5/2 Cobb PMPS 122 +3 115 +5.75 93 +8.5 115

[Suzanne & Cobb(GA)]

Yesterday

Booooo. Here's a great example of what I was talking about yesterday about why I hesitate changing the dose. I never should have moved it from 23uL. Both times he's been on that dose he has had nice blue numbers. Now he's in the high 300s. It doesn't make sense.

Cobb doesn't seem to mind this morning's higher number. Hopefully the R I gave him will keep from seeing red.

Dang it!

~Suzanne

 

[Shelly & Jersey (GA)]

Re: 5/2 Cobb AMPS 371(3uR)

Sending calming vines your way, Suzanne. It sounds like you need them! :YMHUG: Come on, Cobb, help the bean out today. We need to see some blue!

 

[Sandy and Black Kitty]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272

Hi there

I never should have moved it from 23uL. Both times he's been on that dose he has had nice blue numbers. Now he's in the high 300s. It doesn't make sense.

Food for thought -
I have not had my coffee yet however the first thought that popped in my head was that I wonder what would happen if you went back to 23uL ?

I still want to respond to some comments from yesterdays condo, and have other thoughts that have been forming as well. . .but need
(I'm running a quart low)
bbl

 

[Suzanne & Cobb(GA)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272

Sandy I am wondering that as well. I'm interested to hear your thoughts!

 

[Suzanne & Cobb(GA)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231

Yikes. I may have given too much R and set up a bounce. He did have a fast drop at +2.5.

 

[Suzanne & Cobb(GA)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231 PMPS 122

Sooooo confused!!! :dizcat :dizcat :dizcat My mind is churning from trying to comprehend today's numbers.

I didn't back him back to 23uL, although I stood with the syringe in hand after getting his PMPS, trying to decide what to do. I'd love any and all opinions.

 

[julie & punkin (ga)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231 PMPS 122

the drop was 40 points an hour, so might/might not be so fast that it causes a bounce. if it was 100 pts an hour, it'd be pretty well guaranteed, but perhaps that was slow enough that he won't bounce.

I don't have any great insight. wish i did! :lol: but i look at a pmps of 122 and think

YOU GO COBB! Let's see what Sandy has to say. All i'm thinking is that what you are doing is working.

you took a BOO HISS amps and turned it into a WOOT pmps!

Wendy's comment yesterday was interesting about thinking that since Neko had her first green, she'd stopped having the dose "go stale." perhaps getting the cat into normal numbers is the key to breaking that iaa resistance. it's an interesting idea. we might have to look at different iaa cats and see if that appears to be true across the board.

 

[Suzanne & Cobb(GA)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231 PMPS 122

Ok, so I'm going to ask the thought that has been churning in my head, but I hesitate because it's...well, I don't know why anyone would deliberately try it. And I don't want any lurkers thinking it's a good idea but I have to ask.

Here goes:

Several people have said that their cats became more sensitive to insulin after dipping below 50 and that's when the IAA started to break, etc. Cobb has never dipped that far, mainly because if he gets into the 60s or 70s, I've steered the numbers up with food. Maybe I shouldn't do that? Let him dip below 50 and then intervene? I don't know. It's so risky, I know. But multiple people have said it to me, so I can't get it out of my head. I would never give him so much insulin on purpose for it to happen, but just wait to intervene if he's headed down like that?

Don't yell at me. I know it's such a dangerous thought...

 

[julie & punkin (ga)]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231 PMPS 122

nobody's going to yell at you. AT LEAST I DON'T THINK SO! :lol: sorry, i couldn't resist!

i haven't heard that going below 50 increases the insulin sensitivity. A prolonged or symptomatic hypoglycemic episode is known to increase insulin sensitivity, however. I suspect that might be what you were hearing mentioned. The risks of intentionally inducing hypoglycemia would far outweigh any potential benefit, in my mind.

what i have heard Jill say is that basically, all numbers under 120 are equally valuable in the kitty's body, that 50 is not better than 80. there's no reason to push a cat under 50. i thought there was when i first started, but my understanding now is that you really want to avoid a dose decrease if it's easy to do so, because more insulin in the cat will help bring down the higher numbers. I'm saying that specifically for Cobb, not for every cat, and not for newly diagnosed cats - so people reading shouldn't apply this thought to their own situation.

Now, if a person is working to keep a cat above 50, that's a different story. that needs a dose decrease. but when i started and punkin hit 49, people said "decrease the dose." his dose decreases at that stage never held. with some newly diagnosed cats they do hold, so that is the standard, first strategy that we use. if it doesn't work, and the reductions don't hold, then we go to plan B. If you look at the Tilly page, you'll notice that their wording on reductions is a little different than other pages.

When the cat first begins to have daily nadirs in the normal range of a healthy cat (50 to 80 mg/dl) and spends significant amounts of time in this range each day, stop increasing the dose and switch to Phase 3. It doesn't matter when you measure these lower BGs, it can be at pre-shot or sometime between shots. Getting to this point generally takes 1 month, sometimes a lot longer. Cats are extremely variable in terms of the maximum dose they end up requiring: they have ranged from 0.5 IU to 10.0 IU BID in the German forum, with most cats lying between 1.0 IU and 5.0 IU BID.

