? Buster - dose increase

Madm4444

Madm4444

Member Since 2024
Previous thread: https://felinediabetes.com/FDMB/threads/new-member_maf-buster_hello-help_post-dka.297267/


@Suzanne & Darcy
@Wendy&Neko

Buster's Libre reader showed HI until just recently (US 10p EST). Based on AMPS 361 (AlphaTrak) and +6 302 (Libre), it must have been reading just above the reader 401 cutoff most of the day (but really in the high 300s). He's been bright all day & the most active we have seen in a while. You were right @Wendy&Neko, it did my heart good to see how he was when his numbers were lower.

As discussed, this evening was the 6th cycle for 10 units. It's nice to see pinks & a few yellows but it's time for some other colors (and NOT black & red). Unless something radical happens overnight, I will be increasing to 11 units tomorrow morning.

@JL and Chip

The new 20-unit syringes worked great. Thank you again for the info!!
 
Good luck with the increase. Sometimes that larger increase shakes loose some better numbers.
 
Remember how I said we would increase unless something radical happened overnight? Well, it did. A Libre low glucose alarm woke us all at 4am (PM +10). Bg 74 & dropping. Gave him a tsp of baby food mixed with tsp of FF. Came up to 145 pretty quickly. Delayed morning meal a bit. AMPS 234 on Libre.

We're keeping at 10u for one more cycle...

I know there is quite a discrepancy between the Libre & AlphaTrak at the extremes, high/low (we've seen pretty good consistency in 100s/200s). However, I am learning that there is also a real discrepancy between what the Libre reader screen shows & what the Libre software logs. Once I uploaded the data, I saw that there were no numbers below 100. If we have this situation again, we will test to confirm.

I'm pretty sure we didn't do the right things - again. Clinically, he was perfectly fine & he wondered why his mom was rushing around like a crazy person. But, all I saw was a massive 200+ drop and, no matter what the specific numbers were, that scared me for him.

We will see what the day brings but he has already boomeranged back to high 300s... :banghead:

I have updated the spreadsheet.
 
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@Suzanne & Darcy
@Wendy&Neko

Hi. Buster stayed in the 300s today. Still at 10u.

I updated his spreadsheet earlier.

Could you please help me out with tomorrow morning's dose?

I think these are the scenarios:
1 - Stays Libre HI overnight
2 - Stays in 300s overnight. AMPS 300+
3 - Drops to 200s overnight but up to 300 by AMPS
4 - Drops to 200s or lower overnight. 200 or lower at AMPS.

Do you have any suggestions for these scenarios or any other recommendations?

Or am I just spinning my wheels & should just go to 11 & see if we can get those numbers down? :rolleyes:

Thank you!!
 
Scenarios 1-3 mean the same action, an increase. I expect you will see one of those, as he takes longer than 2 cycles to resolve a bounce.
 
Wendy&Neko said:
Scenarios 1-3 mean the same action, an increase. I expect you will see one of those, as he takes longer than 2 cycles to resolve a bounce.
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Increased to 11 yesterday. Brief drop yesterday but has remained Libre HI ever since. Updated his spreadsheet but all I see is black - again. He's acting fine. Even a slight downtick on the urination frequency.

Is this what you & @Suzanne & Darcy were expecting to see? I'm not sure what to do now...
 
@Suzanne & Darcy
@Wendy&Neko

Just started 3rd cycle with 11 units. Libre HI all day yesterday. Should we be going to 12 tomorrow?

Also, we have an SRT consultation scheduled for this afternoon with a local hospital. Unfortunately, it is only a teleconference but hopefully it will give us some information.
 
Let me now look at Buster’s spreadsheet. Okay? I am sorry I missed your post from this morning! It’s good that you PM’ed me.
 
Okay. I ws just looking over his spreadsheet and it does look like you can move to 12 units tomorrow. He has had enough time after his most recent lower numbers and still seems to remain high. Now, if you get a lower than typical preshot number (something in mid to lower yellow or a blue) tomorrow morning, I would hold off on the increase and stay with 11 units a little longer. Okay? Otherwise, I would increase to 12 tomorrow morning.

How is Buster feeling? How did the consultation go? Did you get some answers?
 
Thank you!

He's doing okay but I think all these high numbers are taking a lot out of him. Hind legs seem weaker. He was never much for play before but now, bursts of energy are few & far between and he gets tired even faster. I have ordered the B-12 Methylcobalamin for him. I think I will have better luck taking the powder from the capsule than trying a pill.

