11/26 Hoot PMPS 284, +2/245, +5/249 Bounces?

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Pam & Hoot

Pam & Hoot

Member Since 2012
11/25 Condo

11/25 Recap:
AMPS - 221
+2.5 - 223
+4 - 193
PMPS - 232
+2 - 231
+4 - 154
+5.5 - 132

Good Morning LL ~O)
All is well in Hooterville except those stinky pinky bounces :roll: I'm just confused :? Is it something I'm doing or not doing?
His bounces are getting worse. Do you think he needs another dosecrease? It's so hard to tell because everytime he gets good numbers he bounces for a day or two :roll:
I'm just not liking all those pinks in his SS lately :-x
He is feeling good, luckily I have never noticed that he feels bad with any numbers he hits, high or low :smile:
His appy is good and he is just sooooo happy being able to get out on the catio when ever he wants. What a happy cat he is these days :-D
He played and ran in and out of the catio door so much yesterday :lol: :lol: I haven't seen him play like that in a very long time :-D :-D
So I just need some advice on if I should be doing something different with him or is this just a cat being a cat??
I am taking all 4 kitties, my 3 and Hissin Heidi to get their vaccinations today so that won't help his BG :roll:
Thanks for all the visits yesterday :-D
Sending ♥vines♥ to all in need today :YMHUG:
Have a great Tuesday LL :YMPEACE:
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Hoot is being a bit more bouncy! I don't know that I would increase right now. This dose is bringing Hoot into the 50s so you don't have all that much room to increase. You might want to consider using a method that's used on the German Lantus board -- they hold the dose until the kitty drops into the 40s on 3 separate occasions. In other words, Hoot will need to work harder for a dose reduction. That may help to level things out a bit.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Pam-
I am sorry Hoot has been so confusing lately! I looked over his SS at length and I find it interesting that he initially did very well on lower doses (i.e. he had great numbers at .25U and below just before his OTJ trial last year). This means that he has a functioning pancreas and he can go OTJ again. The question is... why is his BG going so high on 1.75U now? As long as his diet is still the same as last year, it's hard to say what changed.
After Mr.Cat failed his first OTJ trial, I received a lovely PM from a veteran member of this site with great advice. I will forward that to you. The person essentially said that I should hold doses longer. It seemed to do the trick (so far) with Mr.Cat.
If you've tried everything and Hoot's numbers are still off, it may be worth it to see if there is something else going on with Hoot that could be causing the high numbers. It sounds like Hoot feels fine, so there may not be any issues except a pancreas that is deciding to take a nap! ;-)
Whatever is going on, I hope you get to the bottom of it! :-D
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Hi Pam! When you do get that PM from Jess maybe you could post it in Hoot's condo, so that it's available for everyone to discuss. The "Suggestions for Advice Givers" in the Lantus TR group reminds us of one of the things that's great about this site . . . many eyes.

Keep your advice public. Helping cats is a team effort, and it's undermined when people are receiving offline advice, unknown to the rest of the group. Many sets of eyes are better than one.
Click to expand...

I'm glad Hoot seems to be feeling well, though! Have a great day.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Here is the PM advice. I didn't post it because it is long.... And also it is not my advice, but the advice of someone else who may not want to post publicly....

Also, Amy, should I post your PM to me the other day?

Re: Natural Choice / dosing
Sent: Wed Sep 11, 2013 12:21 pm
From: Ilkka and Tom
To: Jess and MrCat

Jess-
Please excuse these comments, but... Mr Cat can probably go OTJ except you are changing the dose too often and if you keep it up, he may miss his opportunity.

Please consider:

- insulin dosing is not like steering a car, where the response to a change is immediate. Insulin has been compared to an ocean tanker where, when you turn the wheel to change direction, it takes miles of open ocean (=many days) before the ship turns. Don't confuse an immediate reduction or increase in BG to reflect what that dose actually will mean in a few days.

- With a new dose, even though the BG changes, you do not see the effect of the new dose, really, for a few days, a minimum of 3 though 5 is more like it. so don't confuse the immediate change for the actual effect which takes days.

- BG at any point in time is not just a response to the new dose of insulin, it is a response to an accumulated pattern of insulin doses. That's why they say "hold the dose." when you first give a new dose, the new BG reflects the old doses followed by the new. It is a completely different number than the new dose that has been repeated 10 times (5 days).

Good luck !!
Ilkka

The second message .......

