11/3 Charlie rebound check day 2: amps 435, 2.5u

Status
Not open for further replies.
yes lower than thought it would be too. tom has all 4 paws crossed and he's looking really strange :-D
taking another peek at the ss.
 
+6:385 (1 hour after meal). I'm picturing tom with his paws crossed and he does indeed look funny, but Charlie has his crossed too-he loves to sit like a proper gentleman!
 
Continues to shift downward. Good. Do you have any idea what his food spike numbers are? 30-50pts or such? Next time try and get the reading before food.

Not any better or worse than the past few days....

How is he acting?


So an estimated pre-feed would have been 350 or lower?
 
wow, almost as if 2.5 units, 4.2 units...same results?
blue you do know how very different prozinc operates than lantus i'm sure.
there is not very much if any overlap.
sometimes peeps come over from lantus and comment if you move over to lantus you have to forget all the rules you practice here in pzi. but the reverse is true as well.
pzi shows rather instant results, does not build up (as in shed) and rebound is a 12-24 hour event. just sayin.
yet, this is an interesting test. robin is fully behind it. i am wondering why charlie does not show movement (an acceptable level) from his dose whatever it is so far.
 
lori and tom said:
wow, almost as if 2.5 units, 4.2 units...same results?
blue you do know how very different prozinc operates than lantus i'm sure.
there is not very much if any overlap.
sometimes peeps come over from lantus and comment if you move over to lantus you have to forget all the rules you practice here in pzi. but the reverse is true as well.
pzi shows rather instant results, does not build up (as in shed) and rebound is a 12-24 hour event. just sayin.
yet, this is an interesting test. robin is fully behind it. i am wondering why charlie does not show movement (an acceptable level) from his dose whatever it is so far.
Click to expand...

Right now we're seeing an overlap from his liver, not the insulin. Real rebound vs. Lantus bounce. Real rebound can be 12-72 hours. All the links I posted the other day are for regular type insulins. We're not waiting for the insulin shed to empty, there is no shed. We're waiting for Charlie's liver to settle down.

As noted in the one link from Dr. Hodgkins (I think), rebound can happen at almost any number. Charlie suddenly found himself in yellow territory. His liver was like...

Hey, what the heck is going on here! You're not supposed to be here. Up Charlie! Up!
Click to expand...

I am hoping to see him continue to drop and we're near 36 hours now. He should start to fall noticeably. He should start to really "clear" here this evening. I hope Claudia will get us a +4 this evening.

I've used 3 different insulins with PZI being one of them. I had a huge learning curve on switching to lantus in Sept., and I am still learning. Atlas has a strong history of being "bouncy" on both Humilin N and Lantus. I think I've finally found a way to trim his bounce over the past few days. The thought line for that is in Think Tank for discussion.
 
lori and tom said:
wow, almost as if 2.5 units, 4.2 units...same results?
yet, this is an interesting test. robin is fully behind it. i am wondering why charlie does not show movement (an acceptable level) from his dose whatever it is so far.
Click to expand...

Detecting and avoiding chronic somogyi rebound
# Oddly, too little insulin means pre-shots are too high and too much insulin often also means pre-shots are too high. This "Somogyi effect" is often noted by those who test their pets' blood glucose at home.The reason: Anytime the glucose level drops too far or too fast, the cat or dog may defensively dump glucose (converted from glycogen in the liver), as well as hormones epinephrine and cortisol, into the bloodstream. (If these are insufficient, hypoglycemia ensues!) The glycogen raises the blood glucose, the other two may make the pet insulin-resistant for a time. This phenomenon was first documented by a Dr. Michael Somogyi.

Even when raising the insulin dose slowly and carefully, it's possible to pass the correct dose and go on to an overdose. (A typical case is increasing bidaily dosage from 1 unit to 2, passing a correct dose of 1.5 units.) This may produce a rebound -- a swift jump in blood glucose up from a dangerously low reading, to beyond the previous pre-shot level. The pet may be a bit less responsive to the same dose the next shot, from those other hormones. Repeating the overdose on subsequent days, and checking only pre-shot readings or urine glucose, can give the dangerously wrong impression that more insulin is needed! Remember to check occasionally at the expected nadir (low point) as well.

It's unusual to be monitoring glucose right when this happens, and typical to just continue the overdose, leading to a repeated rebound situation. So it's good to learn to recognize the patterns of repeated rebound. A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin!)

# When using shorter-acting insulins, repeated Somogyi rebound may manifest instead as rapidly alternating high and low blood sugar numbers with no apparent logic. The highs and lows will both be exaggerated compared to what you'd see on a smaller dose.

