3/31 Rocky PMPS 304 +1 304 +2 222 +3 201 +4.75 110 +8 100

[Tina & Rocky]

Good morning,

Yesterday's Condo:
viewtopic.php?f=9&t=119554

Yesterdays SS:
Not good enough. Still above renal threshold, going on 7 months now.

I increased Rocky's insulin shot today to 2.25u from 2.0u. He's had 7 cycles on 2.0u. Some of those shots were even given with an increase of insulin as well as an insulin overlap-- and he still did not see BG numbers that were consistently between 50 to 150 for more than a few hours. Extremely depressing..:YMSIGH:

I don't think that raising Rocky's insulin dose until he has 4 or 5 hours of BGs between 50-150, then he goes below 40 and gets an insulin reduction, does anything to help heal his pancreas. We're killing what remaining beta cells he has left, IF he has any left. :roll: A prolonged amount of days in BGs of 500, 400, and 300 from a larger amount of insulin that REQUIRES a front end carb load to not go below 40, and then the soon after drained dept, is a hell of a price to pay for a few hours of BG between 50 to 150..

Rocky is very poorly regulated. He doesn't have ringworm any longer at all. He does however have HORRIBLE DANDRUFF.

BTW, Rocky went below 40 two times on the 1.75u dose, (5/18 and 5/20). Thank God I did not lower his dose even more when that happened. Now we are back up to 2.25u.:roll:

The advise givers have all weighed in on the TID (three times a day insulin shot) and none of them want me to do it unless I am an expert like them at knowing how to read an SS. However, after looking at Rocky's SS, BJM concurred with me that Rocky is metabolizing his insulin pretty fast, and so Rocky is seeing those stinky pinky numbers at the end of only one cycle.

BJM WROTE:
It does look like the Lantus hits him really fast, he nadirs early, and then the insulin wears off quickly from the numbers above.

viewtopic.php?f=9&t=119507
She also wrote as a precaution to me:

BJM WROTE:
Remember: too much insulin can kill.

But, alas, unregulated diabetes will also slowly kill.

I will be out of town on June 12 and will need to take Rocky to the vet for an overnight medical board, as well as on June 19 through at least June 22, and most likely for a few extended days beyond that, but I am not sure yet for how many days. I have no one to watch and take care of Rocky while I am away because no one I know wants to deal with his diabetes. I will be way up in the mountains in the remote wilderness at Gomde CA, a Buddhist retreat center. It's a one-way drive 5 hours from my house. In addition, there are no cell towers where I am going so I will be unreachable by cell phone.

I am still thinking strongly to change Rocky's shooting schedule to 3x per day, instead of 2x per day but I will wait until at least the beginning of July when I am not scheduled to be out of town for the rest of the entire summer.

Do I sound unhappy? That's because I am. This TR protocol, so far, seven months into it, is not helping Rocky's pancreas to heal. I am making him worse.

I pray and HOPE that I get to eat crow and that an increase in insulin will help him to get regulated.

 

[julie & punkin (ga)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383

I don't know about anyone else, but when you put words in bold and big letters, I feel yelled at. All it does is make me angry.

if you want to do something else, do it. nobody is tying your hands. The advice i give you is the best that i can, from the experience & understanding i have in using the TR protocol & Lantus. That's what I know and is all i have to offer. I'm certain that's true of every other person that has tried to help you as well.

I've spent many HOURS over the past year looking at Rocky's spreadsheet and posting advice to you. You are always free to do what you want to do.

What I would suggest to you is that you spend some time figuring out his spreadsheet. it's not rocket science. If you don't want to do that, then re-look at all the suggestions you've been given and give each one at least a month's effort. Not a couple of days, not one week - but a solid month. I'm not going to repeat them all again. Keep good notes on his spreadsheet so you know what works and what doesn't.

Get him some exercise. Living confined in a bathroom for 7 months isn't helping him. No cost, no risk and potential for a lot of benefit.

He doesn't look as bad as you make him out to be. He's getting green numbers every other night right now with a bounce day in between. That is progress, even though you insist on focusing on the negative.

 

[Jill & Alex (GA)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383

umm... time for everyone to step back and take a deep breath.

 

[Marje and Gracie]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383

The advise givers have all weighed in on the TID (three times a day insulin shot) and none of them want me to do it unless I am an expert like them at knowing how to read an SS.

