Help Plz - Father Passed, Leaving Town...And Spot's Readings Going Up With Insulin Increase

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Sweet Spot

Sweet Spot

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Good Morning,


Please help, once again........we are so distressed and confused.......


My father passed away a few days ago and we are leaving on our 2,000 mile journey to Illinois this afternoon. As you can understand, our frequent testing has been extremely minimal – but we have grabbed a few where we could and always do pre-shot testing. I took a few minutes to update his spreadsheet, to reflect what we are seeing, if you would be so kind as to take a look after reading this post. It is going UP since increasing insulin dose.


Right before my father passed, THIS LINK shows when we increased his dose, he had a bounce. But now it appears the dose has made his overall numbers higher and higher every day! He is acting “normal” - no hiding, great appetite...but we “think” we are seeing a higher volume of urine output (more wetness in the litterbox) in addition to his appetite possibly being greater than usual (and as a grazer, he is eating frequently so we might be constantly getting food influenced readings?). But not acting ill, not hiding...he is grooming himself and animated.


My brain is so overloaded right now I don't trust my own assessment. Is it even possible his dose is too high – or is this an adjustment phase? Seems too high is impossible given he didn't budge on 1u. But how can an increased dose cause an increased reading each time now? He wasn't great at 1u but his numbers certainly look worse on 1.5u.


I should add, which I haven't to date (so sorry) that all of Spot's recent labwork was excellent – including kidneys and liver – BUT his lipase was high. He was not symptomatic of pancreatitis so that lipase issue is still “out there” and not being addressed by the vet. I know Spot is new to insulin so it could be that we just need more time to see results – I just thought he would budge a little? I especially didn't expect to see numbers creep up with a .5u dose increase....


Please know I will be reading replies on the road – we will be gone for weeks – so please don't take my slowness to respond as any lack of involvement or appreciation. Believe me, I will be reading all of your advice and will thank you in advance for helping us through these difficult times.


Robin (and Spot)
 
Robin, you have my deepest condolences on the passing of your dad. I know how hard that is. Are you taking Spot with you or leaving him at home with someone?

I think you just haven't gotten to a good dose yet. No, I don't think the dose is too high. There isn't anything to suggest that. Cats need as much as they need and it looks like you're just at the beginning of this. Was he diagnosed or started on insulin on 5/13/16?

When you're looking at what to do with the dose, the low numbers make the decision. It's always answering the question, how low can this dose cause my cat's blood sugar to go? I'm noticing that yellow 262 and wondering if he went any lower than that afterwards. You don't need to stay up all night testing, but if you do notice a drop like that one in the future, it can be helpful to follow it up with more tests to see how low the kitty is getting.

I would just stay the course for now, but do try to get a test right before you go to bed. So many cats have their lowest numbers at night that the pm cycle is really important.

Please ask as many questions as you have. We're happy to answer.
 
Robin, I so very sorry about the passing of your father; you sure have a lot on you plate right now. :bighug::bighug::bighug:

There is something called New Dose Wonkiness NDK which can cause the BG's to go up after an increase but, it is usually within 24 hours and it is temporary. So, that is not be the case with Spot right now.

Are you testing for ketones. With numbers in this range, it would be advisable.

Are you following TR or Start Low, Go Slow method? If you could get some more test in around the mid-cycle to see how low that dose is taking him, that would be helpful. Also, before bed test are good ones to get too.

Safe journey to you and keep posting.
 
:bighug::bighug::bighug: Hugs to you and your family at this difficult time of transition for all of you.

Great job on getting all those "at home" tests in the midst of all that you are doing right now. I don't have answers to your questions but I can tell you, in my very limited experience, that my cat needed insulin treatment for at least a month before the numbers started moving much. Take care of yourselves. We'll all be here to help when you are in need of suggestions. :)
 
Thank you so much, Julie -

To answer your questions:

  1. Yes, he did start insulin 5/13/16
  2. Yes, he will be coming with us

The only "upside" to traveling with him (and there are few right now) is that we will have more evening time uninterrupted to get more PM tests in. Of course, we have to take into account the stress of travel - but we will be in motels each night and able to perform and keep an eye on evening readings much more closely. We are definitely lacking evening data.
 
Thank you, Bobbie and Jan......

Bobbie - I have not tested for ketones but will try to once we arrive in Illinois. I have no access to ordering anything online right now. Is there a test that is reputable which can be purchased at a chain store (Walgreens, etc?). Also, I am doing TR protocol - or trying to - but with stress of travel I likely can't follow it perfectly right now until at least to a motel where we will stay for a longer duration than an overnight.