It's not always easy to tell a rebound from a regular curve showing insulin action ending normally. One way to tell the difference is to take a "curve" (repeated tests every 2 hours starting with the insulin shot) on a weekend and look for the shape of the curve. If the curve is valley-shaped, and gradual, then you are not seeing Somogyi rebound.

Other shapes should arouse suspicion. In particular, if the rise after peak action is faster and rises higher than the original pre-insulin level and the original fall in blood sugar, you have good cause to consider rebound. The only sure way to check is to reduce dosage and look for a better-shaped curve. A fairly sure sign: Anytime blood glucose numbers seem higher after dosage is raised, consider the possibility of a somogyi rebound. But other things can cause unexpectedly high blood glucose too, so look for a clear correlation with dosage changes

posting.php?mode=quote&f=24&p=296463

A fairly sure sign: Anytime blood glucose numbers seem higher after dosage is raised, consider the possibility of a somogyi rebound
Click to expand...

From Charlie's SS:
10/11 we've never had an amps this low before.
10/22 Really high amps- not a fur shot last nite.
10/26 so that may have elevated his numbers.
10/27 Hopefully that will explain the extra high amps #.
10/29 Last nite was NOT a fur shot or a drippy syringe. Just a really high am for poor Charlie.
 
hi blue, yes i see what your saying.
that second quote...where did that come from? did i say that????
i looked on the thread and did'nt see it, it does'nt even make sense.
claudia has been so good with all of this. my cat listens to every dose i give him. i mean he reacts in a regulatory way. your slow/go approach has helped me put the reigns on my impulse to raise dose...but if charlie goes up for another day i hope we will all be on the same page about 'big gulp'
 
Sorry Lori...

I was trying to quote Charlie's liver.... :o

I do find it interesting that the readings are similar, but slightly lower. I am holding out hope that they start to drop tonight or tomorrow.

But it does raise the question of ...insulin inactivity. But in that case I am trusting you guys and the care & handling of the insulin.

I don't believe I know Robin, but have heard her referenced several times now. Is she on the board?
 
Thought I pop in a do a little nay-sayin' ;-) and bring up the concept of "liver training" or "shooting through the high numbers" as counter point to the excellent discussion here. I do follow Blue's logic that for safety sake, testing for rebound would be a good idea to test before upping the "risk." But occasionally we do run into "stubborn livers" here. Maybe additional testing for big gulper's might be warranted too before pushing things. I've got my fingers crossed that things will turn around here. I'm hoping lori is 'wrong' on this one ;-) lol
 
Whew!! This is a lot to take in! I'll try to get a +3 this evening (+4 would be after his evening dinner). Ran out of good lancets again, so these horrible micro-thin ones are tearing up his poor ears!! They seem to make them longer to compensate for them being thinner, and they poke right thru his ear even on the shallowest setting. Dh is running out now for more good ones! I don't know anything about what gator mentioned in his post- I'll have to read up on that liver training more. I hope hope hope this is it! Btw, blue: robin is "rob and Harley", she pops by every so often to help me and Charlie!
 
I'll jar to shoot a little early to get that +3 though. He HAS to eat at 9 or he will freak out. He runs this household!
 
Sorry I've been awol, my mom was in the ER and hospital.

This is an important and inexpensive ( barring complications ) test, which will, in my best guess (...emphasize guess), help you feel confident in moving forward with your dose increases, and acro test. For Blue, who may not have been posting then, you might find it interesting to read her 10/27/10 thread. viewtopic.php?f=24&t=28391

Unfortunately he fits a lot of the common acro characteristics
snoring, big demanding appetite (must be fed at 9 or he flips out, and eats ~14oz/day), difficult regulation, heart murmur, large cat, 9+yrs old, male, (and even the difficulty with anesthesia, which I didn't follow up on, could be from airway overgrowth common in acro) eating another cats vomit (desperate hunger- Cody used to eat tomatoes off the counter), normal pzi onset and duration with flattish nadir in relation to the dose (growth hormone blocks many insulin receptors, so insulin doesn't function efficiently, but does work somewhat)

-all in the absence of dental or other medical conditions (which could explain difficult regulation).

I hope I'm wrong also, but I'm around if you need me later ;-)
 
Thanks Nancy. I hope your mom is doing ok! I see your logic (Lori seems to share it, too), but I do hope you're both wrong...I'm very scared of acro. But it's nice to know we have support if that's the case.
 
+3:362
Btw Nancy- not sure if it makes any difference, but he's been a ravenous eater since birth, and has eaten darlas puke since she cane around (when he was 1). He's also always had the anesthesia problem- his first dental was at 4 yo. Probably doesn't make any difference, but it helps to keep me in denial a little longer (in my happy place ;-) )
 
Hi Nancy,

Thanks for being here too. Sorry to here about your Mom.

