12-23-17 Jones - PMPS -250, +2 175

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Tracey&Jones (GA)

Tracey&Jones (GA)

Member Since 2016
I am getting a little worried about these runs of high yellows and pinks. This has been going on for some time and Wendy mentioned glucose toxicity. I have been reading up on it and the way I read it is that his beta cells are not secreting any/enough insulin and combined with some insulin resistance the cat will become diabetic. Which he was diagnosed over a year ago (I have been thinking this whole time if he wasn't on prednisolone he would eventually not need insulin) and have been injecting insulin which is the remedy (maybe not quite the right word) for FD. I have also read this can occur in cats the are even well regulated with insulin and their needs for a higher dose occurs.

So if that is the case..how do you know a cat has glucose toxicity? Is it due to seeing higher numbers, no real nadir that occurs for no particular reason?

My thoughts have been that he seems to be fully recovered from his ER visit in late September. I think I am seeing improvement in his numbers in the following weeks up to about Dec 10th or so. We have seen no greens, in fact we in general have seen higher blues that seem to be setting off a high bounces. I have added in some addition carb for his PS meal and the first bites in his bowl. That seems to have stopped the big drops that may have been triggering bounces. Yesterdays cycles really upset me in that I know we missed the +6 however I don't think it would of dropped that much however it was it seems were are in another bounce or he is just going up and up.

So my questions 1) Does he look like he has glucose toxicity ? 2) Does the rate of increasing dosing change at all with glucose toxicity? 3) This morning makes 8 cycles on the current F0.20 dose. Do I stay here for 4 more and do a curve or do I increase now that I am basically home for the next 3 days and keep getting as many tests as possible.

And how is Jones - pretty good. Eating well, purring lots, poops are good (well for him anyway), peeing volumes are higher at the moment but I think that is to be expected with these higher numbers. He is all groomed up and is actually quite alert this morning.

Wishing everyone happy "final" season preparations and chin rubs for all the kitty's.

ETA to add last condo.
 
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Others will know better than me, but I got the impression that glucose toxicity is more of an issue with really higher numbers, ie blacks and reds. I think what gives me this impression is that initially, my vet said that we'd like to get Quintus "as many hours a day as possible" under 20 mmol/l. If staying between 10-20 was his initial goal, I'm suspecting that it's a "less risky" space than higher up.
 
Stephanie & Quintus said:
Others will know better than me, but I got the impression that glucose toxicity is more of an issue with really higher numbers, ie blacks and reds. I think what gives me this impression is that initially, my vet said that we'd like to get Quintus "as many hours a day as possible" under 20 mmol/l. If staying between 10-20 was his initial goal, I'm suspecting that it's a "less risky" space than higher up.
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Someone told me that Silver had developed glucose toxicity after my return from Scotland and I had to keep increasing until it broke. Dunno tho. How late was your night last night?
 
I believe that Boomer had glucose toxicity for a while. I believe I caused it when, after a dental, I restarted insulin at a very small dose instead of at his regular dose (I had a reason, he had gone into remission after previous dental so when BG was low I hoped he was repeating it). It took several weeks and consistent .25u increases until we reached 3 units and he started reacting finally. And then he earned reductions pretty quickly and he was down to 2 units in about a month.
 
Judy and Boomer said:
I believe that Boomer had glucose toxicity for a while. I believe I caused it when, after a dental, I restarted insulin at a very small dose instead of at his regular dose (I had a reason, he had gone into remission after previous dental so when BG was low I hoped he was repeating it). It took several weeks and consistent .25u increases until we reached 3 units and he started reacting finally. And then he earned reductions pretty quickly and he was down to 2 units in about a month.
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I can see the numbers rise about 10 days after the dental. The BG's ranged up to yellow's and pink with a few blues or greens but nothing that stuck. Now you are back down to some pretty sold greens and blues. It looks like it took about 3 months.

You are on TR so you don't have to hold your dose as long as SLGS do you? It seems like 12 cycles was your longest until you hit 3 units and saw some nice blue greens on a more consistent manner.
 
Judy and Boomer said:
I believe that Boomer had glucose toxicity for a while. I believe I caused it when, after a dental, I restarted insulin at a very small dose instead of at his regular dose (I had a reason, he had gone into remission after previous dental so when BG was low I hoped he was repeating it). It took several weeks and consistent .25u increases until we reached 3 units and he started reacting finally. And then he earned reductions pretty quickly and he was down to 2 units in about a month.
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Yup. Same happened with Silver. My fault. Had to reduce dose when petsitter wasn’t able to test.
 
