12/14 Gracie PMPS 334 +1 325 +2 314 +4 291

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Marje and Gracie

Marje and Gracie

Member Since 2010
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Yesterday: viewtopic.php?f=9&t=32018

AMPS: 390 4th cycle f1u
+2: 303
+3: 127
+3.5: 108
+4: 87
+4.5: 103
+5.5: 98
+8: 183
PMPS: 379 5th cycle f1u
+2: 191
+2.5: 159
+3: 137
+3.5: 139
+4: 156
+5: 181

Wishing you all a lovely Tuesday morning. We're sending positive vetty vines to Mannie today that everything is just fine with him and he just has a little injection site scar tissue.

WCR: 4Ps in place and a silly little girl this morning. Her PS are very slowly coming down but she's still doing these dramatic dives. Last night at PMPS, we added a little 9% gravy to her food and fed at PMPS, +.5, +1 and she still dove at +2 but then we got her flattened out a bit. I don't like keeping her out of the green but we need to stop these crazy drops. This morning I gave her a little more 9% gravy and feeding every half hour. We like the blues/greens she is getting on this dose but have got to get the diving under control and hopefully bring her PSs down.

Last night, she was rattling around the kitchen playing. I have a little Christmas cat magnet on the dishwasher and she kept standing up and sliding it down so it got to be a game with me putting it up, her sliding it down. But then I went to put the last of Tobey's supplement for his stuffy head in his food and his capsule was gone off the countertop and I knew the culprit...Miss Gracie. She has always been enamored with capsules. We looked and looked and looked and never found it. I can't believe she ate it but she could have...it wouldn't hurt her but still...YUCK!! I opened her mouth but saw no dry, capsule remnants so she might have squirreled it away somewhere :lol: :lol:

Off to TBP. Have a wonderful day. I miss reading everyone's condos...between trying to monitor Gracie so much with these plummeting numbers, work, and the remainder of my Christmas list of things to do, I haven't gotten to condos much but I am thinking of you all and sending hugs.
 
Re: 12/14 Gracie AMPS 355

At least she seems to level off nicely when she does go down. Lil stinker! Leave Tobey's meds alone, don't you get enough of you own!
 
Re: 12/14 Gracie AMPS 355

No worries on the inability to read the condos. It is the same for me. I start out with the best intentions, and run out of time before I truly get started. We all understand! and there are so many newbies!

Gracie had such a nice day yesterday. I almost think that her PMPS was a reaction to the lows during the day. PM injection comes around and back down she goes to where she was during the day. Mannie will do this at times too. Those sudden drops back to what he surfing during the day. Frustrating, I know.

Love the magnet story. very cute. wow on the capsule... :lol: One of my civvies is fascinated with the lancets. I test freehand, will leave the lancet next to the testing spot while I get Mannie all set to go. She will come over and grab that thing and start a session of lancet hockey. OMG!, and thank goodness the cap is never off.

I hope Gracie can clear the 355 soon. I bet she does. have a good day at TBP.

Gracie - good luck at the vetty bean. See you later - I know we will both need spa treatments! ~~ Mannie
 
Re: 12/14 Gracie AMPS 355

Ugh with the diving and the bouncing. Looks like you are doing your best to help her out with this. I wish you luck and I hope that this bounce doesn't last to long....and she comes down nice and slow and gives you a nice low blue surf w/o any assistance!

Liked hearing Gracie's new game....I can just imagine her playing with the magnet and you putting it back up there...however, the pill thingy...Gracie...you should know it's not nice to play with anyone's meds!

So, is Gracie going to the vet today too? I haven't had time to visit many condo's either (it's either no time or brain matter just doesn't want to cooperate and focus), so I know what you are going through, but with that said, I may have missed something...is something wrong with Gracie?? I hope not...but if she is going to vettie bean, I send good vettie bean vines.

Gracie!!!! You going to vettie bean too!! Oh my...me budder yesterday, Mannie and you today....good gosh, I hope I'm not next!! Oh how I hate vettie bean!!!! N E way, I'll see you with the KTSS crew after your bisit and den we can go to Mannie's and gib him his treatment. Tess said she will pick me up in her furrari, you want us to pick you up too??? Call me...........Lubs, Spot
 
Re: 12/14 Gracie AMPS 355 +1 339

I guess I did miss that about Gracie....still hope visit goes well.