Every single CG should know what their cat's onset, nadir, and duration are and when to spot when these change. None of us claim to be experts and you shouldn't have to be an expert to be able to see some patterns in Rockys SS. Will you see them all? Likely not. I do think it is often easier to spot the more nuanced patterns in other SSs than your own cat's but you should have some familiarity with his basic patterns. We are just volunteers with our own diabetic cats. I think I am safe in saying that none of us (Sienne, Julie, Dyana, Wendy, Sandy, or me) would feel comfortable with TID dosing for our own cats much less yours. It's been suggested that you contact Jill or Libby so if you are stuck on doing TID dosing, you absolutely need to get the help of someone who knows how to do it correctly. They have the experience.

However, after looking at Rocky's SS, BJM concurred with me that Rocky is metabolizing his insulin pretty fast, and so Rocky is seeing those stinky pinky numbers at the end of only one cycle.

That is not what she said. She said:

It does look like the Lantus hits him really fast, he nadirs early, and then the insulin wears off quickly from the numbers above

.

That indicates to me that she thinks he does not get good duration. This has been known as big insulin poop out or BIPO. It is not uncommon.

Here is what Jill told Rebekah about Ole when Rebekah had the same observation:

Re: 1/17 Ole AMPS 427(+1.5R) +1 396 +2 304(+3.5R) +3 264 (+4
by Jill & Alex » Fri Jan 17, 2014 2:26 pm

Rebekah wrote:
Any ideas as to why Lantus seems to lose effectiveness at the end of Ole's cycle.

the "loss of effectiveness" you're seeing is actually very common in kitties who aren't close to having reached an optimum Lantus dose.
we call it BIPO or Big Insulin Poop Out.

simply put, there's not enough insulin on board to last through the entire cycle. once Ole gets closer to an optimum basal dose you'll see the duration extend.

 

[Jill & Alex (GA)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383

just to bring everyone up to speed...

tina has contacted both libby and myself. as of now, neither of us have given tina our thoughts or suggestions.

from tina today:

I have decided to wait until at least the beginning of July to do a TID because I will be out of town on June xx, June xx through June xx, and even maybe a few days after that.. Because I have no one to take care of Rocky I will need to take him to a vet for a medical board.

In the meantime, I have increased his insulin dose, again. I hope and pray that these increases in insulin will help him get regulated.

so that's her plan... for now.

rocky does appear to need more insulin.
perhaps manipulating the curve with food to prevent rocky from bottoming out/mandatory reductions would be helpful at this time...

 

[Tina & Rocky]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383 +3 333 +365

JULIE WROTE:
I don't know about anyone else, but when you put words in bold and big letters, I feel yelled at. All it does is make me angry.

I am sorry that you feel that I yelled at you, Julie. And I am sorry if any other advise giver feels that way as well. Rocky is not your responsibility, nor is he any of the other advise giver's responsibility. So please, try to understand that when I use big letters that I am expressing my unhappiness with a lack of results using the TR for Lantus. This protocol probably isn't perfect, is not designed or made for every cat.

How do you think I feel to be told that you think that I am not listening to you?? Why do you think I am not listening to you? I am listening to you. I am listening to ALL of you, and doing what you suggest, or I would not be here. :cry: I am feeding him 8 mini-meals at pre-shot, AMPS/PMPS +1, +2, +3, and I have been doing this routine for a few months now. I am feeding him the 4% carbs instead of the zero carb food, as many advice givers suggested. I bought other percentage carb foods and have also feed him those as well to try to stop a severe drop into the 40s. None of the alterations in his routine have helped to get Rocky regulated.

Let's use today as an example. I gave Rocky a .25u insulin increase. He had a small food spike right after his first mini-meal. Then, it looked like his BG might come down but instead it just went up to 365 at AMPS +6. I already know what all of you will say. You're going to tell me-- "it's a bounce," "some cats are bouncy," "cats will bounce until they don't bounce," 'the insulin isn't taking hold yet."

MARJE WROTE:
That indicates to me that she thinks he does not get good duration. This has been known as big insulin poop out or BIPO. It is not uncommon.

