Bell is bouncing

[Seth&Bell]

She was doing quite nicely with her numbers slowly coming down and then, boom, last cycle (PM of 7/10/24) was all in the mid-300's, which is about 100 higher than her average levels without insulin. I'm fairly certain I got the insulin in her last night. I notice today she is drinking more again. I'll try to get a urine ketone test this morning.

If I am understanding the TR protocol correctly, I would need to 2-4 more cycles before increasing the dose, since she has already been on the 0.25 dose for 6 cycles. This assumes she doesn't meet the criteria for a dose reduction in that time period.

Thank you!

 

[Bron and Sheba (GA)]

Looks like she is bouncing from that 98 yesterday. She has bounced after each lot of green BGs.
I would not increase the dose at the moment as the dose is bringing her down to 98.
***I did notice however she had ketones at diagnosis and the SS said she had a trace of ketones sometime today. Can you repeat the test and post a photo of the strip please? You will need to get the photo quickly as it starts to go darker after 15 seconds. To post the photo just copy and paste it.
Is she eating ok and is she at all lethargic?

 

[Seth&Bell]

Hi Bron,

She is eating great, actually. Better than normal. I did start the SEB a couple days ago, so that may be a factor, and the relatively high BG levels seem to increase her appetite more (along with the increased drinking and urination). Her energy levels are better than they have been in a few weeks as well. I think getting off the constraining wrapping that held her Libre on helped her feel more comfortable as well.

I got a urine test this morning and it looks squarely "Trace" to me:

For reference here was her strip before she started insulin and had a blood test that showed 5.7 mmol/L:

And here is and example of the negatives I was seeing when her BG was low:

 

[Seth&Bell]

I may need a little help understanding parts of the TR protocol. The guidelines seem pretty straightforward when to increase and decrease dosage, but I am a little confused on when to maintain a current dosage. This was the guideline that seemed to indicate that she is ready for a dosage increase:

I read that as: as long as she doesn't meet the criteria for a dose reduction in 3-5 days (<50 BG) increase the dosage. That is the part that is a bit fuzzy to me. Seems like there is no criteria to hold a dose over a longer period of time.

I'm guessing that you are wisely telling me that those guidelines are for when I have more data/confidence in how she will react to different dosages, and that I should be cautious about increases in dosage since she is new to insulin.

Thank you

 

[Bron and Sheba (GA)]

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.

This is the third line for increasing the dose:
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing. That means if Bell drops under 100 on a particular dose, you hold the dose for at least 10 cycles. So Bell dropped to 98 the day before yesterday…so you would hold the dose for at least 10 cycles before increasing the dose.
However when there are ketones in the picture we tend to be a bit more aggressive.
Bell had ketones at diagnosis and is showing a trace of ketones now. Can you increase the food a bit more (more snacks) and can you add a teaspoon of water to her food each time…if she will allow you to do that?
I’m glad to hear her energy levels are better.
Can you get another urine ketones test later today please?
I hesitate to say increase the dose at the moment as she seems otherwise well and is eating well but I am going to tag @Wendy&Neko @Bandit's Mom and @tiffmaxee to look in and check how things are going later today.
I’m heading to bed (I live in Australia ) but will look in when I wake up.
If she gets lethargic, vomits, ketones increase or goes off her food please let us know and don’t hesitate to take her to the vet if you think she is unwell. Hopefully she will be fine but I am just covering all the bases.

 

[Seth&Bell]

Thank you Bron!

I missed that point about nadirs under 100, appreciate it.

Bell is pretty underweight right now (8.5 lbs from 11.5 lbs a couple years ago) so right now I’m feeding her as much as she will eat. Her appetite was the limiting factor for the past month, but recently as she’s gotten her appetite back, she is eating like a queen . She actually prefers her pates soupy so I do add lots of water (probably a few tablespoons or more) to each meal. She has a small meal about every 2-3 hours with a lot of water in it.

I suspect that the “trace” will turn to “negative” once this bounce has run its course. I will try to catch her again tonight for another urine test.

She’s got a vet checkup today so I will see what they say as well.

 

[Wendy&Neko]

We hold doses with green nadirs (note the plural) for 10 cycles. You've only seen one green. Today is cycle 9 and 10. If no green today, I think you can increase. Regardless, if it's a green above 80, you still have room to increase. I'm taking into consideration that this dose is making her show ketones. A little more insulin will help the higher numbers too. Plus, 0.5 units wasn't taking her below 50.

 

[Seth&Bell]

Thanks. 250 at 6+ after AM. I think I’ll increase to 0.5 tonight.

Saw the vet briefly (she had an emergency surgery so couldn’t talk long). Sounds like she’s on board with me home testing and is going to use my spreadsheet (yay).

She did express Bell’s anal gland which had ruptured 3 weeks ago. Said it looked much better but gave her an injection of Convenia to be on the safe side.

Appreciate all who have been looking out for Bell on here