Spot is doing great, it was civvie Ralph that I was concerned about. He just hasn't been acting like Ralph lately...it seemed like he was depressed, wasn't purring, sleeping lots, but appy never ceased! Did a blood panel on him...not much showed up there except his bg's were high (vet stress fur shur on that one), and his BUN was slightly elevated. They gave him some pain meds and some fluids and sent us home. He looks better...did some purring and I heard his little cry this morning (he used to cry all the time w/his little stuffed toy in his mouth, but hasn't done that in about a month). Vet didn't seem overly concerned w/BUN number, just wants to keep an eye on it...said his urine was clear, good sign that kidneys were still working. Thought maybe he was just dehydrated. So, I think I may have to stop the Miralax for a while and add more water to his food. Maybe that will help. Thanks for asking!
 
Re: 12/14 Gracie AMPS 355 +1 339

Sending good vetty vines to dear Gracie today--Wow big vet day in LL!! Hope ALL results will be totally Normal!--
So cute with the magnet!! Love those pictures in my head!! Hugs & hope all will be well--I know it will! :mrgreen:
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286

DH here - 286 at+2. Thats the first yellow we have seen since +1 Sunday night. She has been moving thru yellow so fast in both directions we haven't captured one. So, don't know if this is from the extra carbs we've been giving early in the cycle, settling into the dose, or just being slower to clear the last bounce. Guess we'll just keep doing what we're doing and see what happens. Her vet appt today is just a regular visit/follow-up with the nutrition response vet. Try explaining that to Gracie though.
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286 +3 197

DH here - 197 at +3. Her drop has sped up a little. Didn't give her any gravy at +2 or +3. I guess that could explain it. Will test again at +4 and see where she is going.
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286 +3 197 +4 156

DH here - 156 at +4. Nice slowdown. May not get into green this cycle but a flatter curve.
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286 +3 197 +4 156

Ok Gracie....slow it down just a little bit!
Nice +4 tho!
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286 +3 197 +4 156 +5 172

DH here - I guess we slowed her/precarbed too much. Didn't think 9% gravy would do that. Expecting a high PMPS after her vet visit so we weren't going to give her the early gravy tonight anyway, and will probably cut it back tomorrow morning. We like that this dose is getting her back into greens, but she has been getting there so fast she doesn't surf. Just bounces right back up. I think patience, as always, is the key. So, a priest, a rabbi, and a minister walk into a bar. The bartender looks at them and says "what is this, some kind of a joke?"
 
Re: 12/14 Gracie AMPS 355 +1 339 +2 286 +3 197 +4 156 +5 172

Mike and I need your thoughts ASAP....as you know, I had a nice long visit with our regular vet last week. She, in turn, decided to take Gracie's SS to a local board certified internal medicine vet who deals only with cats (I didn't know she was consulting with this other vet). I got a call this afternoon from my vet's office relaying this info and they said the other vet (Dr. K.) wanted to meet with me so I did and she asked me to bring Gracie's most current SS.

After looking at everything and especially the odd days Gracie has had lately, she told me that she does not think that Gracie is diabetic. She said she manages alot of diabetic cats and one of her own cats is diabetic. She said for Gracie to be dropping as low as she does as fast as she does indicates that she has too much insulin. I asked her about the bounces...she said she believes that when Gracie is dropping low that her adrenals are releasing stress hormones that are causing the blood sugar to go way up and she is having Somogyi (sp?) rebound because she does not need the insulin. I told her I thought that Somogyi rebound had not been documented in cats and she said that wasn't true. She was familiar with tight regulation protocol...I got the idea she wasn't a big fan but she didn't criticize it other than to say she worries about cats getting low numbers under 50; she said she wants me to take Gracie off insulin for 2 days and give her body time to equilibrate and then check her BG and urine.

Either way, whether she still has high numbers or not, she wants to do an fPLI so she said IF Gracie's numbers stay up, to let her do a fasting fPLI first (she does not want to fast a cat on insulin) and then I can get her back on lantus but she said she would probably recommend a lower dose like .5u bid to start.

