? Treating FD with simultaneous illnesses?

[DevilPup]

(I posted this thread in the general health forum because it involved more than just dosing)
We started dosing Spike last week Sunday with .5 unit of Lantus. He was doing well. His numbers were coming down, but we thought he would need to be increased to .75. We decided to dose at .5 for a week, then do a curve to get a better picture of how the insulin was reacting with him.
Around Tuesday night, into Wednesday, he started displaying his chronic allergic sinusitis/rhinitis. He is on azithromycin for mycolplasma daily. Cornell Vet advised he may need to take that indefinitely. He is on no other antibiotic. He will always have this condition.
Usually when he shows the sinus issues, we give him several vaporizer treatments over the course of 2 or 3 days. It usually improves his condition and he gets better. We have been doing that this week. Thursday he seemed very unwell.
We continued to test his numbers, feed him and dose him with .5 units. If you review his SS, you can see an increase in numbers.
We know that an infection or inflammation of some type in his system will increase his numbers. That being said, we're unsure if we should increase his insulin to .75 or let it ride until he fully comes out of this sinus issue. We checked his temperature tonight and he does not have a fever. I will be giving him a cerenia tomorrow morning. He is eating, drinking, using the litter box okay, stool is fine. ketones have been negative.
Another problem. We are between Vets. We have an appointment with the new vet on 8/29. I have not advised the current vet of the change, so in a "major" pinch, we could see him. I also don't want to take him in the current vet if unnecessary, with the new appointment in 10 days. Spike gets very, very stressed at the vets, sometimes it throws him into a pancreatitis flare. (which I try everything to avoid the flares)
We are travelling on a slippery slope with Spike, trying to juggle his illnesses and doing the best to control them all. But I fear I may never get him into a possible remission with all the inflammatory and infections he does get/have. And you know, that's okay, as long as I can control him with insulin.
Any words of advice at this point? His SS can be found in signature line. Thanks.

 

[Wendy&Neko]

Hello and welcome to you and sweet Spike. Sorry you've got multiple issues to deal with, it can be challenging. Having a dosing method to follow can help you make decisions. We use onenof two dosing methods here, Start Low Go Slow method (SLGS) or the Tight Regulation (TR) protocol. Take a read of the Sticky Notes at the top of this forum, including the one for SLGS. With some dry food still in the picture, it is the dosing method you would use.

According to SLGS, you hold the initial dose for a week, then do a curve and see what to do next. Looks like you did that curve today. He is still seeing numbers all above 150, so you would increase to .75 units. If he starts to feel better and the numbers go down, either 0.75 units will be a good dose with nadirs between 90 and 150, or he will earn a reduction by going under 90.

 

[DevilPup]

Thank you. I have read all the stickys. We have been using the SLGS method. I understand about raising the dosage to .75. My concern was that his other conditions, one of which is currently present, may be raising his numbers. When this situation has resolved itself, the numbers would naturally drop. I don't want him to drop too low. From what I have read here, I shouldn't "chase" the numbers by increasing too fast. But I think we are safe by raising his dose to .75. Thanks

I looked at your Tribute to Neko. What a beautiful kitty she was. I could not view it w/o sharing your pain with her illness and your joy with her life. Until you meet again.

 

[Sienne and Gabby (GA)]

One basic rule of thumb is that you can adjust insulin in order to address other, more pressing medical concerns. We've had kitties that needed to be on steroids for a period which raise numbers. The same is true with antibiotics -- the kitty has an infection that requires the antibiotic, within a couple of days, the medication kicks in and numbers drop. As long as you know what the scenario is likely to be and are monitoring, you should be fine. The only concern I would alert you to is that the presence of an infection/inflammation, not a sufficient amount of insulin, and a reduction in the amount of calories Spike is consuming can increase the risk of ketones developing. You might want to consider getting ketone tests in as a preventative measure.

 

[DevilPup]

One basic rule of thumb is that you can adjust insulin in order to address other, more pressing medical concerns. We've had kitties that needed to be on steroids for a period which raise numbers. The same is true with antibiotics -- the kitty has an infection that requires the antibiotic, within a couple of days, the medication kicks in and numbers drop. As long as you know what the scenario is likely to be and are monitoring, you should be fine. The only concern I would alert you to is that the presence of an infection/inflammation, not a sufficient amount of insulin, and a reduction in the amount of calories Spike is consuming can increase the risk of ketones developing. You might want to consider getting ketone tests in as a preventative measure.

Thanks. I understand. We have raised the dosage to .75 units this morning. I have read not to raise him too fast, so increasing by 1/4 unit is safe. We can go this route for another week. If he needs more insulin, we will raise again to 1 unit. I will continue to monitor him--much to his dismay. He is eating good. Also, off to the right of my SS, I have added a column for "ketones." I check quite regularly. I try for EOD, but if I can get a reading everyday, I go for it. Thanks for the heads-up!