11/5 Muffin AMPS 153 +3 94 +5 85 +7 160 +10.25 387 PMPS 425 +3 271 +6.5 282

[Julie + Muffin]

Big question. In reviewing Muffin’s SS from the beginning it looks to me that dose increases have not been beneficial in most instances. When she was on a lower dose in the beginning she had consistently better numbers. Even though she hasn’t earned a reduction, I am thinking of reversing the dose rather than raising it to see where she goes. Has anyone ever tried this before? Do you have any recommendations on how to do this? Reduce gradually by cycles? I don’t know the risk but I have a feeling she is just not a typical diabetic cat. It’s been months and we are not making progress. It would be helpful to have some experienced eyes on her entire SS. Any help would be appreciated.

 

[Doodles & Karen]

Anything more then the last week or two of data is old data and not relevant unfortunately. You were forced to take a back to back reduction on 10/25 and 10/26 because of the low numbers which can eventually stall progress. Also shooting late on 10/30 and again on 10/31 can disrupt things. If I shot late with Doodles it could take weeks for him to get back on track. Of course ECID. In my time here, back tracking and reducing the insulin never worked. It looks like she needs an increase. It's common to go up and down in dose and sometimes you have to go up and up to come back down. Some kitties are easier to regulate then others but insulin is a hormone with many factors along the way...even the weather. Another option to think about is switching to Levemir.

I'll tag a few to help weigh in @Marje and Gracie or @Sienne and Gabby (GA) or @Wendy&Neko

 

[Bobbie And Bubba]

Hi Julie, I agree with Karen that back to back reductions and then two dates close together shooting late could be playing havoc with the cycle. I would not recommend lowering the dose as she has too much pinks in her chart and she just gave you that beautiful blue pre shot. It's not uncommon to dance between a dose a few times. I would see how today's cycle plays out.

 

[Julie + Muffin]

Hi Julie, I agree with Karen that back to back reductions and then two dates close together shooting late could be playing havoc with the cycle. I would not recommend lowering the dose as she has too much pinks in her chart and she just gave you that beautiful blue pre shot. It's not uncommon to dance between a dose a few times. I would see how today's cycle plays out.

ok Thank you! I was very surprised to see blue at amps. We shot (no increase) and will check at +1 just in case.

 

[Wendy&Neko]

n reviewing Muffin’s SS from the beginning it looks to me that dose increases have not been beneficial in most instances. When she was on a lower dose in the beginning she had consistently better numbers. Even though she hasn’t earned a reduction, I am thinking of reversing the dose rather than raising it to see where she goes. Has anyone ever tried this before? Do you have any recommendations on how to do this? Reduce gradually by cycles? I don’t know the risk but I have a feeling she is just not a typical diabetic cat. It’s been months and we are not making progress. It would be helpful to have some experienced eyes on her entire SS. Any help would be appreciated.

Muffin is not atypical. As Karen mentioned, insulin is a hormone so you can't expect each dose increase to look a little bit better. You keep increasing until you find a dose where you get the numbers you want. It can involve a lot of up and down in dose. The other thing that can be at play is glucose toxicity. Take a look at other kitties spreadsheet. Boomer's SS is an example of a kitty doing well, then mid July went off the rails, got glucose toxicity and Judy had to go quite a bit higher before he finally broke through and is now on the way back down. Note that he got some green at doses on the way up, but it didn't hold and she had to keep increasing. Libby's Lucy is another example of a cat that went up, then down, then back up then down in dose before finally going OTJ.

I did try reducing the dose once with Neko. She had had radiation therapy for her acromegaly (which causes her diabetes), and it was possible she just suddently needed less insulin. I just went down a bit, but it clearly was not the answer - she needed more insulin, not less. The only time it works to reduce the insulin is if you started at too high a dose, or did unsafe increases without testing. Luckily for Muffin, such is not the case for her.

 

[Alicia & Maggie (GA)]

Nice to see a blue AMPS!

 

[Sienne and Gabby (GA)]

I agree with Karen, as well. The notion of dropping the dose back is based on the dealing with Somogyi rebound. The fundamental problem is that Somogyi rebound is a phenomenon that's never been scientifically established in humans let along in cats and when it was first proposed (1938), we didn't have long-acting, depot type of insulin.

The only thing I would add is to be sure you are truly following TR if that's what your dosing strategy is.

 

[Julie + Muffin]

Well Muffin decided to show me. Today has been her best day so far maybe ever. Always worry she will go too low. She has been eating but seems a bit tired. Yes we are following TR protocol but I can't say it has been perfect. As to her lc food it has been perfect unless she needed hc to get through a very low number. She does not get any dry food whatsoever. She was actually due for an increase today but I didn't let it happen given her amps. I think it was the right decision but not sure when I will know for sure.

Thank you all for input. Very important and appreciated

 

[Doodles & Karen]

Well Muffin decided to show me

I love when they read their condo about an increase and tell you otherwise! Nice work Muffin.

She has been eating but seems a bit tired

When they are not use to lower numbers this is normal. The more she gets use to them she'll actually feel better. It's kind of like if you're a coffee drinker and don't have any coffee...you feel icky until you get use to it.

 

[Marje and Gracie]

When we are following TR and raising and lowering doses by a small amount (0.25u), it’s hard to get them overdosed. It’s very common to think there might be too much insulin with patterns like hers but, as the others have said, doing a rebound check by dropping the dose usually puts the kitty even further behind and builds up more glucose toxicity. In the 7 years we’ve been here, I can count on two hands the number of overdosed cats I’ve seen and it’s usually due to the vet starting the kitty at too high of a dose and raising it by 1-2u at a time.

It’s very common to see them seem to do better at a lower dose and then fizzle out or they might start out doing well on a dose and then fizzle. It takes stepping back and looking at the big picture (which is really hard to do with your own cat quite often).

I know it’s hard, when you get a pink number at PMPS, to do another poke but I can tell she started down last night at some point. If you can just manage to always get at least a before bed test to know where she’s headed. Because you always do a great job of testing at night, I figure something different come up for you.

You’re doing a great job...hang in there!