Emmett con’t—dosage clarification

KLD

KLD

Active Member
Hello! Emmett’s previous thread here (sorry, I’m on my phone, hope I linked correctly) https://felinediabetes.com/FDMB/threads/i-cant-make-sense-of-emmetts-numbersadvice.290834/

I’m looking for some clarification on what Emmett’s dose should be. He keeps going under 3.8/70 so I’ve been lowering his dose almost every day this week. He’s gone from 3.75 units to 2.25 in a fairly short amount of time.

This morning, his dose technically should have been 2.25 units, but I gave him 2 units because I had a suspicion even 2 units would be too much. He is pretty frequently testing in the blue or yellow in the morning (except when he’s bouncing) so I’ve been trying to find a good dose for him at those numbers. Hasn’t been easy because his dose has been lowering so dramatically, so I feel like I can’t even use data from a couple days ago to compare. Anyway, he went below 3.8 this morning, so I understand he needs a dose decrease again. Since his dose should have been 2.25 this morning (even though I gave a reduced dose of 2 units), does that mean his new dose should be 2 units tonight? I think I’m confusing myself because I feel weird reducing his dose to a dose that has already made him go below 3.8.

Thanks!
 
Also, Suzanne, I know you had suggested feeding Emmett 8% carbs for his +2 meal to stop his steep drops in blood sugar early on. I’ve been feeding him something that is around 6% (I could be off on that though) and I’m not sure it’s making much of a difference. I keep looking for non poultry food he can eat that fits the carb criteria but I’m struggling. I’m going to keep looking though.
 
Wow. I see what you mean. Those doses and numbers are all over the place, but, hey, needing reductions is not a bad thing :) It is also hard to make decisions based on the recent data because of all the temporary reductions… mixed in with the regular doses that were also being reduced out of necessity. He’s certainly been keeping you on your toes, hasn’t he? I’m thinking that, for sanity, you should keep him at 2 units tonight and possibly going forward, as long as he doesn’t keep going lime green. You can always tweak the dose and go back up if he starts having increased BG.

About the food — can you find anything that’s even higher in carbs— a medium carb food for his early snack — something 11-14 percent maybe? It’s kind of limiting to keep it below ten percent when he can’t eat poultry — so that might open up a few more non-poultry foods to you as well as to help with his early diving.​
 
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Suzanne & Darcy said:
Wow. I see what you mean. Those doses and numbers are all over the place, but, hey, needing reductions is not a bad thing :) It is also hard to make decisions based on the recent data because of all the temporary reductions… mixed in with the regular doses that were also being reduced out of necessity. He’s certainly been keeping you on your toes, hasn’t he? I’m thinking that, for sanity, you should keep him at 2 units tonight and possibly going forward, as long as he doesn’t keep going lime green. You can always tweak the dose and go back up if he starts having increased BG.

About the food — can you find anything that’s even higher in carbs— a medium carb food for his early snack — something 11-14 percent maybe? It’s kind of limiting to keep it below ten percent when he can’t eat poultry — so that might open up a few more non-poultry foods to you as well as to help with his early diving.​
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Interestingly, he had been at 2 units in June, and seemed to be responding well to it. That same day he had Convenia and literally over night stopped responding to 2 units and ended up needing to go to 3.75. Now we’re almost two months out from the Convenia and he’s back down to 2 units. I don’t know if it’s coincidence but the fact that this has happened twice now (in addition to the weird behavioural changes he had) makes me wish there was some research out there on this.

I’ll do 2 units tonight. Thankfully I’ve got a few days before I need to be back in the office so I can get some good monitoring it and won’t feel the need to do lower precautionary doses.

He loves the Fancy Feast beef chunks in gravy, which is around 12%. He gets it when he goes a bit low and it pretty consistently brings him up about 2 mmol/L. I had been thinking of trying a little of that at +2 to see if it helps, so might do that and see if it helps.
 
KLD said:
Interestingly, he had been at 2 units in June, and seemed to be responding well to it. That same day he had Convenia and literally over night stopped responding to 2 units and ended up needing to go to 3.75. Now we’re almost two months out from the Convenia and he’s back down to 2 units. I don’t know if it’s coincidence but the fact that this has happened twice now (in addition to the weird behavioural changes he had) makes me wish there was some research out there on this.

I’ll do 2 units tonight. Thankfully I’ve got a few days before I need to be back in the office so I can get some good monitoring it and won’t feel the need to do lower precautionary doses.

