Blue AMPS 402 10/12

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I'm back. I really feel we were on the verge of him regulating. If you look at the last week he was in the blue one entire day and then he dipped into the green. I think I'll probably keep going on as normal. I might not want to test as much as I've been doing since he is stressed and needs rest.
Do you all think I could do this safely?
 
Glad you're home safe, Patty. :bighug:

Patty and Blue said:
I think I'll probably keep going on as normal. I might not want to test as much as I've been doing since he is stressed and needs rest.
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That's cool, Patty. You'll need to factor that into dosing decisions. Obviously there is always the chance that Blue might throw you a curve ball but using your spreadsheet data should help reduce the risk of that.

WRT insulin treatment going forward, I'd like to first hear what your vet says to you about dosing, target range, the reasons for his recommendations and any comments he has on the pancreatitis side of things. At the end of the day, he's the one with the degree, and he's the one who's done the diagnostics so it's important to see what his treatment advice is.

Tips:

- Ask for a copy of Blue's test results, etc., and also the BG readings/dosing info for his stay at the vet's (so you'll have an idea of where the depot's at and what has been working for Blue during his treatment).

- Ask for a supply of supportive meds to take home so that you can address any eating issues, etc., promptly while he's convalescing (pain relief, anti-nausea, appetite stimulant for the pancreatitis side of things).


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I have two meds for Blue. Amoxicillin and Cerenia for nausea and vomiting.

Dr. Johnson said they found that 1 unit in the morning stays with Blue for 18 hours and they want that one big drop. If .5 is given it took him down but then back up and then the next .5 took him down to far. They're okay with him going way up because he is still acting normal. I'm still waiting on their BG testing.

I don't know :arghh:
 
Patty and Blue said:
I have two meds for Blue. Amoxicillin and Cerenia for nausea and vomiting.
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Good about the Cerenia. Would like to have seen something for pain relief (bupe).

Dr. Johnson said they found that 1 unit in the morning stays with Blue for 18 hours and they want that one big drop. If .5 is given it took him down but then back up and then the next .5 took him down too far.
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What's their definition of "down too far"?

They're okay with him going way up because he is still acting normal.
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Exactly how far up is he going? How high are they happy to see him running?

Just because a cat may act normally at higher BG levels it doesn't mean having the cat running at those levels is good for its overall health.

First impression is that the vet is trying to apply canine diabetes principles to feline diabetes, and using Lantus as an extra-long-lasting in-out insulin like Vetsulin, but that's only an opinion formed with incomplete information. Impossible to know what's going on in the vet's head without knowing the target range he wants to keep Blue running in. (@tiffmaxee, @Red & Rover (GA): Any thoughts?)

I really hope that you manage to get the actual blood glucose readings and dosing info from the vets, Patty, not just a broad-brush summary of what they tried while Blue was with them.

But now to the most important thing: is your Bluebird home yet???

(((Blue)))


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Patty and Blue said:
Dr. Johnson said they found that 1 unit in the morning stays with Blue for 18 hours and they want that one big drop. If .5 is given it took him down but then back up and then the next .5 took him down to far. They're okay with him going way up because he is still acting normal. I'm still waiting on their BG testing.
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Possibly what they are not taking into account is the depot – if there is any depot left (nothing on the spreadsheet after 12 Oct).

I can see the pdf but am not great at reading labs. Patty, it would be a good idea to delete the pdf, cross your last name and contact information out, then upload it again.
 
No labs but here he is in his ”bed”. Glad to be home.
 

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Where are the lab reports? Haven’t been on much and just came on only for Blue. I don’t agree with your vet on dosing.
 
Patty and Blue said:
I have only ever used Mac so when my daughter gave me the PC laptop I haven't really used it because it's so different. Now I'm trying to learn fast. I might try my iPad next. Maybe it'd be easier.

You need some rest my friend...:bighug:
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I’m on an iPad most of the time.
 
He's doing great. Marching on me now and giving me kisses.
The .5 dose they said only drops it so far then BG comes back up but not enough. Then I give another .5 and he goes to low. So he goes up down up down. They want only one dramatic lowering and don't care how high it goes after. They said for Blue the first dose in morning of 1 unit lasts for him 18 hours. They don't want a flat line of BG. I don't understand enough to ask them the correct questions.
 
Is what I relayed making any sense? Dr. Bruno called when I was checking in at eye doctor and when I picked up Blue I asked Dr Johnson the questions. Dr. Bruno was gone. It's so hard without sitting down eye to eye and going through everything. I'm already going in blind so struggling to ask the right questions.
 
Patty and Blue said:
The .5 dose they said only drops it so far then BG comes back up but not enough.
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The main aim of using a depot insulin is for numbers not to go up.

What do they consider to be 'up enough'? (I dread their answer.)

Then [...] give another .5 and he goes too low.
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What do they regard as too low?

So he goes up down up down.
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They're either referring to two nadirs a day (which is what we want diabetic kitties to have from their two doses of insulin per day), or to bouncing (not likely if they think 'he comes back up but not enough': we know only too well just how high Blue can bounce).

They want only one dramatic lowering and don't care how high it goes after.
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Do they think Blue is a diabetic dog?

Have they said *why* they want this?

They don't want a flat line of BG.
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This, to me, sounds like they want Blue's response to Lantus to fit what they think feline diabetes should look like. (Note: If your vet has been used to treating cats with in-out insulins like Vetsulin in the past they may not have got their head around how depot insulins work best, namely keeping BG levels low and flat.) ETA: Also, they are applying canine diabetes management principles to a cat.

Snap verdict? ---> :banghead:



(ETA: @tiffmaxee, @Red & Rover (GA): Thoughts?)


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Red & Rover (GA) said:
Possibly what they are not taking into account is the depot – if there is any depot left (nothing on the spreadsheet after 12 Oct).

I can see the pdf but am not great at reading labs. Patty, it would be a good idea to delete the pdf, cross your last name and contact information out, then upload it again.
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Thank you. I never thought about that.
 
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