then a new form of insulin, Lantus (glargine) and by extension, Levemir. The original research has been published and there have been several follow-up studies. SLGS is a generic method of dosing that was developed here. We encourage new members to follow the guidelines laid out in SLGS because you really don't know what you're doing. It takes several months to understand how your cat responds to insulin and be confident in your ability to manage your cat's diabetes. In addition, if you personalize treatment, the experienced members may not really know what it is you're doing and it would be difficult to offer any input. Once you have a solid grasp on the process, it makes more sense to attempt to personalize what you're doing. I will say, though, for many of the spreadsheets I've seen where members have been doing their own thing, the spreadsheets don't look that great.

My suggestion is to increase the dose back up to 0.75u.

Ok, that makes sense. Thanks for the info and suggestion!:cat:

Another related question, I was wondering about the correlation between stress and BG levels. Just how much can stress make levels go up and how long does it usually take for them to come down once stress is diminished or gone? Should stress be considered when looking at higher numbers before changing dose? Jessi did have two very stressful days this week, one of them today. How much should I factor that in?
 
Last edited:
I might conk out soon, having trouble keeping my eyes open...but I will check messages as soon as I get up in case other members have different or similar suggestions. I feel comfortable going up .25 but I'm also totally ok with waiting another day if the consensus is to have more info on the spreadsheet since there was none for so many days. :oops:
 
I wonder why there is no middle ground between TR and SLGS. They seem too polar. Hasn't someone come up with an intermediate method? Or is that where you make your own customized version that works best for your cat, your health, lifestyle, etc.?
Each method has been tested by itself. There are safety mechanism built into each method as written. As lot more detail is in the 37th post of this thread: Protocols: Myths Debunked
I was wondering about the correlation between stress and BG levels. Just how much can stress make levels go up and how long does it usually take for them to come down once stress is diminished or gone? Should stress be considered when looking at higher numbers before changing dose?
No, stress should not be considered. Depending on what caused the stress, some cats BG's drop instead of going higher. Also depends on the situation on how long it takes to resolve. Also, whether there any lingering reminders of the stress (eg. new kitten). But it should be over in a hours or a cycle or two at most.

I agree with Sienne, I think you can increase.

As for tagging, just be careful not to overuse it. I've seen people tag a whole bunch of people, when they don't even have any questions or something particular to report. Sort of a "look at me". If you have a question it's fine to tag, just remember that we have lives outside of here and might not get to it right away. Putting up the "?" prefix on your subject line and paraphrasing the question might get you faster and better responses.
http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/
 
Stress can have an effect on blood glucose levels. You've likely heard the term, "stress hormones." These are naturally produced corticosteroids that are released in response to a stressful situation (e.g., some external event like you're having construction done in your home or an internal event such as illness). You may have noticed someone mentioning steroid-induced diabetes. This typically happens if a cat is prescribed steroids for a medical reason such as asthma or IBD although being on steroids doesn't always cause diabetes. Likewise, if you are putting your cat in a carrier, driving to the vet (my cats routinely hate being in the car), and then the entire experience at the vet's office (strange smells, strange noises, strange people doing strange things to your cat, DOGS!), it's no surprise that a blood glucose reading at the vet's office is artificially high. This is one reason that a curve at the vet's office is unreliable because the cat is often experiencing stress related hyperglycemia.

Aside from medications, a stress response is a short lived situation. Most cats are back to normal numbers within a few hours. As Wendy noted, some cats respond to stress with a drop in their numbers. As with most things, you need to know how your cat responds.

I would not factor in stress levels. Frankly, I'm not sure how you would tease apart high numbers due to not enough insulin from high numbers due to stress unless there was an obvious source of stress. I've always treated the numbers as the numbers. It you try to read too much into what you're seeing, it will likely be a misinterpretation. You've got to trust that you're getting accurate results and if you think a number is goofy, re-test.
 
Thanks everyone! I did shoot .75 AMPS 343 not as bad as I thought it would be. From what I have seen, Jessi's BGs go up with stress, but now that I know they can also go down, well, as you say, you can't factor that in with dosing. Maybe it's just helpful for understanding if/why BGs are unusual. Will make a new thread now. :bighug:
 
Back
Top