? 1/31/21 Chicamonkey AMPS 376/+3 346/ +8 306/+10 360/PMPS 499/+3.5 403/+5 353 reduced dose to 3.25

Suzi and Chicamonkey

Suzi and Chicamonkey

Member Since 2020
I’m concerned that I have overshot her desired insulin amount. When I look back at her spreadsheet- when she was on 2.5 her numbers were much better. Since increasing past that point, her numbers have risen... and she’s flat through the cycle.
I’m either dealing with an acrocat or I’m past her range.
I suspect it’s the latter of the two.

I have dropped her back a little this morning to 3.25 units her +6 last night was 368 and her amps was 376. And that was her 2nd dose at 3.75.

the nurse in me is telling me it’s too much insulin. My spidey senses are up

https://docs.google.com/spreadsheets/d/1TjuFg14iN2ubR9d_eIpYXjemtT0ZwOHO05doh-0vtz4/edit

yesterday
https://felinediabetes.com/FDMB/thr...its-3-385-7-274-pmps-420.242306/#post-2730141
 
Hope Chicamonkey slides down for you :bighug: FWIW, a cat's insulins needs change and a dose that worked before may not work now. If you are open to it, throw up a question to get others input on the dose (if not, totally respect that too!). Hope you have a wonderful day!
 
JaxBenji said:
Hope Chicamonkey slides down for you :bighug: FWIW, a cat's insulins needs change and a dose that worked before may not work now. If you are open to it, throw up a question to get others input on the dose (if not, totally respect that too!). Hope you have a wonderful day!
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I’m totally open to all input.
I just have that gut feeling..... maybe I’m wrong BUT.... no great results since the dose of 2.5
 
Hi Suzi,

I can see why you think some change of strategy might be needed. I am not the expert you want.
But when my naive eyes look at your SS it seems like chica was the best before switching to Lantus? What was she on?
 
Hercule's mum said:
Hi Suzi,

I can see why you think some change of strategy might be needed. I am not the expert you want.
But when my naive eyes look at your SS it seems like chica was the best before switching to Lantus? What was she on?
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NPH. I think the lantus will be the best but... everything in me is telling me it’s too high of a dose.
When I see bounces that only “recover” to the 300-400 level... and flat curves..... Nadirs of above 280....
My gut says back off BUT slowly.
The last thing I want is for her to hypo from too high of a dose or DKA from backing off too much too soon.
Walking a tightrope........
 
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It would be good to have the opinion of someone that might have experience on what too much of a dose looks like... @tiffmaxee ? @Bandit's Mom ?

In my naive understanding I tought that too much would look like bounces, but then we should see some lower values somewhere? :confused:

I know nothing about NPH, and hercs has done very well on Lantus, but ECID!!!! Maybe Lantus is not the right one for her?
 
If Monkey was getting too much insulin you would see her dropping under 50. You aren’t seeing any green period. Sometimes you have to keep raising the dose until you hit one that clicks. We have shown you numerous spreadsheets that prove this. Once they stay in higher numbers you have to give more and more insulin until you find the breakthrough dose. I think you are making a intake by lowering the dose but you hold the syringe. It’s also possible IAA or Acro or both are the cause of the high numbers. You are doing a great job of testing so would have caught any lower numbers.
 
The longer you leave her in higher numbers, the more insulin you will need to break through the glucose toxicity. If you were giving too much insulin, you would have caught a low number at some point on every dose. The only way you can overshoot the good dose is by either (a) increasing by too large an amount (like multiples of 1U) or (b) by not getting tests to see how low the dose is taking Monkey.

Here's another SS of Squeaky who went up to 4U and is coming back down:
https://docs.google.com/spreadsheet...t0qz59f9Qr0Kl0_ytNEpSJjs_d_8sboRnMyLW/pubhtml

We have already given you an example of Henry where the "reset" to a lower dose did not work. He went up to 4.75U and is now down to 0.75U
https://docs.google.com/spreadsheet...mPldCL2zOzzolQR8CnLKrz4CthDU9g8CG6OC7/pubhtml

Take a look at this SS. The CG was not testing enough. Even then, the kitty gave green and lime pre-shots to indicate that the dose was too high
https://docs.google.com/spreadsheet...Un9WM7ef-10InTiXJVyOeHupY/edit#gid=1128964611
 
tiffmaxee said:
If Monkey was getting too much insulin you would see her dropping under 50. You aren’t seeing any green period. Sometimes you have to keep raising the dose until you hit one that clicks. We have shown you numerous spreadsheets that prove this. Once they stay in higher numbers you have to give more and more insulin until you find the breakthrough dose. I think you are making a intake by lowering the dose but you hold the syringe. It’s also possible IAA or Acro or both are the cause of the high numbers. You are doing a great job of testing so would have caught any lower numbers.
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Respectfully, I don’t think that’s the case . I’m getting worse responses with higher doses... it keeps climbing without lower nadirs.
 
