? 9/25 Methos amps 287, +4 205, +11 196

[SmallestSparrow]

Last: https://felinediabetes.com/FDMB/thr...ase-help-me-keep-in-blue.294284/#post-3208905

I read @tiffmaxee instructions on stalling and am fairly confused. Actually really confused. I know your protocol drops only 0.25 (so would have been down to 2.75) but my vet said go down to 2.5 and even then—well here I am. I want to give him insulin but I don’t want to run him into needing MC food or karo. He looked really worn out the day after the last time.

she said I could give him 2 U and recheck at +2 then go from there. I can try to stall to see if he comes up but I’m already way off my schedule.

so I guess I will check him in 20 min, feed tsp LC, see if he comes up in 15 (how much is up? More than 10% certainly but how much more) but I can’t stall 2 more hours after feeding —I’m already 2 hr off from stalling 2 day ago. So at that point I guess I will give the 2U she said should be safe.

I’m sorry I wanted to follow your protocol @Diane Tyler's Mom GA but he’s dropping too quickly I know I gave 2.0 at this number before and it wasn’t enough but I gave 2.75 at this number and had to check him and feed him LC plus HC treats every hour and that started me into a cycle of shot/NS/shot/reduced shot. How do I get a dose that doesn’t jerk him around all night?

 

[Wendy&Neko]

see if he comes up in 15 (how much is up? More than 10% certainly but how much more)

Do you have a "no shoot" number yet? For brand new people we suggest 200, but you have more data than a new person. You shot full dose on 202 yesterday.

The issue now is that the 3.0 unit depot is still influencing his cycles and make him go lower than you are comfortable, but that is still a very safe number. The larger depot can influence 4-6 cycles after the reduction. With our SLGS dosing method you reduce if they go below 90 anytime, but he hasn't even been below 150 on this dose yet. Our dosing methods suggest dosing based on the nadirs or lows, not the preshots.

 

[SmallestSparrow]

Do you have a "no shoot" number yet? For brand new people we suggest 200, but you have more data than a new person. You shot full dose on 202 yesterday.

The issue now is that the 3.0 unit depot is still influencing his cycles and make him go lower than you are comfortable, but that is still a very safe number. The larger depot can influence 4-6 cycles after the reduction. With our SLGS dosing method you reduce if they go below 90 anytime, but he hasn't even been below 150 on this dose yet. Our dosing methods suggest dosing based on the nadirs or lows, not the preshots.

I’m personally very stressed at anything under 230. Otoh since he dropped to 75 after 342 I’m pretty much anxiety filled with any number. But I’ve skipped below 200 and it really messed him up. I’ve given reduced doses below 200, usually after stalling but then I need to stick his poor fragile ear so much and the last two times I fed him proplan as the MC food and he was nauseated the next day. But I think I will need to do that again. This is not fair to him

 

[SmallestSparrow]

Our dosing methods suggest dosing based on the nadirs or lows, not the preshots.

I’m new to this but it seems his nadir is starting to overlap his pre shot. When I’ve skipped shots and fed him his BG continued to drop. On some days if i plot the curve it’s just a down slope all the way to the next shot. Or it’s flat then at the end drops. Some of these all nighters as soon as I stop feeding him LC food he drops. One I stopped feeding at +3, he held steady to +9 at 160 then somewhere in the next 4 hours descended again to 83 for pre shot (in retrospect I wish I’d skipped that shot. Beginning to wish I skipped this one.

if I understand my vet correctly we are not dosing based on pre shot. Going up it was based on inadequate nadir, coming down it’s been based on him requiring constant testing and feeding, even if shots are reduced , or are too low to shoot , or delays to shoot—I can’t keep him arbitrarily at a dose when many cycles it requires repeatedly testing to keep him safe

again i don’t get a lot of this but considering im up shredding his ear with a reduced 2U, indont see how him being at 2.75 (rather than 2.5) would improve the situation. What am i missing?
Thanks

 

[Wendy&Neko]

Looks like a nice flat cycle tonight.

My cat often nadired at +12. Which in a sense means you are dosing based on preshots, cause it's the same as the nadir. Think of it as "how low can this dose take my cat"? You don't want him below 90 when following SLGS. A later nadir than normal can be the sign of a bounce breaking, which results in downward momentum of the BG. And the scenario you describe above.

indont see how him being at 2.75 (rather than 2.5) would improve the situation.

Methos isn't a "normal" diabetic. For a normal type 2 type diabetic cat, spending time in normal blood sugar numbers can help the pancreas heal. The dosing methods weren't written with Cushings in mind (or acromegaly or IAA). I pretty much followed TR with Neko, who had the latter two conditions. With those conditions you do need an extra degree of caution when the dose is on a downward trend. On the other hand, you also don't need to be afraid of normal blood sugar numbers. But you do know what you have to do to get him into safe numbers should he go low. Which he can do with high preshots as he can with low preshots. See the AM of the 20th when he started at 342.

 

[SmallestSparrow]

See the AM of the 20th when he started at 342.

Yes. That’s why I said there no longer is a comfortable preshot. I’m told I can use the data I have to predict but I don’t see how when many times he went up after a shot in the 300s, sometimes he stayed the same, sometimes he went down about 50 and then that.

