10/18 Sooty - will resume tomorrow @ 3.0u

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Perry and Sooty

Perry and Sooty

Member Since 2010
Yesterday...

AMBG 264 this morning. So this looks like he's stable on no Lantus now. Last shot was >72 hours ago.
Now to decide where are we, what does this mean - and what to do now. This was the eventiality for which I admit, we were least prepared.
250 is an interesting number as I understand is the threshold number for diagnosis of clinical vs sub-clinical DM.

I'd be very grateful for any suggestions or opinions - as in this situation, quite frankly, I think I'd be out of my mind to go it alone (or do so any longer...!)

Will leave him at status quo for the time being and keep on with regular checks today. As he's now stable I think there is minimal risk in doing so..? (ETA: compared to his recent history, at least).
Have a wonderful Monday - I have to head off the tbp now but will look in here as and when I get the chance...!
Perry (thinking cap firmly ON!)

ETA: pls see a later post in this condo, here: click here for Question..
 
Re: 10/18 Sooty AMBG 264

Morning Perry....you might find this interesting, I did : http://petdiabetes.wikia.com/wiki/Blood ... guidelines
particularly under "Too High" where it states "damage to the pancreatic beta cells (the ones that make insulin) continues down to levels as low as 140mg/dL"

While Sooty is not getting Pinks, I believe that those yellows indicate that some insulin is definitely needed and would be beneficial to helping him. Have you been doing ketone tests? (Raja was in the yellow range when we first started out on Vetsulin, a short duration insulin. Her numbers improved greatly when we switched to Levemir since the longer duration insulin really helped with steady and shallow curves.)

This from the Tilly Page under Home Testing: http://www.tillydiabetes.net/en_6importantfactors.htm
The first goal with a long or ultra-long acting insulin should be to have the cat's nadir in the normal blood glucose range of a healthy cat. The second goal should be to keep the blood glucose levels under the renal threshold (200-220 mg/dl) for as long as possible every day. The first goal is the more important of the two. The second goal stems from the fact that the renal threshold is the blood glucose level above which the kidneys begin to extract glucose from the blood and excrete it into the urine. Blood glucose levels above the renal threshold are unhealthy for the cat and eventually lead to organ damage.

I hope others will come by to suggest a starting dose for Sooty...if you are willing to go ahead and start again....IMHO, he would do well to get those numbers down. What are your thoughts?
 
Re: 10/18 Sooty AMBG 264

I don't have much in the way of advice but it looks like Pat has given you some great reading material .. I hope you figure out what is best for you guys to do .. have a great monday!
 
Re: 10/18 Sooty AMBG 264 +2 29

Thanks guys appreciate the feedback. Yes, I fully understand that 250s are still too high and still have consequences, the thing is he's been on varying doses of Lantus insulin for over 3 months now and we we have never got him anywhere close to the goal, whatever the dose was (between 1.5 minimum to 5.5 maximum).

(ETA: ketones were checked this morning: Negative).

That's why we felt we we had to do this, to try and eliminate any possiblity of chronic overdose actually causing (or prolonging) his Hyperglycemia (which I understand, really IS possible). Also the fact that his behavior quite definitely became noticably and definitely worse each time his dose reached 3u and above (even while nothing really was changing as regards BG levels).

I do think it might well be time to come back with insulin at maybe 0.25u - but before I did anything, I'd really like to see if there are any more opinions out there. I think one more day or so at 250s will be alright (after all this time...)

