12/15 Gracie PMPS 372 +1 284 +2 198 +3 122 112 +4 111 +5 160

Yesterday: viewtopic.php?f=9&t=32089

Recap:
AMPS: 355 6th cycle f1u
+1: 339
+2: 286
+3: 197
+4: 156
+5: 172
+7: VETTY VISIT
PMPS: 334 7th cycle f1u
+1: 325
+2: 314
+4: 291

Good morning and Happy Wednesday. How many sleeps to Christmas, Claudia? :lol: :lol: I hope I can get to your condo today to find out. We're celebrating Mannie's good news today and hoping Ann is having great success with her ceramics project.

WCR: 4Ps in place, happy, chirpy girl. She loves the Christmas tree and she and Tobey have been having so much fun with it as I am sure all your kitties are.

Thankfully, she doesn't know all the excitement from last night. Mike and I thank you all for your support and encouragement. I think sometimes we would all love to pull the blanket over our heads and hope that this diagnosis was just a bad dream.....I think it's the "hope" part that we cling to and maybe it's because we are newbies that Mike and I still want to be in denial :lol:. Anyway, today I am going to ask the vet from yesterday for her sources and will provide her with more. I was so caught off guard yesterday by the quick chain of events; I was at work and didn't have time to pull off the protocol and other materials to take to her so I wasn't well prepared. And my regular vet and I were just under the impression that she (Dr. K the IM) had some ideas on how to address Gracie's bounciness. Interestingly, the point about taking her off insulin was not where she started...it was where she ended.

I'm off to TBP and hope you all have a spectacular day. Thank you, our friends, for hanging in there with us, understanding where our heads were, and helping us stay on track and focused.

Re: 12/15 Gracie AMPS 270

Morning Marjorie, Mike, and Gracie! happy Wednesday! shesshhhh - how many more sleeps is it til christmas? OMG - panic-ville here.... :shock:

It is nice to see Gracie slowing coming down from last nights pinks. I hope she will continue, end up with those awesome blues and greens. GO Gracie!

I am sorry for all that you and Mike were put through yesterday - what an emotional roller-coaster. I am glad too that today you can meet with the vet prepared - I hope it will be enlightening for her, and that she willingly provides her sources for her conclusions. I, and I am sure many others, would really like to read them, know what they are. --- on the wanting to pull the blanket over your head - I cannot count the number of times that I have done that. true. We all have hope that someday... I still do, even after 2.5 years. I hope, and am also so very glad that Mannie is happy, content, living a good life. What more is there than that? He's doing well, and for me that is the bottom line. So - good luck today! Sock it to 'em.

Gracie!! What is up for today? Do we all need a chillaxin' day? Maybe get all the kitties from the frozen northern lands and take them someplace warm, by the beach or a pool, and sip niptinis and catmint tea? whatd'ya say? hey - thanks too for the KTSS yesterday! It was so cool that even Ted and Miss Emily came - what fun! See you later? ~ Mannie

Re: 12/15 Gracie AMPS 270

((((((Marjorie)))))) took a peek at your condo really late last night. I'm so sorry you got put through that yesterday, Yes, we all want to pull that blanket over our heads, pretty much every morning. Since she isn't your vet, you didn't ask for the consult and she has never met Gracie, I would be skeptical and really want to see her data. I would be very careful about going cold turkey with her, yes we miss a shot every once in a while, but 2 days is much different. I'm so sorry you got put through that. Give her the reading assignments we have all been studying and tell her you will talk again when she has read it all!

On a brighter note, nice to see Gracie starting out in the yellows rather than the pinks today.

Re: 12/15 Gracie AMPS 270

What a crazy day for you guys yesterday.
This is all I have to say about it.....

Re: 12/15 Gracie AMPS 270 +1 225

Morning all. DH here. Gracie is at 225 at +1. We are feeding her 8% this morning. No preloaded early gravy with this carb level. I'll be interested (like every day) to see what she does today. Hoping for a nice slow slide to good numbers, looking well on her way with only a 50 pt drop first hour. So, 2 cannibals were eating a clown. One cannibal looked at the other one and said "does this taste funny to you?"

Re: 12/15 Gracie AMPS 270 +1 225

Nice +1 there Gracie - nice and slow though, OK? You've got all day to find those blues and greens.

oh :lol: :lol: Mike. I could use some morning humor...

Re: 12/15 Gracie AMPS 270 +1 225 +2 119

So... 119 at +2. So much for the nice slow slide. Gave her some 8% with a spoonful of 12% gravy and recheck in 30 minutes.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +2.5 99

DH here - 99 at +2.5. Nice slowdown. Gave her a little more 8% food with a touch of 12% gravy, hoping to settle her into a high green surf.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +2.5 99

and look at her go! Nice management Mike - I hope she will settle into a nice green surf. Go Gracie! :mrgreen: :mrgreen: :mrgreen:

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +2.5 99 +3 94

Michelle, Ann, and CD: thank you all for your support and comments. Yes, emotional roller coaster but isn't almost every day with FD? I mean, we all deal with it in different ways and manage to go on.

