Not sure what to do

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Rusty/Jen & Ernie

Rusty/Jen & Ernie

Member Since 2015
If you look through some of my other thread, you will find that we are in vet limbo until Thursday this week, due to some issues with the clinic that originally DX'd.

We have also totally eliminated dry food & that made a huge difference on it's own. At this point, Ernie hasn't had any insulin since Wednesday (8/12) due to low numbers & wanting to also see how he would respond to a short honeymoon. And if you look at his chart since 8/9, you will find a few dose changes & multiple skips.
He has been hovering between 100-200, with his last dose on Wednesday evening being shot due to a 235 number.

So, my question is, should I try to regulate him a little tighter, using tiny amounts, less than 0.25 units? Or should we ride it out for now & see how he responds? One of my questions for the new vet will be to discuss if switching to PZI or Lantus would be better than Vetsulin in his case.

He is the most loving & energetic that we have seen him in the last month. So, I know he feels better as well.
 
As you can see, several times a day, he practically begs to play & we certainly welcome it!
Ernie 1.JPG


Ernie 2.JPG
 
Wow, Rusty & Jennifer ... just WOW!!! Ernie's trajectory is just spectacular! I would wait to see what you get tonight @ PMPS time; yes, you could elect to micro dose at, say, 0.15 or less tonight if you have a shootable # - but you'd, of course, want to monitor because he's already popping at such low #s in the mornings. I'm sure others will be hopping on here in a few minutes to share their best advice, too.

So happy for all 3 of you! Thanks for the cute pix of Ernie - heartwarming! :bighug::bighug::bighug: - Robin
 
Isn't it amazing how much fun our kitties can have with a plain old box?? He looks like he's really having fun!!

As far as the insulin questions, he sure isn't making it black and white as to if he needs insulin or not!! A lot of his blood glucose numbers are normal, but there are a few that are a little too high

What you might try for the next few days is testing and feeding him and then test again about 3 hours later....if the number goes down, that means his pancreas is doing something good!

He sure is a great example of how much difference a diet change can make!!!
 
OOPS - scratch the part about tonight (duh, I see you've already skipped, which is great). Same advice applies for tomorrow!
 
Thank you for the advice Robin & Chris for your feedback. I am going to test in another 2 hours or so, but seeing the 107 in the PMPS was a goosebump moment!

Even though we didn't plan to take him off Vetsulin this soon, nor did we expect to have a fight with the vet, we can't help but feel good about the results so far. However, we also realize that this could be a short term honeymoon, or it could mean OTJ. But time will tell & we are just excited that he is himself.

After his DX, we bought several new toys, a 3rd water fountain, & some extra cat furniture. Our coffee table went into storage because we had to make room for the cat "equipment!" We wanted to keep him from being so reclusive, & keep him exercising, plus with us feeding & watering in the living room, we were able to keep a better eye on his intakes of food & water. I hate to admit it, but we moved a cat box into the living room too. This way, from my chair, I could see which of the 3 cats were using the litter box. And when I need a urine sample for ketone checking, we put the other 2 boxes away & I sit and wait to see him go into the only box left!!


You are right though Chris, his numbers keep bouncing from good to okay. Especially over night, probably due to not eating as much. But we wake up to nearly empty bowls every morning. So the 3 cats aren't fasting overnight, that much I know! Actually he has put on 1 pound since his DX. And the 2 female civvies are putting on some "Winter weight." I assume once the novelty of wet food wears off & they realize it is always going to be there, they will probably slow down. (Really they are still grazing, so it isn't like they are gorging themselves) But yes, some of his lows in the past 4 days have been great. And some of his highs have been less than ideal, but not terrible.

Could it be possible that the antibiotics & anti-imflammatories helped with the inflammation in the pancreas & the low dosing of insulin helped to support the pancreas's function while it was in healing mode. And once it was cleared up, the pancreas was able to keep up with his bodily needs a little better?
 
I am planning to test him as much as possible the next couple of days, at varying times through the day. In order to try and gather as much data as I can before our vet "interview" on Thursday.
 
We do know that both infection and inflammation can raise the BG levels, so if he had those going on earlier, it's possible that by clearing those up, it allowed his numbers to come down
 
Rusty & Jennifer Shafer said:
Our coffee table went into storage because we had to make room for the cat "equipment!"
Click to expand...
You guys definitely have your priorities in order! ;) :cat:

We wanted to keep him from being so reclusive, & keep him exercising, plus with us feeding & watering in the living room, we were able to keep a better eye on his intakes of food & water. I hate to admit it, but we moved a cat box into the living room too. This way, from my chair, I could see which of the 3 cats were using the litter box. And when I need a urine sample for ketone checking, we put the other 2 boxes away & I sit and wait to see him go into the only box left!!
Click to expand...

OK, so the set-up won't make it into Décor magazine, but you're doing a fantastic job with the secondary monitoring, too. :D

Rusty & Jennifer Shafer said:
Actually he has put on 1 pound since his DX.
Click to expand...
This, plus the improvements in playfulness and activity is the real good news. The BG numbers are only a guide; clinical signs are where it's at! I'm really happy for all of you to see Ernie making such great progress and getting his mojo back. :D

At Ernie's current numbers, if he were mine I'd be very disinclined to give him any Vetsulin unless I was able to monitor right the way through the cycle (and maybe a bit beyond if his next preshot is low). Even then I'd only give the tiniest drop possible (done by pushing the syringe plunger right the way down, inserting needle into vial then squeezing on plunger to suck up a tiny, tiny droplet of insulin). If it turns out that Ernie does need a little more support from insulin, if he were mine I'd be looking at Lantus and then only tiny, tiny doses. He just needs a bit of a nudge...