If a cat gets too much insulin, you will see the bg drop under 50. You haven’t. You have not hit the correct dose. Monkey is getting used to higher numbers which will only require more and more insulin. I hope you are checking for ketones.
 
Suzi

I’ll try to put this as politely as I possibly can :) Elise and Bhooma have both been trying to tell you many times that Monkey is not overdosed. I believe I’ve even addressed this before. They are spot on. They have linked SSs for you to illustrate what they are advising. They have put a lot of time, energy, care, and concern into helping Monkey and you.

I know you love your beautiful little girl but it comes down to whether you trust us, here, with all of our decades of experience, or you don’t. If you don’t, we might not be the place for you. Wendy, Sienne, and I, as moderators, have, cumulatively, about 30 years of experience with FD and have helped probably well over a thousand cats. We were trained and mentored by the very experienced members before us like Jill and Libby but including a vet tech named JoJo who had the most vast knowledge and experience with FD that I’ve ever seen. We’ve passed our knowledge on to many of the members who have been trying to help you. We’ve all used the TR protocol with our own cats.

Doing a rebound check like you did this morning is nothing short of harmful to Monkey. That is the long and short of it. You have to throw aside your nursing instincts because human diabetes does not equal feline diabetes. If you want Monkey to do better, you have to have a little faith in us and increase the dose after every six cycles in accordance with the TR protocol until she starts seeing numbers below 200. I understand it’s hard; I danced this dance for over 5 years; we’ve all done it. We get it.

It’s time to stop reaching for conclusions that are not there. She is not overdosed; she can’t be with the way you’ve been dosing which, of recent and until this morning, was correct. I understand you are worried about IAA and acromegaly but it’s too soon and several members have told you that. Evidence from the Royal Veterinary College, which is an amazing resource for acro, is that testing before she’s been on insulin for 73 days is likely to not reveal the correct answer. We recommend you wait until she gets to 6u for good reason; we’ve seen cats that get up to over 5u and are not acro or IAA. On the possibility that she is acro, by reducing her dose and not continuing to increase it, you are not doing her any favors. She needs the insulin she needs so why not give it to her when the testing and the TR protocol indicate it’s time for an increase? You are just causing her to build up more glucose toxicity and it will take longer and more insulin to break through it, acro or not.

I’m sorry to be so blunt but somehow, with all the members trying to help, we aren’t getting through to you. I hope you will start listening. I strongly urge you to take her dose back up to 3.75u tonight and just consider this morning’s shot to be like a one-time reduced dose or a partial fur shot.
 
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Marje and Gracie said:
Suzi

I’ll try to put this as politely as I possibly can :) Elise and Bhooma have both been trying to tell you many times that Monkey is not overdosed. I believe I’ve even addressed this before. They are spot on. They have linked SSs for you to illustrate what they are advising. They have put a lot of time, energy, care, and concern into helping Monkey and you.

I know you love your beautiful little girl but it comes down to whether you trust us, here, with all of our decades of experience, or you don’t. If you don’t, we might not be the place for you. Wendy, Sienne, and I, as moderators, have, cumulatively, about 30 years of experience with FD and have helped probably well over a thousand cats. We were trained and mentored by the very experienced members before us like Jill and Libby but including a vet tech named JoJo who had the most vast knowledge and experience with FD that I’ve ever seen. We’ve all used the TR protocol with our own cats.

Doing a rebound check like you did this morning is nothing short of harmful to Monkey. That is the long and short of it. You have to throw aside your nursing instincts because human diabetes does not equal feline diabetes. If you want Monkey to do better, you have to have a little faith in us and increase the dose after every six cycles in accordance with the TR protocol until she starts seeing numbers below 200. I understand it’s hard; I danced this dance for over 5 years; we’ve all done it. We get it.

It’s time to stop reaching for conclusions that are not there. She is not overdosed; she can’t be with the way you’ve been dosing which, of recent and until this morning, was correct. I understand you are worried about IAA and acromegaly but it’s too soon and several members have told you that. Evidence from the Royal Veterinary College, which is an amazing resource for acro, is that testing before she’s been on insulin for 73 days is likely to not reveal the correct answer. We recommend you wait until she gets to 6u for good reason; we’ve seen cats that get up to over 5u and are not acro or IAA. On the possibility that she is acro, by reducing her dose and not continuing to increase it, you are not doing her any favors. She needs the insulin she needs so why not give it to her when the testing and the TR protocol indicate it’s time for an increase? You are just causing her to build up more glucose toxicity and it will take longer and more insulin to break through it, acro or not.