Tracey&Jones said:
I can see the numbers rise about 10 days after the dental. The BG's ranged up to yellow's and pink with a few blues or greens but nothing that stuck. Now you are back down to some pretty sold greens and blues. It looks like it took about 3 months.

You are on TR so you don't have to hold your dose as long as SLGS do you? It seems like 12 cycles was your longest until you hit 3 units and saw some nice blue greens on a more consistent manner.
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He also decided during this glucose toxicity period that he was going to bounce after lower numbers, something I had never had to deal with before. So sometimes I held the dose a bit longer than I probably should have because I wanted to see if he would come down from the bounce. It was a very frustrating period of time and felt much much longer than the 3 months.
 
Judy and Boomer said:
bounce after lower numbers
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Jones seems way more "sensitive" now. I thought it may have been to that Aug incident of being really low. I was in the ER and my back up did the injection but not the prednisolone dose. But I am beginning to think it is more than that. A high blue sends him right back to high yellows and pinks. Like you, he didn't seem like that before.
 
Yes he could have some glucose toxicity but I’ve seen much worse.

IMHO, the issue is more that you are increasing in too small increments. The only time you want to go up by fattening the dose is if the nadirs are already green and you just need to fine tune it. In looking at his SS, I see that as a good part of the issue as far back as Sept.

He could be trying to clear a bounce from the last blues and tonight would be the sixth cycle. You can see what he does the remainder of today, if you like, but if he doesn’t get back down to green, my suggestion would be to increase by 0.25u.

I keep seeing on member’s signature blocks “modified SLGS”. I don’t really understand what this means since SLGS is the most flexible of the approaches we have. The guidelines are to help new members get a start but once someone has data and knows their cat, they should be modifying SLGS for their cat. It makes me wonder if members feel the need to put “modified SLGS” because other members don’t understand that is what should happen as you get more experienced and so they try to continue to hold those following it to the exact guidelines and it’s easier to just indicate “modified SLGS” than to always explain it. :rolleyes::confused::confused: If I don’t see “TR” and the member has some experience and data, I assume they have tailored SLGS to their kitty’s needs .....which is excellent.

ETA: I am not suggesting new members modify SLGS right off the bat. You need to have data; be able to identify your cat’s onset, nadir, duration; understand how your cat responds to food; understand how to manage the food and insulin together, etc. My comments are specifically aimed towards experienced members who know all of the above.

I’m sure you’ve answered this question so please forgive me, but you test plenty for TR and I don’t see that he is eating dry food. Is it your work, perhaps?

I also see on last night’s remarks that you ask about “double nadir”. He was actually pretty flat yesterday from what we can see and he might have come down lower but if the numbers were not meter variance, his PMPS was likely a double dip.
 
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Marje and Gracie said:
Yes he could have some glucose toxicity but I’ve seen much worse.

IMHO, the issue is more that you are increasing in too small increments. The only time you want to go up by fattening the dose is if the nadirs are already green and you just need to fine tune it. In looking at his SS, I see that as a good part of the issue as far back as Sept.

He could be trying to clear a bounce from the last blues and tonight would be the sixth cycle. You can see what he does the remainder of today, if you like, but if he doesn’t get back down to green, my suggestion would be to increase by 0.25u.

I keep seeing on member’s signature blocks “modified SLGS”. I don’t really understand what this means since SLGS is the most flexible of the approaches we have. The guidelines are to help new members get a start but once someone has data and knows their cat, they should be modifying SLGS for their cat. It makes me wonder if members feel the need to put “modified SLGS” because other members don’t understand that is what should happen as you get more experienced and so they try to continue to hold those following it to the exact guidelines and it’s easier to just indicate “modified SLGS” than to always explain it. :rolleyes::confused::confused: If I don’t see “TR” and the member has some experience and data, I assume they have tailored SLGS to their kitty’s needs .....which is excellent.

I’m sure you’ve answered this question so please forgive me, but you test plenty for TR and I don’t see that he is eating dry food. Is it your work, perhaps?

I also see on last night’s remarks that you ask about “double nadir”. He was actually pretty flat yesterday from what we can see and he might have come down lower but if the numbers were not meter variance, his PMPS was likely a double dip.
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I’m one that didn’t know you were supposed to modify SLGS method so I wonder if the method can be updated to make that clearer? I for one would really would love to do TR but having read it several times it seems it’s not possible unless you can regularly catch the nadir. I would love more ideas on how SLGS should be tailored? Maybe a think tank topic?
 