He loves the Fancy Feast beef chunks in gravy, which is around 12%. He gets it when he goes a bit low and it pretty consistently brings him up about 2 mmol/L. I had been thinking of trying a little of that at +2 to see if it helps, so might do that and see if it helps.
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I think it’s a great idea to use the Fancy Feast for that early snack. He just needs a few more carbs at that part of the cycle to help prevent steep drops. Every cat is different.

I am in total agreement with you about the Convenia. I don’t like them. It’s still detectable in the cat’s body for eight weeks. With his history with Convenia, I would avoid them in the future.
 
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Suzanne & Darcy said:
I think it’s a great idea to use the Fancy Feast for that early snack. He just needs a few more carbs at that part of the cycle to help prevent steep drops. Every cat is different.

I am in total agreement with you about the Convenia. I don’t like them. It’s still detectable in the cat’s body for eight weeks. With his history with Convenia, I would avoid them in the future.
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Will do. Hopefully the higher carbs help.

And yes, from now on I’ll be advocating for him to not get Convenia. If he needs antibiotics, I have no problem giving him pills. He’s needed them before for an infected puncture wound and he actually would eat them like they were treats lol.
 
He is very friendly but an absolute menace. He gets called spicy a lot. He wants to be everyone's friend, unless you are the vet in which case he needs a LOT of gabapentin lol. I would attach a picture but it's not letting me upload a file.
 
Suzanne & Darcy said:
Is Emmett okay? Sick? Paw bothering him? His numbers have gone bad.
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Unfortunately I have no idea what happened. He was doing so well and then overnight a big change. His paw is bothering him, but no more than usual. I’ve emailed the vet about it. Otherwise he seems generally low energy but that’s only within the last day or two, so I think it was more to do with the continual high blood sugar.
 
KLD said:
Unfortunately I have no idea what happened. He was doing so well and then overnight a big change. His paw is bothering him, but no more than usual. I’ve emailed the vet about it. Otherwise he seems generally low energy but that’s only within the last day or two, so I think it was more to do with the continual high blood sugar.
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The lethargy is concerning. If Emmett were my cat, I would take him to the vet and get a CBC to see if he has an infection and get a once over from the vet. It could be very serious if he has an infection of some kind. Do you have a way of checking ketones? Is he vomiting? Is he eating normally or does he have a reduced appetite?
 
Suzanne & Darcy said:
The lethargy is concerning. If Emmett were my cat, I would take him to the vet and get a CBC to see if he has an infection and get a once over from the vet. It could be very serious if he has an infection of some kind. Do you have a way of checking ketones? Is he vomiting? Is he eating normally or does he have a reduced appetite?
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I hope it’s not an infection or anything serious. He does still play a lot, it’s just that he runs out of energy a lot faster when his blood sugar is high. The one random night a couple nights ago when he was testing around 6/120 he didn’t stop running around all night, which again is why my first thought was just that he was generally run down from the high blood sugar.

I do have ketone testing strips. I test when I can but don’t always catch him in the litter box lately. I’ll try to get a test in ASAP.

Otherwise, no concerns—no vomiting, appetite is normal.
 
Okay. But it’s so strange… seems like such a dramatic change. I’m glad you went up to 2 units. If he doesn’t see lower numbers, I would increase another .25 after 6 cycles (since he eats all LC wet food and can follow MPM rules.) as long as you can do your usual excellent job of testing during his cycles.
 
Suzanne & Darcy said:
Okay. But it’s so strange… seems like such a dramatic change. I’m glad you went up to 2 units. If he doesn’t see lower numbers, I would increase another .25 after 6 cycles (since he eats all LC wet food and can follow MPM rules.) as long as you can do your usual excellent job of testing during his cycles.
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Fingers crossed for a better number tonight (I’ll test him in another 40 minutes). It is really strange. He did this exact thing after the Convenia, and now I’m just afraid this is going to be a weird pattern with him.
 
Suzanne & Darcy said:
I suppose it could be? I really thought it was the Convenia. Hopefully, we can manage the spiked numbers with insulin.
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I kind of hope it is something like his paw bothering him more lately. At least that has a clear cause. I’ll see what the vet says tomorrow.

I’m worried I’m going to end up having a hard time telling the difference between bouncing and needing a dose increase, if his insulin response ends up having a tendency to change so drastically so quickly.
 
Well he’s not currently bouncing. If it’s a true bounce, you will see sustained high numbers and you won’t see the numbers come down (until they do.) He has been dropping into yellow so it’s not a bounce. As you know, bounces result from either steep/rapid drops in BG or from the cat being in numbers he’s not used to. Bounces can last up to six cycles, but don’t necessarily last that long.
With all the different doses being shot lately, it’s really hard to see what’s going on. I would really try to hold the 2 units at least a couple more days — and let’s see how it goes. He definitely had too many lime greens back at the end of July and early August. It’s possible his body isn’t adjusting well to all the dose changes. Some of the dose changes (.25 unit reductions) were necessary due to the lime greens.
 