Mogs
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Critter Mom said:
You guys definitely have your priorities in order! ;) :cat:



OK, so the set-up won't make it into Décor magazine, but you're doing a fantastic job with the secondary monitoring, too. :D


This, plus the improvements in playfulness and activity is the real good news. The BG numbers are only a guide; clinical signs are where it's at! I'm really happy for all of you to see Ernie making such great progress and getting his mojo back. :D

At Ernie's current numbers, if he were mine I'd be very disinclined to give him any Vetsulin unless I was able to monitor right the way through the cycle (and maybe a bit beyond if his next preshot is low). Even then I'd only give the tiniest drop possible (done by pushing the syringe plunger right the way down, inserting needle into vial then squeezing on plunger to suck up a tiny, tiny droplet of insulin). If it turns out that Ernie does need a little more support from insulin, if he were mine I'd be looking at Lantus and then only tiny, tiny doses. He just needs a bit of a nudge...


Mogs
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Click to expand...



Thank you for the encouragement & advice Mogs. You have been there to lend your support since day 1.

With Lantus beinga depot insulin & what appears to be likely an inconsistent dosing need, would we be better off to look at PZI since it is more "dosed on the PS #'s?" What I mean is, if his number had been good for 2 days & he suddenly spiked a bit high, would a tiny dose of Lantus actually make a difference fairly quickly, or would it take a couple of days to build up a depot?
 
ProZinc and BCP PZI may have the dose adjusted based on the pre-shot WHEN you have data showing how low a particular dose may take the glucose. That means you do need to get some nadir testing done whenever possible, or you won't be able to do adjustments safely.
 
Lantus needs consistent dosing. You start with a dose based on the cat's weight but possibly adjusted based on its response to a previous insulin should one have been administered before starting Lantus. You can follow either Tight Regulation or Start Low/Go Slow protocols. When starting Lantus one holds the starting dose for 5-7 days (assuming no numbers below the hypo threshold) and then assess results. Thereafter, doses are adjusted - up or down - in 0.25 unit increments; every 6 cycles for TRP, longer for SLGS (can't remember offhand - think it's every 10 or 14 cycles).

The idea of the depot insulins is to create a sort of 'chemical mini pancreas' in the cat's body so that it receives a steady supply of insulin. All going well, you will work towards and reach a 'good dose' which produces a very smooth, gentle curve; very different to the wider swings between high and low that may be seen on in-out insulins like Vetsulin. Lantus doses are based primarily on the nadir. If you do get bounces, you just work your way through them following the guidelines in the protocol you're using and once they clear better numbers will return. Ideally you aim to get a smooth, soft curve at a range the cat is comfortable with and therefore doesn't trigger too many bounces. Then you gradually adjust the dose in small, steady steps to lower the soft curve into a BG range that gives the pancreas a chance to heal. A Vetsulin curve is to roller coaster as a Lantus curve is to a smile. There are a lot of stickies at the top of the Lantus & Levemir board where you can learn more about the depot insulins and how they work.

I've not used Prozinc so can't give you much information. It's an in-out insulin, and working with it is like working with Vetsulin. With in-out insulins the dose is administered and typically it all gets used up within the single cycle. Prozinc can provide the caregiver with a little more dosing flexibility (it's done on a sliding scale - see the stickies at the top of the Prozinc support group's board for more info.

Have a look at Saoirse's spreadsheet (the US BG tab will make more sense to you). She was treated first with Caninsulin and then Lantus. Her numbers should give you a good idea of how differently the two insulins work. (Saoirse's a good example to see because she was very straightforward to regulate and she's not a 'bouncy' cat; it's very clear from her numbers how the two insulin types work. I used to graph Saoirse's BG numbers. The curve of her transition off Vetsulin to Lantus looked like a decaying sine wave.

Once you've had a read, we'll do our best to answer any further questions you have. FWIW, I don't think Saoirse could have become diet-controlled were it not for the fact that Lantus allowed me to safely extend the duration of her insulin treatment to give further time for her beta cells to recover. More importantly, she was miserable on Caninsulin; the wide swings in BG wiped her out for 18-20 hours every day. She was bright and perky on Lantus. It was like night and day.


Mogs
 
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Thank you BJM & Mogs. We experienced the same thing with Ernie on Insulin. He was perky pre-shot & perky towards the end of the cycle. But in the middle he looked "drugged" would be the best way to describe it. Just not himself at all. And that is why I pushed for the vet to look at other options.

I will explore Lantus vs PZI a little deeper. And get back with some specific questions. I know they both seem to be a little gentler, with Lantus being the gentlest. But I also knew that PZI was close in structure to feline native insulin.

Bottom line is, I want the best insulin for him, that is the easiest on him. And if it happens to be that we get OTJ using that insulin, all the more better!
 
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