New Member, 6mo post-Dx, can’t regulate, please help

[Jay Dee]

@Jay Dee no problem, I hope Snuggies numbers start to come down , we will just have to see how he does, you can always tag for help.I'm glad your spreadsheet is all ready fo go tomorrow when you use the human meter
He looks like a cutie , how old is he

@Diane Tyler's Mom thabk you! We think he’s around 15

 

[Sienne and Gabby (GA)]

It looks like you just increased Snuggle's dose If you are going to stick with a 4.0u dose, please stick with the dose. And, please get a before bed test EVERY night. If you don't test during the PM cycle, you're missing half of your data. Many cats experience lower numbers during the PM cycle. It that's the case with Snuggle, it may go a long way to explaining the higher numbers.

What does "Custom/panic" mean in your signature?

 

[Jay Dee]

It looks like you just increased Snuggle's dose If you are going to stick with a 4.0u dose, please stick with the dose. And, please get a before bed test EVERY night. If you don't test during the PM cycle, you're missing half of your data. Many cats experience lower numbers during the PM cycle. It that's the case with Snuggle, it may go a long way to explaining the higher numbers.

What does "Custom/panic" mean in your signature?

@Sienne and Gabby (GA) someone suggested I go back to 4 and thinks I will need to increase to 6. I don’t know who to listen to anymore: I’m about ready to leave and just figure this out on my own

I’ll stick with 4 til 4 doesn’t work

custom was an option I saw. Panic is that we have been treating a few other things ans he almost died a few times

 

[Marje and Gracie]

All - since his max dose was 6 and his last good dose was 4, is going from his current 2.5u to 4u at his next dose considered fast tracking an increase? Or is fast tracking anything beyond a max dose?

Fast tracking is where we take the dose up a little faster when the BG is over 400 all the time. For example, instead of waiting six cycles, we might increase after four or we might wait six cycles but increase by 0.5u instead of 0.25u. There are different ways to do it depending on the insulin and the cat and that’s why it is really, really important to work with someone who is very experienced at it. Fast tracking also involves very closely monitoring.

As Wendy said, taking him back to 4u is just getting him back to a dose he was at before and shouldn’t have been reduced from.

We have a dosing method for PZ on the PZ insulin support group so I suggest you read through all those files. It will give you some guidance on how the dose can be increased (fast tracking is more aggressive).

 

[Jay Dee]

@Marje and Gracie thabk you: I’m on info overload at the moment. My cat literally had like 5 things wrong with him at once and was at ER vet once. I’m not sure picking 4u and just sticking with it is right but he’s at 4 now and I’ll test a few times and stick with it for a few days til I see if it’s working. I think I need a few days to absorb all this info and talk w my vet.

 

[Chris & China (GA)]

I’m not sure picking 4u and just sticking with it is right but he’s at 4 now and I’ll test a few times and stick with it for a few days til I see if it’s working.

We won't keep him at 4U if he proves he needs more (which he probably will) but with all the dose changes and all the medical stuff he's been through, we just want to get a stable baseline for how he is doing NOW. When it comes to feline diabetes, things that happened a month ago can be very old news and have nothing to do with what's going on now.

Hang in there. We're all going to do everything we can to help!

 

[Marje and Gracie]

@Marje and Gracie thabk you: I’m on info overload at the moment. My cat literally had like 5 things wrong with him at once and was at ER vet once. I’m not sure picking 4u and just sticking with it is right but he’s at 4 now and I’ll test a few times and stick with it for a few days til I see if it’s working. I think I need a few days to absorb all this info and talk w my vet.

Just remember that we are very accustomed to seeing these kinds of situations which means we have your back. If you are testing and we see it’s too much insulin, we will let you know. If it’s too little, we will also let you know. I suspect, for many reasons, that the dose will need to go up but...baby steps.

 

[Diane Tyler's Mom GA]

@Sienne and Gabby (GA) someone suggested I go back to 4 and thinks I will need to increase to 6. I don’t know who to listen to anymore: I’m about ready to leave and just figure this out on my own

I’ll stick with 4 til 4 doesn’t work

custom was an option I saw. Panic is that we have been treating a few other things ans he almost died a few times

@Jay Dee
Hi Jill just checking in, please don't leave, I know you have been told to change the dose many times by a Facebook group, which was wrong. Please stay and listen to @Marje and Gracie
@Chris & China (GA)

@Wendy&Neko

they will help you, when you see the 4 units isn't doing much please tag them and ask for advice. Like Wendy said you may have to get him checked for Acro
She gave you the codes and info in #33 above.
I assume Sienne didn't read your first post above and didn't see what the Facebook forum gave you wrong info about dosing.
So please don't leave ok ♥
Did you happen to test for ketones yet

 

[Diane Tyler's Mom GA]

I see Wendy gave you the info below if you need to check for acro




The tests you want are only done at Michigan State University. You want the following:
https://vdl.msu.edu/Bin/Catalog/Catalog.exe
Search for code 20005 for acromegaly or IGF-1 test. Positive is over 92.
Search for code 20031 for IAA test.
A result > 20% is considered positive for IAA.

