? 6/8 Max - 6/7/PMPS out of range of Libre sensor (>500); +1 493; +2 378; +5 313; +7 400

[Rebecca & Max (GA)]

1) I need advice on what to give Max in 3 hours (been updating SS as I take readings), and 2) if a cat is constipated, does that affect BG levels?

I got help 6/5 on dosing Max as he got really high in the PM on because I did not shoot him in the AM (his AMPS was 118). I have now had him at 0.5U Lantus for 6 full cycles and noticed he did not stay below 200 for very long yesterday (6/7) and am wondering if it's time to bump his dose up to 0.75U starting today?
Until we had the Libre sensor implanted, we were having a VERY difficult time testing Max (either him being uncooperative or we just didn't get blood) and really had nothing to go by. While I know the Libre is NOT optimal, I needed it for my sanity. He has been slightly irritated with it since Thursday and has been content to stay inside, sleeping under OR on my bed, but this had led to my next predicament...

Max has been an indoor/outdoor cat since he adopted us 14 year ago. He'd sleep inside, but his litterbox was always our yard. He does not travel around our cul-de-sac, and no one on the street leaves out cat food. He's been getting used to using the litterbox to pee, and he does 2-3 times a day, but I have not found poop in the box! I am actually not sure if he has pooped since Thursday. There was a present in the kitchen on Friday morning, but we have 2 small dogs, so I'm not sure it was one of them. We finally let Max out last night after his PM shoot (he was meowing at the door and would not leave), so we stayed outside to hopefully let him do his business. He moved over to his favorite pooping spot, but we did not follow for fear of spooking him. My daughter went back out to see if she could find anything but didn't. Max woke me a bit after 6 AM demanding to go out, so I went with him again. He headed to his pooping spot, but this time I followed, and he just sat there on the edge of the driveway. I backed off, but he ran back towards the door so I brought him back in. While out, he ate some grass, but once back inside he ran right back under my bed. I do have Miralax I use for my CDK kitty but was unsure if it's okay for Sugancats? Last night was the first night since DX that he wanted to sleep on the back of the couch again. I had hoped he was feeling better but his BG levels are staying high. Tested him at 7:15 AM (+7) and he's back up to 400.

Attaching his Libre graphs for the three 24-hr periods, plus reads so far for Mon...I know you all use the SS, but thought the graphs might be of interest.

 

[tiffmaxee]

Constipation can influence the bg. You could try a little Miralax or a teaspoon of 100% canned pumpkin. Both are mild and will take a few days to work though. If eating well I would increase if following TR. If he still seems in pain you might need a vet visit and possible enema. Hard to say since you dint know if he’s had a movement or not.

 

[Rebecca & Max (GA)]

Constipation can influence the bg. You could try a little Miralax or a teaspoon of 100% canned pumpkin. Both are mild and will take a few days to work though. If eating well I would increase if following TR. If he still seems in pain you might need a vet visit and possible enema. Hard to say since you dint know if he’s had a movement or not.

Thank you. We are sitting outside in the sun right now but will add the Miralax if he doesn’t poop outside this morning. I have been going with the going slow method as that’s what our vet started him off with, and I really have no knowledge of TR (read about the differences but was too tired to process it all). Up until this morning, he’s been eating well. I am wondering how much the Libre sensor bothers him too. It’s been a godsend for us, but clearly not a nice thing for him. Better than the ear sticks, though.

 

[tiffmaxee]

With SLGS you hold the dose for a week unless a drop under 90 occurs. Then you do a curve. Please add SLGS to your signature.

 

[Chris & China (GA)]

There's no reason to be scared of TR, especially since you have the Libre on now.

TR is more aggressive, but it can also be more successful as well as giving Max a better chance at remission. The sooner you get his numbers under control the better.

TR lets you increase the dose as often as every 6 cycles if it's not getting him where you want him. SLGS has you hold the dose for a full 14 cycles which means leaving him in higher numbers for longer.

You can always switch back to SLGS if you don't continue with the Libre and are still having trouble with regular testing.

All that being said, on TR you'd hold the dose for 8-10 cycles because he has gotten down into lower blue numbers on the .5 dose!

From the TR protocol:

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

 

[Rebecca & Max (GA)]

I would like to give him the best chance at remission. I laid off on reporting testing today and just let him hang out with me. We even took a short nap today. Just to mess with my worry, he's back down to lower numbers. I kept thinking I would see him go back up, but he's held a slow decline! At +11, he's down to 199. If I look at doing TR, I could increase his dose by 0.25U because his nadirs have been greater than 200 but less than 300...but you stated to hold for 8-10 cycles because of his blue numbers, correct? Going into today, I had figured I would be bumping his does up tonight, but then he dropped lower today, and now I'm figuring hold him at 0.5U for another few cycles as you said.
Is this tied to the phases of the moon? If Mercury is in retrograde? Cats getting angry that they don't have opposable thumbs?