Jan - thank you for sharing your story....it gives me some optimism, which I desperately need right now. Did you ever have consistent rise in numbers with an increased dose? That is what I am so confused about. I like to understand and research why things happen - but have had no time to do so given my father's health crisis these past few months.
 
Robin at any pharmacy, you can get ketone test strips. You have to catch him in he litter box and get the strip under the stream of urine and then you check the color of the test strip after waiting 15 seconds then compare it to the color chart on the side of test strip vial to see if ketones are present. Some peeps get a kitchen ladle with a long handle and they place it under kitty bum to catch some urine. I always had trouble finding Bubba in the LB at the right time. I purchased a ketone meter from Amazon around 30-35 bucks called the Precision Xtra meter. I found that so much easier than trying to catch urine. The test strips are pricey though, but to me worth it as the ketones show up faster in blood than urine. Maybe that's something you could look into. Meantime, you can pick up some ketone urine test strips.

After getting some test in during the night cycle to see how low Spot is going, it will help to know what to do next. Post and ask for dosing advise after you get some PM test in.
 
Sweet Spot said:
Thank you, Bobbie and Jan......

Jan - thank you for sharing your story....it gives me some optimism, which I desperately need right now. Did you ever have consistent rise in numbers with an increased dose? That is what I am so confused about. I like to understand and research why things happen - but have had no time to do so given my father's health crisis these past few months.
Click to expand...

When we were first giving insulin to Radar a year ago, I basically knew nothing about diabetes and I didn't know how to even begin to interpret the numbers I gathered from home testing. The first two months of treatment I was in a constant state of uncertainty about everything I was doing to try to help my kitty feel better. When I found this site and started reading here every day, that was when things really changed for Radar. As I read more, then I began asking questions and was able to build on each day's learning. I am also the person who wants to know "why?" so I understand your urge to dig inside the numbers and really understand them. In the beginning of our learning about diabetes, I found it very valuable to look at the spreadsheets of other kitties so I could begin to understand the numbers better. Take a look at Radar's spreadsheet - there's a link in my signature. When you get to the ss, go to the bottom of it and click on the 2015 tab and you'll be able to see our early days. When we started with Vetsulin in April his BG levels were just really high and as we raised the dose more and more the numbers began coming down. I could see what was happening more clearly as I began testing more and more. My suggestion to you is to breathe, hug your kitty and keep reading. It takes time for the humans to understand how to help the kitty and it takes time for the kitty's body to adjust to the insulin so it can work. Hang in there. It does get easier. Really. It does. :bighug::bighug::bighug:
 
Robin :bighug::bighug::bighug:sending you my condolences at this difficult time.

Looking at Spot's ss I was wondering the same thing as Julie about that yellow, and whether Spot dropped a little lower, and wondering whether that
I would suggest getting those evening tests in as a matter of course, I always tried to get a +1 or +2 and then a before bed (for me that was a +4 or +5) following up with more if the numbers demanded it. You have had a lot on your plate so it's understandable that this has been difficult.
Spot seems to have been staying flat in the pinks during the am cycle, but we can't say for sure if he has been doing the same at night, as Julie said often Kitties have their lowest numbers at night.:rolleyes:
Getting some night time data before you make a dosing changing might be a good idea, and if you are going to take him up a tad it would be best to time that in such a way that you know you will be able to monitor closely if needed.
He's only newly diagnosed, so don't get disheartened by those pink numbers, BFG spent six weeks in pinks and reds before we got to that 'goldilocks' dose and started seeing some nicer numbers, he was diagnosed in October and went OTJ about a month ago, we also followed TR.
Hang in there:bighug::bighug::bighug: it's a steep learning curve but you will get there. :)
 
It's not at all uncommon for us to see a cat's blood sugar not responding too much to doses until you increase and hit the "sweet spot." hehehe for your Sweet Spot! Then often things come together and suddenly you'll start seeing the response you're hoping for. It's a bit counter-intuitive, because logically speaking, you'd think that increasing a little would bring about a little bit of response and slightly lower numbers. But for whatever reason, that slight lowering of blood sugar overall doesn't always happen.