If you do switch to Levemir just post and tag Wendy, Marje or Chris and they can advise you what dose to start with

Jill if possible after you test his PMPS can you then test maybe @+ 3 and then @+6
Same goes for the AMPS
Hang in there ok

 

[Jay Dee]

I’m still here. Had to take a break last night, I spent all day pouring rhru all the info and advice on here and had a meltdown.
I did a PMPS and a +3 last night. A PM+6 is 2am my time and I have a full time job but if it’s absolutely necessary as a baseline I can do it on occasion.

I guess my next crisis is how the heck do I tell my vet that I made these sh!tty decisions to drop his dose without consulting him? As I mentioned he’s super supportive of my home testing and seems to support dose adjustments but in my mind if numbers are high and flat at 6, may as well see if they improve with less insulin. I guess if we go back to 6 or more I’ll hear the “I told you so” and why I should just listen to him. But going back to 4 sounded reasonable. It’s the drop to 2 I may have a tough time explaining.

I tested for ketones yesterday and the strip turned gray all 3 times. He was his usual self tho and his appetite was fine, no vomiting, same today but I’m set up to do it again.

 

[Marje and Gracie]

I’m still here. Had to take a break last night, I spent all day pouring rhru all the info and advice on here and had a meltdown.
I did a PMPS and a +3 last night. A PM+6 is 2am my time and I have a full time job but if it’s absolutely necessary as a baseline I can do it on occasion.

I guess my next crisis is how the heck do I tell my vet that I made these sh!tty decisions to drop his dose without consulting him? As I mentioned he’s super supportive of my home testing and supports dose adjustments (well his primary is, his backup vet not so much) but in my mind if numbers are high and flat at 6, may as well see if they improve with less insulin. I guess if we go back to 6 or more I’ll hear the “I told you so” and why I should just listen to him. But going back to 4 sounded reasonable. It’s the drop to 2 I may have a tough time explaining.

I tested for ketones yesterday and the strip turned gray all 3 times. He was his usual self tho and his appetite was fine, no vomiting, same today but I’m set up to do it again.

Remember your vet works for you. You don’t have to be afraid to be honest with him. If he says, “I told you so”, then tell him you agree and now it’s time to focus on moving forward to help Snuggie. Then move on to the next question or discussion

No one should beat you up for doing what you thought was best for your baby. You are certainly not the only one that has ever done what we call a “rebound check”. Many new members, especially coming from the FB group you were in (not the one associated with FDMB) have done it. Now we just focus on helping Snuggie towards regulation.

We know it’s a lot at once; we try to not dump it all on you but there are things that just have to be read and learned from the get-go. We are a great support group and you can let us know what your questions are and whether you are getting overwhelmed. However, the bottom line is you are still his primary source for helping him improve. That’s a lot of pressure but we’ve all been there and you will be surprised where you are in what you’ve learned here and how much more at ease you are when you look back in a month.

 

[Diane Tyler's Mom GA]

Hey Jill it's ok to have a melt down, I understand
Yes if on occasion it would be helpful to get that @+6 at night
When you say the strip turned gray , so no ketones
I never had to test for them did you follow the instructions on the bottle and check exactly 15 seconds later and compare the color on the strip to the colors on the bottle
I don't see gray
.

 

[Diane Tyler's Mom GA]

Remember your vet works for you. You don’t have to be afraid to be honest with him. If he says, “I told you so”, then tell him you agree and now it’s time to focus on moving forward to help Snuggie. Then move on to the next question or discussion

No one should beat you up for doing what you thought was best for your baby. You are certainly not the only one that has ever done what we call a “rebound check”. Many new members, especially coming from the FB group you were in (not the one associated with FDMB) have done it. Now we just focus on helping Snuggie towards regulation.

We know it’s a lot at once; we try to not dump it all on you but there are things that just have to be read and learned from the get-go. We are a great support group and you can let us know what your questions are and whether you are getting overwhelmed. However, the bottom line is you are still his primary source for helping him improve. That’s a lot of pressure but we’ve all been there and you will be surprised where you are in what you’ve learned here and how much more at ease you are when you look back in a month.

