5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(1uR)

[Suzanne & Cobb(GA)]

Yesterday

A nice cycle yesterday. We're starting a bit higher today.

So I decided to increase Cobb's dose. I hope it helps bring those blues down even further...maybe see some green even? I hate raising his dose because it seems like it takes him two dosecreases to see good numbers again, and then those numbers won't be any better than the ones two doses down. So I feel like what's the point in raising it? Just my feelings on dosecreases right now. But I know doses can get stale, and I know there is room for improvement on the numbers. So, I bit the bullet.

Cobb is doing well, asking for breakfast this morning. He's such a good boy (when he wants to be, of course).

I caught a glimpse of my future last night. We have a smaller, baby-sized soccer ball for Matty. Matt gave him his first soccer lesson last night. Yes, to our 10-month-old. And he was kicking the soccer ball in our bedroom - using the pack and play as a goal. I pictures myself yelling, "no playing soccer in the house!" many gems to come in the future. :roll: I feel like my darling husband may be the instigator as well. :lol:

Anyway, happy Fursday all!

~Suzanne

 

[Melissa & Tarragon]

Re: 5/1 Cobb AMPS 272(1uR)

Work that juice Cobb. Good luck with the increase. I hope it brings some nicer numbers. Oh yes on the soccer ball. I remember those days. Have a great day!

 

[Sandy and Black Kitty]

Re: 5/1 Cobb AMPS 272(1uR) +4 264

good morning

Fingers crossed on the increase.

Yesterday you commented -

You all know my issues with messing with a dose that's giving me promising numbers.

Can you tell me about those issues?

 

[Suzanne & Cobb(GA)]

Re: 5/1 Cobb AMPS 272(1uR) +4 264

Yesterday you commented -

You all know my issues with messing with a dose that's giving me promising numbers.

Can you tell me about those issues?

Sure. It seems like (although I may be wrong) any time I increase Cobb's dose, I get worse numbers than I was on the lower dose until I increase again.

For example...look at the week of 3/30...Cobb was having good blue numbers on 19uL. I increased .5u to see if I could find tune that and get green numbers. The BG's basically remained the same so I went up again to 20uL. I saw a green, he bounced out of that...never to see that again on that dose OR on 22uL. I was trying to tweak my strategy after we got the IAA diagnosis, popped him up 2 units (10% more), and I saw worse numbers, not better. I feel like I should have waited out that bounce instead of trying to get ahead of the antibodies by being real aggressive that day.

Take a look at last week. We were seeing some blues on the dose of 21uL. I upped it to 22uL to get some more consistent blues - and nothing. I thought I left that for 4 cycles, but see now it was only 3. On 23uL we had a nice, nice streak of blue. But I'd like to see more low blues and some green, so I upped to 24uL today.

So now I'm hesitant to adjust the dose because it seems like it takes several adjustments to see the same results I was seeing on a lower dose. So why give more insulin if the response is going to be the same? Does that make sense?

Is R the key to breaking through the antibodies? It seems like the R sometimes brings Cobb down during that delayed onset. And then Lantus does a good job of lowering the numbers some more for the PMPS, but then loses that action overnight, contributing to a higher AMPS. Is the L dose not right?

 

[Sandy and Black Kitty]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233

Hi there

So now I'm hesitant to adjust the dose because it seems like it takes several adjustments to see the same results I was seeing on a lower dose. So why give more insulin if the response is going to be the same? Does that make sense?

Gotcha.

It seems like the R sometimes brings Cobb down during that delayed onset. And then Lantus does a good job of lowering the numbers some more for the PMPS, but then loses that action overnight, contributing to a higher AMPS.

You can always try a TOR at PM+6 and see if that makes for a better AMPS.

Is the L dose not right?

Honestly, I don't know. What I do know is that in the case of IAA, you are dealing with a lot of moving parts (insulin-binding affinity, insulin-binding capacity, percentage of insulin binding and percentage of insulin dissociation) that all impact Cobbs BG in some way and most of which can't be measured at home. If Acro is part of the equation add another variable that can't be measured (pituitary hormone activity)to the group.

Is R the key to breaking through the antibodies?

My understanding is that you don't break through, you wait it out. IAA is self limiting and lasts only 1 year or so. The R bolus is to keep Cobb at a safe BG until you notice a return to insulin sensitivity.

Again, we don't know if Acro is in the mix but if he were only IAA I'd try holding the L dose, tweaking the R and see what results you get.

(Thinking out loud here)
All this thinking about IAA has got me thinking about BKs experience. Clearly his teeth and gums were his Achilles heel in terms of BGs and once addressed things started changing big time. However a question has formed in my mind -
Is it a coincidence that the IAAs decided to pack up and leave town precisely then?

 

[Suzanne & Cobb(GA)]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(

I suppose two doses of R brought Cobb down about 100 points today. But why not the same as yesterday? (Kinda just thinking out loud here...wondering to myself.) NDW? He had the same depot he did the past few days on the 23uL. I know a number of you have explained NDW to me before. It just doesn't make sense. I'm trying to make sense of it.

You can always try a TOR at PM+6 and see if that makes for a better AMPS.