Suzanne & Darcy said:
Well he’s not currently bouncing. If it’s a true bounce, you will see sustained high numbers and you won’t see the numbers come down (until they do.) He has been dropping into yellow so it’s not a bounce. As you know, bounces result from either steep/rapid drops in BG or from the cat being in numbers he’s not used to. Bounces can last up to six cycles, but don’t necessarily last that long.
With all the different doses being shot lately, it’s really hard to see what’s going on. I would really try to hold the 2 units at least a couple more days — and let’s see how it goes. He definitely had too many lime greens back at the end of July and early August. It’s possible his body isn’t adjusting well to all the dose changes. Some of the dose changes (.25 unit reductions) were necessary due to the lime greens.
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That’s true, thanks.

yeah, I kind of wonder if with all the changes his body just went “nope” and stopped responding. I try as much as I can to be consistent with his dose, but lately it just hasn’t been working out.

His vet got back to me and said our options are to either do a biopsy or Atopica. She says she doesn’t like atopica because it takes a long time to work and can cause vomiting. Im just wondering what the best option is if visually there is nothing noticeably wrong with his paw, except for being a bit swollen. Other times he has had lesions on his paw, but not this time.
 
It’s a problem— so limited as to treatments since he’s diabetic. He’s getting down into yellow numbers now, so I have hope that if you hold for a couple more days and do another .25 unit increase that things will get even better. I think taking it slowly with him is a good idea. But he is very challenging! :bighug:
 
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Suzanne & Darcy said:
It’s a problem— so limited as to treatments since he’s diabetic. He’s getting down into yellow numbers now, so I have hope that if you hold for a couple more days and do another .25 unit increase that things will get even better. I think taking it slowly with him is a good idea. But he is very challenging! :bighug:
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My mom and I joke that he’s a really weird cat when it come to diabetes but I think it might actually just be true lol. Nothing is ever easy with him. I won’t be able to test him tomorrow (in the office) but will increase in the next couple of days if things don’t change. At least I don’t think he’ll need quite as big of an increase as back in June :)

he is going to the vet on Thursday. The vet had also mentioned possibly doing a non-steroid anti-inflammatory (since she doesn’t know if a biopsy is viable given there is no noticeable lesion) but I said I would rather do a proper examination and figure out as best we can what is wrong first before we throw more treatments at him.
 
I’m glad he’s going to the vet. Watch out for NSAIDs like Onsior which is only approved in cats for three days due to its potential for harming the kidneys. I will not use Metacam (Meloxicam) in my cats due to its black box warning about kidney failure in cats. It is used in low doses in Europe in cats though for kidney disease of all things. It’s controversial in the U.S.
 
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Suzanne & Darcy said:
I’m glad he’s going to the vet. Watch out for NSAIDs like Onsior which is only approved in cats for three days due to its potential for harming the kidneys. I will not use Metacam (Meloxicam) in my cats due to its black box warning about kidney failure in cats. It is used in low doses in Europe in cats though for kidney disease of all things. It’s controversial in the U.S.
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Interesting. I didn’t get a name for which one she wanted to use (I did ask but she may have just missed the question) but she mentioned it can cause vomiting, in which case it would need to be discontinued. I’m pretty sure one of my cats has had metacam before, but it would have been years ago, possibly when neutered.
 
I just double checked his records and it was Emmett who got meloxicam/metacam. He’s actually had it a couple times, including the first time his paw issue popped up—it didn’t make a difference! He was actually apparently given Convenia back then too. Wish I had checked that a few months ago—I would have never agreed to it this time around had I remembered that was the failed treatment in the past.
 
Well it’s a lot to keep up with ( past treatments from years ago.) Some vets do still use Metacam for post neutering pain. Robenacoxib is the generic name for Onsior. Have you tried some things like glucosamine and chondroitin or turmeric or CBD or MSM? I am just throwing things out there that are anti-inflammatory (not necessarily recommending anything.)
 
Suzanne & Darcy said:
Well it’s a lot to keep up with ( past treatments from years ago.) Some vets do still use Metacam for post neutering pain. Robenacoxib is the generic name for Onsior. Have you tried some things like glucosamine and chondroitin or turmeric or CBD or MSM? I am just throwing things out there that are anti-inflammatory (not necessarily recommending anything.)
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I haven’t tried any of those, no, and none of those popped up when looking through his old records. It seems like metacam was the go to pain med for his old clinic, and he hasn’t needed any pain management since going to our new clinic. I was trying to figure out what Emmett got after he was neutered because it made him absolutely insane and I don’t want to accidentally give him that again. But he went to a spay/neuter clinic through the shelter he was adopted from and they didn’t list the name of the meds in any documents they sent me home with.
 