Re: Natural Choice / dosing
Sent: Fri Sep 13, 2013 12:58 pm
by Ilkka and Tom

yes, I see, very good - & yes, antibiotics can definitely queer the deal because they can influence or skew the hormonal system, and insulin is a hormone. I would say I am still optimistic for Mr. Cat. Just calm down, steady hand does it. :)

Let me just add a couple of other things to the previous. Human or cat, the mechanics are very similar - Mr. Cat clearly is Type II, meaning that his own system is still capable of producing enough insulin to process the glucose he gets from food. He could not have flirted with OTJ were that not the case. NOW, when you give insulin to a Type II diabetic, you are really not giving all the insulin the diabetic needs - you are trying to cover only the shortfall of insulin. So in theory:

The right shot dose + Mr. Cat's own insulin = exactly the required insulin level for glucose regulation.

So the dose you are trying to give is what is needed on top of what Mr. Cat produces, right? Using more sustained doses and looking at the numbers, you can figure that out. Two problems:

1) what Mr. Cat produces changes, because the pancreas which produces the insulin makes decisions of how much to produce, based on many things. It varies on liver, thyroid, adrenals, stress, food, mood, inflammation. So you may get a higher or lower BG than you want, but in fact that number has less to do with the dose, than with the cat's own biological process. To then change the dose again, is to confuse the cat further. (Of course if the BG is below 50, you want to decrease a bit. )

2) there is more and more scientific evidence to suggest that hormonal messaging is key to Type II diabetes - that is to say, how much insulin the cat who has a relatively undamaged pancreas actually produces in response to glucose, is based on its inner information of what is needed. If Mr. Cat can't count on a steady supplement of insulin from you, the task of deciding what to produce becomes more complex. This view of it means that Type II diabetes is not a "hardware" problem, not due to an irreversibly damaged organ, but a software problem - like a computer virus.

Finally, then, the trouble with letting a Type II the cat surf in the higher BG ranges too long is the cat may begin to interpret that higher BG as the new normal. That 300 is OK. So the pancreas is capable of producing insulin to bring 300 down to 100, but doesn't, because the information , call it the metering system that decides on how much insulin is needed, has been corrupted, recalibrated to diabetic levels.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

I agree with Amy -- "advice" that is provided by PM does not have the advantage of many eyes reviewing the information. We really do try to keep all information in the public forum.

I looked over his SS at length and I find it interesting that he initially did very well on lower doses (i.e. he had great numbers at .25U and below just before his OTJ trial last year). This means that he has a functioning pancreas and he can go OTJ again. The question is... why is his BG going so high on 1.75U now? As long as his diet is still the same as last year, it's hard to say what changed.
Click to expand...
I agree that it's hard to know what may have changed. However, unless Hoot lets us know, there's no way to be certain just how much his pancreas is functioning. One observation that I can make is that often, for a kitty back from the Falls, you will need to exceed the maximum dose that you were giving the first time around. You may also need to be a bit more aggressive. Usually, a kitty that has fallen out of remission doesn't get a dose reduction unless numbers fall below 40. If you opt to use the dosing strategy from the German board, that is also an aggressive strategy so you reduce by 0.25u the same way you would with a drop below 40.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Sienne and Gabby said:
unless Hoot lets us know, there's no way to be certain just how much his pancreas is functioning.
Click to expand...

Please see the post from Ilkka above regarding the pancreas and dosing. If Hoot's pancreas was completely shot, he would not have gone OTJ for a while. My point is that there is still hope for Hoot! :-D Also, the insulin he receives should be complementing Hoot's pancreatic function, whatever level it is functioning now. Maybe we don't know how much it is functioning, but I believe that he has some function left and that he can improve. The key is finding the right dose and providing a steady supply of insulin over time. :-D
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Hi Pam ~O) ~O) ~O)

What a great discussion here. Love it. I have no advice, what has been given is very good. I know with Mannie I had to hold doses longer than most would, he did better when things were consistent. The cycles were more even then. I knew he's never be an OTJ kitty, he went undiagnosed for too long. well anyways - good stuff here, and I hope it will help you with Hoot.

And Hoot, nice to see you are headed down. Surf well today, aim for those blues. That would be an awesome surf.

Have a great day today. I hope all goes well. :-D
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

I don't disagree that there may be some pancreatic function. My point was that this is an assumption on your part. While a cat can go OTJ, falling out of remission is another piece of data. In other words, the pancreas wasn't producing sufficient insulin to maintain itself strictly on an endogenous supply and, instead, requires exogenous support. There are certainly cats who come back from the Falls, need some additional support, and return to remission status. And, there are cats to do not return to remission status. Unless you have a crystal ball, there's no way to know what Hoot's up to and as of yet, Hoot's not telling.

