Kelley and Merlin - New Instructions from Vet

[Kelley and Merlin]

We had our weekly check up appointment with the vet today. Starting tonight:

Over 300 give 3 units
150-300 give 2 units
80-150 give 1 unit
Under 80 hold

Blood ketones were 2.8 at vet (down from 3.2 last week). Weight was 7.7 (down 2 ounces from last week). Received rx for Cerenia to give as needed 7.5 mg per 24 hours (we discussed Ondansetron and she felt the Cerenia would be more effective).

Going to start mixing in some diabetic wet food to wean off the baby food. I have the wet glycobalance but thinking about sending it back to Chewy for a refund since someone here said it is higher in carbs and they've seen cats go into remission when they get off it. I also have the wet Purina DM, but someone said not to give the selects and I think mine is selects. Why not selects?

We go back for another check next week.

 

[CORKY]

We had our weekly check up appointment with the vet today. Starting tonight:

Over 300 give 3 units
150-300 give 2 units
80-150 give 1 unit
Under 80 hold

Blood ketones were 2.8 at vet (down from 3.2 last week). Weight was 7.7 (down 2 ounces from last week). Received rx for Cerenia to give as needed 7.5 mg per 24 hours (we discussed Ondansetron and she felt the Cerenia would be more effective).
@Bron and Sheba (GA)
Going to start mixing in some diabetic wet food to wean off the baby food. I have the wet glycobalance but thinking about sending it back to Chewy for a refund since someone here said it is higher in carbs and they've seen cats go into remission when they get off it. I also have the wet Purina DM, but someone said not to give the selects and I think mine is selects. Why not selects?

We go back for another check next week.

 

[CORKY]

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

tonight:
Over 300 give 3 units
150-300 give 2 units
80-150 give 1 unit
Under 80 hold

Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot BG and we do not use a sliding scale here. Chopping and changing the dose every dose will mess with the depot and give you wonky numbers. I would definitely not recommend the dosing regime the vet suggested. That would be a backwards step.
With ketones in the picture, you need to be giving a consistent dose, and taking the number of ketones into consideration as well.
I think you should increase the dose to 2.25 units at the next dose and stay at the 2.25 unit dose unless Merlin drops under 50.
You are not feeding any dry food are you?

Blood ketones were 2.8 at vet (down from 3.2 last week)

Is he lethargic at all? How is his appetite?
Are you able to get a urine ketones test done? I’d be interested to see what that is showing you as you had a neg/ trace ketones urine test 2 days ago.

Received rx for Cerenia to give as needed 7.5 mg per 24 hours (we discussed Ondansetron and she felt the Cerenia would be more effective).

What was her reasoning not to give you the ondansetron. That is a shame as it is better for nausea than cerenia which is more for vomiting.

 

[Kelley and Merlin]

Mer's PMPS was 263 AT, 251 RO. I gave him the 2 units indicated above. I was glad it was under 300 because I didn't want to give him 3 units for the first time before we went to bed. If it had been over 300 tonight, I would have just given 2 units and waited until daytime to try 3 units.

 

[Kelley and Merlin]

I think we were posting at the same time.

Honestly, I'm a little worried about trying 3 units. I will try the 2.25 tomorrow to see if it helps.

No, he's not getting any dry food at all.

His blood ketones at the vet today were lower than last week, they were 2.8. At his lowest when he came home from the ER he was 2.4, so he is almost back to that level. I didn't get a urine ketone test today. Even at his worst in the ER, he hasn't had any urine ketones over a trace. I remember the ER vet saying he was not spilling over into his urine and it seems to have remained the same throughout this ordeal.

He's not lethargic at all. I mean, he's not running and playing, but he's old and generally lazy. If I didn't know better, I would think he was his old self. He has a great appetite.

I can't remember exactly what she said about the drugs. She said they were both good. She said the Cerenia does something in the brain which makes it more effective.

Do you know why Purina DM *selects* isn't a good food to choose? What Purina DM type should he eat if it isn't the *select*?

 

[Bron and Sheba (GA)]

Honestly, I'm a little worried about trying 3 units. I will try the 2.25 tomorrow to see if it helps.

