Need dose advice

[Krista & Copernicus]

Note: all my data is not from the same source. As Copernicus loses weight, I have more trouble with libre. Then I went to AlphaTrak per vet. Now I am using Keto Mojo so I can test both glucose and ketones on one meter. I think I got a libre on him tonight. He had such a good day yesterday, followed by a horrible day today.

4/13: fPL = 9.6
4/17: fPLI = 19.2 ug/L
4/24: lipase = 795
4/24: catalyst pancreatic lipase = 2.1
*5/7: lipase 5,599 !
**5/7: catalyst pancreatic lipase = > 50!

Have you ever seen number this high, can he even recover from this?

I have been giving cerenia, Zofran, fluids, buprenorphine (but the vets did subQ not oral) as needed because he was still eating, but now I am trying to do more consistently.

4/6: 9 lbs
4/12: 8.94
5/2: 8.62
5/5: 8.44
5/9: 8.22

He was on a food called Identity pork and pork broth for suspected IBD,. Now I am making him boiled chicken, egg yolks, lean pork loin. I am trying to switch to a novel rabbit. Doing Tiki rabbit and chicken until Rawz rabbit arrives in the mail. Waiting to talk to a nutritionist.

He IS eating.

Thank you,
Krista

 

[Bandit's Mom]

I'm linking your other condo where you're getting dosing help.
? - Copernicus - DK update (help)

 

[Staci & Ivy]

I hope Copernicus had a better night

 

[Marje and Gracie]

Note: all my data is not from the same source. As Copernicus loses weight, I have more trouble with libre. Then I went to AlphaTrak per vet. Now I am using Keto Mojo so I can test both glucose and ketones on one meter. I think I got a libre on him tonight. He had such a good day yesterday, followed by a horrible day today.

4/13: fPL = 9.6
4/17: fPLI = 19.2 ug/L
4/24: lipase = 795
4/24: catalyst pancreatic lipase = 2.1
*5/7: lipase 5,599 !
**5/7: catalyst pancreatic lipase = > 50!

Have you ever seen number this high, can he even recover from this?

I have been giving cerenia, Zofran, fluids, buprenorphine (but the vets did subQ not oral) as needed because he was still eating, but now I am trying to do more consistently.

4/6: 9 lbs
4/12: 8.94
5/2: 8.62
5/5: 8.44
5/9: 8.22

He was on a food called Identity pork and pork broth for suspected IBD,. Now I am making him boiled chicken, egg yolks, lean pork loin. I am trying to switch to a novel rabbit. Doing Tiki rabbit and chicken until Rawz rabbit arrives in the mail. Waiting to talk to a nutritionist.

He IS eating.

Thank you,
Krista

Welcome to this insulin support group.

On the pancreatic tests results, I know it is difficult but I think it is more important to focusing on getting him feeling better, as I know you are doing, and getting his BG under control than worrying about the actual test number from the pancreatic tests. We know he has pancreatitis and he feels pretty bad. He might even have chronic pancreatitis but first, we want him to feel better.

Just as an aside, while these tests can be accurate, they can also be a bit inaccurate. In a routine health check, the tests had an extremely high number for my little girl but she had no symptoms at all. Based on the tests, we did an ultrasound and her pancreas looked perfect.

I do not doubt at all that Copernicus has pancreatitis; his symptoms are most definitely there but that’s why I just would like to focus on that fact and getting him better rather than potential severity.

You are doing the right things: fluid, pain meds, cerenia, ondansetron, food, insulin. It takes time to recover from pancreatitis for kitties.

What dose insulin did you shoot last night? And when you say he had a good day vs a bad day, do you mean in the way he felt or his BG? It’s important we distinguish between the two.

Yes, his BG is high but I mentioned to you fast-tracking him until we start to see BGs under 300. Also, you indicate you are doing SLGS but if he is eating only wet food and no dry, I urge you to consider TR because the dose can be changed faster once we are done fast-tracking him. What dose did you think?

If you could please read our posting guidelines and start a new thread (we call them “condo” here) each day with the correct subject title, we’d appreciate it. Due to the members we have and this being a more advanced group than Main Health, posting the subject line correctly helps us keep track of everyone at a glance. Let us k is if you have questions about that.

