Time for a different kind of Insulin?

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Bobbie And Bubba

Bobbie And Bubba

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Should I switch Bubba to one of the human insulins. His being stuck in pink and yellow is really upsetting me. This morning I accidently under-dosed him by a 1/2 unit so not sure how this cycle is going to pan out. Thoughts on which insulin we should try? I still have ProZinc but think I should start looking into a switch. Unless y'all think to continue raising will help....... I feel so defeated. He was making some good progress but it's been 1 month since he went into a green and 9 days since he was in the blue and it was marginal. Am I overreacting?
 
It is up to you, Bobbi. I think you could be more aggressive with the ProZinc, upping the dose by 0.25 after three cycles in the yellows and pinks. We usually suggest a switch after the cat is in higher doses - over 5 units. But you have been struggling with him a long time and a change to a depot insulin may make the difference.
 
Sue and Oliver (GA) said:
It is up to you, Bobbi. I think you could be more aggressive with the ProZinc, upping the dose by 0.25 after three cycles in the yellows and pinks. We usually suggest a switch after the cat is in higher doses - over 5 units. But you have been struggling with him a long time and a change to a depot insulin may make the difference.
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Guess I should keep going and see what happens. Are there syringes with 1/4 marking or are peeps eyeballing it or doing .2 increase ? I have 100's.
 
Bobbie And Bubba said:
Are there syringes with 1/4 marking or are peeps eyeballing it or doing .2 increase ?
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I'm not aware of any that are marked on the quarter-unit. Perhaps someone else knows more about that ...

Bubba certainly is a puzzle, Bobbie.:confused: @Sue and Oliver (GA) may be right: Just might be time to try a depot insulin before long ...
(I was just looking back over Bubba's SS, and he actually seemed to do better - for a while, anyway -at lower doses than what he's been getting lately.) I see he's been staying kinda flat much of the time in his cycles over the past several days - don't know what's up with that.o_O How frustrating for you!
:banghead: Sure wish I had a magic wand... :bighug:
 
Bobbie. I'm certainly no expert here, but wondering why you lowered the dose this morning and on the 13th. I do not know how Prozinc works.

The spread sheet looks like what I use to do with Smokey. If he was in the good numbers I lowered dose thinking it would keep him there. Then when he went high I raised the dose. So actually I was basing his dose by numbers from previous dose. I was so wrong. I was constantly making him rollercoast. No wonder he didn't feel well.

I finally caught on. After reading everything over and over and over. I finally had to reign myself in and wait out the dose to see what happens. This is when I learned Smokey takes 5 days to adjust to a change. Then his numbers move however so slowly. But they are moving.

Smokey just earned a decrease. Today is the first lower dose and look where he is RED. But I know we have to wait it out for another 4 days.

Maybe it's to many quick changes for him and his body is confused. My opinion and mine only based on your ss is stick to 3u and wait it out for 5 days. Test AM and PM and when you go to bed. Mid day when you can. Give Bubba time to adjust.

I would try it before switching. If you switch and do the same thing it might not work either.
 
woodsywife said:
Bobbie. I'm certainly no expert here, but wondering why you lowered the dose this morning and on the 13th. I do not know how Prozinc works.

The spread sheet looks like what I use to do with Smokey. If he was in the good numbers I lowered dose thinking it would keep him there. Then when he went high I raised the dose. So actually I was basing his dose by numbers from previous dose. I was so wrong. I was constantly making him rollercoast. No wonder he didn't feel well.

I finally caught on. After reading everything over and over and over. I finally had to reign myself in and wait out the dose to see what happens. This is when I learned Smokey takes 5 days to adjust to a change. Then his numbers move however so slowly. But they are moving.

Smokey just earned a decrease. Today is the first lower dose and look where he is RED. But I know we have to wait it out for another 4 days.

Maybe it's to many quick changes for him and his body is confused. My opinion and mine only based on your ss is stick to 3u and wait it out for 5 days. Test AM and PM and when you go to bed. Mid day when you can. Give Bubba time to adjust.

