5/17 Jane's continuing adventure: AMPS 409; 91 at +4

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Kris & Jane (GA)

Kris & Jane (GA)

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Jane and I had a girls night in -- doing each other's hair, testing blood sugar, fun stuff.

She reacted not at all to last night's shot, escalating into the high 500s, and the wonderful people here talked me off the ceiling and made me fight the urge to shoot. AMPS is 409. Gave her the same dose, 0.25u, flank shot, and will check her throughout the day.

Going to run her to the vet's for a CBC and T4.

Appt is at 2:45 eastern - I'm guessing that because she's 91 now, we'll be in the 500s again tomorrow - can anyone tell me how to even this out?
 
ell, I am not too bright about this but 2 suggestions from me.
1) could try keeping dose same and feeding a little every hour until +6 to slow the drop
2) lower dose a little and let the numbers work themselves out
3) lower dose and shoot TID

that is about all I can think of.
 
Hi, I dont know if you posted under Dian & Wheezer too, I am confused with the posts, but I did reply to that one & said this:

I don't know if understand what you are asking, but I think you mean - you need an explanation as to why this kitty sees high #s & then low #s too?
When blood sugar levels drop too far or too fast, the animal will defensively dump stored glucose from the liver into their bloodstream, resulting in high blood sugar. So her greens are great, but the body does not understand that quite yet - so you have the liver dumping glucose which then causes the high #s. Please educate yourself by reading the link I have provided. We often refer to this as "Liver Training School" here in Lantus Land.

Somogyi Rebound
 
She might just need a little more exposure to the the greens to calm down.
I've also had similar thoughts as dian -- possibly lowering dose a drop and see if she would go flatter.
Let's wait and see where she goes for the rest of the cycle. Grab some more tests and see if you can find the bounce starting.
Once this all settles down, she'll be a good SS to keep around for helping other kitties.
 
i'd reduce dose a hair if i could, or give slightly more carbs each day to balance out insulin (difference between 0.1u and 0.25 is so miniscule using our syringes).
if 0.1u is too little and 0.25 is too much, and you can't do something in between, i'd increase her carb load.

other suggestion is to try scruff shots and see if that evens out her numbers.
i use scruff shots when cleo's preshot value is a little low. they don't tend to bring her down as much. this does not work for everyone, so it's a matter of testing to see if it works for miss janie.
 
ahh, she was doing scruff shots and just gave flank shot last night
If ya put glasses on, it is doable to get between .1 and .25. Janie is on a special cooked turkey and supps diet to avoid liquid poo from her rectal cancer surgery 2 years ago.
 
In my opinion and for what it's worth, I think that it's the speed of the descent that causes the brutal bounce. I'm not sure what your feeding schedule is, but the onset needs to be soften with food (versus the pedal to the metal). So, shot and feed a small snack and keep the small snakuses coming until nadir or alternatively, feed a bigger snack just before onset.

PS. W.r.t. somogyi effect -> not quite right as technically you need an official hypo, but rebound is similar in principal. - not starting 3rd WW here, but just clarifing.
 
The carb suggestions sounds like it may be a possibility. Since Janie's on a special diet, can a drop or two of Karo be added to the food. It's what several of the members who have IBD kitties do since the carbs in most FF varieties isn't good for their IBD.
 
To my very inexperienced eyes...

1. I can't help but wonder if consistently shooting in either the scruff or the flank would help. I'm guessing one absorbs better than the other, but it's hard to tell until you stick with just one. I know flank is advised, but I always shot in the scruff for Max (he's very sensitive about his flanks) and he did perfectly with it.

2. It's hard to tell with only 2 weeks numbers, but is it possible that she's a little resistant to Lantus? Would switching to Levemir work better maybe?

3. I also can't help but wonder if maybe Janie just needs a little more time. I've seen other kitties just need a few (like 3 or 4) weeks at a consistent dose to even out their curves and stop the bounces.

4. Is it possible she has some sort of infection that would make her bg bounce all over?
 
yeah, mindy, i was mentioning to kris last night that maybe a switch to lev would level janie out. she's gotten some nice greens on lantus, tho, so it may just be a matter of liver retraining. just hard to see these big drops/bounces since yesterday. i'm so used to relatively flat curves on lantus it is amazing to see such drops--not to the 40s, tho, but to normal nondiabetic numbers. still, an over 400-point drop is huge.

maybe consistent scruff shots would help, as would giving food (or food with a drop of karo) every hour or two after feeding to slow the drop. i'd try at least a few more things before switching.
 