I’m also removing the “?” Prefix since I’ve answered your question about dosing but let us know if you have more.

 

[JL and Chip]

Have you ever seen number this high, can he even recover from this?

I have been giving cerenia, Zofran, fluids, buprenorphine (but the vets did subQ not oral) as needed because he was still eating, but now I am trying to do more consistently.

My Charlie was a complicated case and had severe chronic pancreatitis along with IBD, kidney disease, hyperthyroidism, and diabetes. As for the chronic pancreatitis, it was a bear to get on top of, but we finally did. It took awhile to figure out what worked. So can cats recover? Yes. There are never guarantees, but pancreatitis flares aren’t uncommon in diabetics. Charlie was a train wreck and we were able to get him to a manageable state. But it took time. And lots of pepcid, subQ fluids, buprenorphine (injectable), novel protein food, patience and persistence. All we can really do is supportive care. Sounds like you’re doing everything right.

Pancreatitis can keep BG high. Copernicus is newly diagnosed as well, so you haven’t yet even had a chance to see what regulation might look like for him. It can feel impossible right now but try to take it one day at a time.

It’s easy to get stressed by a “bad” BG day. Cats have days where BG is higher for various reasons, but looking at a block of days gives you a better feel for trends and the overall picture. When looking at his spreadsheet, draw a box around several days’ worth of data and look at it as a block — a “10,000 foot view” so to speak. Sometimes that helps. The black “HI” readings are hard to see, I know. They happen. Try not to let them discourage you. But please do strongly consider TR to fast-track dosing changes. I don’t think you’ll regret going with that protocol … I am concerned, however, that you might regret NOT doing it.

As for urinating outside the box (as noted on your spreadsheet), is this common for Copernicus? If not, you might want to have him checked for a UTI. If you don’t want to haul him to the vet, even a free catch sample that you drop off, though not ideal, can provide clues. Also, is the soiling happening near the box or farther away? If near, it might be an “overshoot.” Cats don’t always squat as well or get entirely in the box when they’re sick or if they’re experiencing a bit of neuropathy, so urine can end up outside the box. If the soiling is farther away from the box, it can be a sign that he doesn’t feel well enough to go that far. A few extra temporary litter boxes (and definitely at least one on each floor of the home) can help. How’s that for lots of advice you didn’t ask for, lol??

Glad to see the ketones at 1.0. Yep, they can flux. But hey, let’s celebrate the positives when we get them.

 

[Krista & Copernicus]

My Charlie was a complicated case and had severe chronic pancreatitis along with IBD, kidney disease, hyperthyroidism, and diabetes. As for the chronic pancreatitis, it was a bear to get on top of, but we finally did. It took awhile to figure out what worked. So can cats recover? Yes. There are never guarantees, but pancreatitis flares aren’t uncommon in diabetics. Charlie was a train wreck and we were able to get him to a manageable state. But it took time. And lots of pepcid, subQ fluids, buprenorphine (injectable), novel protein food, patience and persistence. All we can really do is supportive care. Sounds like you’re doing everything right.

Pancreatitis can keep BG high. Copernicus is newly diagnosed as well, so you haven’t yet even had a chance to see what regulation might look like for him. It can feel impossible right now but try to take it one day at a time.

It’s easy to get stressed by a “bad” BG day. Cats have days where BG is higher for various reasons, but looking at a block of days gives you a better feel for trends and the overall picture. When looking at his spreadsheet, draw a box around several days’ worth of data and look at it as a block — a “10,000 foot view” so to speak. Sometimes that helps. The black “HI” readings are hard to see, I know. They happen. Try not to let them discourage you. But please do strongly consider TR to fast-track dosing changes. I don’t think you’ll regret going with that protocol … I am concerned, however, that you might regret NOT doing it.

As for urinating outside the box (as noted on your spreadsheet), is this common for Copernicus? If not, you might want to have him checked for a UTI. If you don’t want to haul him to the vet, even a free catch sample that you drop off, though not ideal, can provide clues. Also, is the soiling happening near the box or farther away? If near, it might be an “overshoot.” Cats don’t always squat as well or get entirely in the box when they’re sick or if they’re experiencing a bit of neuropathy, so urine can end up outside the box. If the soiling is farther away from the box, it can be a sign that he doesn’t feel well enough to go that far. A few extra temporary litter boxes (and definitely at least one on each floor of the home) can help. How’s that for lots of advice you didn’t ask for, lol??