What is the difference in saying that a cat is metabolizing his insulin shot pretty fast versus saying that the cat is not getting the duration that he needs on the insulin? Doesn't not getting duration on the insulin dose mean that the cat is using the insulin shot pretty fast, so there is nothing left at the end of the cycle?

I want to understand this, can you please explain to me Marje what makes each of these definitions different from one another? confused_cat

I know that some of the CGs who have been in this forum were never able to get their cat regulated. A lot of the time it was because their cat was very sick, with other poor health problems, and low immune system issues. Rocky has no other health problems. His only health problem is diabetes. None of his blood tests at the hospital showed liver disease, kidney disease, pancreatitis, dental problems, Acro, or IBD. He has never had diarrhea nor has he vomited, not even when he was DKA at the hospital. Even right now Rocky does not show any clinical signs of being sick, not even with diabetes. {Oh, there is one sign of being not regulated-- Rocky has VERY BAD DANDRUFF.] In fact, Rocky does not even PEE excessive amounts of urine. He always has a great appetite and will eat anything I put in front of him as long as he likes the flavor. And Rocky is not a picky guy.

There seems to be some other reason that Rocky is not regulated after 6 months on Lantus insulin. I do not believe that there has been a lack of progress in getting Rocky regulated due to not enough exercise. Rocky is not confined to a cage. Rocky is not obese or overweight. There are plenty of cats on this board who sleep all day long.

If you take away nothing else from this post, please know this--- there is no one to blame that Rocky is not getting regulated. It's not my fault, and it's not your fault. I have simply not found the right method that works best for Rocky yet.

If you want to keep making suggestions for Rocky, please do it. I have done everything that you have advised me to do for Rocky.

 

[Alexis & Nikki (GA)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383 +3 333 +365

If I might make a suggestion, it might make sense to try a set pattern to the number of carbs fed at points in the cycle. I believe this might have been suggested in an earlier condo. Just as an example (because I'm not experienced in managing a diving cat), if Rocky's down 50 points at +1, go with 4% carbs, if he's down 100 points at +1, go with 8% carbs, etc. You could add a few columns to the spreadsheet for each + hour and note what carb % is fed to determine it's effect on BG.

I think tackling feeding systematically might help you figure out the right carb % to fed at the right times. It probably will never be an exact science, but this way you can systematically determine how to slow down a drop. Just like Lantus likes consistency, I think consistently feeding the same percent carbs for drops of different sizes might help.

I hope Rocky levels out for you!

 

[Suzanne & Cobb(GA)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383 +3 333 +365

Tina,

I wish I knew what to tell you or give you the perfect piece of advice or strategy that would just make it click for Rocky. I can only share what I've observed during the 9 months I've been on the board.

I would guess that you saw an increase in today's BG's because you did increase the dose. That's fine. You felt an increase was necessary. I know you're tired of hearing all the terms that are thrown around. But New Dose Wonkiness is a real thing. I've seen many cats here respond to a higher dose with higher numbers. Cobb does it. It's why I hate changing his dose. I don't know why it happens. I don't think anyone knows why it happens. But we've all seen it happen. Lantus will not immediately pull down that high number. Given my experience, R insulin doesn't always do it either.

I will share this: the vet that diagnosed Cobb originally put him on Prozinc. It isn't a depot insulin. While we now know that other things were interfering with his BG, she told me that after 6 months, if this insulin isn't working, find a new one. That's when we switched to Lantus. Perhaps switching is something you should really consider.

I think others have mentioned you switching Rocky to Prozinc because it seems like you want to dose off the high numbers, not the low ones that Rocky sees fairly regularly. And he does see normal numbers regularly. I understand you want him to spend more time in those healing numbers and you don't feel 2-5 hours is enough time for his pancreas to heal. I have no idea. I do know there are cats that spent A LOT more time in those higher numbers that went OTJ (Black Kitty comes to mind). I think everyone gets concerned when you start talking about increasing a dose because Rocky bounced from a low number, and they discourage it because if the (hypothetical) 2 units got Rocky to 39, yeah he bounced to 400, but how much lower will more insulin take him? Does that make sense? Since you seem to be focused on the 400, not the 39, Prozinc may be a better insulin for you to work with. (All numbers in my example are hypothetical, not based off Rocky's SS. I literally pulled them out of thin air.)

