Jai Jai - UPDATE and DISCUSSION

[BJM]

When a cat vomits, you may want to wait a little bit on giving more food so his stomach can settle a bit. Lantus has a slow gentle onset, so it is OK if he hasn't eaten much when you inject. Monitor him and feed in small amounts to reduce the chances of throwing up again.

 

[heyhollis]

Hi, Mogs. Don't feel sorry as you've already rendered so much support to me and Jai Jai. You don't know how thankful I am!!!!

I have read your post and I know you really need some rest and comfort. Please do not carry along the worries with you. You have to stay strong in order to take care of Saoirse.

Please get some sleep and don't worry about me too.

 

[heyhollis]

When a cat vomits, you may want to wait a little bit on giving more food so his stomach can settle a bit. Lantus has a slow gentle onset, so it is OK if he hasn't eaten much when you inject. Monitor him and feed in small amounts to reduce the chances of throwing up again.

I am doing it right now and I am so glad he eats. Oh, god, I was so scared of another hypo.

 

[BJM]

Now that he's down to 0.5 units, that is much less likely. He may still be draining some of the depot from the former high dose. Also, vomiting is a stressor and may actually raise the glucose level a bit.

 

[heyhollis]

Now that he's down to 0.5 units, that is much less likely. He may still be draining some of the depot from the former high dose. Also, vomiting is a stressor and may actually raise the glucose level a bit.

Exactly, his AM+2 on 31/8 is 527. This is the first time seeing black after changing to 0.5 units.

 

[BJM]

Cats can tolerate higher glucose levels for a moderate period. Do test for urine or blood ketones and smell the breath (2 of 3 ketones have a distinctive odor - like nail polish, or fruity).

 

[heyhollis]

Cats can tolerate higher glucose levels for a moderate period. Do test for urine or blood ketones and smell the breath (2 of 3 ketones have a distinctive odor - like nail polish, or fruity).

Ketones -ve. I check it everyday per your advice.

BG is 562 at AM +5 (31/8). OMG. Is it a bounce from the yellow and pink yesterday?

 

[Critter Mom]

Hi Hollis,

I am wondering whether Jai Jai might go lower at PMPS.

By the way, what sort of personality does Jai Jai have? Is he a sensitive little kitty? From his picture, he looks to have a very sweet nature.


Mogs
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[heyhollis]

Hi Hollis,

I am wondering whether Jai Jai might go lower at PMPS.

By the way, what sort of personality does Jai Jai have? Is he a sensitive little kitty? From his picture, he looks to have a very sweet nature.


Mogs
.

Hi, Mogs. Have you had a good rest? How about Saoirse? I hope you two are fine.

Do you think Jai Jai had a bounce this AM? I discussed with my hubby and he also felt that holding the 0.5 dose until 2/9 PM was right, he thought Jai Jai had high BGs because of vomit. To keep Jai Jai hydrated, we will give him 100ml subQ fluids two consecutive days. We hope that he will be fine.

Jai Jai is very sweet. Before I found out that he is diabetic, he always sat next to me when I was using the computer. He sometimes slept on my laps. But, if we do something that he does not like (brush his teeth, prick his ears, etc.), he has a very bad temper.

I do not remember if I had mentioned, MM is a black cat. Here is what he looks like:

MM is a very naughty cat, and he has some hate against Jai Jai. I think Saoirse is a much much more lovely and adorable cat.

 

[Marje and Gracie]

Hi Hollis

I haven't posted to you yet but after reading this thread, I feel the need to as I don't agree with some of the information you've been given.

First, your signature block says you are following the TR protocol but Jai's Jai's SS is not indicative of that....in other words...whatever dosing advice you've been given is not TR. Just to clarify, although it doesn't affect you or Jai Jai, but SLGS is not a protocol. It's an approach. It has no scientific basis. That doesn't mean it's not effective or doesn't work....it does work for some kitties and was the approach used on this board for many years and resulted in many cats going into remission. TR just provides a better chance. Here is an excellent post on Can you do TR and work full time that you might want to read.