Glad to see the ketones at 1.0. Yep, they can flux. But hey, let’s celebrate the positives when we get them.

Thank you! He pooped in the bath tub right next to his box. i added an extra box that is closer. He doesn’t close his eyes on the injectable bup, does that mean the dose is too high?

 

[Krista & Copernicus]

My Charlie was a complicated case and had severe chronic pancreatitis along with IBD, kidney disease, hyperthyroidism, and diabetes. As for the chronic pancreatitis, it was a bear to get on top of, but we finally did. It took awhile to figure out what worked. So can cats recover? Yes. There are never guarantees, but pancreatitis flares aren’t uncommon in diabetics. Charlie was a train wreck and we were able to get him to a manageable state. But it took time. And lots of pepcid, subQ fluids, buprenorphine (injectable), novel protein food, patience and persistence. All we can really do is supportive care. Sounds like you’re doing everything right.

Pancreatitis can keep BG high. Copernicus is newly diagnosed as well, so you haven’t yet even had a chance to see what regulation might look like for him. It can feel impossible right now but try to take it one day at a time.

It’s easy to get stressed by a “bad” BG day. Cats have days where BG is higher for various reasons, but looking at a block of days gives you a better feel for trends and the overall picture. When looking at his spreadsheet, draw a box around several days’ worth of data and look at it as a block — a “10,000 foot view” so to speak. Sometimes that helps. The black “HI” readings are hard to see, I know. They happen. Try not to let them discourage you. But please do strongly consider TR to fast-track dosing changes. I don’t think you’ll regret going with that protocol … I am concerned, however, that you might regret NOT doing it.

As for urinating outside the box (as noted on your spreadsheet), is this common for Copernicus? If not, you might want to have him checked for a UTI. If you don’t want to haul him to the vet, even a free catch sample that you drop off, though not ideal, can provide clues. Also, is the soiling happening near the box or farther away? If near, it might be an “overshoot.” Cats don’t always squat as well or get entirely in the box when they’re sick or if they’re experiencing a bit of neuropathy, so urine can end up outside the box. If the soiling is farther away from the box, it can be a sign that he doesn’t feel well enough to go that far. A few extra temporary litter boxes (and definitely at least one on each floor of the home) can help. How’s that for lots of advice you didn’t ask for, lol??

Glad to see the ketones at 1.0. Yep, they can flux. But hey, let’s celebrate the positives when we get them.

Welcome to this insulin support group.

On the pancreatic tests results, I know it is difficult but I think it is more important to focusing on getting him feeling better, as I know you are doing, and getting his BG under control than worrying about the actual test number from the pancreatic tests. We know he has pancreatitis and he feels pretty bad. He might even have chronic pancreatitis but first, we want him to feel better.

Just as an aside, while these tests can be accurate, they can also be a bit inaccurate. In a routine health check, the tests had an extremely high number for my little girl but she had no symptoms at all. Based on the tests, we did an ultrasound and her pancreas looked perfect.

I do not doubt at all that Copernicus has pancreatitis; his symptoms are most definitely there but that’s why I just would like to focus on that fact and getting him better rather than potential severity.

You are doing the right things: fluid, pain meds, cerenia, ondansetron, food, insulin. It takes time to recover from pancreatitis for kitties.

What dose insulin did you shoot last night? And when you say he had a good day vs a bad day, do you mean in the way he felt or his BG? It’s important we distinguish between the two.

Yes, his BG is high but I mentioned to you fast-tracking him until we start to see BGs under 300. Also, you indicate you are doing SLGS but if he is eating only wet food and no dry, I urge you to consider TR because the dose can be changed faster once we are done fast-tracking him. What dose did you think?

If you could please read our posting guidelines and start a new thread (we call them “condo” here) each day with the correct subject title, we’d appreciate it. Due to the members we have and this being a more advanced group than Main Health, posting the subject line correctly helps us keep track of everyone at a glance. Let us k is if you have questions about that.

I’m also removing the “?” Prefix since I’ve answered your question about dosing but let us know if you have more.

