? - 6/18 Bella AMPS 276, +1 240, +5.5 139, PMPS 247 *advice please | Feline Diabetes Management Board

? 6/18 Bella AMPS 276, +1 240, +5.5 139, PMPS 247 *advice please

Bellas_mom_2020

Bellas_mom_2020

Member
This is a long post so please bear with me but I need to explain whats been going on.

It’s been awhile since I’ve been on here because Bella was doing great. However, for the past almost two weeks something is going on. On 5/26 she got down to a 55 and we got so excited because we thought she was close to another reduction. But then a week later she started to get a few sugars in the 200s and in the past when that happens we know it’s time to start a new insulin.

We got a new box and started a new pen on 6/3 and her numbers were not so bad but then a few days later she was getting higher numbers again. My husband is the one who gives her insulin but something told me to check the pen and when I looked it looked weird - looked like bubbles were stuck or floaties were in it so we threw it out.

After starting a new pen we noticed her numbers weren’t really good still so I started to think maybe the whole box of insulin was defective or weak. So I called the vet and she sent in a new prescription and I got a new box and we started that on 6/14 and we saw a few lower numbers but still not seeing what we usually see.

With Bella she always ranged between 60-120/130 most days and she was doing good with the 0.15 dose since starting in April. Now we’re seeing mostly high numbers with the random lower numbers. she’s acting fine, eating, playing, using the litter box regularly, she’s her usually loving self. Maybe a little extra needy but that’s how she normally is. She’s not showing us anything weird or out of her usual behavior.

One of the admins suggested getting some different numbers throughout the day and I’m trying but it’s hard since I work full time. I don’t understand why all of a sudden her numbers are all over the place, and we even raised her up to 0.25 to see if they made a difference. Could it be that she was getting weak insulin for over a week and having high numbers that she’s like starting over? Does it have to do with her depot? Is she sick and we don’t know. Ugh…I’m just overwhelmed by all of it - it’s making me super stressed and I have knots in my stomach. I’ll take any advice.

And sorry if i seem to be stuck on this, but I suffer from anxiety and I am a chronic Overthinker. It’s been a long two years with Bella and her health starting with her stroke in 2023, ever since then I have really bad PTSD when it comes to her and i cannot control it.

Bella’s Spreadsheet
 
Hey there, I'm so sorry for all the extra stress around Bella's numbers. You're in good company here being an Overthinker, that may be a common thread with most of us :p

Most important part of all this is that Bella is feeling well and acting normal! I'm not experienced enough to give you actionable dosing advice but I'm sure someone will pop in soon! Maybe a few comments: From what I've read from other members, floaties in the insulin could indeed mean that it is time for a new pen/vial. That being said, speaking of your new pens, as long as they are refrigerated and clear of floaties, it is most likely not an insulin problem. Easy advice to give, I know. For a period of time I was absolutely convinced that the insulin was bad for my Bell, but it turned out to be something unrelated. I'd also say that switching between dosages without earning a reduction or waiting the entire length of time suggested by SLGS or TR will add more variables in the long run as you troubleshoot this. So, for example, the reduction on 6/11 PM's shot might not even impact that night's cycle due to the depot.

But someone more experienced can walk you through a dosing plan. I had Bell super well regulated early on in her FD journey but her insulin needs have drastically changed over the past year. I don't think that is out of the ordinary, but I absolutely don't mean to downplay your stress and anxiety. Like I said the most important part of this is that Bella is feeling well and acting normal.
 
As a chronic Overthinker myself, I totally understand. I was just saying the other day that I believe I also have PTSD from recent health emergencies, including Charlie's. You don't seem like you're stuck on this at all, I think any change in their usual number pattern is enough to warrant investigation and close monitoring. Hopefully someone more experienced will offer their advice re: the depot and dosing soon. But I just wanted to say I hear you, you are DEFINITELY not alone, and I hope it's just a weird fluke with Bella and she normalizes soon.
 
CharliesMom22 said:
As a chronic Overthinker myself, I totally understand. I was just saying the other day that I believe I also have PTSD from recent health emergencies, including Charlie's. You don't seem like you're stuck on this at all, I think any change in their usual number pattern is enough to warrant investigation and close monitoring. Hopefully someone more experienced will offer their advice re: the depot and dosing soon. But I just wanted to say I hear you, you are DEFINITELY not alone, and I hope it's just a weird fluke with Bella and she normalizes soon.
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Thank you. I think im frustrated the most about how she was having such good numbers until we switched pens. Then we kept going back and forth with the doses and I feel like that messed her up. Then that causes my guilt. Being a pet parent of a sick pet is a full time job and I’m exhausted. I also deal with my own health stuff like my own diabetes.
 
