1/9 PapayaAMPS=594 +4=308 PMPS=594 +3=356 +6=272

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Amy & Papaya (GA)

Amy & Papaya (GA)

Member Since 2012
Papaya Jan. 8

:evil: Papaya started off the day with another bounce right into black. She had a scheduled checkup with the vet this morning, but I got the other vet at the practice instead of the usual really nice one.

What a terrible experience! This vet scolded me for not having her BG under control, telling me how bad the high numbers are for her, treated me like an idiot by telling me all the basics as if I had never heard of diabetes before, and started on this long explanation of how this Saturday he wants me to test her every hour and write it all down. So I interupted, you want me to do a curve? Do you see how much I am testing already? Exactly what information are you looking for? He wants to know when the insulin starts to bring her numbers down. So I reply "Onset? I can tell you, it is sometimes a bit after 2 hours, sometimes a bit before". He looked surprised every time I used a moderately technical word, and kept going back to telling me how bad the high numbers are for her. (I KNOW, MAN!! but can you tell me how to fix them?) Then he suggests oh, maybe she's insulin resistant. Again I am pointing at the spreadsheet, HELLO, do you see the low numbers here every couple of cycles? I was trying to be so polite but I was getting so angry. I finally gritted my teeth and asked "Do you not perhaps think that these high numbers are because her body doesn't like the drop to low numbers, and her liver dumps glucose into her system?" He actually LAUGHED at me and said Oh, no, that's not possible, it would NEVER take the numbers that high. At which point I put the cat back in the carrier and said I would discuss it with the regular vet when he returns. AAAAAArgh. I feel so bad when I see her numbers going so high, but it's honestly not because I am some kind of idiot. [end rant]

However, I am not pleased to see her numbers right back up at PMPS where they were at AMPS. That's not usual. So I am bumping the dose up to an even 2, and I'm not going to hold that for long if the numbers don't start improving.
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

I am so sorry that you had such a horrible experience with that vet. Maybe that vet just had an exceptionally hard day today, you never know.
I would try to avoid him as far as diabetes goes in the future. I think a lot of vets just don't understand enough about diabetes in cats. You'll get there. Give yourself a treat or something because you deserve it.

I would give the 1.75 units some more time to settle in. The depot on the 1.75 units probably isn't even build up completely yet. I do not think your Papaya is insulin resistant either. Every cat is different, and some cats just take longer to find the correct dose.
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

Ya know how we talk about patience pants around here (or Marje does, anyway)? We're going to get you a pair.

You need to listen to your own astute interpretation of Papaya's SS. You were absolutely correct -- she's bouncing. (BTW, it's glucagon, not glucose that gets dumped into the system along with counterregulatory hormones -- the vet will really be astounded that you know that). At the 1.25u dose, you were seeing some high green numbers with some big bounces. You raised the dose. At 1.5u, you were seeing more green and blue plus bounces. Because your nadirs were in better ranges, you could/should have held the dose for 5 days. You raised the dose after 7 cycles. You've now been at 1.75u for 2 cycles. You really, really need to hold the dose for at least 6 cycles. And instead, you raised the dose.

What you were seeing today is a combination of a bounce off of the blue numbers and new dose wonkiness (NDW). Increasing the dose is only going to complicate things since rapid changes in dose throws the depot out of whack and probably cause more NDW.

I have this sneaky suspicion that despite being rightfully pissed at the vet, you reacted to what he said. I think you should have trusted your gut and know that you were doing the right thing. (I also suspect if you asked him if he'd read the Roomp & Rand Tight Regulation Protocol he might have looked at you cross-eyed.)

(This is where we start the repeating audio file of, "Patience, grasshopper.")
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

You're totally right, Sienne. Despite my knowing that his manner and specific suggestions made NO sense, I did get pressured into raising the dose because he told me to. I know I should have held it for a couple more days. It just made me feel so guilty, to get scolded and contradicted over everything, to be told that blood sugar that high "is like syrup in all her capillaries!!"

In fact, I've just been sitting here looking up food values because he told me I should be feeding her kitten food instead of what I am giving her, since the kitten food is higher protein. Well, according to the Lisa Pierson DVM Sept 2012 lists, the Fancy Feast kitten food (turkey flavour) is exactly the same protein level as the Fancy Feast chicken pate that I am using. The kitten stuff is just higher in fat. So clearly I should have taken his dosage suggestion with the same skepticism. I'll go back to the 1.75 in the morning and hold it properly until all the wonkiness settles.