 

[Krista & Copernicus]

Thank you! I shot 3.5 in the A.M. and it did not bring him below HI. I went back to 3.0 because he didn’t eat as much for dinner. When I say good day that means he is sitting up for meals and sleeping comfortable verses a bad day is drowning himself in the water bowl and constantly laid flat out on the floor not moving. Or moving too much from discomfort. I do have one question around this new dosing protocol because his vet called and gave me a warning. You can see in his sheet that he bounces and has some good BG days below 400 and then he goes back up. She is concerned (with his severe pancreatitis) that if his pancreas wakes up and we are increasing the dose that he could go hypo? Thoughts?

 

[Staci & Ivy]

Thank you! I shot 3.5 in the A.M. and it did not bring him below HI. I went back to 3.0 because he didn’t eat as much for dinner. When I say good day that means he is sitting up for meals and sleeping comfortable verses a bad day is drowning himself in the water bowl and constantly laid flat out on the floor not moving. Or moving too much from discomfort. I do have one question around this new dosing protocol because his vet called and gave me a warning. You can see in his sheet that he bounces and has some good BG days below 400 and then he goes back up. She is concerned (with his severe pancreatitis) that if his pancreas wakes up and we are increasing the dose that he could go hypo? Thoughts?

It's a valid concern about the pancreas waking up. With either the Libre (if still working) and or testing with blood tests, you will see how he is trending. If he begins to see lower BG, you would certainly discuss reducing the dose to avoid a hypo situation.

How is he doing today? I hope he's feeling better. Sending you both hugs!

 

[Wendy&Neko]

She is concerned (with his severe pancreatitis) that if his pancreas wakes up and we are increasing the dose that he could go hypo?

It's not like his pancreas will be inflamed one day and perfectly fine the next. Healing is gradual. You have time to respond by lowering his insulin dose should his numbers get anywhere near 100. Bouncing is perfectly normal and very annoying to us. Cats who aren't used to numbers in the 200's can still bounce if they are used to numbers above 300.

I agree with Marje that TR would be a much better dosing method for your boy. I think you should go back to 3.5 units tonight. 3.0 units was not enough insulin and his nadirs were all above 300. There are several of us who have been in your shoes and wondered if the dose was too high because of the high numbers. It was not, the dose was too low. Marje was one of those who coached me way back when I joined.

You also don't need to reduce his dose if he doesn't eat as much for dinner. Lantus does not hit hard and fast, you have time to get food in him. We have several members whose cats are grazers, that's OK.

Speaking of food, food transitions and changes need to be done slowly or they can cause upset tummy. Especially in a kitty with IBD. It can take time to see if a food change is working, especially with pancreatitis in the picture.

He doesn’t close his eyes on the injectable bup, does that mean the dose is too high?

What is his bupe dose and how much does he weigh? I'm used to giving oral bupe, but did have one kitty on too high a dose when the emergency vet gave me some that was more concentrated than I was used to.

 

[Marje and Gracie]

Thank you! I shot 3.5 in the A.M. and it did not bring him below HI. I went back to 3.0 because he didn’t eat as much for dinner. When I say good day that means he is sitting up for meals and sleeping comfortable verses a bad day is drowning himself in the water bowl and constantly laid flat out on the floor not moving. Or moving too much from discomfort. I do have one question around this new dosing protocol because his vet called and gave me a warning. You can see in his sheet that he bounces and has some good BG days below 400 and then he goes back up. She is concerned (with his severe pancreatitis) that if his pancreas wakes up and we are increasing the dose that he could go hypo? Thoughts?

You can’t expect an immediate response with Lantus. It is a depot insulin which is what makes it longer lasting than a fat-acting insulin which might drop the BG quickly but has much shorter duration.

Using Lantus is the gold standard but you have to have patience. Hopping around his dose does not help him.

It sounds to me like he might have been given too much buprenorphine. It has a wide range of dosing but I have found with both my cats, the lower end works better for them. Perhaps you should call the vet you trust most and ask bout the dosing and method of dosing.

 

[JL and Chip]

What is his bupe dose and how much does he weigh? I'm used to giving oral bupe, but did have one kitty on too high a dose when the emergency vet gave me some that was more concentrated than I was used to.