The dosing guidelines follow a basic plan of 3 phases. Cats start out in the "increasing the dose" phase. You stay with those directions on the Tight Reg sticky until you start seeing green nadirs. Then you are in a "hold the dose" phase, trying to keep the cat in normal range as much as possible. In that range, roughly 50-120 on a human glucometer, the cat's pancreas has the opportunity to heal if it is able to do so. Newly diagnosed cats have the best chance at that since the damage to their pancreatic beta cells may not be too much. Once the cat begins earning dose reductions - the body is telling you the insulin dose is too large when the blood sugar dips below 50 (also human meter.) Then you enter the dose reduction phase, reducing the dose in response to blood sugar tests.

So for now, you are in the "increasing the dose" phase. Don't let the high numbers get to you - it's likely that Spot was diabetic for a little while before you noticed and he got diagnosed. Increasing methodically, per the Tight Reg guidelines, will get you safely to a dose that will move his blood sugar into normal range.

Are you familiar with bouncing? or New Dose Wonkiness that Bobbi mentioned? Take a look at the first 2 posts in this thread. They explain higher numbers that we see sometimes.

One observation - that red amps on 5/19 followed the pm cycle that had the yellow test in it. That suggests to me that the 5/19 may have been a bounce in response to the lower numbers on 5/18. At the phase that Spot is in, it would be pretty likely that a bounce would last a full 3 days. Counting forward 3 days from the night of 5/18 would've been last night. And VOILA, this morning, Spot has red numbers again.

I would expect him to have high numbers for another 3ish days and would be looking for him to clear this bounce about 5/25. In the meantime, I'd try to get 4 tests per day, both preshots and one in the day cycle and one right before you go to bed. At any point if you see a yellow number, if you can, follow it up with another test an hour or two later to see if he's dropping. It would be great if you could see how low this dose is taking him. I think you have a choice about what to do now with the dose. If you were going to be home, I'd suggest you increase the dose by 0.25u now. You've had more than 6 cycles at this dose and the lowest test in there (and you've done a pretty good job of getting tests in, too - kudos) is in the 200's.

Given your circumstance, if you want to hold the dose it would be understandable.

This is the part of the Tight Reg guidelines that I'm looking at:
INCREASING THE DOSE:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Thank you all again and again........what great information......when on the road I will read this over and over....
I agree PM readings is what is missing big time in this spreadsheet.

We did just do a +4 and he is at 407...not budging (which fits his cattitude, I might add)..........
 
Robin, just wanted to pop in and offer my deepest condolences on the loss of your father. I'm so sorry you're having to deal with stress over Spot's FD at this already difficult time. Anything we can do to help you through it, we will. Just keep asking questions!!

:bighug::bighug::bighug:
 
Thank you everyone........got one last reading (nadir at 6 hrs and 15 mins) before getting on the road - it was 359 - I know it isn't healthy still, but a little parting gift going in the right direction until the motel tonight.

Again....thank you all....I feel bad not being able to reply to everyone separately - I so look forward to a future where Spot can get my undivided attention and I can get to know you all better.......

Take care,
Robin
 
I am so sorry at the loss of your father. Please accept our condolences. Hugs to you, you are doing a super job with everything that's going on. Keep following the protocol, the numbers will get better. Spot is a handsome guy, so lucky to have such caring beans (as in human beings :joyful: ).
Liz
 
((((Robin))))
I'm so sorry for your loss. Hopefully, having Spot with you will ease the stress of the loss and reduce you're worrying about him if he were at home.

I agree with what Julie posted -- I don't think your kitty has reached a good dose yet. It can take longer than what most of us initially expect to see movement in numbers. What most of us don't think about at the beginning of this diabetic adventure is that it is likely that our kitties were diabetic for some time before they were actually diagnosed. Reduce the stress of worrying about the numbers. As long as you follow the protocol and systematically increase the dose, your cat's numbers will respond. Since most of us have crystal balls that refuse to work, we just can't tell you when you'll see a change in Spot's numbers.

FWIW, you are doing a good job at getting test data. As you've noted and others suggested, a "before bed" test every night will help you to have a handle on the PM cycle. Many cats experience lower numbers at night so getting a test or two in is helpful.

Please don't worry about responding to each and every post. Let us know if you have questions or how we can help. It's an understandably difficult time for you and we're here to offer whatever support you need.

 
When there isn't enough insulin to use the carbohydrate from food, the body breaks down fat for energy. Lipase is an enzyme which breaks down fat, so that could be the reason for the elevation.

My condolences on the death of your father. {{hugs}}
 
Dear Robin,
Our deepest sympathy on the loss of your father. We wish you a good trip with not too much stress. You have gotten some excellent information here. Hopefully you will find Spot's good dose and see some lower numbers soon.

:bighug::bighug::bighug:

Ella & Rusty
 
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