As Penny's dose goes up, numbers go up-AMPS 475

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Robyn and Penny

Robyn and Penny

Member Since 2013
Good morning! Long story short...Penny was OTJ for 14 months after being on Lantus and then Levemir for 6 weeks in 2013. In October 2014, she had an episode in her sleep (she sleeps on her back) that 3 vets concur was not a seizure but spinal arthritis pain (x ray was bad quality so not confirmed). She had a full blood workup and chem panel with this incident, as well. Started her on gabapentin 40mg bid and it seemed to be working well till her numbers started going up again. Increased gabapentin to 80mg bid per one vet's suggestion and then her numbers shot up, over 2 weeks of severe diarrhea, etc etc. I then learned that fluctuating blood sugars are a "rare" side effect of gabapentin, and since she had another episode while ON gabapentin, and with the vet's approval, decided to start slowly weaning her off. Gabapentin has been known to suddenly stop working in humans and I read even cats can develop a tolerance quickly to it. In the interim, we decided she should go back on insulin since her numbers shot up so much that she's over renal threshold all the time.

I should note that even with a compounding pharmacy, I cannot afford buprenex besides for breakthrough pain. My Care Credit is maxed out at this point as it is. She is on week 5 of Adequan injections and judging by the way she is moving around, especially with her new exercise program (exploring our unfinished mess of a basement for a half hour per day), if she is in pain, she's hiding it very well. Pupils are reactive to room light and not dilated to indicate she's in pain.

That all being said, she is currently on 24mg of gaba twice per day and will be going down to 16mg Monday or Tuesday. I'm holding each gaba dose reduction 4 days so she won't go into seizures. We started her back up on Levemir at .5u bid since that was the highest dose she was on before she started going OTJ. And I've been holding each Levemir dose increase 3-4 days. Currently she is getting 1 u bid. This last increase and her numbers are not flat at all and I'm wondering if I should be holding the increases a little longer since she has a panicky liver. It seems as her dose goes up, her pre-shots go up and no real big dent in her nadirs.

Spreadsheet is in my signature. TIA for everybody's help!
 
Levemir may take longer to settle in dose than Lantus, but if you're getting high nadirs, you do what you have to do.

Its taking a really long time to see the most recent glucose tests. As an option, you might copy the page, then label one 2013 and delete off the 2014 entries, and label the other and delete off the 2013 entries.
 
Thanks BJ...I haven't had time to make a new 2015 and I'm way more proficient in Excel than Google SS's lol I'll set a new one up for 2015. Do you think I should hold that 1u another day or so before increasing?
 
If it has been 2 full days and the nadirs are still high, you can follow the rapid increase version of TR, which means yes, you can increase. Check the protocol.

In Google Sheets, if you right click on the bottom tab, it gives you the option of duplicating the sheet, just like Excel does. With similar programs, it is often true that if you can do something in one of them, you can find a way to do it in any of them.
 
Just fixed it BJ..thanks. I did one for 2013-2014 since she was OTJ most of the time and dx'ed at the end of 2013 and a new tab for 2015. I'm gonna check her nadir today in about an hour but most likely increasing her tonight. If the insulin isn't cloudy and there's no particles, could it be a possibility her pen is bad?
 
If I read your post right, your Lev is from 2013. It can last a really long time, but of course, it could have lost it's potency since fall of 2013. If you consider that meters have a 20% variance, most of your recent tests show almost no curve which could mean that your insulin is indeed bad. If the Lev is indeed bad, it could be the reason for her higher numbers. I see that money is tight, but can you get a new pen?
 
No Debby...I didn't clarify...she started a new pen of Lev when she went back on insulin. No way that open pen from Oct 2013 would still be good! lol

I'm def thinking that it's bad, though, because you're right...she's high flat most days. Although she had a big drop yesterday but the insulin is not even making a dent in her numbers. I expect her number to go down today b/c she passed a mouse-sized hairball in her stool this morning about 15mins after her test. When she was OTJ a big hairball would jack her up in the high 100s for a couple of days, it would pass, and she'd be in the 50s the next day lol
 
Hey Debby if I decide to try a new pen, do you think I should start over or start at 1u? Her numbers are saying start at 1u, I guess, huh?
 
The last known "good" dose with functioning insulin is what you'll want. Without that, being conservative at 1 unit will be safest.
 
Thanks Debby...her +6.5h was 169. Yesterday at this time it was 159 but I wasn't sure if that was correct. Today I had a good blood sample, on the left ear, which is where I usually test, and the blood wicked all the way up. I expected a big drop from the mouse-sized hairball she passed, but this shows me the insulin is working, too. And she may be going low overnight b/c she's a social eater so she won't eat overnight unless she gets one of us up to go sit with her lol. So I'm thinking bounce at this point...She was a bouncer before when she started hitting lower numbers (like blues and greens). Should I wait a day to see if her numbers settle before increasing? I know what TR protocol says, but that even allows for 8-10 cycles if cat is "new" to numbers under 200. She hasn't seen a number below 200 since after Christmas. What do you think?
 
Robyn, I haven't had a diabetic in a long time. A lot of things have changed, so I never suggest insulin dosage. I just try to help with general stuff. Like wondering if the Lev was 14 months old ;).
 
Okay...thanks. I feel like i'm not giving her enough time to settle in at a new dose in 3 1/2 days so I'm gonna go with my gut and hold 1 unit another day. She went OTJ so quickly the first time, it's really hard to know a pattern with her this time around, although she has changed the rules. Her nadir used to be +14 on Lev the last time and now it's +6...it's like dealing with a different cat.
 
She IS a different cat. She has new problems that are complicating things. Listening to gut is usually a good idea. You'll work it out...
 
Thanks Debby :) She's on a weight loss program now that she gets to go down to the unfinished basement once per day for like a half hour. Trying to get her to do the steps at least twice in that time. But she's so excited being down with all the 'storage' (read: junk) that she's brisk walking all excited, climbing stuff she shouldn't be, jumping, etc and she's been playing with her civvie sister more. So really hoping the exercise helps. I'm a weight loss coach with an obese cat. It's embarrassing lol. The weight loss will really help with the arthritis more than Adequan or anything will, so I'm really hoping I can keep her interested in this. Even if I have to motivate her with food to get her to do the steps. Whatever it takes!
 
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