 

[Laura and Gremlin (GA)]

Max is so very handsome!
How do you find the Libre sensor? My vet offered it to me for Gremlin when they were very first released in Australia but I declined at the time as he was steady and stable. Does Max try to get it off? Do you have to have it taped or bandaged?

 

[tiffmaxee]

I would like to give him the best chance at remission. I laid off on reporting testing today and just let him hang out with me. We even took a short nap today. Just to mess with my worry, he's back down to lower numbers. I kept thinking I would see him go back up, but he's held a slow decline! At +11, he's down to 199. If I look at doing TR, I could increase his dose by 0.25U because his nadirs have been greater than 200 but less than 300...but you stated to hold for 8-10 cycles because of his blue numbers, correct? Going into today, I had figured I would be bumping his does up tonight, but then he dropped lower today, and now I'm figuring hold him at 0.5U for another few cycles as you said.

Is this tied to the phases of the moon? If Mercury is in retrograde? Cats getting angry that they don't have opposable thumbs?

It’s frustrating that’s for sure. A cat can eat exactly the same food same amount and each cycle can be different. When they are lower than they are used to they can bounce to the sky or not depending on who knows what. ECID, every cat is different.

That is correct that with TR you could increase as you want them to get used to lower and lower numbers to hopefully get into remission or at least stay under renal threshold, when they spill glucose into the urine. The main difference is when you increase and decrease with TR being more aggressive. Even with TR I might hold a little longer since you are seeing better numbers but let me take a look at your ss. Be right back.
,

 

[tiffmaxee]

Glad a looked. Congrats on the green numbers. With SLGS a reduction is earned to .25. With TR it was almost earned.

 

[Rebecca & Max (GA)]

Glad a looked. Congrats on the green numbers. With SLGS a reduction is earned to .25. With TR it was almost earned.

If you are still around, can you PLEASE look again?? He has spiked BACK up to the mid 400s. Our FDMB facbook members are saying he's overdosed as he climbed after only 3 hours and that too much can cause him to be high them very low. But I not supposed to take dosing advice on the FB page...

 

[Rebecca & Max (GA)]

Max is so very handsome!
How do you find the Libre sensor? My vet offered it to me for Gremlin when they were very first released in Australia but I declined at the time as he was steady and stable. Does Max try to get it off? Do you have to have it taped or bandaged?

Sorry for the late reply..its been a weird 12 hours! I love the Libre - total lifesaver. BUT only because we were not very good at testing Max. He was very difficult and would bite and scratch us, and I was at the end of my rope. It has been phenomenal to watch how his body reacts to insulin and food, but it's also maddening because I see every nuance and then I freak out. If we had been able to test Max regularly, I would not have gone this route. This was an 'I'm at my wit's end and am afraid my cat will die' (being too high OR too low) thing. He's slightly bothered by it, but much less than ear sticks and reading samples.

 

[tiffmaxee]

I totally disagree with the Facebook group. He went high because he was not used to bring in lower numbers. He bounced as his body protected him. The more he’s in normal numbers the more healing for the pancreas and the less he will bounce. Whether or not you reduce depends on whether you follow TR or SLGS.

 

[Rebecca & Max (GA)]

I totally disagree with the Facebook group. He went high because he was not used to bring in lower numbers. He bounced as his body protected him. The more he’s in normal numbers the more healing for the pancreas and the less he will bounce. Whether or not you reduce depends on whether you follow TR or SLGS.

That's what another member said as well (lol was that perhaps you?). Chris suggested we try TR because he's got the Libre and I can test often, and I am willing to give that a try. This is just so ARGH!! I just posted a new thread about this tho, since its a new day.

 

[Rebecca & Max (GA)]

I totally disagree with the Facebook group. He went high because he was not used to bring in lower numbers. He bounced as his body protected him. The more he’s in normal numbers the more healing for the pancreas and the less he will bounce. Whether or not you reduce depends on whether you follow TR or SLGS.

But since you are here...You had stated earlier he almost earned a reduction in dose with TR, but did with SLGS. If I stay with TR, does that mean he gets his 0.5U does again this morning? Then do I watch him for dipping again? I guess I'm trying to figure out why he dipped so low. Not enough food? ECID? Getting uesed to Lantus?