I'm still very curious about Somogyi rebound. I'm not saying that the vet yesterday is right, but I'm trying to understand the DIFFERENCE between what Gracie (and other cats are doing) that we call "liver training" and Somogyi rebound; I just don't understand the difference and am hoping someone can explain it. on the first Sticky in LL, it has a link to this (wikia) and I read that and then clicked on one of the links at the bottom of that page. It states:

What is the Somogyi Effect?

Glucagon and insulin are released by the pancreas. Glucagon and insulin have opposite effects: insulin makes the blood sugar go down and glucagon causes blood sugar to go up. They work together to balance blood glucose levels. Glucagon can increase blood glucose levels by causing the liver to release its stored glucose to the blood stream. Insulin lowers blood glucose by allowing tissues to use or store glucose.

When too much insulin is given the blood glucose drops rapidly and hypoglycemia (low blood sugar) results. This can trigger the body to release glucagon (and other hormones) and the result is that glucose is dumped into the blood. This can lead to hyperglycemia (high blood sugar). So, you have hyperglycemia induced by hypoglycemia, or the Somogyi effect. (Somogyi was a scientist who did research on glucose production by liver during times of stress.)

The method of determining if Somogyi effect is occuring is to do a blood glucose curve. Your cat will have a specific pattern of hyperglycemia if the Somogyi effect is occuring. Although at first it seems odd, the treatment for this type of hyperglycemia is to DEcrease the insulin dose. This prevents the hypoglycemia from occuring and triggering the Somogyi effect.

1.If ALL of the BG readings are HIGH, an approximate 10% INcrease in the insulin dose can be made.
2.If ALL of the BG readings are LOW, an approximate 10% DEcrease in the insulin dose can be made. If your cat is symptomatic, the dosage may be reduced further.
3.If the readings are HIGH only before insulin is given (or around the time of the morning meal) OR at the time the insulin duration is almost over, do NOT change the dose.
4.If the readings are HIGH at BOTH the morning and evening readings, consider Somogyi effect and DECREASE the amount of insulin.

Click to expand...

I bolded the last two things. I find them to be a little confusing; I don't understand the difference between the readings being HIGH before insulin is given OR at the time the insulin duration is over AND if the readings are HIGH at both morning and evening readings because the insulin duration in lantus is over about the same time as the evening reading (typically) and so you would expect to have high readings before insulin is given in the a.m. and p.m.

I also found this: http://gorbzilla.com/somogyi_rebound_minifaq.htm (please note this link references FDMB). At that link, was this statement:

Clue #4 - Flat curves. If you are seeing higher preshots and suspect rebound you should do at least one curve to see what's really going on. Somogyi often results in a period of insulin resistance** (remember, the body is trying to protect itself from dropping too much so will keep spilling out glucagon) and you may see nothing but high numbers no matter how much you check the glucose that day.

Click to expand...

From the "Pets with Diabetes" page, it states:

Somogyi can be diagnosed when you get blood glucose levels below 65mg/mL followed by hyperglycemia (typically >300 mg/dL) within one 24-hour period after an insulin injection.

Click to expand...

I

In looking at Gracie's SS, you will see cycles (12/6 & 12/9) where she had flat yellows or flat pinks for 1-3 cycles back to back which seems to indicate to my untrained eye that she is resistant to the insulin at that point AND days where she went from below 65 to above 300 and sometimes very quickly (12/12). Her curve doesn't look exactly like the example given but neither does it look "normal".

Again...not trying to shake the apple tree but trying to learn about what is going on with Gracie because I see her numbers as just too erratic...and I don't see improvement when she's on a lower dose either...perhaps I didn't give her a long enough time on lower doses. Sorry to ask so many questions but I need to understand what is going on and why. Thank you all very much.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +3.5 98 +4.5 1

reply sent via PM:

i'm in-between appointments, but i'll quickly post a few links in your condo. more reading material for you. lol!

read through these threads carefully (including the links contained in the threads themselves). i think they'll help...

http://www.felinediabetes.com/phorum5/read.php?15,1714582,1714582,sv=2#msg-1714582

http://www.felinediabetes.com/phorum5/read.php?22,1710806,1710806#msg-1710806

http://www.felinediabetes.com/phorum5/read.php?22,1708611

will be back later...

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +3.5 98 +4.5 1

Jill

I read through EVERYTHING :shock: Wow....some of it made sense, some I didn't totally understand....like insulin induced insulin resistance and when/how that occurs and what it looks like. You will probably laugh but the link that made the most sense to me was the last with Barbara and Tuffy. I have to say that Tuffy's SS looks WORSE than Gracie's I think :lol: :lol: and yet she went OTJ but the take home for me was Tuffy's liver just didn't get it and I think we are seeing that with Gracie. One thing I didn't see on Tuffy's SS was just high flat yellows for 2-3 cycles. Do you know what causes that because that's what seems like insulin resistance to me.