@Marje and Gracie
Thanks for your reply. I was looking to go up tonight to 0.25 and will hold that for a week. And I now realize looking back at what you are saying about the dose. I guess I got stuck to much in the past dosing regime vs. looking at the now. Thanks for that!

I had to smile at the modified SLGS comments. I put that in my signature because I did modify it for Jones and adjusted the reduction point to 70 vs 90 after some input. And when asking for input....some people remembered and some didn't. So I thought if I put it in my signature that people would ask to clarify if needed. And based on Juliet response I would say that yes, new members don't know that it can be modified eventually.

I originally went to SLGS because when he was first diagnosed, I was the only one testing him and yes work. However, life being what it is, DH was badly injured in a motorcycle accident and has been home for over a year now. He healed up enough to learn to test. DH can test as well. So that is why we are getting those mid cycle tests every day. I do the night ones. Also, in light of Jones never going off prednisolone, remission was not my goal. Not sure if those were good reasons or not...
 
Juliet said:
I’m one that didn’t know you were supposed to modify SLGS method so I wonder if the method can be updated to make that clearer? I for one would really would love to do TR but having read it several times it seems it’s not possible unless you can regularly catch the nadir. I would love more ideas on how SLGS should be tailored? Maybe a think tank topic?
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The one caveat is that the member has plenty of data and knows their cat’s patterns; I don’t think you are there with Silver yet, IMHO. That isn’t a critique; it is just the way it is because you have to keep him safe during those long work hours.

There isn’t “one” way to tailor SLGS. It really depends on the cat, the patterns, the availability and ability of the CG to test, etc. The sticky on SLGS does state that they are “general” guidelines and should be “personalized” to your cat’s needs and to address your cat’s response to insulin and food. I think any more said about it than that and even new members would be changing things up before they’ve even built the basic data; could identify their cat’s onset, nadir, duration”; understand how their cat reacts to food, etc. Anyone can start a Think Tank topic, but you’re going to get a ton of things likely thrown at you that may have no bearing on Silver. It’s really ECID but you must understand your cat’s patterns, etc. For the most part, you would be able to make dosing decisions on your own and know when and when not to shoot or shoot a BCS, etc. Yes, sometimes it’s hard to see the forest for the trees and even as an experienced member, I’d occasionally have Jill look at Gracie’s SS but, by and large, you’ve got to really know your cat.

Tracey&Jones said:
@Marje and Gracie
Thanks for your reply. I was looking to go up tonight to 0.25 and will hold that for a week. And I now realize looking back at what you are saying about the dose. I guess I got stuck to much in the past dosing regime vs. looking at the now. Thanks for that!
You’re welcome. :)
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Tracey&Jones said:
had to smile at the modified SLGS comments. I put that in my signature because I did modify it for Jones and adjusted the reduction point to 70 vs 90 after some input. And when asking for input....some people remembered and some didn't. So I thought if I put it in my signature that people would ask to clarify if needed. And based on Juliet response I would say that yes, new members don't know that it can be modified eventually.
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As I suspected. Like all things L/L Land, some members copy it not having the basis for doing so as you do. I wonder if it’s better just to leave it as “Individualized Dosing---Do Not Copy”. If I see just that and it’s an experienced member like yourself, I “get” it. That doesn’t mean I won’t make recommendations, but I understand what they are doing.

Tracey&Jones said:
originally went to SLGS because when he was first diagnosed, I was the only one testing him and yes work. However, life being what it is, DH was badly injured in a motorcycle accident and has been home for over a year now. He healed up enough to learn to test. DH can test as well. So that is why we are getting those mid cycle tests every day. I do the night ones. Also, in light of Jones never going off prednisolone, remission was not my goal. Not sure if those were good reasons or not...
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You don’t have to worry about whether it is a “good” reason to anyone but you. I was just curious. You should do what you know is best for you and Jones :bighug::bighug::bighug::bighug:
 
Tracey&Jones said:
Will make that change.

And since we are talking modifications...I said I would hold a week but in this circumstance that we are currently in, would it be ok to go up in dose quicker than a week? After input of course.;)
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The way I look at it is you are very experienced at this point and you know what you are doing. Yes, sometimes even those of us that are experienced need someone else to peek at the SS and offer suggestions. Many using SLGS don’t have anywhere near the data you do and they need that weekly curve to help them see what might be going on. You don’t; you’ve tested enough to know he needs more insulin. It’s the holidays and you’re around so I’d take advantage of it. When you have him looking a bit better, if you want to go back to holding doses for a week, that’s :cool::cool:
 
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