But given your circumstances, maybe SLGS is better for you and Jai Jai and you can hold the doses for a week at a time and then run curves on the weekends per that approach.

I know it's tough seeing the reds, but because Lantus is a depot insulin the effect of changing a dose may not be apparent for several days. By waiting several days on the 0.5 unit dose it will allow the depot to drain a little and then stabilize at the capacity that matches the lower dose. Once that happens we will hopefully have a better picture of what just half a unit is actually doing for Jai Jai when he's not on his invisible trampoline. Thereafter we can look at adjusting the dose very gradually to see if we can find a 'goldilocks' level that helps improve his numbers. Does that sound like an OK plan to you?

I know you are worried about a hypo and I always am, as well. I'm sure the night he spent all that time in the 20s was horrible for you and it's not something any of us want to see for others' cats or our own. However, you shot 1.5u that night. I have to agree with Julie that you've cut the dose to 1/3 what he got that evening. And the above advice I quoted is not correct for a decrease that leaves a cat in these high numbers. For a cat getting high numbers like this, you don't leave the dose for "several days". If a low number has caused a bounce, let the bounce clear, take the dose up if the kitty doesn't come back down into normal numbers. From the modified TR protocol we use:

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

The question is...what is the last good dose for Jai Jai? In order to be cautious, I'd give him 0.75u and see how he does within six cycles of consistent dosing. And I do think that inconsistent dosing is also an issue here. There might be other things we can suggest regarding feeding, etc., to help him flatten out a bit.

While I don't know if it occurred, let's just assume he dropped lower in the a.m. Cycle of 8/28. He's had plenty of time to clear the bounce. While I have seen a couple of cats take longer than six cycles, those cats were extremely overdosed (I'm talking 10u) and had an enormous depot. I don't see that here. I also agree with Julie's comments on the L/L forum that Jai Jai needs a 0.25u increase. I understand you work and are worried but hyperglycemia is also a serious issue if left unaddressed.

One other thing is that many things control what happens to the BG in a cycle. Syringes sre grossly inaccurate and 1.5u could have been a lot more if you got a really bad syringe that cycle. Jai Jai could have had some extra absorption that night due to the fluids even though you didn't seem to change anything from how you've done it before. I'm not saying 1.5u wasn't too much.....it was that cycle and that's all that matters. The dose had to come down.

I am also concerned about you posting in two forums. It makes it really, really difficult for people helping you to keep track of all the threads. Can you imagine if everyone did that? For people giving suggestions, especially about dose, it takes time to read the thread, study the SS, etc and to have to go back and forth between forums adds time. So I would suggest that you pick the forum where you are most comfortable. Consistency in this will also help you and Jai Jai both. Keep in mind that on the L/L forum, we have the most people with a long history of using Lantus and levemir and familiarity with the TR protocol as well as SLGS Approach. But it is your choice.

If Jai Jai were my kitty, I'd spend some time deciding whether I wanted to follow the TR protocol or the SLGS approach and then I'd stick to it as closely as possible. Yes, there are going to be occasional exceptions that will cause the need to do something a little different. You aren't following the TR protocol if you hold a "steady dose for 5 to 7 days" even if he's sky high. Frankly, looking at his SS, I don't see that Jai Jai needs longer than six cycles at a dose to tell you that he needs more insulin or not. What I do see is some missed reductions for some really low numbers (7/17, 7/19, 7/25).

In summary, my suggestions, based on five years of experience with Lantus and levemir and looking at hundreds of SSs, is that you decide TR or SLGS and then that you post daily in the L/L forum so we can help you stay on track with following the method you pick. Anyone helping you in this Health forum can also post in the L/L forum and, that way, you have one thread going that everyone can track. You won't need to do an "active thread link" in your signature because we post a link daily in the L/L thread to the previous thread. Easy.

BTW, you are doing a good job of getting nighttime tests now and that's important.

