Joplin AMPS: 306

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Hi Cheryl - I see you shot 2U today. Unless Joplin goes under 50, you should try to stay with this dose at least 6 cycles so we can see what it does. From yesterday's data it looks like Joplin's Lev nadir is somewhere around +8 or +9 so try to get a test in there if you can.

How is Joplin doing now that it's a couple days after his hypo incident? He acting any different, is he eating, using LB OK?
 
Sorry so late in replying, Cheryl!

We should have told you to expect a higher number this morning and to just hold the 1.5 dose. Levemir is a depot insulin and it takes time to level out and see how each dose is really going to work. We don't dose based on the pre-shot number...Dose is based on how low it takes them and it takes at least 3 days on the same dose to really see how it's going to work

When a cat goes lower than their body has become used to, their liver thinks they're starving to death and releases stored sugar and hormones to bring the blood glucose back up quickly. This is called "bouncing". It's a leftover survival mechanism from when our kitties were living in the wild and times were tough. If their blood glucose got too low, the liver released those sugars to keep them alive long enough to (hopefully) find food. Our diabetic kitties don't have to worry about finding food, but Mr. Liver still does his thing! Since our cats have gotten used to being in high numbers, even dropping to "Normal" numbers can trigger a bounce.

I see you already shot 2 units this morning. Please just remember to test. Joplin may need 2 units...but until you're getting regular tests in and holding the dose for 3 days, there's no way to know.

Get at least a mid-cycle test today and a "before bed" test on the PM cycle. If you can get more tests, that's all the better since it'll help to show you how Joplin responds. With him just having that symptomatic hypo, you need to really keep an eye on him for awhile.

With him getting a glucose drip from the vet and his dose changing around, right now it's really a guessing game as to what dose he'll need.

If he drops below 50, it's an automatic reduction

If you post and need dose advice, please add something like "Dose advice needed!" to your subject line so it's easy for people who are scanning the board to see that you're needing help sooner rather than later.

Good luck with Joplin and keep on testing!
 
Wendy&Neko said:
Hi Cheryl - I see you shot 2U today. Unless Joplin goes under 50, you should try to stay with this dose at least 6 cycles so we can see what it does. From yesterday's data it looks like Joplin's Lev nadir is somewhere around +8 or +9 so try to get a test in there if you can.

How is Joplin doing now that it's a couple days after his hypo incident? He acting any different, is he eating, using LB OK?
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Hi Wendy....sorry, I tried to wait but frankly I haven't slept myself in about 3 days and was about to pass out so I went with my instinct with giving him the 2u. Chris (referring to her post below), that's always been my issue....using the pre-shot number to judge how much to give. When will I learn? Sigh. If all goes well today with the 2, I will hold it, I promise :)

Joplin is doing very well. He is eating, using litterbox all as normal. One thing that has changed is he keeps climbing into my lap and cuddling up, which is something he's never really done! He used to maybe climb up for a second, let me pet him and jump down but he's been kneading my tummy and curling up for half hour at a time which is unlike him. He's just as feisty with the other cats, and meowing loudly randomly around the house as before though (which is actually the reason I brought him to the vet in the first place when he was first diagnosed!!)
 
hi cheryl!

dosing based upon the preshot is a hard habit to break! just make a practice of looking for the low numbers in the past 3 days, then comparing it to the TR protocol and deciding if the nadirs say you should hold the dose longer or increase. if you're going to err, i'd err on the side of holding the dose TOO long, rather than moving it too quickly.

you're not even 3 days yet from the symptomatic hypo. i don't think you want to dose yet as if all is normal. that isn't normal - that was a significant, dangerous event. As low as he got, i would've expected a bounce that would've lasted for several days, but even yesterday Joplin got to 111. You do want to use caution right now. Since you're at the 2.0u, i'd stay there, as both Chris and Wendy suggested. sit on your hands and give him at least another 3 days of lots of monitoring and don't change the dose for at least that long.

that would be holding til at least Thursday morning.

A symptomatic hypo will often change a cat's response to insulin, making them MORE sensitive. Sometimes the pancreas is so shocked by the hypo that it will begin producing insulin again and the cat will go OTJ.