Of course, Mike and I are freaked...this is not what I would have expected...not sure what I expected as the whole thing caught me off guard. We are worried that if we take her off insulin and she is diabetic, that she'll spend two days with crazy numbers and then we'll have to start all over again. Conversely, if there is even the slightest chance that she is NOT diabetic, we want to give her that chance. There were a few things that she said that I questioned...such as that a cat can spill glucose into their urine at BG 170 just from stress in the vet's office but it doesn't mean the cat is diabetic. She said that if Gracie has no glucose in her urine after two days, test her BG, but she would tend to say that Gracie is running in normal numbers; I disagree with that and told her that I would only base keeping her off insulin on BG not urine and she said that was fine just depending on how stressed Gracie gets from ear pokes (which I don't think she does...we don't have to chase her, she lies there quietly, she doesn't run after we're done).

Anyway...now we are really confused. Any thoughts to help us with this? If we did decide to not give insulin, how far back would it set us if she is wrong and we have to start over? Thank you for any help...we have no idea what is the best thing to do for Gracie.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

Hi Marjorie, Gosh, I'm not an expert, but I would think that it would be best to keep following our protocol. Gracie should be moving down the dose scale gradually before going Otj. Now her dose is a fat 1 unit. She has a ways to go before she is in microunits. And when she is ready, she will have her 2-week OTJ trial. I think it would be inadvisable for you to follow this new vet's advice and simply take her off insulin and see what happens! Our protocol is designed to do things in a manner that is safe for the cat. Let's see what others say, but I would only remind you that you know your Gracie much better than either of these vets. The "specialist" hasn't even examined Gracie!
Some of her thoughts seem out of date (the somoji rebound thing, for example).

Ella
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

breathe!!!!

I'm trying to jog through some condos quickly but will stop back by. I just want to say that we have heard this a million times. Vets aren't used to seeing these numbers, but we are. They see 50s and panic and tell people to stop shooting. Gracie is on f1u, and the vet probably doesn't think you can shoot less than 1 unit. Of course you can, there are a LOT of smaller possible doses. They think Gracie's numbers and patterns are unusual, but that is just because they don't usually see numbers like that at the vet. Her numbers aren't unusual at all. She's a bit bouncy, but her patterns are pretty typical of a cat who is just now finding a consistent response on a dose.

The fact is, you started on a small dose (0.5 units BID) and worked up to your current dose very diligently according to protocol. The lower doses weren't enough, that's why you increased. Yes, there are a few cats who need doses smaller than 0.5u, but you are one of the rare people who got plenty of tests in right from the beginning so we had *plenty* of numbers to go by right from the start. If 0.5 had been too much we would have been able to see that in her numbers. If the current dose was too much, we would be able to see that too.

I know it's hard to weigh your vet's opinion against ours (actually TWO vet's opinions), and I know it's scary, but we really do see this all the time. In fact, I almost always worry when someone whose cat is doing this well goes to the vet, because I know that much of the time the bean will come back that evening and post that the vet told them to stop shooting. Sometimes it works, but we find a much better chance of long-lasting success by working down the dosing ladder slowly.

I'll let others address Somogyi because I know some here have done more extensive reading than I have.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

WOW - not too sure what to say on any of that - but I do agree with what Ella wrote. I have a hard time with the "let's see what happens" thing. I just don't buy any of it. I think you had valid agreement points.

I am curious what the experts here have to say. Sure didn't expect to read this on your condo today.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

Libby...thanks for writing that. This vet did say that if, after stopping her for two days, if her numbers are up, that we should not give more than .5u bid. She said if Gracie is diabetic, she thinks she needs a much lower dose. It's also the Somogyi thing I'm curious about because when we read the link in the stickys...it sounds like Gracie esp lately. Yes...she definitely was worried about the 50 numbers and I expected that. I wanted to show her some of the other SSs where the numbers are low and consistent (like Curry) but she didn't have wifi and she said looking at those SSs wouldn't tell her much because she had no info about those cats. My regular vet did not say to take Gracie off insulin...she didn't know what Gracie was doing and I think she just wanted another set of eyes. I have a call into her as I know she doesn't know this yet.