We;re back from the vet. Had a blood draw for thyroid, regular panel and bg. she'll call me by close of business with numbers.

She wants us to shoot 0.5 BID in the belly - she's afraid she's not getting enough sometimes.
 
i do too. i am inclined to stay at .25 but will do belly shots - she says that's the best absorption. i'll give it a solid week and see what we get. it could be the thyroid going bonkers - will know when she calls.
 
I totally disagree too. read the advise above and pick one to follow. If you are staying with .25 then feed more often or add the karo cause she gets too steep of a drop and bounces
 
just chiming in to say that I think most of the LL advice is better than your vet's. :smile: My cat went through a lot of bouncing before she leveled out. Some of them are like that.

The way we usually deal with the bouncy ones here is:

1) get to a dose that has a nadir where you want it (which this one does, she has hit 60's on it), then hold the dose and let them bounce until one day it levels out. If the nadir starts to creep up, then increase the dose. Some cats catch on quickly, others take a long time. This is mostly how we did it when my Lucy was on insulin.

or

2) some of the bouncy kitties here are having success with increasing the dose just a little bit (to help with the high PS numbers), and then manipulating the cycle with food. Yesterday, Jane was at 500 at AMPS, then 229 at +2. Normally +2 is about the same as PS, so that is a fast drop. Even though the numbers is in the 200's, you can anticipate that the speed of the drop will continue or speed up when the insulin kicks in. So at the 229, you could feed a little bit of high carb food to try to put on the brakes. The idea is that the slower drop might not set off as much of a bounce. Some of the really bouncy cats are even testing at +1 and intervening with low carb food there if there is a drop. You would have to experiment to see what works for Janie.

TID dosing is another possibility, there are a few (like Wheezer and Doodle) who are doing that. It's a lot of work and you would probably want to get input from Jojo before starting it. It works great for some, though.
 
your cat dropped 400+ points off 0.25. no bloody way would i go up to 0.5u in the belly. i think she may be getting TOO much absorption, which is why i recommended scruff (much less absorption there but BGs tend to keep level longer, in cleo's experience--it may work for janie as well if done consistently)

there's a possibility that the 501 yesterday was the high before the drop, then you got a big drop and rebound (tho it may just be a bounce off the earlier green). regardless, you don't give more insulin to a cat that is dropping big-time. if we're using tilly and adjusting by nadir, to stay with that we'd be just keeping going til her liver stops overreacting so much, coz her greens are actually great nadir numbers.

i love cleo's specialty vets very much but i am AMAZED at how little even the so-called experts there really know about treating feline diabetes. it's not arrogance on our part -- guessing it's the sheer numbers of people treating diabetic cats here and the accumulated knowledge learned.
 
and I should reword my #2 about increasing the dose and feeding the curve. You wouldn't increase the dose right off the bat - first you would start feeding the curve on the current dose. Then the nadirs will come up (because you're feeding to prevent them from going as low). Once the nadirs start to come up, then you would probably increase the dose a little to start working the nadirs back down where you want them.
 
Libby and Lucy said:
and I should reword my #2 about increasing the dose and feeding the curve. You wouldn't increase the dose right off the bat - first you would start feeding the curve on the current dose. Then the nadirs will come up (because you're feeding to prevent them from going as low). Once the nadirs start to come up, then you would probably increase the dose a little to start working the nadirs back down where you want them.
Click to expand...

exactly! main problem for me is, how much time/energy will this take (feeding the curve) and do you have it? it's an extra time commitment.
it may very well be, tho, kris, that soon enough janie's numbers will level out more and you won't see this kind of overreaction to nice greens, so this kind of approach (feeding the curve) may only be necessary for a short time period. it would also depend on what your +1 and +2 are (or whenever her general onset is). if she doesn't drop so much you wouldn't need to baby the numbers along with extra food.
 
after her cancer surgery, she can only tolerate turkey, and at that, homecooked or a bit of FF classic. ANything else gives her what I call pooding, and her bum gets skyrocket red. so food manipulation isn't too much of an option for her.

My head is just swimming, and I want God to come down from the heavens and tell me what to do.
 
