1/10 GOBBLES AMBS 481

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TheBowHuntress

TheBowHuntress

Member Since 2012
Gobby had a dose increase a few days ago. I just gave him his 6th in his cycle. Can someone take a look at his SS -- Also, at 1/9 PM +10 = 501 !!! I assume it is due to the increase insulin and hopefully he will start coming down. I am told by a friend that this is what happens sometimes with a dose increase and I really value her knowledge. The numbers were coming down a few days ago, but have now skyrocketed. He is eating and drinking a lot of water, and peeing excessively. I tested for keytones yesterday and he was negative.

CONDO: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=86625
 
It looks to me like Gobbles bounced off of the 170 yesterday. This is not at all unusual. Most of our cats have been diabetic for a while prior to being diagnosed and even in the early post-diagnosis stage, are in higher numbers. Their bodies get accustomed to those higher ranges and treat them as their new "normal." As a result, when you start giving insulin and numbers begin to come down, their bodies (i.e., liver and pancreas) don't recognize those truly normal numbers as "safe" and their bodies panic. The result is that a stored form of glucose, along with counterregulatory hormones, are released and numbers spike upward. It can take up to 72 hours for the bounce to clear.

I think your friend is referring to what we call New Dose Wonkiness (NDW). In some cases, when a dose is increased, while it's counterintuitive, the numbers go up for a cycle or two rather than come down. I don't know I could definitively say that what you're seeing is NDW. With the late shots, it's really hard to know how this all factors in. It is a legit phenomenon though that we see on occasion.
 
Sienne and Gabby said:
It looks to me like Gobbles bounced off of the 170 yesterday. This is not at all unusual. I think your friend is referring to what we call New Dose Wonkiness (NDW). In some cases, when a dose is increased, while it's counterintuitive, the numbers go up for a cycle or two rather than come down. I don't know I could definitively say that what you're seeing is NDW. With the late shots, it's really hard to know how this all factors in. It is a legit phenomenon though that we see on occasion.
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How about this Sienne: the first dose I gave of 1.5IU on the 7th was odd because I gave it like at 4pm after the vets appointment, and then gave the next one the following morning which was more than 12 hours later. I am going to ignore the shot on the 7th and count the morning of the 8th as the first one instead. Which means tonite would be cycle 6 and I would increase tomorrow morning instead of tonite. I think that another advantage of waiting till tomorrow morning to increase is because I can do a nighttime tonite test to see what happens, and have a little more data before I increase tomorrow.
 
What I think Sienne is referring to is that after PMPS on 1/7, you didn't shoot in the morning when you took Gobbles to the vet and then you shot at 4:00pm when you got him home, that's 18.5 hours after the previous shot. Then you didn't shoot again until 9:30am on 1/8 which is 17.5 hours after the 4:00pm shot. I got this from your notes, you don't actually show that 4:00 shot on the SS.

A shot that is more than 15 minutes late has the same effect as a dose decrease, during the time between when the shot should have been given and when you actually shoot the insulin, the shed is being drained, used up. You did this two shots in a row, so the shed became really depleted. Any time you shoot late your next shot must be 12 hours after the time the insulin was actually given, you don't go back to your regular shot time. You need to work back to it in 15 minute increments.

Anytime you delay a shot you reset the counter for the number of cycles before an increase and you may need even more than 6 cycles considering how much Gobbles shed was drained. In other words you are almost back to the beginning in building the shed up and this morning is only cycle 5 since the delayed shots.
 
Hi Kat

TheBowHuntress said:
6 cycles = higher BG's = insulin increase?
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Not necessarily and that's what Sienne was saying. Gobbles got down to 170 yesterday and his liver reacted by starting a bounce. Bounces can take up to six cycles to clear and with new members, we typically suggest you let the bounce clear before you increase the dose. When determining dosing, you need to ignore the bounce numbers and look at the numbers when the bounce has cleared. Also, when she said "late shots" she meant that the shot on 1/7 at 4pm was after a skipped shot and then the next shot came at +17.5 which is late. So you could expect to see some higher, wonky numbers (remember Libby mentioned it as well).

It's possible that he is going to need more insulin; usually when they clear a bounce, we'd like to see them come down to green and if they don't, its an indication that more insulin is needed. I wouldn't increase tonight. Let's see where he goes today/tonight It looks like he's coming down with his +6 284.