The information in Ilkka's post is nothing new. You haven't been here long enough to know that some of the phrasing in her note is mine -- in particular the information about glucose toxicity which s/he vaguely makes reference to. While you may have found the information that Ilkka sent you helpful for Mr. Cat, I don't know who this person is. The total number of posts was 121. One of the means you have of assessing someone's knowledge base is, among other things, the number of posts they have offered on the Board. The more posts, the more their information has been reviewed by others here. It's fundamentally a matter of considering the source. The information you received may be very applicable to your cat. It may or may not be applicable to any other kitty.

While Ilkka's comment about insulin is correct for Lantus and Lev, it is not a generalizable statement. The reaction to shorter acting insulin is far more immediate. The response to Humulin R, for example, is immediate and very powerful depending on the dose. With Lantus or Lev, we do observe that a dose change can take several days to "settle" and for a response to be evident. This is due to the depot. On the other hand, this isn't always the case.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Good luck figuring out the bouncing. I've been going through the same thing with Furball. It is confusing. I have a hard time telling if it is too much or not enough insulin. That's great Hoot is happy all of the time and loves his catio.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Here is the PM advice. I didn't post it because it is long.... And also it is not my advice, but the advice of someone else who may not want to post publicly...
Click to expand...

Any advice that wouldn't want to be posted publicly shouldn't be posted at all. Advising by PM is against the "Terms of Use" for the board. This place doesn't work without "peer review", and the people who set up the forum understood that. You really shouldn't say anything by PM that you wouldn't want made public. Yes, it is a "Private Message". And bad advice by PM can be reported to a moderator just as easily as what is said publicly. Moderators can't see your PMs, but if someone reports the message, they sure can.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

While Ilkka's comment about insulin is correct for Lantus and Lev, it is not a generalizable statement.
Click to expand...
I agree. It might pertain to one of the "L" insulins, but usually not to a non-depot type like R, or even PZI. The whole point of using a sliding scale for Prozinc/PZI is because you can expect more immediate results.

I am sorry Hoot has been so confusing lately! I looked over his SS at length and I find it interesting that he initially did very well on lower doses (i.e. he had great numbers at .25U and below just before his OTJ trial last year). This means that he has a functioning pancreas and he can go OTJ again. The question is... why is his BG going so high on 1.75U now? As long as his diet is still the same as last year, it's hard to say what changed.
Click to expand...

Hard? It's impossible to say what changed. My cat was diagnosed two and a half years ago. He got PZI for 10 weeks, and went OTJ, where he remained for two years and 4 months. Then "something happened". And three weeks later, he was dead. It wasn't just his pancreas that decided to quit working. Unfortunately, I'll never know what went wrong. All I know is that his numbers went high, and insulin didn't fix the problem. Could have been infection, could have been cancer for all I know. But whether his pancreas was functioning or not, it wasn't functioning well enough or correctly enough to control his BG.

The thing I'd point out is as time goes by, things inside their bodies change. Daily. Heck, things can change from one cycle to the next. A dose works for a few days, and then it doesn't. Bob was not the same cat last month that he was two years ago. Neither is Mr. Cat, or Papaya, or Hoot, or any other kitty for that matter. What worked yesterday isn't guaranteed to work today or tomorrow. And what failed in the past can work like clockwork tomorrow. We can shoot insulin until we're blue in the face, but keep in mind that you are always shooting at a moving target.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Carl & Bob (GA) said:
you are always shooting at a moving target
Click to expand...

That is such an encouraging thing to remember, because when cats are being cats sometimes it even feels like Star Trek's Scotty described the hitting-a-moving-target concept:

"The notion of transwarp beaming is like trying to hit a bullet with a smaller bullet, whilst wearing a blindfold, riding a horse." :lol:

Hang in there, Pam!
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

I appreciate everyone's viewpoint here but I don't think it is appropriate to berate my comments, my experience, or the experience of anyone else inside Pam's condo. She asked a very important question to the group about Hoot and I think she deserves support and input. Maybe it's better to stay on topic with her question?
I've been doing months of research and have spoken to many veterinary experts (some of whom actually set the TR protocol that folks here are trying to follow). Many of those experts disagree with much of what is written here. I have tried to keep an open mind (studying, learning from the veterinary experts, reading what people post here) and done my best to synthesize all the information, including the contradicting information. There are a lot of contradictions, so who does one believe? A vet expert who has done years of studies about feline diabetes and remission or people on a website with unknown experience and education? The truth is, you can't say that someone knows more just because they have more posts on a website than other people. I think it is important for everyone to keep an open mind when exploring how to care for our very dear feline friends.