I would try it before switching. If you switch and do the same thing it might not work either.
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The dose this morning was an accident. I meant to do 3.5 units again but somehow in my morning fog, I was thinking the AM number was a blue....... by the time I realized it, it was a 1/2 hour later. I have pretty much been sticking with a dose for probably too long except recently when I upped it .2 one day and again .2 to following day. He is just stuck!!! No bouncing, just can't get out of the pink/yellows...... I do think he is one of those that takes a bit to settle into a dose too. Good advice Paula. Thanks.
 
Lots of good advice here, Bobbie, but I know it is frustrating. I think since you have some Prozinc left, to keep trying it, upping the dose after 3 cycles (or more) and keeping it there to see how he settles into the new dose. His numbers aren't that bad and if you don't see improvement when your Prozinc is getting low, maybe then switch to a different insulin. Hang in there! :bighug:
 
Does Bubba have a followup appointment with the vet sometime soon? I'm still wondering if some sort of infection is messing up his numbers, even if it's not visible or obvious around the surgery site.
 
No appointment but I can certainly make one. Here's what I think is happening: Somogyi's
Starting on 10.16, he dropped fast to 51 @ +7 on 2 units I did not reduce the dose because it was above 50 and he didn't hypo. Ever since then he has been higher and flat. I held the dose and got an occasional blue enough to tease me. Surgery came and went and he really never went that high (surgery was 10.29) After the cone was off and his stress level was down, I started playing with the dose and when I increased, so did his numbers. Yesterday, I asked about the difference between somogyi and rebound but since then I found an article that says a full blown hypo is not necessary, just a really low number. If the dose continues high, it results in a higher flat cycle.....that's my Bubba.

So, I accidently gave him 1.2 unit too less this morning. Tonight I will reduce back to 2.5 and the in a few cycles get him back to 1.8 which is a bit lower than he was when this whole thing started. If it doesn't work, I can go back up. I f this is what is happening, I hope I haven't fried his pancreas for the last month.

http://petdiabetes.wikia.com/wiki/Somogyi_rebound
 
Good luck with the strategy change. Hope it works. BTW, love the new pic. Is he
Lickin' his chops after a mouse meal?!
 
Sharon14 said:
Good luck with the strategy change. Hope it works. BTW, love the new pic. Is he
Lickin' his chops after a mouse meal?!
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Thanks Sharon, fingers and paws crossed. We did a photo shoot in the back field today. It wasn't until I cropped the picture that I noticed his tongue out.
 
One note of caution. Given his numbers, if this isn't his problem, keeping an eye out for ketones would be a good move. I'm thinking this is one of those things I'd run by my vet first.
 
You know the "recipe" for ketones right?
Insufficient insulin
Insufficient food
Some type of infection present.

Sometimes only 2 out of 3 can cause them. That's why I've been harping on maybe an infection ;)

How's his appy?
 
I printed out the link you posted, but I'm still confused. Is Somogyi the same as a bounce? Colin is bouncing high today, from PS 194 to 400's all day.
 
Carl & Polly & Bob (GA) said:
You know the "recipe" for ketones right?
Insufficient insulin
Insufficient food
Some type of infection present.

Sometimes only 2 out of 3 can cause them. That's why I've been harping on maybe an infection ;)

How's his appy?
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I appreciate that. His appetite is great! He'd eat more if I would let him, especially in the last few days with the insulin increase he seems hungrier again. His LB habits are good, he has energy and was out for about 6 hours today scouting, I just have this feeling it's too much insulin right now. Did you look at the link by any chance? He has had some real weird cycles with inversions instead of smiles, going down then back up and then down again all in one cycle.
Also, another one of the traits of somogyi's is with another increase he would go up again. It was like I have been giving him water. If it is Somogyi's it could take a few days to see his numbers go down. I am optimistic.
 
Sharon14 said:
I printed out the link you posted, but I'm still confused. Is Somogyi the same as a bounce? Colin is bouncing high today, from PS 194 to 400's all day.
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The difference between the two is that somogyi's occurs after a very low number approaching hypo. If the dose stays too high, it results in a higher flat cycle. The bounce is from just a lower number the cat is used to experiencing. This is the way I understand it.
 
Actually, the existence of "somogyi" is open to debate in the medical community.

On the board, it seems that lots of times, the terms "somogyi", "rebound" and "bouncing" are used interchangeably.

I usually use "bouncing".