Last weight from a couple of days ago was 8.1 lbs (per previous post and spreadsheet).

Bupe dosing (per previous thread) is:

.5 mg/mL per mL say to give .04 mL under the skin

@CopernicusDM is the above correct? I’m also curious—did the vet pre-load the syringes or give you an ampule/vial from which to draw the bupe yourself?

I don’t recall seeing the symptoms you described when using injectable bupe.

Edited to add: I agree with what the others have said about pancreatitis being a slow process of healing. It’s not an on/off switch. You’re monitoring BG so you’ll have data giving you ample warning and be able to adjust dose as needed when the time comes.

 

[Krista & Copernicus]

You can’t expect an immediate response with Lantus. It is a depot insulin which is what makes it longer lasting than a fat-acting insulin which might drop the BG quickly but has much shorter duration.

Using Lantus is the gold standard but you have to have patience. Hopping around his dose does not help him.

It sounds to me like he might have been given too much buprenorphine. It has a wide range of dosing but I have found with both my cats, the lower end works better for them. Perhaps you should call the vet you trust most and ask bout the dosing and method of dosing.

I understand it would take time, but his glucose is worse now as I go up as opposed to the nice trending down I saw around 2-2.5. I got a 554 at PMPS tonight. I don't see hopping. I see incremental increases, except 1 night he didn't eat much I dropped by half. The vet instructed me to give half if he doesn't eat.

I got oral bup. tonight so I will have to try the dosing. He's so little!

 

[Krista & Copernicus]

It's not like his pancreas will be inflamed one day and perfectly fine the next. Healing is gradual. You have time to respond by lowering his insulin dose should his numbers get anywhere near 100. Bouncing is perfectly normal and very annoying to us. Cats who aren't used to numbers in the 200's can still bounce if they are used to numbers above 300.

I agree with Marje that TR would be a much better dosing method for your boy. I think you should go back to 3.5 units tonight. 3.0 units was not enough insulin and his nadirs were all above 300. There are several of us who have been in your shoes and wondered if the dose was too high because of the high numbers. It was not, the dose was too low. Marje was one of those who coached me way back when I joined.

You also don't need to reduce his dose if he doesn't eat as much for dinner. Lantus does not hit hard and fast, you have time to get food in him. We have several members whose cats are grazers, that's OK.

Speaking of food, food transitions and changes need to be done slowly or they can cause upset tummy. Especially in a kitty with IBD. It can take time to see if a food change is working, especially with pancreatitis in the picture.


What is his bupe dose and how much does he weigh? I'm used to giving oral bupe, but did have one kitty on too high a dose when the emergency vet gave me some that was more concentrated than I was used to.

He basically stopped eating his regular diet so I didn't have time to transition like I normally would. He's 8.2 pounds. I picked up some oral instead of the subq. It's .5mg/ml and they want me to give .07 ml.

 

[JL and Chip]

I understand it would take time, but his glucose is worse now as I go up as opposed to the nice trending down I saw around 2-2.5. I got a 554 at PMPS tonight. I don't see hopping. I see incremental increases, except 1 night he didn't eat much I dropped by half. The vet instructed me to give half if he doesn't eat.

Remember, you don’t want look at a single cycle to draw conclusions about dosing. It’s easy to do that, but that’s not how Lantus works. The lower dose might seem correlated to better numbers, but correlation is not causation.

As hard as it is, you need to trust the protocol. It’s tried and true. I really encourage you to go with the 3.5u for now and try not to let the high numbers lead you astray. (We see this type of thing regularly—high numbers, the appearance that lower dose gives lower numbers, etc., but it’s a mirage. Seriously. Trust the protocol and the steady, methodical, data-driven dosing guidance it provides.)

 

[Marje and Gracie]

I agree with JL. If you don’t understand how Lantus works, you are less likely to use it to its maximum benefit. If you could just trust us, you will be amazed.

It is dose hopping when you don’t leave the dose the prescribed cycles (unless he were to drop below 50). His higher BG could be because he’s in pain or just the presence of the pancreatitis. He is also likely building glucose toxicity which will mean more insulin is required.

Look at Zero’s SS and how his BG has changed with our advice.

All we can do is give you our best dosing advice based on experience and knowledge developed over decades.