To be honest, I myself have toyed with the idea of dosing Cobb more frequently. Lowering his Lantus dose and giving R three or more times a day. I ran it by others. We discussed the pros and cons. And, for me, it would be too time consuming. And I'm home all day long. I theoretically have the flexibility to leave Matty for 5 minutes in his pack and play, test Cobb and give him a shot. But what kind of life is that? For you or the cat? Always to be tied to the clock...every 8 hours? That's a lot of work. Dedication, yes. But a lot of work. Can you honestly say that you have the time to monitor Rocky found the clock with all the other work you're doing with your rescues?

How long has Rocky's ringworm been cleared up? Is it fully cleared up? I'm just asking because you said Rocky had no other health issues except FD. I'm guessing you were referring to acro, IAA, and pancreatitis. You mentioned in a recent condo that Rocky's ears were dirty. I don't remember if they were or are, I'm sorry. Could there be any kind of underlying infection or something brewing there?

Ultimately, Tina, you have to do what you think is best. I can hear the frustration in your writing. I wish there were something more I could recommend, but there isn't. Some cats waver back and forth between doses until it clicks. It looks like Rocky is one of those cats. Frustrating for the CG, I'm sure.

I hope you find something that works real soon.

~Suzanne

 

[Carl & Polly & Bob (GA)]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383 +3 333 +365

I think everyone gets concerned when you start talking about increasing a dose because Rocky bounced from a low number, and they discourage it because if the (hypothetical) 2 units got Rocky to 39, yeah he bounced to 400, but how much lower will more insulin take him? Does that make sense? Since you seem to be focused on the 400, not the 39, Prozinc may be a better insulin for you to work with.

I have to disagree with the premise that Prozinc would be the better choice if working with these numbers, even hypothetically.
If a kitty drops from 400 to 39 on Prozinc, that a loud statement that the dose is too high, and there would be just as much - if not more - concern if a caregiver started saying "increase" out loud. Lots of people are of the opinion that the preshot numbers are the "determining factor" for dosing prozinc or PZI. I don't agree with that at all. You have to base dosage on both the preshot and the nadir, and on lots of historical data, in order to use a P insulin with a "scale" for dosage. Personally, I think it's more difficult to use a sliding scale with Prozinc than to follow the TR protocol used here.

And although many cats seem to get 12 or fewer hours out of a dose of Prozinc, there are some that experience carryover and/or overlap like you see often with the L's. A good person to ask on that would be Jen, who experienced that at times with Eddie before switching to Lantus.

 

[BJM]

Re: dosecrease 2.25u 3/31 Rocky AMPS 379 +1 383 +3 333 +365

I'm going to copy something I posted to another person today because it occurs to me you may find the ideas useful.

You're focusing a lot on his BG numbers and there are numerous ways to assess the health of your cat. Just a thought - In my signature link is a list of Secondary Monitoring Tools. You might look over those and consider how [your cat] is doing on some of those.
Does [he]:
Purr?
Play?
Preen/groom?
Show signs of dehydration?
Weigh too much or not enough?
Drink and urinate excessively?
Have urine that has almost no odor?
Eat ravenously?
Have abnormal feces - are they loose/constipated, gray or pasty, voluminous, foul-smelling?
Have breath that smells like fruit or nail polish remover?
Have breath that smells like urine?

As for the dandruff, it can be helpful to use a natural bristle brush to help brush out the oils and flakes of skin. )works for humans, too)

 

[Tina & Rocky]

Re: dosecrease 3/31 Rocky PMPS 304 +1 304 +2 222 +3 201

I appreciate your secondary monitoring notes. I've read through all of them. He has none of the negative ones. As far as purring and preening, everything perfect there. Rocky does groom himself, usually right after he eats. The other thing I always forget to mention is that he doesn't suffer from neuropathy.

Although it's expensive I am thinking of having a blood work-up done on him while I'm away and he is at the vet's office for a medical board. I will also have them check out his teeth and gums to see if there is anything bad going on there. Rocky doesn't have bad breath. It also does not smell like nail polish remover, fruit, or anything sweet.

If they find that his white blood cell count is higher than it should be I will have them treat him for an infection with anything but a Cerenia Covenia shot.