If you are not giving any dry food, I think you should follow the TR protocol which is best if there are ketones or DKA.
Have a read of it and see if you are happy with it. If so, can you put TR into your signature and the SS please?
I’ll link the protocol below.
DOSING METHODS

Please don’t go up from 2 units to 3 units. As per the TR protocol, you would increase the dose by 0.25 units
Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

[QUOTE="Kelley and Merlin, post: 3227181, member: 31329"]Do you know why Purina DM *selects* isn't a good food to choose? What Purina DM type should he eat if it isn't the *select[/QUOTE]
I couldn’t see the selects in the food chart so I’m not sure but they might be higher carb. Have a look in the food chart and see other purina canned foods with lower carb content. Do you need to feed the purina food? There are lots of other foods available. Just look for canned foods that are 10% or lower foods.
FOOD CHART

 

[Kelley and Merlin]

This morning I was caught in a work meeting and was almost an hour late. Merlin's AMPS was 509 AT, 549 RO. He ate and I gave 2 units at 9:20am. I will read the above about TR protocol and then start it, but I need to understand it well first so i just gave the usual dose this morning.

 

[Kelley and Merlin]

Ok, I was gone most of the day, so Merlin only had his two pre-shot meals today. Tonight his PMPS was 195 AT, 157 RO. He ate and I gave him the usual 2 units @ 9:10pm. I've printed out all of the TR info to read over. Tonight his numbers are making me feel better. Idk if it is because he didn't eat much all day or not. We will see how things look tomorrow and then maybe I can try the .25 increase if he's going up.

 

[Bron and Sheba (GA)]

Ok, I was gone most of the day, so Merlin only had his two pre-shot meals today. Tonight his PMPS was 195 AT, 157 RO. He ate and I gave him the usual 2 units @ 9:10pm. I've printed out all of the TR info to read over. Tonight his numbers are making me feel better. Idk if it is because he didn't eat much all day or not. We will see how things look tomorrow and then maybe I can try the .25 increase if he's going up.

Because it is a lower than normal preshot tonight, I would get a +2 to see what he has in mind for the cycle.

 

[Kelley and Merlin]

Sorry, I miss some evening posts bc we fall asleep. This morning he was at 238 AT, 206 RO. I gave the usual 2 units. Maybe he's coming out of his bounce and going to do well with just the 2 units?

I also think he's feeling better because he's being his crusty old man self again. He's over me sticking him in the ears and isn't shy about telling me so.

 

[Kelley and Merlin]

So frustrating. After a couple of days of much better numbers, this morning he is super high again with 665 AT and HI RO. I guess I will do the 2.25 units this morning to see if that helps.

 

[Kelley and Merlin]

Ugh, my syringes only have half unit marks. I did the best I could. It was less than 2.5, but more than 2.

 

[CORKY]

So frustrating. After a couple of days of much better numbers, this morning he is super high again with 665 AT and HI RO. I guess I will do the 2.25 units this morning to see if that helps.

The continued change in dose amount, May well be the cause of big bounces, it takes several cycles with the recommenced dose to begin able to see a change in his BG, I have not seen here any member increase a dose according to the BG for that day, and if your cat is not eating and you are dosing in an empty stomach can be dangerous, especially such high dose, try as Marje suggested, to get the SS filled out so the dosing experts can help you regulate him,

 

[Sienne and Gabby (GA)]

Is there any way you can routinely get at least one test during the PM cycle? It's going to be particularly important if you're out of the house all day.

If I knew that my crystal ball was working, my guess is that Merlin's numbers may have dropped more during the PM cycle on 12/11. He's not used to spending time in blue numbers and this triggered a bounce. His numbers were heading up throughout the AM cycle on 12/12. They likely continued to rise during the PM cycle until they got truly ugly this morning. If you look at your data from 12/5, you'll see a similar pattern where numbers dropped to 112 and then skyrocketed.

Bounces are truly annoying. They are not dangerous though. It can take 3 days (and for some cats even a bit longer) for the bounce to clear and numbers to get back to expected levels.

I'm not entirely clear on what Maria is telling you. It was fine to raise the dose. With SLGS, you hold the dose for 5 days which you had done. If you switch to TR, doses are held for 3 days. Please let us know if you have questions about TR.

 

[Kelley and Merlin]

Is there any way you can routinely get at least one test during the PM cycle? It's going to be particularly important if you're out of the house all day.

Hi Sienne. I was gone much of today, but got a +2.5 this morning before I left. 2.25 units had brought it down from 665 to 434 in 2.5 hours this morning. I just tested him and he was back at 539 on both the AT and RO. I just gave him another 2.25 units. Yes, I will try to get a +4 tonight.

If I knew that my crystal ball was working, my guess is that Merlin's numbers may have dropped more during the PM cycle on 12/11. He's not used to spending time in blue numbers and this triggered a bounce. His numbers were heading up throughout the AM cycle on 12/12. They likely continued to rise during the PM cycle until they got truly ugly this morning. If you look at your data from 12/5, you'll see a similar pattern where numbers dropped to 112 and then skyrocketed.