Thank you @Marje and Gracie
I feel so bad for Jill and Suggie

 

[Jay Dee]

@Diane Tyler's Mom @Marje and Gracie
Thank you both! I did read thru the dosing guide and a bunch of other stuff and my head was just spinning. I’ll reread a few more times to let it all sink in.

We did the ketone thing again today - an obvious negative so that’s a relief.

Switched to the human meter today. Low 400s AMPS and AM+3.

I called the vet and they don’t stock Levemir, so I’ll discuss the change at his 4/29 appt. If we decide on the switch, I can at least buy a bottle of ProZinc to tide him over til it comes in. I can’t return it for any $ but they will accept it as a donation, so at least it won’t go to waste.

But - should I wait until we see what the 4u and possibly more do? And/or to see what the acro and IAA test results are before committing to the switch?

 

[Wendy&Neko]

Great job getting that +3 last night, that's enough to tell us he wasn't dropping low the rest of the night. Usually you'll see a much larger drop early on if that is going to happen.

Vets don't generally stock the human insulins (Lantus and Levemir). They give you a paper prescription that you take to a human pharmacy. If you decide to fill the prescription in Canada (Marks is a real bricks and mortar pharmacy - 25 minutes from where I live), you just fax/scan and email the prescription to them. They have great customer service and can help you through it. In the mean time, phone around local pharmacies for pricing, I have heard of some people being able to get a single pen to tide them through. Or check out our Supply Closet forum where people are getting rid of supplies they no longer need.

But - should I wait until we see what the 4u and possibly more do? And/or to see what the acro and IAA test results are before committing to the switch?

We should know within a few days what 4 units is doing for Snuggle. This isn't a rush, we can wait on the decision. However, if for any reason he needs larger amounts of insulin, I think you'd find the other insulins will do a better job.

 

[Diane Tyler's Mom GA]

Glad there are no ketones!

 

[Chris & China (GA)]

But - should I wait until we see what the 4u and possibly more do? And/or to see what the acro and IAA test results are before committing to the switch?

If he were my cat, I'd ask my vet for a script for Levemir and send it to Marks ASAP so they can get it on it's way to you. It can take a little longer to get to you on the first order...7-10 days (sometimes sooner). Refills will come faster.

I know you're running low on ProZinc so you may have to buy another vial just so you have insulin to give him while the Levemir is shipped (or you could buy the Levemir from a pharmacy here in the US but that's going to cost you several hundred dollars ($300'ish). If you do get Levemir filled here, take a picture of your prescription before you take it to a pharmacy. That way you'll have it to send to Marks in Canada.

 

[Jay Dee]

YOU GUYS!!!! something just donned on me. When we adopted him at ~ 2 yrs old, the shelter said “you don’t want him, he’s got gingivitis” (I know, right??) ... and I was organizing his med folder the other day and it seemed we gave him a round of antibiotics maybe every other year (i complerely forgot what they were for til now) and I know we did a few dentals. He was on Royal Canin Oral Care dry food and Hills Oral Care before the diabetes Dx, and we used to give him CET Dental chews with kitty toothpaste on them. He had a nasty habit of chewing things like electrical cords, wood furniture, and shoes (the latter earning him the nickname Jimmy Chew)... We usually had the vet check his gums and his last vet in CA said he was super impressed and even said we could hold off on the dental before we moved to Utah. His checkup here before the diabetes Dx also was good with respect to his teeth ...

Since the diabetes Dx, obviously we changed his food and treats, I don’t know what toothpastes are safe, and I can’t find CET chews to save my life (they may not be good anyway). He lost interest in his gum massaging worm toys (and my shoes, thank goodness) since the Dx too. He never chewed his dry food but he LOVED those chews. He doesn’t seem to be in pain when he eats now, and he chews his PureBites with enthusiasm...

We do massage his gums with the kitty toothbrush but no paste.

Im hesitant at this point to do any anesthesia for a dental due to the CKD values and unregulated blood glucose, and he’s been on 3 kinds of antibiotics in the last month, but could this be part of his whole issue?? Maybe none of the antibiotics deal with gums (convenia, clindamycin, Orbax)?? I looked at his gums today and they are decidedly more red than pink near the teeth.

also - any recommendations for what’s safe for him tooth-wise?

(in other news, his +6 today was 350 and he actually played fetch with me - running down the hall - with more energy than he’s had in almost a year.....)

 

[Chris & China (GA)]

could this be part of his whole issue??

Absolutely! Dental disease can cause all kinds of trouble, including insulin resistance. Also, it sounds like he may have some painful teeth too and pain can raise the BG too.

any recommendations for what’s safe for him tooth-wise?

If his teeth are in bad shape, he really needs a complete dental (which should include pre and post dental x-rays). Once the tarter is on the teeth, there's nothing you can use to get it off. It must be "chipped off" with dental instruments.

