12/4/14 Keiko AMPS 448

[KeikosHuman]

Here's my last post and ss updated:
viewtopic.php?f=9&t=129421

Mr. K had a wild ride yesterday from 194 or 183 PMPS to 509 in the evening. When he was 194 got I happened to have just talked to my vet who I reached before hearing from FDMB. She suggested 7 units since I planned to not be home last night. I ended up coming back to check on him at +3 and he was so high I gave him the 2 units so he would have 9 total.

What was interesting is different readings in each ear. I'd not yet seen him so low so I took another check in the other ear and he was 10 points lower. He was 230 on Alphatrak.

Back on 9 units today. I gave him some cooked turkey and he did a lovely bounce run with the morsel to his alternate eating spot! Fun! bcatrun_gif

My vet is not on go with the protocol we're using. She mentioned a recent article said many vets discontinued this protocol due to hypo incidents. She thinks 5-7 day waits with a full curve each 5-7 days is preferable. She doesn't think owners should be testing so often. I disagree as more information can only help. I will make the call. Will plan to increase him tomorrow or Sat to 9.5. Your advice is welcome.
Thank you all for your help

 

[Amy&TrixieCat]

It's very contradictory that your vet doesn't like the protocol - which requires a home testing - because it supposedly causes hypos, yet she says to NOT test for 5-7 days. What if a hypo could have been prevented (because of home testing) in those 5-7 days??? Someone who wasn't home testing recently lost his kitty to a hypo thanks to this sort of advice from a vet. What harm does home testing cause?? The cats get used to it, and it keeps them safe. Is she referring to fatal hypos? Symptomatic hypos? Or just reported low numbers? If someone is truly following the protocol - testing and catching low numbers BEFORE they become hypo - then there should be no true hypos.

Not slamming your vet....the discouragement of home testing when an owner is willing to do it - the one thing that will really, truly keep a kitty safe - is a HUGE pet peeve of mine. Grrrr.....

Have you ever split a dose before like that? As I mentioned yesterday, I'm not familiar with high dose cats. I'm not sure what splitting a dose like that does to the depot, but I imagine it could cause some wonkiness. I'm sure someone with the high dose experience will offer some input about your dose question.

 

[KeikosHuman]

No, I've never split the dose. With hindsight, I probably should have given the full dose but I did what seemed safest at the time.

My vet referred to serious /fatal hypo events, saying 2 would end up in euthanasia. She thinks increasing faster than 5-7 days would make it seem he needs more insulin because of symogy effect - BGs go high and they seem to need an increase but they then drop too low. I'm confused - is symogy real or not? The vet thinks it is but what I've read indicates there's controversy.
I'm not deterred but I will hear all sides and decide. In terms of owner monitoring, it's a disease that seems to require a lot of monitoring for people. Would a person only check BG once a week from morning to night? I do not know much about diabetes but I think people check themselves a lot.
Maybe she's concerned I'll go wild and up the dose too fast or that me the lay person doesn't know what they're doing. I guess I could ask. She wants to do a urine test to see what glucose is there. I know its there from his numbers and his frequent copious peeing, I don't see how that would help anything (except the vet's bottom line). Don;t get me wrong, I think she is a good vet but we don't agree on everything at this point.

Can you get ketone checking items over the counter at a drug store?
Thanks!

 

[Sienne and Gabby (GA)]

I saw the article the vet was referring to. There are lots of problems with the article. At a very basic level, and I think you're in agreement with this, the only way to keep your cat safe is to know where Keiko's BG levels are. It doesn't matter if the dose is 0.5u or 5u or 15u. A cat's body needs the amount of insulin it needs and numbers can drop regardless of the size of the dose. The ONLY way to have some control over this process is home testing. I seriously doubt that any MD would ever tell a parent to not test their diabetic child. If they did, the courts would be cluttered with malpractice suits. IMHO, to be a responsible caregiver, you need to home test.

The other problem is that your vet apparently believes in Somogyi. The original research on Somogyi was done in 1938 with a very small number of humans and published a far less than stellar journal (it was the journal of the St. Louis medical society). We are not talking about research that would even be published by today's standards. That aside, more contemporary investigators have attempted to replicate the findings with no success. At best, the concept of Somogyi in humane is controversial. When addressing this with cats, there is no research. Not only is there no research in cats, there is no research in either human or cats with long-acting, depot-type of insulin like Lantus. When vets have convinced caregivers that Somogyi is operating and to either hold the dose overly long or to reduce the dose, I can't even recall a situation where this helped. Instead, we see glucose toxicity developing or it ends up taking longer to make up lost ground.

(I just posted a ton of info on Somogyi in Cinco's condo.)

 

[julie & punkin (ga)]

Glad to see that blue creep in there.

Did he get a shot at pmps on 12/2? there's nothing in the dose column. If he didn't get a shot that evening, I would wait to increase until you had 6 shots at the 9.0u. If he did get a shot that evening and he were mine, I would increase his dose by another 0.5u.

I started out shooting punkin without hometesting, but it doesn't take a genius to figure out that anyone can overdose and become hypoglycemic from too much insulin. Cats, dogs, people. All are at risk if you don't know what the insulin is doing in the diabetic's body. I shot blind for 2 months, then signed up here and let people teach me how to keep punkin safe. Knowing what I know now about how cats' blood sugar can go up and down, there is NO way I would shoot blind now - not even for a day.

There are also a couple of other condos here about Somogyi. Look at the bottom where there is a collection of interesting posts under Somogyi.