Gandalf update, unusual cycles, request Melissa's input too

[Vicky & Gandalf (GA) & Murrlin]

I updated spreadsheet this AM. He's having some odd cycles lately, so Sheila, Pamela & Melissa*, take a look please and give me your thoughts. Anyone else reading this - post and thread will contain speculations. Please do not assume these for your own cats.

Here are mine - new pen started on the 24th. The really wonky stuff didn't start until I did 2 splits on the 28th which resulted in a 50 PMPS at +12/+14 to each split. My conclusion there was that my measurement was off, so he got too much insulin on either 1 or both doses. So dropped the dose and left it there because his numbers weren't too bad. Then on the 3rd he dropped in to the 50s after having 300s after having a 78 preshot on the 2nd. But new pen makes me wonder, as 4 days after starting it this happened, just about right amount of time for shed to overspill.

Now, that was also right after our monster blizzard and it got down to -10 below zero on the 3rd. I don't know if anyone else has noticed this, but when it's going to get real cold, none of my cats seem to eat much! I was home and noticed they all seemed to sleep a lot, so he may just not have eaten enough, but he ate fine when I encouraged him and he came up nicely after that 50.

I dropped the dose to 1.1U, which is 15% less than 1.3U which seemed to be a pretty good dose. The on the 4th he dropped pretty rapidly on the .9U and I dropped again to .75U, but I doubt that's enough, so I brought it back to .9U last night.

What gives? Do we have a wonky pen? Less calories? I started giving pepcid again in case he's getting a flare. I also started up his Clindamycin therapy yesterday. He had an acceptable preshot this morning at 261, so I'll probably stay at .9U through Thursday because I'm off then and can get checks, but he has acupuncture that AM and that usually throws him off. It is also supposed to be bitterly cold ALL WEEK after tomorrow. Highs in the teens is all, lows around or below zero. Ugh. I tracked cold weather last year and he seemed to run higher than not lower but I noticed dose was only 1U.

*edited to add Melissa. If you see this, Melissa, you're always good at pointing out alternative aspects, so I would like to see your ideas as well.

 

[Sheila & Beau GA & Jeddie GA]

Re: Gandalf update, unusual cycles

My thoughts:

What nadir number are you comfortable with? I am wondering if the 50s is just a tad too low for you (because you are gone for so long during the day)? Maybe 1u would work here by taking the edge off the and making 50s into 60s?

I am not so concerned about the drop from 319 to 147. It's 48 points/hour, so not that fast (IMO) and the 319 was probably a bounce number from the 50s the day before.

I'm not understanding the [56/73] on the 28th (pm)? What does that mean? Did you retest him right away?

I don't know that a new pen would be that different, I mean, if it was for humans it would be even more of a problem since they get much bigger doses. It would be the batch, not the individual pen. Maybe Google the pen lot number to see if anything have been reported? Or, how old was the old one? Any chance it was weaker? Pamela posted to me that she thinks the old pen/carts might get more potent at the end, but that is not my experience.

Keep an eye on his appetite, etc. You know that their insulin needs can fluctuate and every once in a while Gandalf gives you numbers that I swear are rebound numbers. But he always seems to settle back into his old responses after a while - likes to keep you on your toes!

Finally, when was the last time you have his T4 tested? I remember that Beau's hyper-T caused BG changes, as did his hypo-T when the meds were too much. I just can't remember off the top of my head which way the numbers changed.

 

[Vicky & Gandalf (GA) & Murrlin]

Re: Gandalf update, unusual cycles

My thoughts:

What nadir number are you comfortable with? I am wondering if the 50s is just a tad too low for you (because you are gone for so long during the day)? Maybe 1u would work here by taking the edge off the and making 50s into 60s?

I agree. I like to keep him above 60 for nadirs.

I am not so concerned about the drop from 319 to 147. It's 48 points/hour, so not that fast (IMO) and the 319 was probably a bounce number from the 50s the day before.

Thanks, missed that.

I'm not understanding the [56/73] on the 28th (pm)? What does that mean? Did you retest him right away?

Yes, it means I tested, got the 56 and waited another 30 minutes. I couldn't move the 73 to the next hour because it was within +1 hour, not a +2 after initial test. Makes sense? 51 was at 10:07, 56 was 10:49 & 73 was 11:22. I should change the arrow though 'cause I shot the 73, not the 56.

I don't know that a new pen would be that different, I mean, if it was for humans it would be even more of a problem since they get much bigger doses. It would be the batch, not the individual pen. Maybe Google the pen lot number to see if anything have been reported? Or, how old was the old one? Any chance it was weaker? Pamela posted to me that she thinks the old pen/carts might get more potent at the end, but that is not my experience.

Numbers with the old pen were excellent and 1.3 has always proven to be a good dose when I have a steadier work schedule.

Not sure how pens are packaged, I would think the 5 pens in a box would all be form the same batch. I threw out the last one already, so can't compare. If control numbers are batch numbers, then the new one is same as one left in box.

Keep an eye on his appetite, etc. You know that their insulin needs can fluctuate and every once in a while Gandalf gives you numbers that I swear are rebound numbers. But he always seems to settle back into his old responses after a while - likes to keep you on your toes!

Don't I know it! Yes, I think appetite is playing a part in this.

Finally, when was the last time you have his T4 tested? I remember that Beau's hyper-T caused BG changes, as did his hypo-T when the meds were too much. I just can't remember off the top of my head which way the numbers changed.

I'm pretty sure it was tested at U of I last fall. Don't remember and don't have paperwork as they called me with results of his parathyroid hormone tests, which I think included free T4.