I’m sorry to be so blunt but somehow, with all the members trying to help, we aren’t getting through to you. I hope you will start listening. I strongly urge you to take her dose back up to 3.75u tonight and just consider this morning’s shot to be like a one-time reduced dose or a partial fur shot.
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Thank you so much for everyone’s help. I really appreciate all of it more than uou know
 
Hi Suzi,
Sorry Chicamonkey's numbers aren't coming down for you. Buddy didn't even see any blues until I got to 4.25 units. It felt like the insulin was doing nothing for long a while there.
I'm sure it's even more frustrating for you because you had some better numbers before. I hope she starts responding for you soon. It's really tough to put all of the effort in and not see any results.
 
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The only point that Marje and Elise did not. underscore is that you have been systematically raising Monkey's dose. It is highly unlikely that you would have gone past what is a good dose if you are raising the dose in a step-by-step manner. You've been doing everything right.

FWIW, not all cats respond in quite the same way. A year or so after I first arrived here, another member joined. It took 2. years for Mocha to go into remission. Sometimes regulation and/or remission doesn't happen on the kind of schedule the caregiver would like to see. If nothing else, managing your cat's FD will teach you patience.
 
Good afternoon Suzi. I just want to say that I have walked in your shoes. When we started out, Neko first saw green about 3.75 units. I was elated. After a single green, it faded away, I increased. Sometimes I saw greens after an increase, sometimes I didn't. Those greens were fleeting, teasing me. Eventually I got four whole hours in a row in greens. We were up 5.25 units by that point. Then green disappeared again, it wasn't until 6.25 units until I saw it again. I had lots of doubts on dosing and it being too much. Sienne, Marje and others pushed me to increase so I did. Finally at 8.75 units she was seeing hours of green and they weren't going away. She earned her first reduction, three and a half months after that first green.

As a graphic picture of what can happen, look at Neko's SS in 2015, starting in mid July. A regulated cat went completely off the rails and I had to chase after her numbers with increases.

That is a story of a cat with insulin resistance. Neko had a combo of acromegaly, IAA and by that point plenty of glucose toxicity happening. All three are forms of resistance. And with all three you just have to keep increasing methodically until you finally catch the resistance. I suspect Monkey has some glucose toxicity for sure at this point. The others, wait to see what your specialist says, you can test now or wait, up to you. I always say that if a caregiver suspects something else is going on, you don't have to wait as long as it's been at least 73 days since insulin started.
 
Wendy&Neko said:
Good afternoon Suzi. I just want to say that I have walked in your shoes. When we started out, Neko first saw green about 3.75 units. I was elated. After a single green, it faded away, I increased. Sometimes I saw greens after an increase, sometimes I didn't. Those greens were fleeting, teasing me. Eventually I got four whole hours in a row in greens. We were up 5.25 units by that point. Then green disappeared again, it wasn't until 6.25 units until I saw it again. I had lots of doubts on dosing and it being too much. Sienne, Marje and others pushed me to increase so I did. Finally at 8.75 units she was seeing hours of green and they weren't going away. She earned her first reduction, three and a half months after that first green.

As a graphic picture of what can happen, look at Neko's SS in 2015, starting in mid July. A regulated cat went completely off the rails and I had to chase after her numbers with increases.

That is a story of a cat with insulin resistance. Neko had a combo of acromegaly, IAA and by that point plenty of glucose toxicity happening. All three are forms of resistance. And with all three you just have to keep increasing methodically until you finally catch the resistance. I suspect Monkey has some glucose toxicity for sure at this point. The others, wait to see what your specialist says, you can test now or wait, up to you. I always say that if a caregiver suspects something else is going on, you don't have to wait as long as it's been at least 73 days since insulin started.
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I understand and respect everyone’s experience.... I know all of you have been there done that.
Equally, ECID..... Monkey , I believe is very different.
I really do appreciate all the input and tome you have spent with us, please don’t think I don’t.

One question I do have though is, what is wrong with my signature? I was contacted and asked for my password so the problem could be fixed and I never give out passwords. Can someone tell me what is wrong with it?
 
Suzi Adams said:
One question I do have though is, what is wrong with my signature? I was contacted and asked for my password so the problem could be fixed and I never give out passwords. Can someone tell me what is wrong with it?
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Who contacted you for your password and how? It's only @Marje and Gracie and I who do that - that too for new members, when they need help with setting up with their Spreadsheet and Signature.

There is nothing really wrong with your Signature. The only thing different is that the hyperlink for your SS is linked to your entire signature text and not just "Chicamonkey's Spreadsheet"
 
Bandit's Mom said:
Who contacted you for your password and how? It's only @Marje and Gracie and I who do that - that too for new members, when they need help with setting up with their Spreadsheet and Signature.

