Normal numbers now what

[SmallestSparrow]

First yes I’m an idiot and horribly inept cat mom who needs to grow a pair. I’m just trying to figure out how what I should have done. I also have watched in awe as you all give 8U at pmps 100. I’m not there yet. I’d really appreciate opinions on how normal or not things are (I will go back to put in his earlier data in SS today if Methos ketones don’t increase and Tammuz’ pancreatitis lets him eat

Methos has been on Glargine since 1 Aug. slowly increased from 1U to 3.5 q12 without dramatic improvement. Some days he stays the same 300 all day. Others he goes up during a cycle. The last three weeks he’s had one day each week where suddenly it seems like the insulin is working. Better than I’m ready to handle. Then his pmps is lower than I’m comfortable giving an entire shot. Just as I thought I could maybe give 3.5 if he was below 200 he was 115 and there went my resolve. I should have given at least 1-2U I know, I kicked myself all night and cried this am. I can’t keep sending panicked texts to my poor vet.

I don’t know why I get a sudden good day—until last night it happended 36-48 hr after his b12 shot so I was beginning to wonder if it’s that ( @Heike & BInie and I both found interesting articles about that) but then 48 hr after a normal day (which my brain sees as low) he had another even more normal day (and today is paying for me skipping his shot). I’m going to make an appt for him to get repeat cortisol and aldosterone levels in case the sprianolactone (12.5 mg BID) and/or vetoryl (10 mg BID) are working too well (to be clear he’s been on those over a year, the DM is recent), or if his pancreatitis has improved (last fPL over 50, amylase & lipase above nml)—or this is just dm looking for a correct dose, or of course just me making bad decisions

My vet is probably going to reduce him to 3U today but now I’m wondering if I should have just given something last night and stayed the course on 3.5. Or if these sporadic drops to normal at pmps is means a decrease is in order but maybe to 3.25?

I just read an article @Wendy&Neko posted elsewhere that mentioned when vetoryl peaks (which I hadn’t been able to find before) and apparently it starts working at +2 and peaks at +4 (similar to Glargine) so I now wonder if that’s part of the reason his nadir usually falls at +4.5-5 rather than +6. So I don’t know if altering when he gets meds will help smooth things.

I’m sort of stuck with vetoryl at 0330/1530 so the clinic is open at +5 for cortisol tests but I can look at maybe shifting it to 830/2030 if the clinic can draw cortisol in the afternoon—if any of you think what’s happening isn’t just normal behavior of DM (and my poor decisions) in the first two months.
Thanks for any advice

 

[Heike & BInie]

Hi Colleen,

first of all I want to say: You are a great cat mom. You do everything you can to help Methos, go into every detail and of course this can be overwhelming from time to time. So I send you a virtual hug. Even if not shooting yesterday night would be a question one can debate - and I am not qualified to say anything about it - you did it because you thought it was the most responsible in that moment. Maybe you can get a feedback now which helps to learn and you can make a even more informed decision next time. So please don't be hard on yourself! And by the way: I never had a 115 PRE. It would have scared me too!

Might be a good idea to put a "?" in your title. Just use the thread tools. That guarantees you really get a response.

Hopy you can relax a little and get helpful answers!

 

[Wendy&Neko]

When a cat starts seeing normal numbers, we stay with that dose. The goal is to get to a dose where they see normal numbers. Eventually their body will learn to like lower numbers, meaning bouncing will reduce.

As to what you could have done, there are a few options when you first see lower preshots. One is to stall (ie wait without feeding) and test 15-30 minutes later to see if he's coming up on his own, and comes up to a number you feel comfy shooting. You can't stall too long, or they may start going down without food. Option 2 is a reduced dose. This options is good only if you can monitor, because the Lantus depot means the first part of the cycle may look like you shot the full dose. Option 3, with data, is to shoot and monitor closely if you can. Option 4 is to skip. Above all, you need to learn your cat and his responses.