What would be really helpful is if you would adjust your SS for us, please. In the PMPS column on 1/7, if you could please put whatever his BG was when you shot at +4 and then put that you shot at +4. So, for example, if +4 was 419, you could put "419 at A.M. +4" and then your remarks would further explain what happened. That way, at a quick glance, we can remember which day/cycle it was and then we can look at remarks for further explanation.

Thanks, Kat!
 
It tok a while to get my last post up, but yes, tonight would be the 6th cycle, but considering how much Gobbles shed may have drained it may take longer to replenish it. AND what Sienne was saying about the bounce is that it could 3 days after the low to clear the bounce as well.
 
Ann & Tess said:
you don't actually show that 4:00 shot on the SS.
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I didn't know where to enter "1.50 U. on the 4:00 shot, so put it in my notes. I don't know how far back you went, but all BG's going backwards from 1/7 were done with my TrueResult and must be taken into consideration...I've heard both bad and good about the glucometer (since have purchased and use a ReliOn) and had the vet check the the TrueResult against his AlphaTrak--he got a reading of 419 with his glocometer and 343 with the TrueResult...therefore, there's a very good chance that all numbers with the TrueResult where reading low--his fructosamine from the same day was a whooping 543!!! When I take Gobbles back to the vet next week, the vet is going to test my ReliOn against his AlphaTrak and I have a sneaking suspicion that the numbers will be much closer. I just updated his SS with AM +6 number.
 
I didn't know where to enter "1.50 U. on the 4:00 shot, so put it in my notes.
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I'd put it in the +6 box and change the background color to the dose column color, 1.5u @ +6.5

Also click the "wrap " button so it all shows.
 
Updated the SS. Should I take a +8 or +9 AM reading? Thank you to everyone. p.s. the +8 reading would have to be taken in 20 minutes.
 
Ann & Tess said:
Nice to see Gobbles back in yellow. It wouldn't hurt, then you'll know if this drop is continuing.
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AM +9 = 324 (see SS) so he is starting to go back up. I'll test him again PMPS!
 
TheBowHuntress said:
I am going to ignore the shot on the 7th and count the morning of the 8th as the first one instead. Which means tonite would be cycle 6 and I would increase tomorrow morning instead of tonite. I think that another advantage of waiting till tomorrow morning to increase is because I can do a nighttime tonite test to see what happens, and have a little more data before I increase tomorrow.
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Very good, you're getting it! The only thing I would add is that once a cat starts getting blue numbers, we usually slow down the increases. Instead of increasing after 6 cycles, we try to hold the dose for at least 10 cycles. I agree with your logic in starting counting on the 8th, though, and also with getting PM data tonight.

This is where you don't want to rush things - if you do increases too soon once the cat starts responding to the insulin, then you risk your cat becoming over dose.

He had some highs after the delayed shots and dose increase, which were expected. He hit blue in cycle 3 of the increased dose even though his insulin depot was probably not completely refilled yet, and now he bounced from the blue (also expected). Let's give this dose enough time to work before changing it again. ;-)
 
Marje and Gracie said:
There isn't really much difference between the AT 419 and the TrueResult 343. I wouldn't worry about that.
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OK. I am bringing my ReliOn next week to Gobbles' vet appointment to see how close that comes to his AT, and for the heck of it, I'll bring the TrueResult as well...He's also going to do another fructosamine...
 
Really....I would pick one glucometer and I, personally, wouldn't care how close it is to the vet. I also would not pay for another fructosamine test. You are getting real time data.....you don't need a fruc test. It's really a waste of your money.
 
I agree with Marje on the waste of money on a fruct test. The data you've been collecting will tell you more than that test will.

If you do decide to compare your meter(s) to their's, make sure and use the same drop of blood for the tests. Otherwise the comparison won't be very useful.

Carl
 
Carl & Bob said:
I agree with Marje on the waste of money on a fruct test. The data you've been collecting will tell you more than that test will.

If you do decide to compare your meter(s) to their's, make sure and use the same drop of blood for the tests. Otherwise the comparison won't be very useful.

Carl
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I am going to forego the fruct. test. His test of 1/7 came back 543--very high!!! That's how he tested his AT to my TR.... regardless, I am thinking that I MAY just move the appointment for a few weeks...?!?!?
 
I agree with everyone else - save your money and skip the vet visit (at least for now) and keep testing at home. For what it's worth I have NEVER had a fructosamine done on Kazi - her weight, coat and normal drinking/urination tell me my meter is fairly accurate. All have gone back to normal now that her BG is under control.