Which in a sense means you are dosing based on preshots, cause it's the same as the nadir. Think of it as "how low can this dose take my cat"? You don't want him below 90 when following SLGS.

i don’t want him below 90 period. Lately it’s looking like his nadir is +14. And if that’s the case then I have no idea how low any dose will tske him bc he’s had similar doses all go in different directions. He’s behind in the amount of broth I’d like him to drink bc I’m afraid to fill him up in case he needs to eat. Which he is getting full so I hope this BG level holds. My vet is trying to find a dose that will get his nadir moved off the preshot. I think. I hope. He may just want to be a one shot a day kind of guy. And stalling has really screwed things up. Luckily so far I only forgot his miralax but I came close to forgetting his vetoryl

I’m afraid to stop testing him bc the last time he held steady for several hours then was 83 amps

 

[JL and Chip]

With your discomfort seeing and shooting lower numbers (understandable given the potential unpredictability of an adrenal tumor), I’m wondering if you wouldn’t be better retreating to a lower dose that you can consistently shoot BID (maybe 2u to start), collect data, push yourself to shoot some lower numbers, and move up the scale in smaller 0.25u increments. In other words, work the dose up from below rather than down from above. It’s a bit less scary for some and perhaps you can nudge your no-shot number lower over time.

Just because 2u didn’t work before doesn’t mean it’s not appropriate now. Things change and looking back farther than the last few weeks, even though it’s good background data, isn’t necessarily going to inform what applies today.

I’d also encourage you to draw an imaginary box around several days’ worth of data and look at it as an entity rather than looking only at a single cycle or a single day in isolation. Look for patterns and trends in that box. A single cycle or day is just too granular to analyze what’s happening overall — its one of the frustrating things about trying to help people who don’t test much. It’s like looking at the road through a straw and trying to make navigation decisions. You’re just guessing, basically, and hoping not to crash.

And remember, you’re not just shooting what his BG is now, but where it’s going. The quarterback throws the football to where the receiver is supposed to go on the play, not where he starts out. You throw the lasso to where the calf is heading. You’re trying to stay out ahead of it.

Nadirs can vary depending on what’s going on—bounces can have an effect on when the numbers bottom out, as can a host of other things. Sometimes too high of a dose can nudge a later nadir. Some cats see a double dip in numbers. It all seems fuzzy and random at first (and maybe it always will be for Methos, though let’s hope not). But most of the time, just like an old Polaroid photo, what starts out gray and fuzzy and random begins to show outline and clarity over time, until eventually you see the picture clearly.

Try not to feel hopeless. You’re doing a lot right. It’s hard in the beginning and the data and fear can get in our heads. Take a deep breath, and then another. You can do this. We will help you.

 

[SmallestSparrow]

I’m wondering if you wouldn’t be better retreating to a lower dose that you can consistently shoot BID (maybe 2u to start), collect data, push yourself to shoot some lower numbe

I think this is what my vet is trying for, a number that I can do q12. She has been trying to keep the dose for a week but he keeps having pre shot numbers that not only I’m not comfortable seeing, but she’d rather not be shot (eg 83). I don’t know if she buys into the feed a tsp and recheck delaying tactic in general or if she just prefers I try to keep on schedule. I offered to try it (and tried it anyway after she said “just give him 2 and stay on track with 6/6)—bc 6/6 is 2 1/2 hours late as it is and I don’t want to shift his other tumor meds so I need to eventually get insulin back to that time —right now I’ve swapped and he gets a lighter “breakfast” at 0330 and a heavier breakfast-like snack with his insulin. I was hoping for a sub 200 amps so I could just skip and get back to where I need to be

thank you so much for your encouragement and advice. I just need a dose that lets me not stick his ear so much. I try to avoid his right (but have stuck it these last three days) so I have an ear for cerenia and mirataz if he stops eating. I’d do a CGM but his skin is too fragile, but so are his poor ears.

 

[SmallestSparrow]

 

[SmallestSparrow]

last few days

 

[SmallestSparrow]

Some of the smoothest lines were at 3.5 but nadir too high but then he started being too errstic at 3.5 some days going higher after insulin and other days needing to decrease a dose

 

[SmallestSparrow]

He’s finally started to look a little more healthy coat-wise and not losing weight as much (still losing) at 3.5 but he couldn’t keep his nadir above 100. She tried to keep him at 3 and 3.5 because I suspect she thinks that will be his magic number

 

[JL and Chip]

Have you tried testing his paw pads?

Not my preference, personally, but given his fragile skin, maybe it would be less damaging??

 

[SmallestSparrow]

Have you tried testing his paw pads?

Not my preference, personally, but given his fragile skin, maybe it would be less damaging??

I’ve considered it but a few things hold me back: he has trouble walking as it is from the muscle wasting of the Conns and Cushing’s, and the diabetic neuropathy so I’d hate to add sore toes to the mix. And he pees a lot, even when BG is better, because of the spiranolactone so I’m afraid he will get urine (or poop) on it. But if this keeps up I may have to try.

 

[Wendy&Neko]

I like JL's idea of 2 units. With fragile skin, you don't to get to a point where you are causing injury with testing. Testing less (and less anxiety for you), but still decent numbers, is a good goal.

Note to any lurkers, this is a suggestion only for Methos because he has Cushings, a special condition.

 

[SmallestSparrow]

I like JL's idea of 2 units. With fragile skin, you don't to get to a point where you are causing injury with testing. Testing less (and less anxiety for you), but still decent numbers, is a good goal.

Note to any lurkers, this is a suggestion only for Methos because he has Cushings, a special condition.

Thank you so much. I’ll see what happens tonight (please please please let +6 have been the nadir) and what she says tomorrow (or tonight if it’s looking to be low again). There’s synchronicity in your choice of words, his Dr’s answers to what’s going on with him is often “well, he’s special” which may be code for “why didn’t you choose a different clinic when you moved here” but I choose to believe it’s not

I’d hoped maybe I could use one of his extra digit pads like @JL and Chip good suggestion but googled “Cushing cat paws” and a couple of articles said Cushing cats are prone to foot infections because of the skin and nail issues, and their altered immune response from excess steroids so sighed and stopped massaging his toes. He looked relieved. He has started to look at my hand for a meter when I pet him