Bellas_mom_2020 said:
Thank you. I think im frustrated the most about how she was having such good numbers until we switched pens. Then we kept going back and forth with the doses and I feel like that messed her up. Then that causes my guilt. Being a pet parent of a sick pet is a full time job and I’m exhausted. I also deal with my own health stuff like my own diabetes.
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I know it's cliche but please try to be forgiving of yourself. Being a parent of a sick pet IS an exhausting, full time job and we often have to make split-second decisions with very little information and a lot at stake. I struggle with guilt too. I'm in the thick of it right now actually, right there with you. All of us here have more than enough to worry and be upset about--guilt serves no purpose and thus has no place here. It might help to procrastinate it. "I'll beat myself up later, right now I have to [insert task]" For me it's take a shower. I really need to take a f'n shower right now. I stink LOL
 
CharliesMom22 said:
I know it's cliche but please try to be forgiving of yourself. Being a parent of a sick pet IS an exhausting, full time job and we often have to make split-second decisions with very little information and a lot at stake. I struggle with guilt too. I'm in the thick of it right now actually, right there with you. All of us here have more than enough to worry and be upset about--guilt serves no purpose and thus has no place here. It might help to procrastinate it. "I'll beat myself up later, right now I have to do/figure out XYZ"
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You’re right…my anxiety always gets the best of me. After Bella had her stroke in 2023 it has given me the worst PTSD so I always automatically think the worst. To say me and my husband are traumatized is an understatement.
 
Yeah please go way easy on yourself. I have a lot of guilt for how far FD had progressed in Bell before I found this place and got her on track. I don't think switching between dosages messed anything up at all. My advice there was more targeted to your future dosages. If you stick to your dosing method of choice, the experienced folks here will be able to better advise.
 
Hi Jen, Just wanted to give you another vote of “ please take care of yourself as best you can”. Of course I’m in the Overthinker club too, so totally understand where you’re coming from.
This is a really hard road for all of us caregivers and it takes a lot to get through every day.

We see you and we hear you 🫂🥰❤️‍🩹🙏💕
 
First, her numbers aren't horrible. I wasn't sure what to expect when I looked at her spreadsheet.

My immediate reaction when numbers are off, especially since you have now ruled out a problem with the insulin, is whether Bella may have an an inflammation or infection brewing. For many cats that are in remission, the need for a dental (i.e., they have gingivitis) can throw them out of remission. Getting a blood panel and urinalysis may clarify if there's anything going on. In many ways, seeing unusual blood glucose results can be a good early warning system so you can treat an infection before it's truly problematic.
 
Hi Jen, Just to support Sienne's guidance, Jude has both UTIs and Feline Interstitial Cystitis, but his symptoms are pretty non-existent. The only way I know he has an infection or his FIC is flaring is that his bg numbers go up. That's when I know I need to get him into the vet to see which situation we are dealing with.
 
Sienne & Gabby (GA) said:
First, her numbers aren't horrible. I wasn't sure what to expect when I looked at her spreadsheet.

My immediate reaction when numbers are off, especially since you have now ruled out a problem with the insulin, is whether Bella may have an an inflammation or infection brewing. For many cats that are in remission, the need for a dental (i.e., they have gingivitis) can throw them out of remission. Getting a blood panel and urinalysis may clarify if there's anything going on. In many ways, seeing unusual blood glucose results can be a good early warning system so you can treat an infection before it's truly problematic.
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I guess they seem high for us because she typically doesn’t go in the 200s. Today her numbers were better but still not where we’re used to seeing. I thought maybe the issue with the insulin and using weak or defective insulin for over a week messed her up. I will have to make her a checkup appointment.
 
If you were using defective insulin for a week, it will take Bella's depot roughly 5 - 7 days to re-stablize. With dropping the dose to 0.15u for a couple of days, your cycle count started over. You've been back at 0.25u for 6 cycles. You can increase the dose.
 
Sienne & Gabby (GA) said:
If you were using defective insulin for a week, it will take Bella's depot roughly 5 - 7 days to re-stablize. With dropping the dose to 0.15u for a couple of days, your cycle count started over. You've been back at 0.25u for 6 cycles. You can increase the dose.
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we were using the defective insulin for 12 days which is 24 cycles right? And when we started the new insulin the 0.15 didn’t seem to work and we only did 3 cycles of that then bumped her up to 0.25 and this morning was her 6th cycle of 0.25.