eta: Michelle...didn't expect to write this or anything in my condo today regarding Gracie and a vet :lol: :lol: Mike took Gracie to the NRT vet while I ran over to this other vet. Interestingly, she was fine with Gracie's diet (didn't mention DM), hometesting, etc etc altho she made a passing remark about info on the internet.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

just telling you what i've gone thru with Rocket....vet told me to stop the insulin once he got to 100 as it was too dangerous for him...she has NO clue that rather than stopping...i'm still at it with him....she was shocked to hear i bought the half unit syringes....had i stopped Rocket would be back where we started...and i would love to help him be otj again if it will happen if not then i'm ok with the #s he is currently at with the little insulin he is getting...it is proving that it is helping him....my thoughts!
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

Is the pancreatitis angle something you should still look into though?

The "spec fPL" test .... I am not sure about the specifics about this test - whether it requires fasting or not. The IDEXX brochure didn't say.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

Marjorie, I hate the things some vets tell you about this disease--
1st vet told me Moonie was a transient diabetic :roll: and yet he kept raising her dose till I stopped him.
Then we went to an ER vet who, bless her, put Moonie on lantus..
One other vet we saw told us Moonie at 150-200 is going into remission! :lol: :lol: :lol:
We let many of these people tell us things that we have learned here that are totally contradictory!

Tell the other consulting vet this: WE Have Had 157 cats Go into Remission since 2008 here in Lantus Land--
How many did this other vet have?
We care about you & Gracie & of course want the best for him..Your vet just needs to listen to you more!
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

you know i don't have a lot of info to offer...but this apply a little.

Binks' vet is exceptional...does all sorts of research and is very positive about FDMB. when she saw the SS and the 50's...she was extremely concerned and wanted to drop his dose. But she sat down with me for over an hour, reviewed protocol then spent 2 days reviewing posts and stickies on the forum...and with that education felt like we were on the right track.

what a crazy day for you...i know libby and others will be along to address your questions and concerns...

you and mike will figure it out, marjorie...you are one of the best most diligent beans we know!

celi
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

Thanks Roni, Celi, Ella....I talked to my regular vet just a few minutes ago. She was funny...she was really surprised by what this vet said and then said that of course a vet is going to be freaked by those numbers because they don't see them normally and they don't have clients that generally do what we do. She said she still thinks two things: (1) FDMB is dealing with FD day in/day out and she believes has the most up to date info and (2) she tends to think that Gracie would not be doing Somogyi on such a low dose. She said if we really thought Gracie might not be diabetic, to ask you all how long it would set her back to take her off the insulin two days. But I got the feeling that she was not convinced that we should take her off.

I think there is that carrot...our darling girl might not be diabetic. But when I told the vet that I could show her several cats that were doing the same thing, she kind of glassed over that...she only wanted to talk about Gracie and the info she had at hand...and I can't blame her for that, in part. One thing she did say is that it has been proven in humans that tight regulation leads to earlier death due to consistent low numbers. Obviously, I've never heard that andso didn't argue but I find that hard to believe. I mean...it isn't like our cats are at 50 all the time AND there are normal cats that run around there. I tested one of my civvies and he was 52 on my glucometer.

We shot Gracie's f1u tonight; one thing we have noticed is her PSs are starting to come down again.....thankfully. We need time to digest but I think we both are feeling that we aren't going to stop her insulin but will continue to follow the protocol. Mike does think that this dose is too much for Gracie based on how weird her curve has been since we started it. Any thoughts? I did not want to change her dose yet....she's only been on it a few cycles and only barely got below 50 once.
 
Re: 12/14 Gracie NEED URGENT HELP...VET THINKS GRACIE NOT FD

First, slow down. None of these recommendations need to be addressed immediately. There is nothing that is life threatening here. You need more information as well as time to digest information.