I also want to say you are doing a GREAT job with Gobbles. I know it is a lot to take in and figure out - it was an incredibly stressful couple of months when Kazi was DX getting the hang of things. It gets easier! =)
 
Amanda said:
I agree with everyone else - save your money and skip the vet visit (at least for now) and keep testing at home. For what it's worth I have NEVER had a fructosamine done on Kazi - her weight, coat and normal drinking/urination tell me my meter is fairly accurate. All have gone back to normal now that her BG is under control.

I also want to say you are doing a GREAT job with Gobbles. I know it is a lot to take in and figure out - it was an incredibly stressful couple of months when Kazi was DX getting the hang of things. It gets easier! =)
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So I think when I go to the vet I will: (1) have my meter tested vs. his AT. (2) get him weighed and compare it the weight I have on him. (3) bring up to the vet that he had 2 bouts of Granular Cell Myoblastoma few summers back, Gobbles' had an infected tooth removed (he had broken the tooth off several years before and it got infected years later). The vet (where I moved from) found a growth on the back of his tongue while doing the dental surgery and had it biopsied...it was benign although she did say it could come back...it came back a year later then disappeared.... After we moved (July of this year) I mentioned this to my (old) vet and had his records transferred...the vet could not find a growth (nor could I see when when I looked). I looked just now but don't see one although it could be way back on his tongue where it can't be seen short of my husband holding him down, my daughter holding his head and mouth open and myself putting on my glasses and using a flashlight. When I take him back to the vet next week, I'll mention it to him (it should be in his records IF the "old" (fired) vet sent those records when I had requested ALL his records be sent to my new vet....
 
I know when we switched vets to get the full printed out record of Tess's records we had to pay for them, I think it was about $10 for printing. Most vets seem to do this. Ordinarily what you get when you just ask for records to be transferred is a computer printout of the services which were billed out.

Call the office of the old vet and ask for a a printout of Gobbles complete records, the handwritten charts for all his visits. Go over and get the copy or have them sent to you and make a copy to keep for your own records before taking them to your new vet.
 
Ann & Tess said:
I know when we switched vets to get the full printed out record of Tess's records we had to pay for them, I think it was about $10 for printing. Most vets seem to do this. Ordinarily what you get when you just ask for records to be transferred is a computer printout of the services which were billed out.

Call the office of the old vet and ask for a a printout of Gobbles complete records, the handwritten charts for all his visits. Go over and get the copy or have them sent to you and make a copy to keep for your own records before taking them to your new vet.
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Picking up the phone here in a minute to call; great idea!
 
Amanda said:
I agree with everyone else - save your money and skip the vet visit (at least for now) and keep testing at home. For what it's worth I have NEVER had a fructosamine done on Kazi - her weight, coat and normal drinking/urination tell me my meter is fairly accurate. All have gone back to normal now that her BG is under control.

I also want to say you are doing a GREAT job with Gobbles. I know it is a lot to take in and figure out - it was an incredibly stressful couple of months when Kazi was DX getting the hang of things. It gets easier! =)
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I am going to call the vet saturday and update him on his numbers and move the appointment to next month. Also, I am going to let him know that I want to hold off on the skin biopsy and fructosamine test. I am thinking that perhaps the reason his hair is thinning may be an allergy caused by me switching brand of cat litter about 3 months back, and I am going to buy a different brand of litter today, and see how that goes....
 
TheBowHuntress said:
Amanda said:
I agree with everyone else - save your money and skip the vet visit (at least for now) and keep testing at home. For what it's worth I have NEVER had a fructosamine done on Kazi - her weight, coat and normal drinking/urination tell me my meter is fairly accurate. All have gone back to normal now that her BG is under control.

I also want to say you are doing a GREAT job with Gobbles. I know it is a lot to take in and figure out - it was an incredibly stressful couple of months when Kazi was DX getting the hang of things. It gets easier! =)
Click to expand...
I am going to call the vet saturday and update him on his numbers and move the appointment to next month. Also, I am going to let him know that I want to hold off on the skin biopsy and fructosamine test. I am thinking that perhaps the reason his hair is thinning may be an allergy caused by me switching brand of cat litter about 3 months back, and I am going to buy a different brand of litter today, and see how that goes....
Click to expand...
I'm going to wait to call the vet for an update until Tuesday (appointment was scheduled for the following day) so that way I will have more information on his BG status. I took some of the $$ today that the vet visit would of cost me and purchased a new scale, more test strips and at least 50 cans of cat food!!! I think I MAY have a copy of his vet records from two vets back (before we moved, where he was seen for 6 years) and will look earnestly for them....if I can't find them, I'm going to give them a call Monday and request same.
 
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