 

[BJM]

You tested a full 5 days to see if restarting at 0.5 units would help get him stabilized and see if maybe that would work better for him. It hasn't and the nadirs are high. It's time to resume following one of the Lantus protocols and increase the dose. Moving up to 0.75 units makes sense.

Another thought is to review the info on dosing with calipers. Using calipers would help ensure the doses were as consistent as possible, despite any variations in the syringe markings, plus allow you to carefully fatten or skinny doses, should he be more sensitive to insulin after those hypo episodes.

 

[heyhollis]

An update of Jai Jai's inflammation, the area had less redness, and Jai Jai did not lick much these two days. I think he will recover from the irritation soon.

 

[heyhollis]

Hi, @Marje and Gracie. I read your message several times, and I asked my hubby to have a look too. I thank for your time for the message, and I actually get something from it.

I spent some time to read through the messages (here and over the L&L again), and also the TR and SLGS. If TR is not the right thing for me (at least for the time being), I need to switch to SLGS in order for Jai Jai to settle a bit.

The question is...what is the last good dose for Jai Jai? In order to be cautious, I'd give him 0.75u and see how he does within six cycles of consistent dosing. And I do think that inconsistent dosing is also an issue here. There might be other things we can suggest regarding feeding, etc., to help him flatten out a bit.

I don't know which is his last good dose. 0.75 is too low, 1 is too high and caused hypo. There may be something that is between 0.75 and 1.0.

Anyone helping you in this Health forum can also post in the L/L forum and, that way, you have one thread going that everyone can track. You won't need to do an "active thread link" in your signature because we post a link daily in the L/L thread to the previous thread. Easy.

Sorry that I prefer to keep this link, because I have link up all the referencing which I cannot do on L&L. I can easily find my condos in #3, and current discussion topics in #1.

It is also useful when I need urgent help without creating other post. Whenever I am in SOS, I do not have time to create a thread and follow the rules on L&L. I always have a delayed post on the L&L forum because of it. I am trying but I need some time to transit. Please don't take it personally.

 

[Marje and Gracie]

Hi, @Marje and Gracie. I read your message several times, and I asked my hubby to have a look too. I thank for your time for the message, and I actually get something from it.

.

Thank you both for taking the time to read it and consider the info.

I spent some time to read through the messages (here and over the L&L again), and also the TR and SLGS. If TR is not the right thing for me (at least for the time being), I need to switch to SLGS in order for Jai Jai to settle a bit.

Discuss it with your husband and see what you both think is the best thing for Jai Jai. TR is a great protocol to follow and I think most people can do it but it's not the only way to get a cat into remission and you have to decide what YOU think is best for you and Jai Jai.

I don't know which is his last good dose. 0.75 is too low, 1 is too high and caused hypo. There may be something that is between 0.75 and 1.0.

I addressed this on your L/L thread today.

Sorry that I prefer to keep this link, because I have link up all the referencing which I cannot do on L&L. I can easily find my condos in #3, and current discussion topics in #1.

No need to apologize. It's your signature block and your time.

It is also useful when I need urgent help without creating other post. Whenever I am in SOS, I do not have time to create a thread and follow the rules on L&L. I always have a delayed post on the L&L forum because of it. I am trying but I need some time to transit. Please don't take it personally.

I've been around way too long to take things personally here and you should never be worried about that with any member. There are only three things we ask in L/L forum. First, that the subject line be in a certain format so we can follow the numbers. Sometimes, you might not see an issue but we will. Second, that you post the link to the previous day's thread in the current day, and third, one thread per cat per day with all your questions. IF you have a 911, don't worry about linking a thread! Put up the 911, put the date and Jai Jai's name in the subject line along with something that catches our eyes like "very low BG" and then write your post. If there is a 911, we aren't going to care about the normal posting guidelines. You are doing a great job with your posts in L/L but just remember that most of us don't have the time to read a thread there and then another one in Health about the same cat on a daily basis. Yes...there might be times when there aren't many people in L/L and you need to post in Health to get eyes on his thread but usually someone is around. I know the time change makes it difficult.

Hang in there!