This makes sense. It is hard for me to see patterns because I'm so new to this. It just looks like chaos on the spreadsheet to me.

Bounces are truly annoying. They are not dangerous though. It can take 3 days (and for some cats even a bit longer) for the bounce to clear and numbers to get back to expected levels.

This makes me feel better. I was worried it was dangerous for him to do this.

I'm not entirely clear on what Maria is telling you. It was fine to raise the dose. With SLGS, you hold the dose for 5 days which you had done. If you switch to TR, doses are held for 3 days. Please let us know if you have questions about TR.

I do have some questions. Someone (I think Bron) said to try TR. So, I need to hold 2.25 for 3 days and then what? If still high, I go to 2.5?

 

[Kelley and Merlin]

Ok, I don't understand how, but Merlin's +4 after 2.25 units went from 539 to 727. This is starting to make me crazy. I just feel like crying.

 

[Sienne and Gabby (GA)]

Kelley -

Is Merlin getting into anything that's high in carbs? Baby food isn't terribly high in carbs but it often contains corn starch. Is there anything that Merlin can snatch that could be contributing to the high numbers? There are some cats that are quite adept at stealing carbs. (We had one cat that would snag waffles out of the toaster!!)

With TR, you evaluate the dose after 3 days/6 cycles. If the numbers are not in a normal range, you increase. There are parameters that go along with all of this (e.g., if you're starting to see more blue numbers) but that's the general idea.

 

[Kelley and Merlin]

Hi Sienne, I don't think he's getting into anything. I either feed the dogs outside or monitor Merlin's whereabouts when I'm feeding them inside and I make sure they clean their bowls. My son left some McD fries in a bag on the floor in the living room when I was gone yesterday and I got onto him. I don't think Merlin got into them though because they were deep in the bag and the bag was still upright. I can't think of anything else he could get into.

Ok, thank you. I will keep it up for three days straight (today is day 2) and then reevaluate for a potential dose increase.

 

[Kelley and Merlin]

At 8:15 tonight Merlin's BG was 277 AT and 254 RO. He ate well and I'm giving him the 2.25 units at 8:30pm. Tomorrow will be day 3 of the increased dose (up .25 unit). I'm going to check him at +4 tonight and make sure he isn't dipping really low and I'll feed him.

 

[Kelley and Merlin]

This morning Merlin was down to 191 AT and 174 RO. I stayed with the 2.25 units but will be around all day to monitor him. This is the lowest he's been PS on 2.25. I'll make sure he is eating and test him throughout the day.

 

[Kelley and Merlin]

Mer was 191 AT when I gave 2.25 units this morning. At +3 he had gone up to 288 AT. At +6 he was at 85 AT. He's eating, but had thrown up a tiny bit right before I tested his BG. I will be gone from around 4:30 or 5:00 until 8:00. What should I do?

I figured out what the unidentifiable stuff in his vomit was - tiny little pieces of the artificial tree greenery and some flocking. He insists on nibbling on it despite me telling him repeatedly to stop.

 

[Kelley and Merlin]

Yesterday Merlin's numbers were sooo good. This morning he has bounced back up. His AMPS was 579 AT and 595 RO. I gave him 2.25 units. This is day 4 of TR. Since he went down so good yesterday (lowest 85 AT at the AM mid-cycle), I don't feel safe upping his dose. What now? Is this bouncing something he may continue to always do?

 

[Sienne and Gabby (GA)]

It's not unusual for cats to bounce for a while. Most of us are clueless as to how long our kitty was diabetic prior to being diagnoses. Their body gets used to higher numbers. Once you start treating the diabetes and numbers drop into a better range, their liver and pancreas panic and as a result, you see a bounce. As they get more accustomed to spending time in lower range numbers, the bounces may become less frequent and/or become shorter. That said, not all cats play by the rules. Some cats appear to like bouncing. We find it terribly annoying but they refuse to listen and continue to bounce. Other cats, get really good at clearing a bounce.

 

[Kelley and Merlin]

Hi Sienne, thank you for the explanation. I just get worried that the bounces are hurting him, but someone (maybe you?) said the other day that they weren't dangerous. I just worry. I didn't get any AM follow-up readings today, but tonight he was at 273 AT, 243 RO. I gave the 2.25 units and will plan to test him around +4.

We go to the vet in the morning for another follow up. It is at the time he is due for his insulin, so I'll let them test his BG and give the insulin there. I'll also ask for another blood ketone test.

How do you know if/when you should increase on TR? I'm guessing since he came down yesterday to 88, I should just stay with this dose even if he's bouncing to really high numbers?