Hi Kris,
here I am as promised! :mrgreen:

So, I have this cat with multiple health issues. She is right about 18yrs old. She had ARF and now CRF for three years (1 semi functioning kidney). She has CP, IBD/lymphoma (no biopsy, so no confirmation on which), Metabolic Acidosis, FD (steroid induced and still on steroid), and multiple other issues that could be one of many things. She eats dry food, along with some wet because she is not a good eater AT ALL. She gets what she is going to eat, even if its a diet of baby food. She is still on a steroid. She has many, many variables involved when figuring out why her BG's are doing what they are doing.

After increasing her pred about 1 month ago due to excessive vomiting/not eating, I also increased her insulin. I did not have much time to collect data because of a horrendous work schedule headed my way for an extended period of time. I just assumed she would go higher with more of the steroid. I decreased her dose for a little bit during this time because she still was not eating great and I could not monitor. But all my spot checks were yellow and pink. So, I brought it back up. Then I started seeing red and black. I thought for sure it was the pred. But, in the back of my mind I wondered if she was going too low. She had NEVER hit these kind of numbers on such a regular basis before. In the meantime she developed a UTI (due to high numbers/pred, Im sure) and had some severe pain from back issues where she could not walk. Maybe this was contributing to higher numbers?!?!

Last week I caught what was going on. She can drop 100-150pts in 1hr ...multiple times and then bounce 200-300pts an hr after hitting her low. Crazy. Amy's winston, who was shooting pm's for me at one point caught her rise 150 pts in FIFTEEN minutes! :shock: Now, I dont need to see latte in the green because she will never go OTJ, and it is dangerous for her due to lack of appetite. All this time she was hitting red/black it was likely because of fast drops too low (for her). So I decreased a drop. Still a lot of red, and a splash of black...but getting very acceptable mid cycle numbers. Took another drop out. *knock on wood* *anti jinx*, the last 6(?) cycles is the longest she has gone without seeing black in a month. And she has only seen red once, I think. On top of that, she is STILL hitting perfectly acceptable mid cycle numbers for me.

This might not be the ideal strategy for most cats. Heck, I dont even know if its going to end up being a good thing, or biting us in the arse! But what we were doing was NOT working and made her feel like crap. So something had to change. It was worth a shot.

I think when dealing with well aged cats, who have multiple health issues you have to be a little more gentle. Bouncing around in the extremes like your Jane or my Latte may not be in their best interest. They are already dealing with enough, ya know? That said, YOU are the one to judge how these swings make Jane feel. Maybe it does not make one iyoda of a difference? In that case, maybe bouncing away for however long it takes...weeks, months, years is acceptable.

Regarding the diet...Latte can only have certain types of foods. I cant give any of the high carb foods so I have to use karo. I mix it in food if need be. I try to use it at times to "feed the curve", as mentioned. I think it helps quite often...to slow the drops. So, if you can use karo than it might be something to consider. The other thing is pinpointing where she is most prone to drop. That may take hourly testing for a day or so. The data can be invaluable, though.

Sorry for so much of the personal back ground. I just wanted you to fully understand why I am making the choices I am for Latte and her insulin needs, rather than just tell you what I think. Maybe some of it will applly for your Jane.
 
Carolyn, you make a mighty lotta sense. My heart is full of gratitude for the time you took to explain that -- and yes, there are lots of parallels. including how much you clearly love latte. Thank you.
 
I called her tonight and left a msg - I don't think I can manage TID - I work downtown and am gone from 8:30 to near 6. DH is home for now, but after knee surgery, will be looking for a job again.

I do think the vet is jumping the gun, now that i've read folks' responses.

i think we will stay with the 0.25 flank and just give it TIME.
 
here's an interesting read on shot placement and overlap from anne's FD library: http://fdlibrary.yuku.com/topic/51/t/Sh ... erlap.html.
"Well ... I've often read that flank shots can result in better absorption. So i started thinking - Hmmm .... better absorption - faster onset - earlier peak - and less duration - So .... scruff shot - slower absorption - slower onset - later peak - more duration - overlap! Viola!"
 
anne's findings

anne's findings originally got me interested in testing insulin shot placement and i agree very much with her. not sure if everyone has had the same experience. at least one person in think tank (old board) disagreed, but it's been very consistent for cleo (flatter numbers and longer duration with scruff shot vs bigger drops and shorter duration with flank/belly).

it's always a balancing act with kitties with multiple health issues, but frankly any of us who've been around here long enough have seen plenty of liver training. janie is doing so great in terms of getting green right from the beginning, but those bounces are so common at first. really think the vet is overreacting.
 
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