Mike and I are confused about how her curve has changed so much since we fattened her dose by a drop. It's almost V-shaped with a very early nadir...she zooms down early on, barely nips green, and then zooms up. This is a very different curve than what she has had in the past. I don't know if it is in response to us giving her a little higher carb gravy (9-12%) early in the cycle with her food to keep her from dropping 100-200 in the first two hours.

Oh how I wish the control freak in me would just take the cycles in stride, knowing that it's normal and ECID as to when they stop doing it, and hoping that she will eventually stop this and let the lantus do what it is supposed to do.

Thanks Jill for your overwhelming patience and astute insight. I hope I don't win the "PITA NEWBIE" award this year.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

Majorie...your questions are great....And its helping all of us to learn.

And I'm sorry you had to go through all the craziness yesterday with the vetty visit. Sienne made a good point about obtaining the scientific references from the vet to back up her comments and recommendations.

Hoping little Gracie finds a happy medium w/her numbers. Paws crossed.

The answer to your question about the number of sleeps until Christmas.....Is it 10 more sleeps?

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

Hey Tena!! Thanks for your supportive words. Can Gracie and I come visit you and Curry and maybe some of Curry's consistency will rub off? :lol: :lol:

On the sleeps before Christmas...gotta check Rocket's condo...I can't keep up :lol: :lol:

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

very interesting stuff.

Nice start for Gracie today - sorry to see her head off the the high yellows - at least she didn't go pink like Mannie did.

have a great evening guys!

PITA NEWBIE AWARD???? :lol: :lol: :lol: :lol: omg - do we even have one of those. too funny. and no - you don't qualify....

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

PITA NEWBIE AWARD???? omg - do we even have one of those.

Click to expand...

If we don't, we should, and I'm nominating myself. :lol: :roll: :roll:

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

I faxed a bunch of info to the IM vet today that you all provided me and then I called to talk to her. They said she wasn't available but they would leave
a message for her to call me on Thursday. It will be interesting to see if she does.....

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

Good for you! I too wonder if she will call...

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

The place where I see most people, vets included, becoming confused is they forget the "chronic" when it comes to Somogyi (i.e., Chronic Somogyi Rebound) or rebound. Our kitties may bounce -- but it's temporary rather than a chronically occurring situation. So yes, our kitties bounce and they learn to stop bouncing by completing liver training school. Because we approach dosing in small increments, the likelihood of being overdose and causing a state of chronic rebound does not occur or is drastically minimized.

I think this was the major point that both Jill and Jojo were making in the links to the posts on the old FDMB board.

If you also go back to what Libby noted last night, most vets become worried when they see a diabetic cat in numbers under 100. I suspect this is because of liability reasons. If a caregiver does not test the way we do and if their cat's BG is under 100, it is probably a signal to the vet that the numbers may have been even lower and there is a risk for hypoglycemia -- especially if the caregiver does not know how to manage lower numbers. So, to see a bounce from a cat that has been happily surfing in the 60s, to the vet this probably indicates the presence of chronic rebound (aka Somogyi). Parenthetically, I don't know how a vet can diagnosis this in cats when there isn't a SS. If you are looking to have a cat stay in a 100 to 200 BG range, there is far less likelihood of a bounce. We look for tight regulation because we home test, know how to manage low pre-shots and low numbers, we look forward to seeing our cats surf in green numbers, and we change doses in small increments.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

Sienne...one question....Gracie (and others) bounce every single day. So I'm assuming that by stating it's not chronic, you mean that they bounce every day but also clear it almost every day? The point in your last paragraph is very well taken and understood.

Re: 12/15 Gracie AMPS 270 +1 225 +2 119 +3 94 +4.5 142 +7 28

Yes, that's right. Also, if you dropped the insulin dose, what you would see is a cat in high numbers vs. a cat that achieves better regulation.

Re: 12/15 Gracie PMPS 372

Also, if you dropped the insulin dose, what you would see is a cat in high numbers vs. a cat that achieves better regulation.

Click to expand...

Not clear on this....do you mean if you dropped the insulin dose on a cat that is bouncing you'd see higher numbers instead of better regulation at the higher dose? And do you mean better regulation over time because I'm seeing no regulation at all here. Thanks!!

Re: 12/15 Gracie PMPS 372

If there was Somogyi, dropping the dose would help. On the other hand, if it's just a temporary bounce, the numbers will be high because there's not enough insulin on board.

Re: 12/15 Gracie PMPS 372 +1 284 DOSE ????

Mike and I are concerned that this dose is not appropriate for Gracie. This is the second cycle where she dropped almost 100 an hour from her PS. She plummets, skims the blue or green, and then fires back up. We've been trying to give her carbs early on to stop the drop but it isn't working. Can any of the dosing experts look at our SS and try to figure out if this dose is too much for her? I only added a drop to her previous dose. We are on the 9th cycle at f1u and we both feel she is less regulated at this dose than any she has been at any before...yes, she's getting into healing ranges more but plummeting there fast with no duration. Please help.