My apologies to Pam and Hoot for the fact that your very important question about Hoot has turned into folks criticizing my post. I will stop posting if you like. Seems like no one wants to hear from me.
Best wishes to all,
J
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Jess,
I think you missed most of the point.
1 - the advice from Illka should never have been sent. It violates the terms of use for the board. It should have been posted for peer review, never done by PM. To you, to Pam, or to anyone.
2 - it isn't that "nobody wants to hear from" you. It's that by withholding carbs to divert a crisis, while it might work for some cats, will NOT work for every cat. And cats have died from that "strategy". You can line up all the experts you want to line up. They can't refute that fact. Unfortunately, there are other message boards for diabetic cats. And my hunch is that you are aware of them. And are also aware that on at least three of them, "alternate dosing advice" is not permitted, not tolerated, and not welcome from anyone except those "in the know" that encourage the "company line". Members here have been banned from participating on some of them, because they had the audacity to present conflicting advice.
3 - Our "protocols" might not be perfect. And our methods might stray from them in some cases, for multiple reasons. There isn't any "cookie cutter" protocol that will work on even two cats the exact same way. There are no perfect answers, and there is no one single way to "do this". Our focus is safety, period. And we try to be accommodating to every caregiver, and treat every cat as unique. Every Cat is actually Different. So is every caregiver.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Bob-
I have always appreciated your input. Do you have advice for Pam and Hoot?

P.S. By the way, I have posted on many "newbie" pages that I DO NOT recommend low-carb and zero carb foods for BG's under 50 for inexperienced caregivers, especially if the caregiver has no experience with insulin, their cat's response to it, etc. I have said many times that the low-carb approach is for EXPERIENCED caregivers who know their cats and have tried low-carb foods at higher numbers with good response. The times I have recommended low-carb foods has been for experienced folks who express frustration and, after years of erratic numbers, are still struggling to keep the BG's in a normal range. Why not try another approach if the one you are trying isn't working? The low-carb approach can be attempted safely with proper monitoring.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

to get back to the matter at hand... :mrgreen:

I feel like all I have done the past week is run around the board talking about feeding curves, but here I go again. :lol:

Lantus and Levemir are really good at flat curves, but they are not the best at bringing down numbers that are high. Increasing the dose can help with the highs, but when you have occasional nadirs in the low 50s then increasing isn't really possible unless you can change something else to allow for it.

Here are a couple of threads where Jill talked about feeding the curve. Take a look and see what you think. The idea is to flatten out the curves so maybe Hoot won't drop as much, which would allow you to increase the dose. There are risks and rewards, which Jill outlined very well in these threads. We're not talking about increasing the carb %, more about figuring out the optimal timing for meals.

Feeding the Curve
More Feeding the Curve

I meant to post these to Kim/Twice yesterday, and maybe Jill already did.
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

YAY!! Hoot sounds like he thinks he's a kitten again :-D :lol: So cute to picture him flying around like that! Guess he really doesn't care what the meter says :lol:

Have a great night Pam!

@ Libby- I see the links here and bookmarked :-D :-D Thank you
 
Re: 11/26 Hoot PMPS 287, +2/245 Bounces?

I want to thank all of you for all the information. There are a few things I learned...that I should try to keep him on this dose or any dose as long as I can.
That ECID and right now we don't know whats going on with his BG...and he isn't talking ;-)
I also know that we all have the same goal and that is to keep our kitties safe and healthy, first and foremost.
So my plan is to stay at this dose as long as he will let me. I will manipulate his BG's with food if I have to, to keep him here longer.
And he will have to drop into the 40's three times to earn a reduction.
Please let me know if I missed something :smile:
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Thanks Libby for all that great info! This really has been a learning week for a lot of us semi newbies.
We do appreciate you bouncing around to help us even if you do have to keep repeating yourself :roll: :lol:
 
Re: 11/26 Hoot AMPS 389, +3/249 Bounces?

Pam- You are fantastic! Keep up the great work - you are doing an excellent job and your plan is a good one!
 
Hi Pam!!
Another interesting & educational condo. :-D

Lucy is being silly with her numbers these days too.
She's not bouncy, but she's been so stubborn about not working the juice... until +2 tonight... at least for now.
Good luck with all your plans. ;-)

And most importantly, I am really glad "Poo Heat" Hoot is happy and playful!
 
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