Hercules new bouncing thread

Link to previous one: https://www.felinediabetes.com/FDMB/threads/help-pmps-5-2.233900/#post-2623794

 

Morning @Critter Mom - I felt asleep, but still got him at +5 and he seemed ok, so I went back to snoring.... I whish I didn't need so much sleep....

Hi AMPS is not too high, so perhaps the bounce has passed?

 

Mornin Mum, I have no advice but wanted to say, for someone that is sleep deprived, you are doing a fantastic job!
jeanne

 

I have never been as tired since having a diabetic cat and we aren't *touchwood* having to do much through the night testing.

You got this!!

 

I must admit I became much more appreciative of the job my own intermal organs quietly and unnoticeably do for me day in, day out since the universe saw fit to turn me into a collection of surrogate feline beta cells.


Mogs
.

 

LOL (((Mogs)))

 

Blues are good to see! We'd like to see even more of them and some green BG tests too.

 

We had a fun time last night managing the blues...
I don't know who is more gone in the middle of the night, me or him.... I need to sort put the feeder, but at the moment I am quite unsure whether he will use it. The two cats are glued to me the whole night....
I guess we are having a bit of bounce this morning?

 

Good morning Mum! Here's hoping today is a better day than yesterday and tomorrow better still. You're doing a fantastic job.
KEEP UP THE GOOD FIGHT!
j.

 

Maybe we should round up all the trampolines on the planet and lock them away in the Raiders of The Lost Ark warehouse

Nice little paddle last night, Hercules!


Mogs
.

 

Could not get on the message board at all on Thursday, so just catching up.

A couple of nice blues, and then the bounce but back down to the yellow ranges today. Keep up the good work!

 

I'm lost!!!! Help!!

So, a pretty unremarkable day yesterday (thanks for checking on us @Deb & Wink !). Had some high values at PMPS and +2. Gave him a good feed at +2 and tought I could have a whole night of sleep..... than we wake up to a 3.6 AMPS!!!!!!!!

I decide to be a cowboy this morning... I am clearly not giving him a dose and decisde to see if just feeding his normal food would do (instead of my initial instincts of pulling out the high carb food). Did I do the right thing? any uk fellow boarders around, @Critter Mom @Elizabeth and Bertie ?

I know I am now supposed to reduce his dose, but honestly, it doesn't seem like the insulin is doing much as it is, and I am worried he is getting dehydrated....
Besides, my hunch is that this very low BG is the result of not being fed at +5 or +6. But that doesn't really make a lot of sense because 6 hours later it wouldn't have matter? How can it be so low in the morning, when it hasn't been this low in weeks? as i said, I am lost, this is not making any sense. Anyone has any ideas of how to go forward?

 

Hi, are you able to test again? ...That's firstly to see if it's just a wonky test number, and secondly (if it's 'not' a wonky number) to ensure that it is coming up. But I 'think' it should be...

 

Hi @Elizabeth and Bertie, thanks for your suggestion. I did immediatly retest after the the 3.6, and got a 4. So I don't think it was a wonky reading.

I just meassured +30 minutes after him eating his normal food, and it is 9.6

Should I give him half a dose at +1 or skip all together?

 

Well, that's certainly a shootable number for him, and it is rising, but it will be influenced by food, so isn't a 'true' number....
And, we don't know what happened last night, and how low his blood glucose might have dropped...
And it may be that he just bounces now from that low...

Options would seem to be; to skip altogether; or to give a reduced dose (if you can monitor); or to wait a bit longer if you're home and see how the blood glucose is trending, and then make a decision based on that...
Of course it's your call. You're the one holding the syringe, and you need to be comfortable with what you decide to do.

 

I hear you Elizabeth, I just don't feel I understand enough the information to make a good decision and I am a scientist in the life sciences!

The low number in the morning should have been his "purest number", as in not affect by insulin (which should have run out of an effect), or food (he hasn't eaten for 10 hours)..... So I am at lost as why it was all of a sudden so low.

Food seem to have a very large and fast effect on him, so I suspect if I feed him normally today I could give him insulin and he will be ok with me monitoring. He is always happy to feed.
I am just not so sure, how bad it is to get out of the 12 hour cycle (especially with prozinc, which is in and out, i.e. not depot). I would think is not that bad, but people here think it is?

 

I'm not quite sure I've understood your question correctly, so do forgive me if I've misunderstood...

I should say upfront that I've not used Prozinc, but have used a couple of other PZI insulins, so I don't have direct experience of using Prozinc. What I know about it I've gleaned from others' experiences over the years...

Prozinc duration can vary a lot from cat to cat (10 - 14 hours), and can also sometimes be affected by dose. There certainly have been people here who thought Prozinc also had depot-like properties in their cats.
If giving a shot late then 'usually' the advice is to give the next shot 12 hours later as you normally would. But...there are also circumstances where you might still give the next shot at the normal time. For example, if a cat gets short duration on Prozinc that shouldn't be a problem. And sometimes if a cat has a much reduced shot (consequently possibly with less welly) that may also not be a problem. Of course, the PS would need to be rising and be a shootable number to be on the safe side.