The ring worm is completely gone- thank heavens!! I have not had it for a few weeks now. My getting it is how I know that he still had it. :lol: He was on the anti-fungal pills for 5 months, and, I gave him (3) lime-sulfur dip bathes. I still do change his bedding weekly and everything is washed in hot water with bleach and dried on the 'sanitize cycle.'

Suzanne, you had asked about Rocky's ears. I remembered that after he started feeling better at the hospital one of the vet's instead of a vet tech took the time to carefully clean out his ears very well. I haven't had a fan on in his room so there is no reason that his ears should be dirty, again. He had been living in a garage for 4 months at my friend's house in a giant dog pen. It was extremely hot in there and she had an industrial fan blowing air around. I think that this, coupled with the fact that he had been living in a 10 acres fields with literally blowing tumbleweeds, deposited all of the dirt into his ears.

He doesn't scratch at his ears at all any more, or any part of his face or body. He doesn't hold his ears in any sort of funny way that looks like they would be hurting him or bothering him. Of course when he is at the vet's office for the stay I will have them re-check his ears as well.

As far as a P-titis test, forget about it. Not doing it. I've had a cat with pancreatitis and know exactly what the symptoms are and he doesn't have any of them, and more importantly, he's not in any pain.

The vets had a question about his liver being a 'bright pink' when he was DKA, but they then said it just looked like the liver of a diabetic cat. I am not going to have another ultra-sound done on his internal organs as there was nothing that was shaped wrong, no growths, nothing that didn't look right. If he has abnormal liver values with the blood test, then I might reconsider getting an ultra-sound but an x-ray would work too and would be cheaper.

I had Rocky's liver tested while he was on those anti-fungal pills and all of his liver values were within normal range. Those pills can really do some damage to the liver. It's not likely that there is anything wrong with his liver.

I suppose he could have developed CKD in the past 6 months that he's been at my house, and that would have an affect on his blood glucose readings. However, he doesn't have excessive thirst and does not drink an inordinate amount of water. In fact, he drinks barely any water, just like a normal cat. :lol: But not to worry because I always add water to all of his wet food. A test would certainly show if he has CKD or not.

 

[tiffmaxee]

Re: 3/31 Rocky PMPS 304 +1 304 +2 222 +3 201

You posted this:
If they find that his white blood cell count is higher than it should be I will have them treat him for an infection with anything but a Cerenia shot.

I think you meant Convenia as cerenia is for nausea. I understand how frustrated and worried you are about Rocky. I am frustrated and worried as well. I wish there was an easier way to figure all this out but there just isn't.

Max has the white flakes as well. I bought Nordic Naturals Omega 3 to try to see if that will help. Because he has had chronic pancreatitis I am giving a very small dose to try so it will be some time before I know if it is working. You might want to give it a try as well.

 

[Tina & Rocky]

Re: 3/31 Rocky PMPS 304 +1 304 +2 222 +3 201

Yes, I made a mistake there. I did mean to say that I won't let them give Rocky Covenia, the antibiotic shot. Thanks for catching that! :lol: I would give him something for his stomach, of course, if he was feeling sick to his stomach. So far Rocky hasn't even had a hairball. But he is a short-haired cat.

I may go back to giving Rocky the one sardine a day, or at least one sardine per week. If I get the Omega-3's for him I think I'll get it in a pill form so the bottle won't oxidize once it is opened.

Thanks for stopping by Elise. Looks like Max is liking his new dosecrease just fine.

 

[Suzanne & Cobb(GA)]

Re: 3/31 Rocky PMPS 304 +1 304 +2 222 +3 201 +4.75 110

Carl, my apologies if I misunderstand how ProZinc works. But if it can be dosed on a sliding scale, then the preshot numbers carry more weight than they do with a L insulin. At least that is what I understand from what I've read here on the board.

My use of those numbers was extreme to make a point. Obviously I failed at doing so. Perhaps I should have picked a lower number not in hypo territory, like 90 or even 100. I was trying to illustrate that if a BG drops that low an increase because the next preshot is much higher isn't necessarily needed.

 

[BJM]

Re: dosecrease 3/31 Rocky PMPS 304 +1 304 +2 222 +3 201

I appreciate your secondary monitoring notes. I've read through all of them. He has none of the negative ones. As far as purring and preening, everything perfect there. Rocky does groom himself, usually right after he eats. ...

Those answers mean he is doing pretty well, even if his glucose numbers aren't perfect.