The consultation was good. It's a lot to process. Based on this discussion, I will be reaching out to a couple of other facilities.

Interesting fact that I did learn: if the tumor is clearly present, the procedure is SRT (3 days high dose). If not clearly defined, that's where the 16-18 days of daily low dose comes into play. Nothing can be decided without the imaging.
But, we are inclined to agree with what @Wendy&Neko said to @ToddyTiger: that many days for an acro cat (in/out of anesthesia) is too much...

I have an appt early in the morning so prbly won't have spreadsheet updated with Libre info til late morning but I will get his AMPS in there.
 
I completely agree about that many days of anesthesia. Way too much really and not just for an acrocat! It’s so stressful, isn’t it. My heart goes out to you. You can do this, though, and can give him more years with good quality of life.
 
How did it go after that? Did he bounce back? I was just trying to check in on Buster, but his spreadsheet hasn’t been updated yet. I was soooo happy to see those beautiful numbers from yesterday’s a.m. cycle that I keep checking his SS to see what happened after…
 
Oh that boy. Yes, bounced back up. Libre reader showed HI all night. Haven't had a chance to upload the data yet to see if the numbers end up pink or black in the spreadsheet. AMPS 365 with AT3. He was quite agitated this morning (which included a bite) so couldn't get a ketone reading. Ugh.

I have a general food question that I will be asking in the Health Forum. Just a heads-up...
 
Sorry about the bounce, but we kind of expected it, and he IS making progress. We will hold this dose for a while (unless a reduction is earned, of course.)
 
I just updated his spreadsheet. Turns out, it was mostly 300s (312-392). Today will be #5/#6 cycles of 12u. Could we touch base this evening to discuss dose?

We also skipped the mirtazapine last night as we thought that was amping his food aggression (which became 'everything' aggression). It was. He was much calmer this morning but still hungry. I think we will be dialing back his dose & try for every other day.
 
Oh yes. The Mirtazapine can make some cats crazy. I usually warn people to use less than the prescribed amount and to start with every other day. I have had it cause aggression in one cat who was not normally aggressive toward other cats. It also can make them very restless and vocal. That’s why we call it Meowtazapine. Are you giving the transdermal ointment or pills?
 
This morning is only the fifth cycle on 12 units so tonight will be the 6th. Let’s hope he comes down today. Tonight he will still need 12 units.
 
Suzanne & Darcy said:
Oh yes. The Mirtazapine can make some cats crazy. I usually warn people to use less than the prescribed amount and to start with every other day. I have had it cause aggression in one cat who was not normally aggressive toward other cats. It also can make them very restless and vocal. That’s why we call it Meowtazapine. Are you giving the transdermal ointment or pills?
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It's the transdermal. I already give him less than when we started but I think it's still too much.
He's always been food-centric (which is why he used to be 16 lbs) & used to get feisty if he was hungry, but never like this with full-on biting. He's like a different kitty.
Even though he is still high in the 300s, I can tell he feels a little better with less drastic swings. I'm curious to see how today goes...
 
I usually use half or less than half of the strip length on the Mirataz box (which I believe is 1.5 “). And every other day works for most of my cats. But it does depend on the cat.

It’s very good to hear that he seems to feel better.

Any action today? Any bounce breaking lower numbers? Any luck getting a ketone test?
 
EDIT: We are not going to increase tomorrow morning due to various considerations like low ketones, previous nadirs on this dose.

It’s very positive that he’s got low ketones. I would go ahead with the increase tomorrow. He should be coming down tonight or tomorrow. The red PMPS may be the high before the break … although it’s not a huge amount higher than his last test. But you still have wiggle room for the increase (unless you get really unexpected lows.)
 
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Not sure if you'll see this tonight...
The Libre shows 270 & heading down. What preshot number would be considered too low for a dose increase for him?
 
I tell you what. Since we are waiting for him to break this bounce and he has seen some higher greens on this 12 unit dose AND his ketones are pretty low at .4 — let’s NOT increase tomorrow morning. Let’s hold this dose a little longer and see how he settles in with it. How does that sound?
 
I am confused about the Libre at 270 and the AT at 411 at PMPS? Is that correct. I see the 411 in bold in the PMPS cell. Is that at the same time you are saying that the Libre is reading 270?

