Jack Update- after HSRT

Andrea Bruesch

Andrea Bruesch

Member
Hello! An update on Jack. And a question as well.

Jack got his HSRT treatment last week. 3 sessions. He did really well with the anesthesia. I thought I was getting close to finding a good dose for him at around 3 units but due to all the fasting days and travel it was hard to tell. Then the Dr put him on a steroid for the next two weeks to keep him from developing inflammation in his brain from the radiation. He consulted with internal medicine before they did this. It caused his BG to soar about 200-300 points. He wants me to consult with my vet about titrations his dose up while he is on the steroids. I broke up with my vet so I am thinking of going to a new one this week to help me.

I need to update Jack’s spreadsheet as I have the numbers elsewhere but I could use some help figuring out what to do and also I wonder if it would be helpful to discuss a short term insulin with my vet.
 
Glad to hear Jack came through the radiation fine.

Once you have the spreadsheet updated, let me know and I can comment on dose. Did the vet say how long until cat’s typically respond to HSRT? I know SRT, not HSRT, but should be similar. The nice thing about SRT is that prednisolone is not needed.

You could ask your vet about using R, but chances are experience with that in acros after radiation is more prevalent here.first task is consistent dosing to get the depot stable so we know where to go next.
 
Thank you Wendy. He seems ell but slept a lot today and I am worried about his high numbers. I didn't know about the Steroids at all before this. He said could be months to years but that he thinks he got a lot of it. I am not really clear on the difference between the HSRT and the SRT. The few half doses in the AM are the days he fasted for his treatment.

Do I need to be super worried about his kidneys or the effect of these high numbers over time? I feel like I get close to getting decent numbers and then something upsets the pace!
Wendy&Neko said:
Glad to hear Jack came through the radiation fine.

Once you have the spreadsheet updated, let me know and I can comment on dose. Did the vet say how long until cat’s typically respond to HSRT? I know SRT, not HSRT, but should be similar. The nice thing about SRT is that prednisolone is not needed.

You could ask your vet about using R, but chances are experience with that in acros after radiation is more prevalent here.first task is consistent dosing to get the depot stable so we know where to go next.
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I am a little worried you've been increasing the dose too fast and by too much. After the treatment days and half doses in the AM, his depot would have been depleted. You should have waited at least six cycles after the last half dose to stabilize the depot. Each subsequent increase should have been held for at least six cycles, and I wouldn't have increased by more than 0.5 units at a time.

We also determine how to change the dose based on the low points or nadirs, not the preshots. That makes getting tests after preshot very important, including at night time if you are working during the day.

What is his current dose of steroids? I don't know the difference between HSRT and SRT either, but with SRT steroids were only given if needed (most don't) and only for a short time.
 
Glad to hear Jack's HSRT sessions went well. I hope he recovers well also, and that his Acro goes away or is reduced.
 
Wendy&Neko said:
I am a little worried you've been increasing the dose too fast and by too much. After the treatment days and half doses in the AM, his depot would have been depleted. You should have waited at least six cycles after the last half dose to stabilize the depot. Each subsequent increase should have been held for at least six cycles, and I wouldn't have increased by more than 0.5 units at a time.

We also determine how to change the dose based on the low points or nadirs, not the preshots. That makes getting tests after preshot very important, including at night time if you are working during the day.

What is his current dose of steroids? I don't know the difference between HSRT and SRT either, but with SRT steroids were only given if needed (most don't) and only for a short time.
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Thank you for taking a look. I had been trying to hold him at six cycles before an increase prior to treatment - but I see what you are saying about depleting the depot with the half doses. I guess I was just so surprised by the jump back into the 500s which the Dr said was most likely due to the steroids - and also scared about what that could be doing to him. He has been at five units for 5 cycles after this morning. Dr says that he will be on this dose of steroid (.5 mL) till the 2 week check up.`
 
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How many mg per mL of steroid? Sounds like you are doing a liquid version? Is it prednisolone?

At this point in Jack’s journey, it is super important to get a couple tests each cycle, including the night time one. Many, probably most, cats go lower at night. It’s possible he’s diving at night and bouncing during the day. All too often we have seen cats with red, or worse preshots, dive down to low numbers and back up again end of the cycle. My girl being one of them. If I only tested during the day I would have increased, where the night time data told me she needed less insulin.