If I were you, that's the goal i would go for. which i think you already are - trying to keep him in normal numbers as much as possible.

 

[Wendy&Neko]

Re: 5/2 Cobb AMPS 371(3uR) +2.5 272 +5.5 163 +7 231 PMPS 122

Great PMPS! Any chance that +7 was a wonky test? or just after fuds?

I did write yesterday that Neko's dose seemed to stop going stale after she first dipped below 50. However, that same dose also got her nice long stretches of green several times. It was the third such stretch that she went below 50. All doses before that she'd hit green maybe once (if at all) or a second dip in the lagoon would be very high 90's, then she'd bounce and never get back to green. I agree with Julie that finding a dose where Cobb can get used to normal numbers could be a goal. However, if the resistance breaks because he gets used to normal, then you might see that under 50.

A couple things are quite different between Cobb and Neko. Number one, our max dose was 8.75U. Of course Nancy's Pepper was IAA/acro and got up just over 25U and she let him get below 50 safely. And number two, Neko really liked the rainbow. The day of her first reduction she started at 422 and made it back to 225 by cycle end. Cobb is a lot more mellow BG-wise. I was trying my darndest to get Neko used to lower numbers to try to reduce the height of the bounces. Unlike Cobb, even now Neko won't stay under renal threshold for 2 cycles without getting some serious green.

 

[Suzanne & Cobb(GA)]

Re: 5/2 Cobb PMPS 122 +3 115 +5.75 93

I take a moment of out my slumber just to say WOOT!!

Wendy and Julie, thanks for not yelling at me! It's just been something swirling around in my head...Wendy, you definitely aren't the only one who has said it, although you've put it into more perspective for me.

 

[Wendy&Neko]

Re: 5/2 Cobb PMPS 122 +3 115 +5.75 93

:mrgreen: :mrgreen: :mrgreen:

 

[julie & punkin (ga)]

Re: 5/2 Cobb PMPS 122 +3 115 +5.75 93

wow, a sleeping WOOT! :lol:

hope you get to sleep the rest of the night!

and i think it's always worth exploring ideas - one might be a gem!

 

[Sandy and Black Kitty]

Re: 5/2 Cobb PMPS 122 +3 115 +5.75 93

Hi there - quite a day !

A few comments fro your 05/01 condo:

I suppose two doses of R brought Cobb down about 100 points today. But why not the same as yesterday?

There is no knowing what the level of available (unbound) insulin floating around in his bloodstream is.
Wouldn't it be wild if there were a meter that could tell us that?
Regarding NDW honestly I have never wrapped my mind around it - likely because BK had ADW (all dose wonkiness) :lol:
However I accept it as a known phenomenon.

I've been wondering lately about all FD kitties, an 84% IAA test result is considered 'extreme' resistance, to me 19% (the very upper limit of 'normal') sounds significant enough to have some sort of effect. (I''m not certain - if someone could chime in with the math thanks in advance)

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)

No, I just want you to be aware that it's another technique you can use, as needed, if needed. If an opportunity arises -
for example an anticipated bounce you want to head off.

I think Cobbs recent pink AMPSs may be a bounces from the previous night cycles.
I do recommend you sprinkle some PM+8-11 tests in to see what is going on. If you or DH can manage it could be very revealing - It's double important information for dosing decisions involving 2 different insulins.

-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)

I'm confused about the dates. how did you know he was diabetic since 04/2012 if he was not diagnosed?

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?

I wish I could tell you when the IAA will break. I see others have told you that the IAA was not already there, it's an immune response to the injected insulin.
The ratio of insulin to antibodies in circulation in Cobbs blood isi also unknown- remember the antibodies don't bind up 100% of the injected insulin. Also my understanding is that( in humans )resistance is not related to dose.

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?

i think Cobbs immune system is still producing antibodies and that one day it will stop, beyond that I don't know.

from 05/02 -

Yikes. I may have given too much R and set up a bounce. He did have a fast drop at +2.5.

Careful. . .

My mind is churning from trying to comprehend today's numbers. I didn't back him back to 23uL, although I stood with the syringe in hand after getting his PMPS, trying to decide what to do. I'd love any and all opinions.

You did the right thing - I was not suggesting you reduce but rather think about it hypothetically as a topic for discussion. Also, food or thought - if this turns out to be a good dose, maybe hang onto it and see how much mileage he gets out of it?

Something else I wonder about (thinking out loud here) considering prolonged action in IAA cats, would/should good doses be held onto until the numbers tell you otherwise?

regarding you getting yelled at regarding that business about inducing hypoglycemia to stop antibody production - WHAT?!? (sorry - I too could not resist ;-) )
I agree with Julie. Risky business. Ii think trying to keep him safe within the healing numbers (under 120) while you wait it out would benefit him most, particularly if he is only IAA.

Lastly,in the interest of keeping Cobbs condo focused on the basics I'm going to move my wandering thinking and forming questions about IAA over to the High Dose forum. Let;s pick up that conversation there