What would the LL advice be, to someone who presented on here with a newly diagnosed kitty that was consistently in the 250 range (as Sooty is now)?
That might be an interesting question to think about?
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 Opinions Please?

no advice from this newbie...but hoping you can post a link to where i can buy a 'thinking cap", i'm seriously in need of one...

celi
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 Opinions Please?

mybuddybinks said:
no advice from this newbie...but hoping you can post a link to where i can buy a 'thinking cap", i'm seriously in need of one...

celi
Click to expand...
I get mine from Amazon.com (hehehehe... if only, huh? LOL!)
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 Opinions Please?

i would not wait. sooty's numbers are almost flat and in the 200s.
i would not start over at 0.25u, as you've really seen no movement in the numbers yet. if after sooty's been off insulin you feel he needs to build back up to his dose i'd start over again at 2u BID, but personally i'd go back to 3u BID and continue increasing per tilly til you see better nadirs.
we don't worry about overdose in lantus/lev tho if we follow tilly.
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

So Perry....what dose are you thinking of starting him out with...and when do you think you would be ready to shoot again?
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

Perry & Sooty said:
I do think it might well be time to come back with insulin at maybe 0.25u - but before I did anything, I'd really like to see if there are any more opinions out there. I think one more day or so at 250s will be alright (after all this time...)
Click to expand...

Please don't take this the wrong way, but I think you've already decided what you want to do.

My opinion is that your spreadsheet is indicative of a cat that needs to be on insulin. You started over at 1.5u and it looks like more insulin was needed to get Sooty out of the yellows. There are cats that need only microdoses and there's always the chance that Sooty is one of them. I'm not sure you've going to be comfortable not knowing whether or not Sooty is a microdose kitty. My biggest concern is that you get Sooty below renal threshold as soon as possible.
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

I agree with Sienne. Sooty does need to be on insulin. Whatever insulin that was in his body, his body has now used up, I'm sure. Please don't hold off any longer in giving him insulin. The longer you leave it, the more possible damage it could be doing to him.

Wishing you tons of good vibes, and healing vines.
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

I agree with Sienne, I think you've already decided what you want to do, and I would urge you to start shooting some insulin soon. The longer a cat stays in high numbers, the more they want to stay in those numbers...they become "stuck" there. It doesn't have to be really high numbers, there are examples of kitties that looked very much like Sooty...stuck in the 200s.

Sooty's SS looks like a cat who needs more insulin. There is nothing there that indicates rebound at all. I'm not saying chronic rebound doesn't happen, but there is absolutely NO indication of rebound in his case....just not enough insulin.

The fact that his numbers are not so high says absolutely nothing about the dose he needs. Tinkles started out with 600+ BG tests, and he needed about 2.25u of ProZinc to get a good response. That's not a very high dose when you look at his numbers. There are cats who need 4+u to bring their numbers down 100 pts. There are cats like Sooty who have mid 200s and needed over 4 units to get the breakthrough and start getting a response....look at Kelly & Oscar, there's an example for you!

Start shooting some insulin, if you want to start with 0.25u, ok...but don't spend any extra days lingering with a dose that doesn't work. Follow the protocol, increase by 0.5u when his numbers call for it, don't stay with a dose that doesn't work for more than 3 days because the longer he stays in those numbers, the longer he will continue to want to stay there. You are not only risking damage to his organs with these numbers, you also are reducing his chances of getting into remission. The clock is ticking.

He's your cat, it's your decision, that's JMHO. I hope you start seeing some better numbers very soon!
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

what I see on your spreadsheet is a cat who hasn't reached the right dose yet. Now Sooty is used to the higher numbers, and a significant amount of glucose toxicity has built up. To break through glucose toxicity, you have to pound it down with insulin. It's not anything you did wrong, most of our cats were diabetic for a long time before we noticed it, and most newly diagnosed cats have a fair amount of toxicity built up. That is one reason you see cats building up to a fairly high dose, then racing down the dosing scale once they have a breakthrough (the other reason is that the pancreas's beta cells can start to heal fairly quickly once the cat sees good numbers).

This is the spreadsheet of a cat who was getting too much insulin. See the difference? Some low numbers surrounded by lots of high ones. You test enough that we would see if there were low numbers creeping in there. I don't see on your spreadsheet any place where I think you might have missed lows.

So, what I'm saying is that you started over once before (I'm glad you did) and worked up to the dose correctly. I don't see that 3 units is too much insulin, and in fact I think it is still too little. It's up to you where you start, but the longer you take to build up to Sooty's breakthrough dose, the more insulin it will probably take to get there.
 