I was concerned as you can tell with the yellows a few days ago and then losing them. Although somewhere in our discussions, we all agreed if the drop back didn't improve the curve, then Claudia should discuss her results with the vet and get the acro tests done.

The only other concern I have is that the insulin has lost sensitivity, but the experts here in PZI land assure me this new ProZinc is more stable than the PZI I was accustomed too.

Having ruled out the other obstacles to regulation, we were thinking going up from the 2.5u rather assertively back to the 4.0. Something like in 0.5u. increments.

I believe Lori then wanted to continue with aggressive dosing until we saw change. And I am in agreement with that. Better for Claudia to deal with this now rather than trying to manage with a newborn too.

Claudia has or does your husband help with Charlie?
 
Noooooo, i'm not thinking acro. not that i know a whole lot about acro. tom has all of those features sans the unregulatable nmbers (other than the fact that he's 100 points or more higher in the evening than in the morning)
i always think acro has to have 'erratic #'s' and these are not erratic. but i know i have pitifuly little info about acro.
 
and nancy, sorry to hear about your mom. hope that er visit did'nt turn out to be a major problem. sending healing vines.
lori
 
well actually only 1 or 2 aggressive increases to see if charlie responds to pzi.
let's face it. a 1 unit increase should have an immediate effect. even if not good enough...something different.
that is the way lantus and pzi are so different. pzi being a faster acting, immediate result insulin.
would levemir be an easier choice if pzi is not the insulin for charlie.
i don't see claudia nailbite_smile for a 40bg to reduce dose...nor do i see her doing the constant testing that happens there. not with a belly dweller soon to be a baby with a very busy mommy.
 
Yep- hub helps, but he's better with shots than by tests. That makes him nervous. he can do it if I'm not around, though.
Lori- I meant you agree with the thought that he may be high-dose, not necessarily acro.
 
hat is the way lantus and pzi are so different. pzi being a faster acting, immediate result insulin.
Click to expand...
Yes. I know that. And that is why I insisted on a rebound check first.

Actually Lantus could be fine for Claudia and Charlie. Even easier depending on what her goal would be with Charlie.

An example I'll use is most of the folks over on the Lantus board use the Tilly Tight Regulation Protocol to attempt to put their cats into remission. I think this scares people off more than it helps. The protocol is tuff. Atlas didn't regulate in 30-45 days.

While I have attempted it with Atlas and feel he is just too bouncy/reboundy I've backed off the whole tight regulation idea for him. Atlas was a severely neglected cat. He more than likely is damaged and will be insulin dependent for the rest of his life.

Why drive myself bonkers with tight regulation? Lantus becomes a very easy insulin to work with if you're not trying to push the lower limits. If Atlas is between 100-300, he's happy, he drinks normal, urinates normal, plays, purrs and even gives Krueger a lil H-E-double toothpicks.

Levemir works the same way as lantus from my understanding. Right now I'm still testing a lot as I am trying to mitigate his bounces from blue numbers and settle his liver down a bit more. There is a thread over in Think Tank that I started discussing using carbs vs. insulin to help regulate the bouncy cat. Which we just started this protocal a few days ago...and looking at my SS...well it just might work for Attie.

All I am saying I guess in the long winded way...is based on Claudia's goals for Charlie, her family, and her new baby...Lantus as a long acting overlap insulin could actually be easier sans the Tight Regulation Protocol.
 
The initial protocol would be the same as you are looking to achieve "regulation."

Regulation meaning: [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia] Blue's and Yellow's

Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin] Note with tight regulation they are below 150...all the time. Green's and Blue's

Here are the pro's and con's from the archive: http://www.felinediabetes.com/phorum5/r ... msg-111567
Click to expand...

Bringing Charlie into a loose regulation with lantus, would leave Claudia room for less worry, less stress etc. There are upsides and downsides.

I don't think there is a "resource" per se as it is understanding what the protocol being used is actually advocating. Maintaining the cat in Euglycemia 50-80 ranges.

Lori's concern or fear of the dreaded 40bg is somewhat mitigated if Claudia would work towards "regulation." You see lots of low numbers in Lantusland because they are working towards a different goal. They are shooting for those low numbers 50-80.
 
I was positing more in the general - not really specific to this situation. It's hard for me not to see things though my own lens. I was a typical "lazy" owner - eventually once I got the fix on things - changing/missing dose time by an hour or so frequently, generally only testing PSs with some spot checks occasionally thrown in [even with a cat who would go on semi-frequent sudden food protests]. I guess I was asking for the "lazy" owners out there. Is non-tight L or L compatible with the "lazy" bean - or the bean that has a schedule that prohibits the seemingly acute attention to detail I've frequently seen in the Lantus SSs?