Could being on defective insulin for that many days set her back that much that we need to go up to 0.5? And if we bring her to 0.5 do we need to wait until she gets under 50 for a reduction? We’ve made so much progress, if that’s the case that’s so discouraging.

I’m also thinking even though she seems fine maybe something is going on that we don’t know. I’m just feeling lost in all this.
 
I know it can be hugely frustrating. Obviously, Bella is happy and that's truly what matters. We're the ones looking at her numbers and wanting to "fix" the problem.

Lantus is a great insulin. The trick with using it is to have an understanding of the depot. The depot provides the longer duration, overlap between cycles, flat curves, etc. It's what make Lantus effective for our kitties. However, the depot is finicky. If you go back to when this journey started, remember that it takes 5 - 7 days for the depot to form and stabilize. Any time you change a dose, it takes time for the depot to catch up -- with TR you give a dose 3 days/6 cycles to "prove" itself and some of that time is to ensure the depot has adjusted to the change. Some of this depends on the cat which is why everyone's spreadsheet looks a bit different.

In Bella's case, what we don't know is if the problem was the insulin. And, if it was the insulin, just how problematic it was. In other words, was the depot 100% effected or 50%, etc. Similarly, without knowing whether the insulin was defective, how much of the depot is still intact after 12 days. No matter what, the depot needs to catch up and that could take as much as a week.

As I mentioned previously, the other explanation is that there is some inflammation or infection brewing. Blood glucose numbers can be a good early warning system for something medical. All we can do is rule out the obvious causes for numbers that shift. And while this may sound ridiculous, back when I first joined the Board, everyone lived in fear of full moons. Some cats' numbers seemed to be influenced by the phase of the moon. Go figure!!
 
Sienne & Gabby (GA) said:
I know it can be hugely frustrating. Obviously, Bella is happy and that's truly what matters. We're the ones looking at her numbers and wanting to "fix" the problem.

Lantus is a great insulin. The trick with using it is to have an understanding of the depot. The depot provides the longer duration, overlap between cycles, flat curves, etc. It's what make Lantus effective for our kitties. However, the depot is finicky. If you go back to when this journey started, remember that it takes 5 - 7 days for the depot to form and stabilize. Any time you change a dose, it takes time for the depot to catch up -- with TR you give a dose 3 days/6 cycles to "prove" itself and some of that time is to ensure the depot has adjusted to the change. Some of this depends on the cat which is why everyone's spreadsheet looks a bit different.

In Bella's case, what we don't know is if the problem was the insulin. And, if it was the insulin, just how problematic it was. In other words, was the depot 100% effected or 50%, etc. Similarly, without knowing whether the insulin was defective, how much of the depot is still intact after 12 days. No matter what, the depot needs to catch up and that could take as much as a week.

As I mentioned previously, the other explanation is that there is some inflammation or infection brewing. Blood glucose numbers can be a good early warning system for something medical. All we can do is rule out the obvious causes for numbers that shift. And while this may sound ridiculous, back when I first joined the Board, everyone lived in fear of full moons. Some cats' numbers seemed to be influenced by the phase of the moon. Go figure!!
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I didn’t realize how the long the depot needs to build back up and stabilize. And there were so many changes being made - we went back and forth with doses and all the pens we were trying. I guess those 12 days or whatever was happening messed her up. We raised her up to 0.5 last night so that means I have to wait 5-7 days to see it make any difference right? I’m trying to be patient and see if this makes a difference and if not then I guess it’s time for a vet visit.
 
I thought it can take about a week to readjust itself. okay so 3 day/6 cycles brings us up to Sunday morning. I guess if we don’t see a real change then that means something else is wrong. 😞😞
 
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If you totally deplete the depot, it can take 5 - 7 days to get reestablished. Once the depot is full, it takes up to 3 days for the depot to catch up with a dose change.
 
Sienne & Gabby (GA) said:
If you totally deplete the depot, it can take 5 - 7 days to get reestablished. Once the depot is full, it takes up to 3 days for the depot to catch up with a dose change.
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There’s so much to learn. Ive had diabetes for 24 years but humans don’t have depots so this is still a learning process. We’re making progress though. Today is the 4th cycle of the 0.5 and she’s in the 100s finally. Feeling more hopeful now. Thank you for all your help ❤️
 
Jen --

Humans have depots! There are many drugs that are pharmacologically depot drugs. Lantus works the same way in humans. It may not be "officially" a depot medication, although I've seem some publications that refer to it that way given it has a considerably longer action than other types of insulin. Typically, a depot drug is a long acting, injectable medication. The most common use is with antipsychotics. (Probably more information than you wanted!!)
 
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