Re: 10/18 Sooty AMBG 264 +2 229 +4 259 +6 238 Opinions?

PM + 2 256.

THANK you everyone and noe especially, Chris, Pat, Sienne, Angela, Laurie & Libby!

That is just exactly what I was hoping for - some of the most experienced LLers, chiming in on this. I am so glad you were able to come over and help me - even though we''ve had such a lot of more serious and ultimately, tragic things going on today, such as Ginger & Lori. So sad that - I admit to shedding tears there...

I still think this was an important thing to do and I think that it has produced some meaningful information and so I don't regret doing it. Of course we don't want to put Sooty thorugh any unnecessary stress and would love nothing better than to see him in or below the 100s. I just HAD to make sure we hadn't overshot (literally!) the proper dose and I still know of no other way we could have determined that. If we now HAVE now determined it, well I am pleased and satisfied. I have no desire to prolong Sooty at too high a BG level a minute longer than necessary. I just wish we knew somehow, in advance, that his perfect dose might be 9 units or 10 units or whatever it may be, and could go straight there. But it is a very bumpy road and full of potential false indications so I just had to try this.

I am now quite convinced by your collective experience and I think that starting tomorrow morning at 8AM we should for sure, resume shots...

Now then, to the million dollar question: what do you think we should resume at? And what dose increases would be appropriate going forward? (If you can say?)

Perry
p.s. THANK YOU all very much again for your guidance, your care, your concern and your patience with me. (I know I am trying it, sorely!!!)
 
Re: 10/18 Sooty - will resume tomorrow!! but at WHAT DOSE???

One thing you can do if you want to start over is base your dose on Sooty's ideal weight. The formula for initial dose is:

dose = 0.25 x ideal weight in kilograms​

Or, you could go back to what you were shooting before, 3.0u.
 
Re: 10/18 Sooty - will resume tomorrow!! but at WHAT DOSE???

Sienne and Gabby said:
One thing you can do if you want to start over is base your dose on Sooty's ideal weight. The formula for initial dose is:

dose = 0.25 x ideal weight in kilograms​

Or, you could go back to what you were shooting before, 3.0u.
Click to expand...
Been there, his IW is 6.8Kg so that was why we restarted at 1.5u last time...
i think we maybe oought to resume back around the 3.0 we were at before - but maybe now up it to 3.5? but am still hoping for some reasoned suggestions. Also as to what dose increases are suggested for a prior dose of 3.0 - the protocols aren't clear at all in this regard, they talk of going up by 0.5 if at a 'higher dose' but they don't say what they consider to be a 'higher dose' !!
 
Re: 10/18 Sooty - will resume tomorrow!! but at WHAT DOSE???

perry, sooty received 4 consecutive cycles at 3u (one of which was 5 hours late), one reduced cycle at 1.5u shot 5 hours early, followed by 2 consecutive cycles at 3 units. we have not seen what kind of results are possible when shooting 6 consecutive cycles at 3 units bid.

when a dose is reduced, the cycle count starts over.

personally, i would not increase the dose by 0.5u until a kitty is over 5u bid or nadirs are over 300. however, there are circumstances where i might think differently depending on an individual cat's overall response. ECID.

just my thoughts...
 
Re: 10/18 Sooty - will resume tomorrow!! but at WHAT DOSE???

totally agree with jill. sounds like a plan, right? 3u for 6 shots unless you get a low number like a 40 and have to reduce.
200s are still pretty nice numbers for a diabetic cat but the sooner we can crack sooty outta them the faster the pancreas heals if at all possible. sometimes it just takes something nearer the right dose before you achieve momentum downward. we've seen 3 reductions in a row for some kitties once resistance is breached.
glad you're getting sooty back on insulin.
 
OK will shoot 3.0 today for 6 cycles.
I do still have a question: Can anyone explain why his AMBGs (specifically) have clearly been LOWER since he was not receiving any insulin?
 
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