There is nothing really wrong with your Signature. The only thing different is that the hyperlink for your SS is linked to your entire signature text and not just "Chicamonkey's Spreadsheet"
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I think it was just an attempt to help make things look neater.... but I’d like to learn and be able to
Bandit's Mom said:
Who contacted you for your password and how? It's only @Marje and Gracie and I who do that - that too for new members, when they need help with setting up with their Spreadsheet and Signature.

There is nothing really wrong with your Signature. The only thing different is that the hyperlink for your SS is linked to your entire signature text and not just "Chicamonkey's Spreadsheet"
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i think that was just to help e but I’d like to learn and fix the error myself.
 
I see you decided to go ahead with the 'Rebound check' and reduce the dose, which is of course your choice.
If numbers remain high I would strongly recommend that you go straight back to the 3.75u, once your experiment is over

You may get some weird numbers, while the depot stabilizes, the depot of the 3.75/3.5u they will still be influencing the next few cycles.
I agree with the others that Chica has been taken up consistently and you haven't reached a good dose yet.

Although she may have seen better numbers, one cycle on the 2.5u, they were not excessively low and she did not return to blue, since then you have been doing a good job monitoring, and there is no evidence of you missing a good dose.

Suzi Adams said:
I think it was just an attempt to help make things look neater.... but I’d like to learn and be able to

i think that was just to help e but I’d like to learn and fix the error myself.
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I'm not sure what you want to change but you can go into your profile and you can edit your signature in there.:)
 
There's nothing wrong with your signature. We let members "fix" their own signatures and do not do this for you. The only people who may ask for a password are Bhooma (Bandit's Mom), Marje/Gracie, and Chris/China. If this happens again, please let a Moderator know or report the post.

What I can tell you about rebound checks is that they rarely, if ever work. The end result is that you lose time in getting to a good dose. In my 12 years here, I've never seen a rebound check work. FWIW, Somogyi rebound is what amounts to an urban myth. There is a paper from Roomp & Rand that I have on my home computer that debunks this in cats prescribed Lantus.
 
Suzi Adams said:
One question I do have though is, what is wrong with my signature? I was contacted and asked for my password so the problem could be fixed and I never give out passwords. Can someone tell me what is wrong with it?
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I wa the one that asked for your password as Bhooma and I helping many, many new members with their signature lines and linking the spreadsheet. As Bhooma said, your entire signature is hyperlinked and so the SS link blends in with everything else. We ask in this post that it be on the last line by itself so we can quickly and easily access it. This is especially helpful in any kind of urgent situation. If you look at all the other signature blocks, you’ll see the info text is in shaded gray and the SS stands out in blue.

I was just offering to help because (1) I know you are busy and (2) it helps us find the SS faster. If you don’t want help, that’s fine but we would appreciate it if you could unhyperlink the entire signature and put the SS link on the last line. Thanks very much:)
 
How are you guys doing?

Just wanted to remind you to check ketones daily, as a precaution for your baby girl.
DKA can be a real concern and life threatening, not to mention expensive, if not picked up early, I'm just concerned that reducing the dose so much may end up in ketones developing.
There's no harm in testing for them and it should give you peace of mind.
I
 
To add to Gill’s post, DKA is a larger threat to diabetic cats than hypos when the caregiver is testing and can also put the kitty at high risk if the CG is not due to hyperglycemia. I also hope you are testing ketones at least daily.
 
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I worry about ketones as well. Have you considered getting a fructosamine test at your vet’s office to see how controlled she is? On a pet meter or sent to a lab these numbers would be even higher.
 
Hi Suzi. I hope you and Chicamonkey are doing well and that she has had no ill effects from the lowered dose. I understand where you are coming from. Having to increase doses was a major point of anxiety for me, and still is, frankly. BUT you have to power through here. If you feel that you missed a great dose, that's all well and good. I hope that you have also had the vet look at her teeth, and any other possible sources that may be causing her high numbers. (my apologies if you have already done that)

Please take a look at Nova's spreadsheet, from 2020 and this year. If I hadn't followed the advised dosing methods, first SLGS, then TR, we would not be where we are today.

Honestly....., not tightly regulated, still bouncing, but in good numbers most of the time. That is the goal. To get our sweet kitties into numbers, blue or green, that help their bodies to possibly heal. Please try to remember that this is a marathon (for most) and not a sprint.

You have been doing much better than I in the beginning of this FD journey. Keep up the good work testing and advocating for your sweet kitty, and try to trust in the process. :bighug::bighug:
 
Gill & George said:
How are you guys doing?

Just wanted to remind you to check ketones daily, as a precaution for your baby girl.
DKA can be a real concern and life threatening, not to mention expensive, if not picked up early, I'm just concerned that reducing the dose so much may end up in ketones developing.
There's no harm in testing for them and it should give you peace of mind.
I
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Thank you . I did test her this morning and ketones were negative
 
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