Bugger all - he's at 301 at +8 today. So no drop on .9U, which is what I would expect when it's not enough insulin.

 

[Melissa&Paul-Kyle]

Re: Gandalf update, unusual cycles, request Melissa's input

Thanks for asking, Vicky...As usual,I am leaving the dosing to you, but if you think this is appetite related and think the cold might play a part in this- my own observation of my cats when itis cold or I leave the cat room window open for Ezra the 3/4 cat that loves the snow, is they all pile up on the floor vent.

I can leave and there they are and when I get back 8 hours later, the organization is a bit shuffled, but there they are again and as soon as I am home ans the window is closed it is like a mad dach for the litterbox and you can imagine the stink with as many butts as I have.

So, my point is, though mine don't have access to food through the day, the have litter box access but don't use it on the cold days until I am home and windows are closed.

So- further to my point- you've mentioned in the past how cold your place can be- I think you get cross breezes on your fingers when at computer?....can you add a the location of food/water/litter box to an area that is close to his resting/cuddle place and keep that area a bit warmer- maybe with a space heater or something? ..hang a blanket from the ceiling to keep the warm in...(light blanket and use stick pins)

I wouldn't *change* the location of these things b/c cats are fussy and don't care for change- you might be compounding the problem to change- but to add can't hurt, can it? And in a warmer location so it is more appealing to old cranky bones on a cold day.

Anyway, that might keep the feeding more consistent and give you more consistent BG's...I'll think on it and re-read post later to see if I come up with anything else...

 

[Vicky & Gandalf (GA) & Murrlin]

Re: Gandalf update, unusual cycles, request Melissa's input

Thanks for asking, Vicky...As usual,I am leaving the dosing to you, but if you think this is appetite related and think the cold might play a part in this- my own observation of my cats when itis cold or I leave the cat room window open for Ezra the 3/4 cat that loves the snow, is they all pile up on the floor vent.

I can leave and there they are and when I get back 8 hours later, the organization is a bit shuffled, but there they are again and as soon as I am home ans the window is closed it is like a mad dach for the litterbox and you can imagine the stink with as many butts as I have.

So, my point is, though mine don't have access to food through the day, the have litter box access but don't use it on the cold days until I am home and windows are closed.

So- further to my point- you've mentioned in the past how cold your place can be- I think you get cross breezes on your fingers when at computer?....can you add a the location of food/water/litter box to an area that is close to his resting/cuddle place and keep that area a bit warmer- maybe with a space heater or something? ..hang a blanket from the ceiling to keep the warm in...(light blanket and use stick pins)

I wouldn't *change* the location of these things b/c cats are fussy and don't care for change- you might be compounding the problem to change- but to add can't hurt, can it? And in a warmer location so it is more appealing to old cranky bones on a cold day.

Anyway, that might keep the feeding more consistent and give you more consistent BG's...I'll think on it and re-read post later to see if I come up with anything else...

Thanks, Melissa.

Yeah, cold in my house is an understatement. But I use heaters and Gandalf's feeder is always kept in the catroom now, which is on south end of the house. Unless the wind is in the south, it is usually the warmest room and I can tell that by how many cats reside there - usually 2 out of 4, if not 3 out of 4. Tigget will not stay in there unless the sun is out because Leahpold antagonizes her. Tigget lays in front of the heater instead, which is usually at the opposite end of house.

Gandalf sleeps in the papasan chair in there, on which I have 2 purr pads. He occasionally will come to the couch in the front room, which is like the old time parlor - big room right off the entryway. Think 150 year old house. That room has the thermostat in it, so it is usually warm also.

So I don't think comfort is a huge issue, rather perhaps change in air pressure is.

Since getting that 300 midcycle I've decide I better go back to 1.1U anyway 'cause he's never had ketones, but first time for everything. Getting a urine test from him is close to impossible as he sneaks to the litter box. And he peed in the closest the other morning, which is a red flag for something unusual going on.

Since he only had surgery a few weeks ago and did a course of Baytril afterwards for 14 days I am leery of an infection cropping up anyway, not necessarily from his surgery sites, both look fine outwardly, but I will have acu vet look at the one Thursday because there is a lump under the skin it feels like to me. Could just be how vet stitched him back up, but I don't think it should feel like it does, even with that. The lumps came back negative for cancerous growth. I cannot imagine one growing back so quickly.

And this time of year was when he had a CP flare last year so I am leery of that as well.

All this pretty much means if I don't see some improvement in numbers or appetite by Thursday I guess I'll be getting his blood tested for infection. Maybe a urine culture too. I kind of need to know how he's concentrating it now anyway.

 

[pamela and tigger]

Re: Gandalf update, unusual cycles, request Melissa's input

Just getting on here. I am sorry I don't have a lot to add Vicky. When looking at your SS all I could say to myself was I agree those are really wonky cycles. And I am relieved to read here you didn't shoot the 51 after all. You guys that shoot those low numbers make me nervous. I like the 73 preshot much better.

I do wonder how the antibiotics are affecting his digestion/appetite though (the Baytril and now the pulse therapy of Clindy). I know you give a pro-biotic but cats digestive systems are so unique and complex. I found this site on the cat digestive system a while back. It is written by a layperson so how accurate it is I have no idea. But it is interesting to say the least:

http://www.felineconstipation.org/gut101chapterone.html

I know there is not much you can do about that though.

I know Tigger is not getting any exercise like he does normally because of all the snow and cold weather. He doesn't eat as well either probably because of that. He also cries a lot since he is bored. I am sure Gandalf is missing going outside too.