KLD said:
I haven’t tried any of those, no, and none of those popped up when looking through his old records. It seems like metacam was the go to pain med for his old clinic, and he hasn’t needed any pain management since going to our new clinic. I was trying to figure out what Emmett got after he was neutered because it made him absolutely insane and I don’t want to accidentally give him that again. But he went to a spay/neuter clinic through the shelter he was adopted from and they didn’t list the name of the meds in any documents they sent me home with.
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I had some foster kittens who were neutered by the local humane society and they went berserk after coming home from their neuter surgeries. They left the house in the morning as loving little kittens who adored their litter mates, and they came home growling and hating their siblings. They were mental. Fortunately it wore off after a day or so. I attributed it to the anesthesia that was used.
 
Suzanne & Darcy said:
I had some foster kittens who were neutered by the local humane society and they went berserk after coming home from their neuter surgeries. They left the house in the morning as loving little kittens who adored their litter mates, and they came home growling and hating their siblings. They were mental. Fortunately it wore off after a day or so. I attributed it to the anesthesia that was used.
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Yeah, that was likely a contributor too. Thankfully he wasn’t aggressive, just aggressively bouncing off the walls :) I remember he was fine the first day/day of surgery and the second day they had me start the pain meds which is when he went wild. Amusing, just not great for healing haha.

Anyway, I hope we can get some answers on Thursday. And hopefully we see some improvement in his blood sugar. Poor guy has dealt with so much in his short life.
 
A little premature on the dose increase. I understand how upsetting it is to see 500. With the allowable meter variance of 20/25 percent his AMPS is pretty much the same as yesterday, but I also hate to see the color black on his ss. You are working today and can’t test, right? I hope he can get his +2 snack (and other snacks?)
 
Suzanne & Darcy said:
A little premature on the dose increase. I understand how upsetting it is to see 500. With the allowable meter variance of 20/25 percent his AMPS is pretty much the same as yesterday, but I also hate to see the color black on his ss. You are working today and can’t test, right? I hope he can get his +2 snack (and other snacks?)
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Honestly I just lost track and thought it had been six cycles already. Didn’t realize I had upped his dose at night. I ended up not feeling well so am working from home and able to test today.
 
Emmett went to the vet today and we’ve got some answers! The vet was able to find lesions on his paw I didn’t notice (they were at the side of his paw pad where it meets the fur, and all between his toes). I had been leaning towards a biopsy so we could get some answers, but because the vet was able to find the issue, and because last time he had this issue on his paw he responded well to steroids, I opted not to go with the biopsy. We’ve got a pretty good idea that it’s eosinophilic granuloma. I decided to go with Atopica and see if that helps.

Also, today he is back into a good range for his blood sugar. We’re off track with his feeding and testing times today because of the vet visit, but he’s doing well!
 
I see he’s back into blues and almost a lovely green!

I am glad you got the vet to look at it. I hope he will tolerate the cyclosporine well. I’ve never tried it, but I have a cat who was on Dexamethasone for skin allergies (she literally licked herself bald except she had a little fur bolero around her neck and shoulders and, of course, she had fur on her head) — anyway, she had orthopedic surgery to stabilize her patella in January and when the vet examined her and also shaved her leg, she found that the steroid was making her skin become very thin. So we took her off of the steroid and she said if she started up the licking again we would have to go with Atopica but that it’s more expensive initially and requires bloodwork monitoring. For some reason she had stopped the over grooming even before the surgery and she now has her beautiful coat and markings back.

So Emmett will do Atopica instead of steroids, right?
 
Suzanne & Darcy said:
I see he’s back into blues and almost a lovely green!

I am glad you got the vet to look at it. I hope he will tolerate the cyclosporine well. I’ve never tried it, but I have a cat who was on Dexamethasone for skin allergies (she literally licked herself bald except she had a little fur bolero around her neck and shoulders and, of course, she had fur on her head) — anyway, she had orthopedic surgery to stabilize her patella in January and when the vet examined her and also shaved her leg, she found that the steroid was making her skin become very thin. So we took her off of the steroid and she said if she started up the licking again we would have to go with Atopica but that it’s more expensive initially and requires bloodwork monitoring. For some reason she had stopped the over grooming even before the surgery and she now has her beautiful coat and markings back.