And I usually try to look at "why" it happens.

If I see a number that is really low, then I would feel that the dose may have been too high that cycle. Like if the nadir is 40, then that indicates less insulin would be the way to go.

If the low was 150, and the cat is used to 300's, that can cause a bounce too. But in that case, I wouldn't change anything. Because 150 is not low. Just too low compared to what the cat is used to. And until he gets used to "normal", he'll probably keep bouncing until he remembers what normal is.

In general, "I'm from Missouri, the Show Me state" I need to see the low that caused a big bounce before believing that a dose was too high and caused a number to go really low.
 
Bobbie And Bubba said:
I think 51 is close enough and if you factor in variance in meter by -20% he could have been at 40. Let's see what happens.
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Bobbie,
Don't misunderstand, yes the 51 could definitely cause a bounce! And I might have even thought about a reduction. If I saw it happen a 2nd time. But I don't think it set up a prologed string of high flat numbers. If that were the case, I don't think you would have seen the blues that you saw the next couple of days is all. I hardly have watched every cat or looked at every spreadsheet over four years. But I've never seen any cat go into a spiraling series of high flat numbers from just one dip into the 40s or 50s.
 
Bobbi, I agree that Bubba is maddeningly unpredictable and very hard to figure out. But I am still thinking you need to gradually increase the dose, 0.25 every three cycles or so, until you see some lower numbers. We've done several restarts, lowering the dose, and they haven't worked.

You hold the syringe and you decide. I am be completely missing something - he is a puzzle for sure - and a redirection might work. But my vote would be steadily increasing.
 
Sharon14 said:
I printed out the link you posted, but I'm still confused. Is Somogyi the same as a bounce? Colin is bouncing high today, from PS 194 to 400's all day.
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I'm sorry Sharon (about the 400s) - from the way I understand it, you are seeing a bounce. Colin hasn't seen a number of 197 in a long time - isn't it nice to know that it's possible, though?
 
Carl & Polly & Bob (GA) said:
Bobbie,
Don't misunderstand, yes the 51 could definitely cause a bounce! And I might have even thought about a reduction. If I saw it happen a 2nd time. But I don't think it set up a prologed string of high flat numbers. If that were the case, I don't think you would have seen the blues that you saw the next couple of days is all. I hardly have watched every cat or looked at every spreadsheet over four years. But I've never seen any cat go into a spiraling series of high flat numbers from just one dip into the 40s or 50s.
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I am so hoping for Bubba sake and my sake that this help. Even today's cycle was crazy, inverted. The link I gave you said that is also another clue to too much insulin.; crazy patterns, not smile curves. Another reason I think it could be too much, on 11.13 PM cycle, I reduced him from 3.5 to 2.5 and his cycle didn't go crazy high, just stayed flat yellows.

If this doesn't work I can think of it as a couple of days of fur shots and proceed to go up again. Maybe, too, considering another type of insulin is not off the table.

I appreciate your input. I need to hear everyone's opinions and ideas because clearly what I was doing was not working.
 
Sue and Oliver (GA) said:
Bobbi, I agree that Bubba is maddeningly unpredictable and very hard to figure out. But I am still thinking you need to gradually increase the dose, 0.25 every three cycles or so, until you see some lower numbers. We've done several restarts, lowering the dose, and they haven't worked.

You hold the syringe and you decide. I am be completely missing something - he is a puzzle for sure - and a redirection might work. But my vote would be steadily increasing.
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Thanks Sue, I feel so strongly that I need to try this again. I can always go back up again. Look at todays cycle, inverted. Also look at 11.13 PM cycle I reduced from 3.5 to 2.5 and his numbers did not go crazy high, they continued yellow and flat after a 1 unit redux. I could be so wrong about this but, the idea started culminating in my mind yesterday after hours and hours of staring at his SS and factoring in so many things. Then today I found different information about Somogyi's and he sounded so much like what was happening with Bubba. After his surgery, and the cone came off, you'd think if his problem was stress related the numbers would come down but, instead they started to go up. That's when I started looking at it differently. Maybe I am wrong, I hope not, not so I can be right, just so there is resolution. I hope that everyone will still weigh in and help me and won't think that "I am a know it all " I just have a hunch.......
 