Thanks also Dyana. Happily, I don't think I will need to see that vet in future, it was just that the usual one was on holidays. I have a good relationship with their very nice tech who schedules the appointments, and I'm sure I can let her know that if my usual vet is away I would prefer just to reschedule an appointment.

But if I do get him again I'll definitely quote the "Roomp & Rand Tight Regulation Protocol" :lol: (And thanks, Sienne, for the correct term on what is causing the bounce, I knew "glucose" wasn't quite the right word but couldn't put my finger on the "glucagon" never mind the "counterregulatory hormones" but I will have it ready next time!)
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

I'm sorry that vet was so rude and unprofessional. And I'm equally glad you'd already found LantusLand so you know he's full of a lot of hot air, suffering from over-inflated ego. Jeesh! Those patience pants are very handy. :-D
Liz
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

Thanks, Liz.

re patience - have you ever heard this one:

if you could win a million dollars by doing ONE of the following, which would you choose:
-doing 50 bungy jumps in a row
- putting together 5000 large jigsaw puzzles
- eating 100 extremely hot peppers
- breaking 100 bricks with your hand (assuming it was physically possible)

Someone started asking this question in a roomful of people once that included me. They framed it as a job interview question they'd heard of. I was the only person in the room who said eat the hot peppers. After everyone had answered it was explained it is a measure of patience - and my choice was the one that showed I was very lacking in patience. :oops:
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

Hmm.... syrup in the capilaries? How would that make sense? If that were the case, then all of our cats would be suffering from incredibly high blood pressure because that would be the only way to get the syrupy blood pumped back up to the heart. Or, all of our cats, especially the long term diabetics, would have cardiomegaly (enlarged heart) because their hearts would have to increase their muscle mass in order to work exceptionally hard to pump that thick syrup around. This is pretty basic physics and it makes no sense. If the blood in the capillaries was that thick, how could we ever get an ear poke to bleed? And how is the blood more syrupy in the capillaries than in the arteries and veins? (I'm screaming, "He's an idiot." in my head.)

Personally, I really hate it when professionals, especially health care professionals, cop an attitude of I know everything and I'm going to dummy it down for you because you really shouldn't tax your paltry little brain with such technical things. I intensely dislike it when they don't know what they're talking about. That "I'm the doctor." attitude doesn't go very far in my book.
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 (and mocked by vet)

First off, Amy, here's some pants for you to try on:



Drop this on your secondary vet if he likes words that start with the letter "G":
Blood Sugar Levels Fall
The alpha cells in the islets of Langerhans of the pancreas product glucagon. Glucagon is “antagonistic” to insulin, basically having the opposite effect on the organs of the body. Glucagon increases the conversion of stored glycogen into glucose in the liver and muscles thereby increasing blood sugar levels.
Glucagon also increases the uptake of amino acids and glycerol into the liver so that more glucose can be synthesized.
Click to expand...
http://bloodsugardiabetic.com/diabetestreatment/insulin/how-the-body-regulates-blood-sugar/ There's a link for him to read in case he has spare time the next time he's working and you tell the vet tech "No that's okay, I'd rather reschedule".

Carl
 

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Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 +3=356

Sienne, a question, if you happen to look at this again:

on Jan. 7 (when I was shooting 1.5) you said : "The PM cycles look good but the AM bounces are just brutal! I wouldn't hold the dose for more than 3 days."
on Jan. 8, you said: "I would increase this evening. I'd bring the dose up by 0.25u."
today you say: "At 1.5u, you were seeing more green and blue plus bounces. Because your nadirs were in better ranges, you could/should have held the dose for 5 days. You raised the dose after 7 cycles."

I realize jumping to 2 today was premature, but I'm having trouble sorting out what you were advising me to do over the last few days. Can you clarify?
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 +3=356

And Carl, that bit on the liver with all the Gs would make an impressive tonguetwister :lol:
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 +3=356

No, I have not heard that one. I would do the jigsaw puzzles. Does that mean I have a lot of patience? I think it means I like to do jigsaw puzzles more than the other stuff. :lol: :lol:
Liz
 
Re: 1/9 Papaya AMPS=594 +4=308 PMPS=594 +3=356

hmmm.
I wouldn't do one bungy jump in a row, or eat one extremely hot pepper. I think I'd pick the puzzles. Breaking the bricks isn't productive and you'd just end up with a pile of red dust. And although 5000 puzzles might take forever and get monotonous, you'd end up with 5000 cool results from all that work.

Carl
 
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