Once they're clean, you can help keep them that way by "brushing" with plain old water. Take a piece of wet cotton gauze and rub it along his gumline to help remove the plaque.

Another option is to give him chicken wings, necks, kidneys, livers, gizzards or hearts to chew on. Cats in the wild keep their teeth in good shape by grinding and chewing against bone, sinew and cartilage. Chicken "innards" are fibrous so have to be chewed well which helps break up the plaque on the teeth. Chewing on raw bones mimics the scraping that helps break off the plaque before it can get too hard to clean without another dental.

he actually played fetch with me - running down the hall - with more energy than he’s had in almost a year.....)

WOO HOO!! Great to hear he seems to be feeling good today!

 

[Jay Dee]

@Chris & China (GA) daaang! Ok I will mention this all to his vet on Thursday. Could this reverse any insulin resistance or should I just continue on w the plan to switch to Levemir?

also - any concerns for anesthesia as a kidney cat & unregulated diabetes?

i massaged his gums good today so I wonder if he was trying to tell me something. It was literally 30 min later that he was playing

 

[Chris & China (GA)]

Could this reverse any insulin resistance or should I just continue on w the plan to switch to Levemir?

It's possible, but I'd go ahead and plan on switching either way. I think the L insulin's seem to work better for most cats (but I'm a little prejudiced since it's what I know best)

any concerns for anesthesia as a kidney cat & unregulated diabetes?

Ahhh....and there's the problem....a lot of vets won't do dentals unless the cat is controlled....but without the dental, it's almost impossible to get that control they want!

Newer anesthetics are much safer than the ones they used to use and a vet should always do routine bloodwork before anesthesia to make sure the kidneys, liver, etc. are all working well enough to tolerate the anesthesia. China had her very first dental at age 15 and had 8 teeth extracted. Was eating later that evening. There are lots of us here who've had dentals done on our older cats and they do great. Will it guarantee to bring the BG down? No...but as least you'll know your cat isn't in tooth pain. Quality of life is important too...who wants to live with a toothache?

I had to go over an hour away to find a vet who could do dental x-rays. Some vets consider cleaning just the visible surface of the tooth is good enough but teeth are like ice burgs....2/3rds of them are under the gums where you can't see what's going on without x-rays.

Here's some good information on dental procedures

 

[Jay Dee]

@Chris & China (GA) THANK YOU! I will definitely inquire about all of this on Thursday. Hehe yea my dad was a dentist so I can relate to the iceberg comparison!

 

[Marje and Gracie]

Alflaxalone (aka Alfaxan) is a more recent anesthesia that keeps the BG from falling after the procedure. Checking labs before the dental will let them know if there is any issue with the kidneys.

Clindamycin is an excellent antibiotic for the mouth.

 

[Diane Tyler's Mom GA]

That's such good news that he was playing fetch with you, it makes me happy!
Love seeing those pinks

 

[Jay Dee]

That's such good news that he was playing fetch with you, it makes me happy!
Love seeing those pinks

Got a red at PM+3.5 but barely - we forgot to heat his fluids so had to give them at the same time as his insulin today - which we try not to do (usually 2 hrs apart or more).
Plus usually I can get the fluids and insulin into different sides but I think we kind of overlapped today - so I’m not sure he’s getting the best insulin bang for buck tonight. I’ll try to get a PM+3 and +6 tomorrow!

YES he had pushed a toy down the top step and when I got it he was interested - figured I’d toss it and see what happened. I was so encouraged to see he wasn’t even walking “wonky” in his back end

 

[Jay Dee]

@Diane Tyler's Mom @Marje and Gracie @Chris & China (GA) @Wendy&Neko

ok - we have some data at 4u (injected too close to fluids injection area last night so may have interfered w insulin absorption).

what are your thoughts so far? Should I try for that PM+6 tonight? (I didn’t want to waste it last night considering the issue we had)

no ketones today either and he’s acting fine...

I’ll be busy this evening but will check when I can. Thanks for your help and advice!!

 

[Chris & China (GA)]

Stick with the 4U dose tonight....You don't necessarily need to stay up until +6...if you can get a +2 or +3 before bed, we can usually tell if you really need to plan on setting an alarm to get more tests.

It would be good if you'd try to get some tests at other points in the AM cycle too. Maybe one day get a +3, +7, another day get a +2, +5, +8...just look for big patches where there's a lot of white and get a test.

 

[Jay Dee]

@Chris & China (GA) thank you! I’m super tired tonight so will get a bedtime one. I expect he’ll be in the 300s again...

And you answered my exact next question

thanks!!