I am always cautious with dosing (especially with regard to other peoples' cats...), probably more cautious than many people here. And I am more inclined to say 'skip the shot' than other people might be. I should probably have the phrase "better too high for a day than too low for a minute" tattooed on me somewhere, haha!
It might actually be helpful to skip and see what happens... It's all data, after all...
But, if you can monitor, there are also potential advantages in giving 'some' insulin...

I do wish I could be more helpful, sorry, but I'm just not one of those more 'prescriptive' people who might say, 'do this'...

 

You have been super helpful @Elizabeth and Bertie ! I understand it is complicated, and every cat is its own. It is easier to see general patterns and talk about it,, but when we go down to individual's behaviour, general scientific patterns tend to fail miserably.

I am 100% with you! But the flip side of this is that I worry so much about low numbers that he is actually not getting low enough....

I guess I have to continue to march on.... I am not feeling confident I am making the right decisions though, and I am worried his peeing and drinking has not improved.

My vet is not one to discuss things with.... Do we have a list of vets in the UK that have experience with diabetes treatment?

 

I do hear you... (((Hugs))) ...And I can sympathise. Bertie's numbers were all over the place at first and seemed to make no sense whatsoever... Incredibly frustrating for a while...

...While I was making my cup of double strength Earl Grey just now I was mulling though some things that can cause wonky numbers. It may be that none of these are relevant in Hercules' case, but I'm just going to list what popped into my head...

Any concurrent health conditions? ...Any history of pancreatitis..? Any inflammatory conditions...?
What exactly are you feeding Hercules?
Does he have a salmon intolerance? (Prozinc contains salmon protamine)
Are you mixing the Prozinc before each shot? (Prozinc needs gentle mixing/rolling, but some people find they haven't been mixing it 'enough'...)
Are you using (human) BD U100 syringes with your U40 insulin? The lines on the U100 barrels are not as 'precise' as those on U40s, which can affect small doses (and particularly very small doses..)

I think that's it for now...

Oh, might your vet be willing to change to a human insulin such as levemir or lantus....?

I don't think there's a list on this forum any more... ....Trying to think where I might have seen one recently...
Where in the UK are you?

But there are very few UK vets who seem to know much about feline diabetes. And some who 'think' they know a lot don't necessarily give good advice. A lady on one of the FB groups got the most appallingly dangerous advice a few weeks ago from an RVC vet who considered himself an "expert"... (She was told to give Caninsulin shots as long as the BG was above 5, and that her cat wasn't in danger of hypo because it was only a low dose... ...The cat then had a symptomatic hypo... Surprise, surprise...)

My own current vet is pretty good. She's a mobile vet who does part of Surrey and a wee bit of London. But even with her knowledge she was startlingly honest when my girl Bonbon was heading toward remission, and said that she "honestly wouldn't know what dose to give her..."
It is the case though that more vets seem willing to prescribe human insulins now. And you may well be able to find a vet who'd do that if your current vet won't....

 

I am using U100 syringes! I changed to it because I tought it would be easier to control smaller doses? My rationale was that even if I was making mistakes, the mistakes ought to be smaller given the diameter of the syringe, but I guess if there is a printing problem... than I am in trouble... I still have a few U40s around, perhaps I'll switch back for a little experiment.

I am mostly concerned that there is something else going on... when he was first diagnosed (2.5 months ago) they did saw the pancreas slightly enlarged, but the vet thought it was likley due to the diabetes and just suggested keeping an eye for vomitting, nausea, etc... He used to throw up a lot, but he has pretty much stopped in the last few months (perhaps because his new buddy has much shorter hair). We changed him over to Feringa cans, we haven't tried fish flavours yet. I don't know if he has any sensitivities to salmon. He loves to steal it from my plate, and I never noticed any strong reaction. He does seem to still be a bit dehydrated, and he has this "strangled "miaw" that was present at his diagnosis, then went away, and is back...

I am close to Bristol, so too far for your vet.... I just have lost thrust on mine. Is a biggish group, always too keen to keep them in and do a load of tests; hard to see the same vet twice...

So did Bertie's number just eventually settled down, or did you finally figured out what was going on?

 

And then there's the other extreme: a feline diabetes and internal medicine specialist at one of the leading veterinary schools in the UK told me - with a completely straight face - that it was unsafe to EVER give a dose of Lantus unless a cat's preshot blood glucose was OVER 11.1mmol/L*. This while she was sitting in front of a screenful of Saoirse's data (Alphatrak) which completely contradicted her. Here's a snippet:





(NB: I customised the colouring on Saoirse's spreadsheet and set a higher alert threshold for low numbers, but green is green is green.)


Mogs


(*As measured on an Alphatrak.)
.

 

@Deb & Wink - I wonder if you have any opinions of what is going on?

Some blues, but still mostly yellows and pinks, with more bouncing than at lower dose. Park here until bouncing stops? or push a bit further to get more blues and the occasional green?

 

I think you want to increase the dose now. You've been at the 0.7U dose for about 18 cycles, if I counted correctly. Her needs more insulin. Bump the dose up by another 0.25U if you would please. That is my recommendation.

Then, with the increase you can hopefully get some blues and some greens in the cycles for Hercules.

 

Thanks forthe advice Deb, I'll notch it up tomorrow when I can stay home the whole day.