There are a few possible reasons for the high numbers; missed low numbers, depleted depot, the steroid, inflammation from the radiation, or a combination of these. Holding the dose long enough to build the depot and see what a dose is doing is a good start. If you can get six cycles with both a preshot test and one other, we can see where the dose should go next. So far you have two cycles that meet this criteria.
 
Wendy&Neko said:
How many mg per mL of steroid? Sounds like you are doing a liquid version? Is it prednisolone?

At this point in Jack’s journey, it is super important to get a couple tests each cycle, including the night time one. Many, probably most, cats go lower at night. It’s possible he’s diving at night and bouncing during the day. All too often we have seen cats with red, or worse preshots, dive down to low numbers and back up again end of the cycle. My girl being one of them. If I only tested during the day I would have increased, where the night time data told me she needed less insulin.

There are a few possible reasons for the high numbers; missed low numbers, depleted depot, the steroid, inflammation from the radiation, or a combination of these. Holding the dose long enough to build the depot and see what a dose is doing is a good start. If you can get six cycles with both a preshot test and one other, we can see where the dose should go next. So far you have two cycles that meet this criteria.
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Hi updated the spreadsheet again. I will check him a few times overnight. Tonight is the 6th cycle at 5 units. I think I have preshot data for all of them as well as some mid cycle checks. Thanks for your help. - He is getting prednisolone 10 mg/mL and a dose of .5 mL once a day
 
Also can anyone tell me if I need to be really worried about the effects of his numbers being so high for so long - months and months. I am worried about his kidneys and whatever else may be affected.
 
For longterm high numbers, without regulation - glucose toxicity will cause many issues. The most noticeable is neuropathy, a common topic on the forum (you can search). The resolution is to regulate your kitteh as best as possible. At least regularly under 200, which is the renal threshold.

If Jack has neuropathy, the resolution is to get him regulated. And to provide supplemental B12, most people use Zobaline which is crushed and sprinkled on the food. Leo had bad neuropathy, and it took 3-5 months to get him to a 90% healthy level.
 
JeffJ said:
For longterm high numbers, without regulation - glucose toxicity will cause many issues. The most noticeable is neuropathy, a common topic on the forum (you can search). The resolution is to regulate your kitteh as best as possible. At least regularly under 200, which is the renal threshold.

If Jack has neuropathy, the resolution is to get him regulated. And to provide supplemental B12, most people use Zobaline which is crushed and sprinkled on the food. Leo had bad neuropathy, and it took 3-5 months to get him to a 90% healthy level.
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Thank you Jeff - Yes Jack has had neuropathy since September or early October. Actually it has gotten better in the last month since we switched the food. Hopefully there are not lurking impending health issues. I just want him to be well!
 
10 days ago he was getting some nice blue numbers, on half the dose he is now. He hasn't been in high numbers too long since then.

Glucose toxicity is a type of insulin resistance and results in him getting used to being in high numbers, which ultimately means higher doses of insulin to break through the resistance.
Andrea Bruesch said:
Tonight is the 6th cycle at 5 units. I think I have preshot data for all of them as well as some mid cycle checks.
Click to expand...
Preshots are good because they tell us if it's safe to give insulin, but we decide how to change the dose based on the low points, which happen somewhere in the curve. Without that mid cycle data, I can't tell if Jack is overdose and bouncing or underdose.
 
Wendy&Neko said:
10 days ago he was getting some nice blue numbers, on half the dose he is now. He hasn't been in high numbers too long since then.

Glucose toxicity is a type of insulin resistance and results in him getting used to being in high numbers, which ultimately means higher doses of insulin to break through the resistance.

Preshots are good because they tell us if it's safe to give insulin, but we decide how to change the dose based on the low points, which happen somewhere in the curve. Without that mid cycle data, I can't tell if Jack is overdose and bouncing or underdose.
Click to expand...
Wendy&Neko said:
10 days ago he was getting some nice blue numbers, on half the dose he is now. He hasn't been in high numbers too long since then.

Glucose toxicity is a type of insulin resistance and results in him getting used to being in high numbers, which ultimately means higher doses of insulin to break through the resistance.

Preshots are good because they tell us if it's safe to give insulin, but we decide how to change the dose based on the low points, which happen somewhere in the curve. Without that mid cycle data, I can't tell if Jack is overdose and bouncing or underdose.
Click to expand...
I wasn't able to get overnight numbers. But I have a lot of mid cycle data during the day. My inclination is it is from the steroids. I usually notice a big behavior change when he is in a bounce - not eating, loss energy... He seems ok otherwise.
 
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