So Emmett will do Atopica instead of steroids, right?
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Hopefully he can keep up the good numbers.

Correct, he will do atopica instead of steroids. The vet mentioned it can cause vomiting, but Emmett has never been a big vomiter even with meds so I’m hoping he’ll be okay.

Oh! Poor cat. I hope she stays okay. I don’t know why over grooming is one of those pet issues that stresses me out, but I’m glad I’ve never had to deal with that with my boys.
 
How is Emmett? Is the Atopica doing anything helpful? He’s doing okay (apart from being bouncy). I see he was due for a dose reduction when he had the lime green (61) a few days ago. He’s been doing all right since then, but he should have had the reduction unless you can think of a specific reason why he dropped so low that day (like not eating or not getting his +2 snack).

Have you found a higher carb food for his breakfast that could help with his steep drops?
 
Suzanne & Darcy said:
How is Emmett? Is the Atopica doing anything helpful? He’s doing okay (apart from being bouncy). I see he was due for a dose reduction when he had the lime green (61) a few days ago. He’s been doing all right since then, but he should have had the reduction unless you can think of a specific reason why he dropped so low that day (like not eating or not getting his +2 snack).

Have you found a higher carb food for his breakfast that could help with his steep drops?
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Emmett is doing okay. It’s hard to tell if the Atopica is helping… he stopped holding his paw up a couple days before he started, and he hasn’t held it up since. That being said, he is occasionally limping on his back paw now. I can’t see anything wrong with it so if it continues, back to the vet I guess.

I kept him at 2.75 after the 61 because technically his dose should have been 3 units that day, but I was inconsistent about it because of the inconsistent pre shot numbers and inability to monitor him some days. I wouldn’t be surprised if he reaches that number again today, just based on the pattern from yesterday.

I’ve been trying a few different foods but honestly nothing seems to really make a difference. I tried a medium carb fancy feast, but when I started trying that, it coincided with his blood sugar going high again and his dose needed to increase. So I don’t think I was really getting an accurate picture. Now that he seems to be stabilizing at lower numbers a bit more, maybe now would be a good time to try some more experimenting.
 
Because of the level of testing that you do and because of his numbers subsequent to that 61, I actually think it’s okay to keep him at 2.75, but I was just wondering. I saw the three units but that was only briefly the dose and it went back down to 2.75 so I was wondering about that. I thought maybe you were responding to his high preshot values. I understand about not being able to monitor the cycle (best to be safe.)
 
Suzanne & Darcy said:
Because of the level of testing that you do and because of his numbers subsequent to that 61, I actually think it’s okay to keep him at 2.75, but I was just wondering. I saw the three units but that was only briefly the dose and it went back down to 2.75 so I was wondering about that. I thought maybe you were responding to his high preshot values. I understand about not being able to monitor the cycle (best to be safe.)
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Okay, cool. I think he’s back in a weird phase where his insulin dose is going to change again. Today’s +6 number kind of confused me though. I was expecting a lower number, but it was around the same as his +4 number. Based on the past couple days, I don’t think it’s because it’s not enough insulin. But sometimes he does this when he’s getting too much insulin and he’s bouncing before I can catch any low numbers.
 
Suzanne & Darcy said:
Poor Emmett has so many troubles for a young cat. That is sad about his back leg/paw. He’s such a mystery.
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He’s lucky I love him so much because he’s such a pain lol. Best case it’s just another eosinophilic granuloma. He had been stealing my other cat’s chicken flavour food so it’s possible he just ate something that triggered it
 
Well let’s find out if Emmett got insulin tonight… he decided to run as soon as I got the needle in him
 
KLD said:
He’s lucky I love him so much because he’s such a pain lol. Best case it’s just another eosinophilic granuloma. He had been stealing my other cat’s chicken flavour food so it’s possible he just ate something that triggered it
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And he’s allergic to chicken, right?
 
He did a similar thing on August 24 (and other days). I think he had good mid-cycle numbers today. If his numbers are higher tonight you will know that it was at least a partial fur shot. Oh well, tomorrow is another day!
 
Suzanne & Darcy said:
And he’s allergic to chicken, right?
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Yes. As soon as I cut out chicken (he doesn’t like any other poultry, so really, he wasn’t eating any poultry altogether) he stopped getting back to back eosinophilic granulomas on his lip (his paw that wouldn’t heal on the other hand…)
 
Suzanne & Darcy said:
He did a similar thing on August 24 (and other days). I think he had good mid-cycle numbers today. If his numbers are higher tonight you will know that it was at least a partial fur shot. Oh well, tomorrow is another day!
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That’s true. This boy is so unpredictable one day to the next!
 
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