I would compare apples to apples. If the AT was 411 at PMPS, I would check with the AT at +2. Or if the Libre said 270 at PMPS, I would check the Libre at +2. If the +2 is a lot lower than PMPS, you will likely have some action tonight and you will want to make sure to feed him the usual mini-meal snacks and keep an eye on the Libre. Since he’s only had higher greens on this dose, I am not anticipating anything extremely low, but it’s just a good idea to be vigilant.
 
Sorry, I think I confused you. At PMPS (6p), the Libre was reading HI, the AT3 result was 411. Since we had no number from the Libre, we tested. The 411 made sense.

When I posted at 10p (PMPS +4), the Libre was showing 270 with a downward trend arrow. He was asleep.

Looks like the Libre went down in the night below 150 but above 70 because the low glucose alarm didn't sound.

Now, at 545a (almost shot time), he is 198 on the Libre with the steady trend arrow. I am planning to do 12u at 6a.
 
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Sounds good.
I am wondering how the Libre knows which direction his BG is going in the future? Or are the up and down arrows just indicating what happened previously? Like he was pretty steady at the time you scanned and got the 198?
 
Suzanne & Darcy said:
Sounds good.
I am wondering how the Libre knows which direction his BG is going in the future? Or are the up and down arrows just indicating what happened previously? Like he was pretty steady at the time you scanned and got the 198?
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Here is info from Libre website:

"The FreeStyle Libre sensor collects glucose data every minute and automatically stores a reading every 15 minutes. When scanned with the reader or FreeStyle LibreLink app, it provides the user with:

• Current sensor glucose reading,
• A graph of stored glucose readings.
• It also typically displays a glucose Trend Arrow pointing to where glucose levels are heading.1

Depending on the direction of change, you can use the Trend Arrow alongside your current glucose reading to make an informed decision as to whether to take any corrective action."

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Looks like he didn't go as low as last time. But at least we have yellows & blues. I guess we are in a waiting game for today's numbers...
 
Okay so he broke the bounce last night with those really nice numbers. And now, sadly, it looks like he may be starting to bounce again. I hope he’s feeling okay. He is making progress. These bounces are so frustrating and discouraging. The time between bounces should gradually decrease as Buster’s body adjusts to the lower BG numbers. Hang in there. You sound a bit stressed, which is understandable.
 
Not much movement today. Unless something crazy happens tonight, I guess I'm going to 13 tomorrow...?
 
I haven't uploaded the data but I was watching the reader most of the day. There were readings registering at shot time. But the daily graph from the reader shows that not much else happened during the day.

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I think he is bouncing and will start to clear the bounce on Wednesday (when you may be taking him to get a CT scan/MRI?). He could start to clear it earlier, but he has been coming down on the fifth cycle. You can increase as long as you will be able to carefully monitor his cycles. You will likely see greens again when he breaks the bounce. I just want you to be prepared. I also am concerned if it happens on a day when you are not at home - taking him for an evaluation? Although I think he would have a reduced dose on that day, right? You can increase, but watch him closely and we can see how it goes.
 
Okay. I am not accustomed to reading the Libre graphs, but those blues were all from last night, which you already charted on the SS. So what I said about him bouncing still stands.
 
Madm4444 said:
Unfortunately, no blues today.
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Understood. I would have been very surprised to see any today. Sorry for my confusion about the blue timing. I knew that could not be right since he had blues last night. I expected high numbers today. Still, he has seen green on 12 units and has bounced a lot in between the greens and the blues.
 
So did you decide to increase or not? Was he still high overnight? Could you update your spreadsheet?

When they start to see lower blue and green nadirs, we hold the doses a little longer than just the six cycles that MPM allows. We also need to consider whether he has ketones or not. Buster has been at 12 units now for 8 cycles.
 
Yes, we did decide to increase to 13. I am booting up the computer to update the spreadsheet now. Should be done shortly.
 
Suzanne & Darcy said:
So did you decide to increase or not? Was he still high overnight? Could you update your spreadsheet?

When they start to see lower blue and green nadirs, we hold the doses a little longer than just the six cycles that MPM allows. We also need to consider whether he has ketones or not. Buster has been at 12 units now for 8 cycles.
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Tonight is the 6th cycle of 13u. We haven't seen much movement. Should we be increasing tomorrow?
 
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