Occasionally I've seen some folks allude to using Lantus differently - just wondering how "different" things can be if one does not care about tight regulation?
 
thanks for the well wishes for mom- we are in the midst of a new set of changes and loss of independence- its hard...

lots of thought
I think its a fine test- I really didn't like the loss of yellow nadir either- not sure what to make of it. My first concern was the speed of increase causing a backlash.

I'm inclined to hold doses a minimum of 4 cycles, but maybe even that's too fast.
I did almost all .5 increases and thought I was going slow at the time

Acro isn't always erratic- take a look at out numbers in jan / feb 2010. I couldn't get anything but yellow no matter what dose I tried. Like I was injecting water....
Acros dont always have super high numbers, but seem to tolerate them for extended time without losing weight.
Acro isn't a death sentence, but it means you aren't looking for OTJ, it also means that you are not trying to achieve levels under 100, which makes it less stressful.
Supposedly, because they can have functioning pancreas that can get you into hypo trouble if you've given 15u and the growth hormone suddenly tapers off. Its never happened to me- I've never seen a reading under about 79 in 3 1/2 yrs, but I still adjust doses when I see low blue.
Many acros do not exhibit physical signs, esp younger ones. This is a common vet misconception. Cody was the little brother, until recently.

IF he turns out to be a high dose cat, the u100 insulins are probably a more cost effective choice-
Most of the high dose cats here are on Levemir, supposedly lantus can sting at high doses, and I think lev is a bit more gradual in action.
 
My current goal is simply regulation. I just want to be able to make sense of his numbers. Right now they don't make sense to me. I'd love to never rise above 300s, ideally staying 200s and below. I soooo appreciate all the input.
 
Gator & H (GA) said:
I guess I was asking for the "lazy" owners out there. Is non-tight L or L compatible with the "lazy" bean - or the bean that has a schedule that prohibits the seemingly acute attention to detail I've frequently seen in the Lantus SSs?

Occasionally I've seen some folks allude to using Lantus differently - just wondering how "different" things can be if one does not care about tight regulation?
Click to expand...

Here is an example. We have a board member who uses Lantus. She is perfectly content to have yellow and blue numbers. These work best for her as she isn't around to test more frequently and minimizes the risk for hypo. Her cat is still defined as "regulated."

I have Attie. He loves the trampoline. Under the protocol I should be upping his dose. I won't because he will asymptomatically hypo. He's been under 20 on Lantus. :shock: I have decided TR is not worth the sudden risk. So we are on our way to living in the blue yellow, occasional pink ranges. I can shoot his 2.25u in the morning, put a bowl of can food out for later, and come home from work to a cat that has his 5 P's in place. His diabetes symptoms are in check too. A few weeks ago...I couldn't have left a bowel of food out for him. He would have scarfed it right down. And I've learned in Attie's case low carb isn't exactly best for him. His numbers are much more consistent and stable with a low carb breffis & dinner, and HC 15% meals in between.

It isn't really about a different protocol. It is about a different goal. If TR isn't the goal, then once the cat achieves and is able to maintain numbers in the desired range of defined "regulation," the owner goes into the maintenance stage. Pre-shots, several weekly midcycles, and a monthly curve.

I can only explain it from a few examples, because most of us who don't feel TR is right for our cats, don't post on LL.
 
Thanks Gator, I appreciate that.

I am only posting here because I was the board person that went to visit Claudia & Charlie when they were first learning to test.

I've pretty much stood back since then and have offered her words of encouragement from the sidelines.

In this case I felt a few insulin regulation checks might be wise. I am glad the PZI folks welcomed my input.
 
blue i thought everyone practiced lantus usage the same way since when i'm there they are all doing it that way. so the one's who are not TR don't post?
and i am not concerned or dread the 40bg dosecreas thing...i just think not everyone has the time, $$ (those every 15 minute tests), or stomach for it.
i have freinds in LL and know the incredible amount of work put into it.
i could steer a 40 or 30 or even a 20 if i had to....i just don't want to aim for it just to decrease my dose.

and i suddenly realized that all this chatter about LL is likely to give poor claudia a headache and we've hijacked her thread! sorry claudia. you've become a topic of interest. but back to charlie............
 
No, no- I want to hear this in case we do end up needing to switch. It's lots of good info, lots of technical stuff too that I don't quite understand yet...but this helps!
 
Status
Not open for further replies.
Back
Top