I can try that. Do you think I should just assume I'm shooting R every 6 hours unless his number is too low? Make that part of my plan of attack? (Assuming I wake up at +6, lol)

My understanding is that you don't break through, you wait it out. IAA is self limiting and lasts only 1 year or so. The R bolus is to keep Cobb at a safe BG until you notice a return to insulin sensitivity. Again, we don't know if Acro is in the mix but if he were only IAA I'd try holding the L dose, tweaking the R and see what results you get.

Let's assume for the sake of simplicity in this that he is IAA only. Here's what we know:
-Cobb has been diabetic since, at least, April 2012
-We were told to put him on a low-carb diet then and not worry about insulin. Us being the trusting people that we used to be, we followed the vet's instructions.
-Cobb was officially diagnosed in April 2013 and started insulin (Prozinc, then Lantus)

So, we know Cobb went an entire year being diabetic without any insulin whatsoever. He was on wet food until he refused to eat it anymore. Then he went to w/d dry (I know, I know!!). Then to the "diabetic" Evo after starting insulin (April 2013), which I now know is not low enough in carbs. (I KNOW!) And then in November 2013, low-carb wet food only (sorry Cobb, get used to it.)

QUESTIONS: If IAA only lasts a year or so, should we be seeing it break sometime in the next few months? Was it there when we initially started insulin? Was it there in the year before we started insulin? Would the time he spent in those extremely high numbers (500+) between April 2013 and November 2013 have contributed to the resistance - meaning, did we make the resistance worse by continuing to feed high carb dry food but giving him larger and larger amounts of insulin, thus allowing the antibodies to get stronger and stronger? Are we really battling IAA AND glucose toxicity? If it is glucose toxicity, how long until a cat's body readjusts to what is really normal readings?

Obviously if he is acro, that would play a role in all of this. But...

QUESTIONS: If Cobb is acro, could the antibodies have already gone away? Or given the dose he is on, would you assume we're battling both? If he is acro AND IAA, can the IAA go away and the insulin dose remain the same? Or would it still drop when the IAA goes away, just not far enough to necessarily be OTJ?

Sorry...lots of questions. I'm having a very rare moment when I can sit and think. It's been a productive hour...all these questions, I've rewritten my resume, posted our blog...like I said, a rare productive hour! :smile:

 

[julie & punkin (ga)]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(

i had a long post written to you and it is lost in FDMB Not Working Land. grrrr.

a couple of thoughts - one is that my understanding of iaa is that it could not have begun before insulin was being injected. i'm pretty certain of that, but Sandy can correct me if i'm wrong. so i don't think that year untreated caused anything.

the way i understand glucose toxicity to work would mean that you have already overcome that. it may have been a factor earlier, but you've had him in lower numbers enough to indicate that it is no longer a factor.

Interesting question about if he is acro, could the iaa already be gone. I suppose that yes, that could be true. i don't know how we would know that, though, with any certainty. the signature look in my eyes, of a cat with iaa, is that he seems to go stale on the dose. the dose that worked before stops working, then when you increase, it might work briefly, but the same process keeps repeating. what i experienced with acro was similar, but not exactly the same. we had phases of trying to increase the dose fast enough to bring down numbers, and we had phases where the dose would work until his numbers took off again. that, to me, is a little different than the look of iaa. i never saw what i would call that iaa look, where you increase the dose, the numbers come down, but then it's like the cat soaks up the extra insulin and there isn't much of a lasting response.

part of what i had written to you earlier this evening is that you've got a lot of different factors at play. Cobb has iaa, possible acro hormones, and every diabetic cat has fluctuating absorption because of factors within their bodies (as much as 50% difference from one shot to the next.) When a person does a science experiment, they hold all variables constant and change one. With cobb's situation, you have no way to hold all the factors constant while tweaking one factor.

I think overall, Suzanne, that even if you think you are not doing well with Cobb, the numbers don't lie. You are doing well. He is under renal threshold most of the time. When factors change and his blood sugar increases, you change the insulin dose and have been successful at getting his numbers back down again. Even non-high dose cats have varying factors and people have trouble controlling their blood sugar sometimes, but high dose cats have extra variables that makes it even more difficult. so my point is - you are doing as well as any person could do. So be encouraged, because really, i'm not just saying this to make you feel good. His spreadsheet SAYS that you're succeeding. Trust what you are doing and keep it up. Cobb is lucky to have you in his court.

 

[Suzanne & Cobb(GA)]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(

Thank you Julie! I appreciate it! I needed to hear that.

 

[julie & punkin (ga)]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(

:YMHUG:

you're having to be the hardest type of scientist - one who deals with constantly changing conditions being thrown at them. i can't imagine a person could possibly do better than you are doing. we can't compare one FD cat to another, but as i said, that's especially true when high dose conditions get added to the situation.

 

[Wendy&Neko]

Re: 5/1 Cobb AMPS 272(1uR) +4 264 +5.5 233 +10 168 PMPS 227(

Suzanne - your condos have been very interesting lately. They've been making me think about Neko's situation and what happened with her, and when her IAA broke. FWIW - her doses stopped going "stale" after she first went under 50 at about 7.5 months after starting insulin. The antibodies are indeed a reaction to the injected insulin as what we are giving is not a cat based insulin, but rather closer to human insulin. The antibodies are fighting a foreign invader.

I agree with Julie that you are doing a great job with Cobb. It's hard for a lot of cats to keep them under renal threshold most of the time, it's even harder with high dose cats with one or possibly two conditions at play.