The topic of Somogyi came up some time before you joined the Board. Both Jill and I did a lot of lit searching. I have access to both a medical and veterinary library system. For a theory that has so many people convinced that it is a factor in human as well as in feline diabetes, there is an amazingly small amount of research on the topic. The earliest paper by Michael Somogyi, is from the 1930s and was not published in a widely recognized medical journal (i.e., it was in the Weekly Bulletin of the St. Louis Medical Society). Note that this was a report based on 5 human subjects and urine glucose, not blood glucose was measured. More recent reports note that Somogyi's observations have not been reliably reproduced under controlled conditions.

Gale said:
Although some patients had a very rapid fluctuation from hypoglycaemia to hyperglycaemia, we found no evidence that changes in counterregulatory hormone levels were responsible.The preceding interval of hypoglycemia was often prolonged, which implied defective homeostasis, and the difference between the patients with apparent rebound and those without could not be explained in terms of circulating levels of cortisol, growth hormone, or glucagon. Other workers have noted very variable changes in growth-hormone and cortisol levels after acute hypoglycsemia in unstable diabetics. We did not measure catecholamines and cannot rule out the possibility that they were partly responsible for the difference between our groups. However, the evidence presented here suggests that free insulin is the major factor involved.
Click to expand...
The bold is mine. It points out that there is no evidence for what the vet is suggesting about "stress" hormones (i.e., cortisol).

In addition to the dearth of empirical research, there is even less that pertains to cats and none that addresses Somogyi phenomenon in the use of Lantus. Given that the presence of Somogyi is believed to be associated with doses that are raised in too large of an increment, it is surprising that this IM vet would not be an enthusiastic supporter of the Queensland/Rand tight regulation protocol. (FYI - there is another TR protocol and the vet may have assumed this was the one you were referring to.)

This is a link to info on Chronic Somogyi Rebound on Wiki. I would draw your attention to the section on Controversy:
Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night fail to wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.
Click to expand...
This information pertains to humans, not cats. However, the phenomenon was based on humans and extrapolated to felines so I'm going to presume the issues with the paucity as well as quality of the research are the same.

If this were me, I would ask the IM vet for more information.
  • I would want her to provide you with the research/empirical studies that she was referring to so you can do some reading and better understand what she thinks is going on with Gracie. (Personally, if there is research out there, I would very much appreciate seeing it because I can't find it and I'm pretty good at doing lit searches.)
  • I would ask to see research documenting Somogyi in cats on Lantus.
  • I would also want to know why she thinks Gracie has pancreatitis. That's what an fPLI is used to assess. From what you've said, Gracie has no symptoms of pancreatitis so I'm not clear on what the purpose of the test is.
 
Re: 12/14 Gracie PMPS 334 +1 325

YAY - headed down with that +1 - better Gracie!

Hey Gracie - thanks for coming with the KTSS today. I feel so much better. It's always good to hang with friends. See you tomorrow? ~~ Mannie
 
Re: 12/14 Gracie PMPS 334 +1 325 +2 314

Michelle...looks like she'll do a flat pink tonight. Tomorrow's another day!

Sienne...thank you so much for the detailed explanation. When I looked at the link in the Stickys to Somogyi, while the description sounds like Gracie, the curve didn't look like hers in that her evening PS is not typically alot higher than her a.m. PS and there were some other differences. I am going to ask this specialist for the information and it will tell alot as to how much she discloses. On the fPLI, I asked her about that because I told her I have had a cat with pancreatitis and Gracie has no symptoms AT ALL. She said cats can have mild, chronic pancreatitis and show no symptoms. Based on the symptoms my kitty had, I would find that a little hard to believe. She said the pancreatitis could be the reason for Gracie's current presentation....I agree that it can be the cause of FD but I can't believe a cat with even mild pancreatitis would play as much as Gracie, eat as much, have no abdominal pain or vomiting, have normal stools, etc. It just doesn't fit.

I'm going to bookmark all this great info you gave me. Thank you for your time...I know you are busy during the workweek with Gabby and keeping up with others who need help on the FDMB.
 
Re: 12/14 Gracie PMPS 334 +1 325 +2 314

like i told you via PM...
not much more i can add to what's already said. glad you shot tonight.
 
DH here - short nightt for me. 291 at +4. I think her little trip to the vet today was too much. Expecting a better day tomorrow.
 
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