Over time you will gather data with lower preshots that support your choices. Right now, pick a "will not shoot full dose below" number and gradually lower that as you gather data close to that "will not shoot below number". The lowest I can see you have shot is 192. Maybe try 180 next time (5% less), if it's a cycle you can monitor.

so I now wonder if that’s part of the reason his nadir usually falls at +4.5-5 rather than +6.

The timing of nadir is really ECID. Neko's Lantus nadir was +7-+9, except when it wasn't. I spotted it from +3.5 to +13. +6 is "typical" but a lot of cats beg to be different. I've seen as early as +2 and even a bit later than Neko. I've seen lots of cats not on Vetoryl have earlier nadirs.

I also have watched in awe as you all give 8U at pmps 100.

It might take some digging (SS might be deleted now), but I know of a spreadsheet or two where people gave 60+ units with preshots below 100. Lantus gives flatter cycles when you shoot lower numbers. Of course, you don't do that right away and can only shoot low with the data, experience, and ability to monitor to do so.

 

[SmallestSparrow]

@Heike & BInie @Wendy&Neko thank you both SO MUCH. I had told myself after the 192 “well, I could have done 3. Next time”…I just didn’t expect next time to be in 48 hours nor even lower. He’s starting lower at 3.25U in search of a number that lowers him to 100s but lets him come up a bit for the next shot. By +2 last night I was cursing myself for not at least giving him 1-2U but then if I had I might have been cursing myself for doing so.

so this is normal for DM? I don’t want to drag him to the clinic to recheck cortisol and aldosterone levels unless I think that’s the only explanation. He’s due to go in 4-6 weeks to repeat his spec fPL and pancreatic enzyme levels (although I’ve been warned what he’s got now might be the new normal). So I can try the 3.25 for a week and see if that fixes this. She was going to put him back to 3 but I begged and promised I’d be very consistent in measuring. Then if I still have these issues I’ll get the lab work done.

his next B12 shot is tomorrow pm so while it’s probably not related, I’m sort of relieved his dose dropped a little.

I’m old. I don’t know if my heart could take looking at someone giving 60U below 100.
Thanks again!

 

[Wendy&Neko]

so this is normal for DM?

Absolutely, the abnormal is normal.

I don’t know if my heart could take looking at someone giving 60U below 100.

If it makes you feel any better, normally she gave I think 20-25 units of R with the Levemir (worked better than Lantus), but skipped the R if preshot below 100. A cat needs however much insulin they need.

 

[SmallestSparrow]

Absolutely, the abnormal is normal.


If it makes you feel any better, normally she gave I think 20-25 units of R with the Levemir (worked better than Lantus), but skipped the R if preshot below 100. A cat needs however much insulin they need.

Well in that case I guess I can hold off on his cortisol and aldosterone levels for a while and see how he does at 3.25. Thanks so much

edit: spent last night poking his ear, feeding him in bed (he feels entitled if I’m testing him), and staring at him asking “is this the vetoryl? The spiranolactone? The B12? Is your pancreas better???they said it wouldnt get better…Why oh why are your numbers still going down?”
He had no answer for me

 

[Heike & BInie]

Wow, I see he is in green and blue numbers today! I know it's great and stressful for you all at once. Happy you got this great advice from Wendy, which will hopefully help you tonight to make a decision which feels safe. I send you a hug. Please take care of yourself too!

 

[SmallestSparrow]

Wow, I see he is in green and blue numbers today! I know it's great and stressful for you all at once. Happy you got this great advice from Wendy, which will hopefully help you tonight to make a decision which feels safe. I send you a hug. Please take care of yourself too!

No I gave karo and high carb treats at 76. I’m pretty sure it shouldn’t drop like that. I’m not sure when the karo and treats wear off but just now134 so I’m hoping he’s ok

 

[Heike & BInie]

No I gave karo and high carb treats at 76. I’m pretty sure it shouldn’t drop like that. I’m not sure when the karo and treats wear off but just now134 so I’m hoping he’s ok

Oh...what a stress. I think the karo wears of quite fast. Maybe you like to tag Wendy to ask for advice? I hope everything is going to be o.k.!

 

[SmallestSparrow]

Thanks good idea. I want to go get a new insulin bottle but afraid to leave the house