You want to be patient and make sure he hasn't become overly-reactive to it. Here's the condo where the cat went OTJ after the hypoglycemic event. you might gather some important info from reading it.
 
I just want to clarify Chris' post above. When a diabetic cat (or anyone) experiences extremely low BG numbers, the ensuing response is NOT because the organs presume they are starving. The excess insulin is moving whatever glucose that's in the bloodstream into the cells which is why when you measure BG, the numbers are low.This is because there is an excess amount of insulin and not because there's no available food. We can presume that this makes our cats hungry -- and if food is available, they will spontaneously eat. It is also not a response that is confined to the liver. Both the liver and pancreas respond to low numbers in a method that is protective. Every organism needs glucose to live. Thus, when BG drops too low, the liver and pancreas react by releasing glucagon and counterregulatory hormones. These substances cause a sharp rise in BG in order to protect your kitty from low BG levels. This spike in numbers is what we refer to as a bounce.

With starvation, the response is somewhat different in that stored fat and protein are part of the response. When fat and protein are being metabolized, ketone bodies appear in the blood. Glucagon stores are depleted within 24 hours in humans -- probably less time in cats since their metabolism is faster. It's useful to keep in mind that you're not starving your cat. With diabetic hypoglycemia, there's an excess of exogenous insulin rather than an absence of food.
 
Sienne and Gabby said:
I just want to clarify Chris' post above. When a diabetic cat (or anyone) experiences extremely low BG numbers, the ensuing response is NOT because the organs presume they are starving. The excess insulin is moving whatever glucose that's in the bloodstream into the cells which is why when you measure BG, the numbers are low.This is because there is an excess amount of insulin and not because there's no available food. We can presume that this makes our cats hungry -- and if food is available, they will spontaneously eat. It is also not a response that is confined to the liver. Both the liver and pancreas respond to low numbers in a method that is protective. Every organism needs glucose to live. Thus, when BG drops too low, the liver and pancreas react by releasing glucagon and counterregulatory hormones. These substances cause a sharp rise in BG in order to protect your kitty from low BG levels. This spike in numbers is what we refer to as a bounce.

With starvation, the response is somewhat different in that stored fat and protein are part of the response. When fat and protein are being metabolized, ketone bodies appear in the blood. Glucagon stores are depleted within 24 hours in humans -- probably less time in cats since their metabolism is faster. It's useful to keep in mind that you're not starving your cat. With diabetic hypoglycemia, there's an excess of exogenous insulin rather than an absence of food.
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sienne, thank you very much for clarifying chris/china's post.

chris: you might want to use the strike-out feature to strike the 3rd paragraph of your post to avoid confusion. :mrgreen:
thank you.
 
Julie, I will hold until Thurs. morning (unless he falls below 50). Thank you, and thanks to everyone else for your helpful advice and information. I'm a little concerned about tomorrow, as I have to leave for work at 8am and won't be home until 4pm :sad: I'm going to leave extra bowls of wet food out and check in on my webcam as often as I can. Normally my husband is home in situations like this, but he's traveling this week :-/
 
That's the best thing to do ....Just leave some food down. You might want to add a little water so it doesn't dry out as much.

Another option for "next time" would be to buy an auto feeder and set it to open when you want to offer Joplin food, or you can make "foodcicles" by mixing some water with some canned food and putting it into an ice cube tray or muffin pan to freeze. Once frozen you can pop them into a baggie and keep them in the freezer. Most cats won't eat what they can't smell, and frozen food doesn't smell as much like food, but after awhile when it thaws, it will once again smell like food and they'll eat it.

Now some cats will eat it frozen, so this is something you should experiment with first! :lol:
 
julie & punkin (ga) said:
You want to be patient and make sure he hasn't become overly-reactive to it. Here's the condo where the cat went OTJ after the hypoglycemic event. you might gather some important info from reading it.
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Julie, I just read this entire thread. WOW, it had me at the edge of my seat!! Very helpful to read (and hopeful as well). Thanks for sharing!
 
it was scary. i'm glad you read through it.

i'm also glad Jill weighed in on how to move ahead for you and Joplin. She has the experience that you need at this time.
 
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