Bobbie,
I understand what you're thinking, and no matter what you do, I'll try to be around to help you figure out what Bubba is doing. I did read the link you posted, and actually I had read it before. It's just that I've read several things (on and off the board) that refute most of what was written there. Let's see what happens (and keep testing for ketones!). I also think a vet visit just to make sure something unseen and funky isn't going on is a great idea.
 
Well, Bobbie, it sounds like you know what you want to do! I agree...sometimes a hunch works out. In the end, you know Bubba best. I very much hope this works for you...please keep us posted. I'd love to see Bubba start getting some good, consistent numbers! If it doesn't work, we'll go from there.
:)
 
Carl & Polly & Bob (GA) said:
Bobbie,
I understand what you're thinking, and no matter what you do, I'll try to be around to help you figure out what Bubba is doing. I did read the link you posted, and actually I had read it before. It's just that I've read several things (on and off the board) that refute most of what was written there. Let's see what happens (and keep testing for ketones!). I also think a vet visit just to make sure something unseen and funky isn't going on is a great idea.
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I appreciate that Carl! :)
 
I think it is great that you are going to try going low one more time. A lot has changed since the last time you tried it and who know; you never know until you try it. I bet that you will know what to do after just a few cycles. You just got to cover all the different possibilities. So Bubba....shape up and find that blue/green number!
 
Rachel said:
Well, Bobbie, it sounds like you know what you want to do! I agree...sometimes a hunch works out. In the end, you know Bubba best. I very much hope this works for you...please keep us posted. I'd love to see Bubba start getting some good, consistent numbers! If it doesn't work, we'll go from there.
:)
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Thanks Rachel, the last thing I want to do is isolate myself from all you great people. I truly appreciate everyone time, feedback, opinions, and data. :)
 
Merlin said:
I think it is great that you are going to try going low one more time. A lot has changed since the last time you tried it and who know; you never know until you try it. I bet that you will know what to do after just a few cycles. You just got to cover all the different possibilities. So Bubba....shape up and find that blue/green number!
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I agree with a lot has happened since we went down and back up again. Fingers and Paws crossed. :)
 
Sharon14 said:
I printed out the link you posted, but I'm still confused. Is Somogyi the same as a bounce? Colin is bouncing high today, from PS 194 to 400's all day.
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Wow, he sure did bounce! It will be interesting to see what tomorrow's cycle does. I was looking at after his dental, he did start coming down, and then you raised the dose. I don't know anything about Levemir , maybe there was a reason you raised him. He was given you some strange patterns also, higher numbers in the middle of the day and then he went lower..... With levemir, is it the most potent 1/2 through the cycle like with ProZinc?
 
Every time I think I'm beginning to understand, I'm totally confused again. I think Lev has a slow, late onset, and a relatively flat cycle. It is a depot insulin, meaning some of the insulin is stored and slowly released. If you decrease the dose, which I did when I got what I thought were low numbers, the depot gets used up and you have to start over storing it up. Like Bubba, Colin has had frowns rather than smiles lately. For Colin, Maybe it's the depot, maybe it's insulin resistance/glucose toxicity or some other high dose thing, or maybe it's the moon! I don't know...:banghead:
 
Yes, Lev and Lantus are another universe. I used to hang out in the L forum and they were very patient in answering any questions I had to ask. I learned a great deal, and made some great friends. One thing I was reminded of frequently when I asked a question was "you need to turn off your PZI brain". And that was 100% true. The insulins don't work the same, they aren't dosed using the same logic, and the cycles are different. But once you start to understand the differences, you start to understand the insulin, and the cycles and all that goes with it. I'm lucky enough to have been able to "learn" a whole lot in 4+ years no matter where I hang out.
 
Bobbie, I agree with the rest that you know Bubba best and like you said, you can always go back up in a few days. It's not going to cause any permanent damage, so I think you should go with your gut and give it a try. Just check for those ketones more often. If sheer determination and hard work is what it takes to get Bubba regulated, there is no way you won't eventually get this. We are all rooting for you and Bubba!

Carol, I so feel your confusion too, it's all new to you, so scary right now for sure. Hang in there!

Paws and fingers crossed for both of you! :bighug:
 
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