5/30 Tuxie AMPS-466; +2-448; +3-380; +3.75-324; +5-248

[Tuxedo Mom]

ALPHA TRAK 2 PET METER Reads higher than human meter

Yesterday:

http://www.felinediabetes.com/FDMB/...68-2-306-4-149-6-70-6-5-88-7-95-8-110.138625/

RECAP:

AMPS-484; +4-340; +7-232; +9-281;

PMPS-268; +2-306; +4-149; +6-70; +6.5-88: +7-95; +8-110


Tuxie had a decent day yesterday and decided to do some dipping in the evening, just to make sure I didn't get aan early night to bed. Of course this morning he has bounced back up, which I totally expected. Plus my AM shot ended up being 1 hour late. Every time he hits a green number he bounces, but at least it wasn't back into the blacks. I will see how the day goes.

 

[Bron and Sheba (GA)]

Hi Mary Ann,
I am no great reader of SS but looking at Tuxie's SS from last night...he had a bit of a food spike at +2 306 then when the levemir kicked in he dropped at +4 149. That is 157 points in 2 hours or 78 points an hour. That would be enough to make Sheba bounce. I try to not let her drop more than 50 points an hour. Tuxie looks like his insulin kicks in about +3 or +3 1/2 so you need to have some carbs aboard by then to slow the drop. I would test him at +3, +3 1/2 +4 +4 1/2 and +5 to find out when his onset is and to monitor the drop. That is how I stopped all the bouncing so high. By constant monitoring of the drop. No point in doing it when there is a bounce though. If you see any drop that is going more than 50 points in an hour or half hour, give a drop of honey or if you prefer a bit of higher carb food.

 

[Tuxedo Mom]

Hi Mary Ann,
I am no great reader of SS but looking at Tuxie's SS from last night...he had a bit of a food spike at +2 306 then when the levemir kicked in he dropped at +4 149. That is 157 points in 2 hours or 78 points an hour. That would be enough to make Sheba bounce. I try to not let her drop more than 50 points an hour. Tuxie looks like his insulin kicks in about +3 or +3 1/2 so you need to have some carbs aboard by then to slow the drop. I would test him at +3, +3 1/2 +4 +4 1/2 and +5 to find out when his onset is and to monitor the drop. That is how I stopped all the bouncing so high. By constant monitoring of the drop. No point in doing it when there is a bounce though. If you see any drop that is going more than 50 points in an hour or half hour, give a drop of honey or if you prefer a bit of higher carb food.

Thanks for your input!!Last night was unusual. He is normally higher at preshot, so part of his +2 number might have been the insulin wearing of from the previous dose as well as a food spike. Also there is a chance he got into some of the grandkitties food..I gave them some 10% friskies as a treat at suppertime, since they are still a bit stressed from being moved here. Usually the insulin kicks in around +3 and his nadir is around +6 but every now and then he likes to change his timing to keep me on my toes. I will be monitoring regularly today to see how his numbers goes.

 

[Meya14]

He's kind hovering in this inbetween state right now, some low numbers, some good numbers, but still a lot of high numbers as well. As you are testing very frequently, and able to control the drops, you could increase again, and try to feed the drops.

I think you mentioned you had him tested for acro and IAA, and both were negative. Looking at your numbers, his highs seems to have a twice-a-day pattern. Could simply be duration issues/glucose toxicity, however patterns like this can happen in cushings. Does he have any symptoms of this? Just thought I'd through it out there due to the high dose. Max had to go up to 7U twice a day to break the glucose toxicity, so that alone could be the issue.

 

[Tuxedo Mom]

I think you mentioned you had him tested for acro and IAA, and both were negative. Looking at your numbers, his highs seems to have a twice-a-day pattern. Could simply be duration issues/glucose toxicity, however patterns like this can happen in cushings. Does he have any symptoms of this?

Actually I did have him tested for Cushing's a few months back. We used the UCCR test and it was done at IDEXX (Canada). The results came back as negative, but they do not have a reference range for cats only for dogs. >35 is considered positive, Tuxie tested out at 14. I am still not 100% convinced that this is ruled out since there are so few studies done on cats. Because Tuxie is so high stress away from home I did not have the ACTH stimulation test done since stress will affect the results. However back the beginning of January he had an U/S and showed organomegaly (enlarged pancreas, liver and adrenals) and the radiologist suggested Cushing's. I did have the dex UCCR done which shows that he does NOT have adrenal based Cushing's, but does not rule out pituitary based Cushing's. I was going to get the UCCR results from Rose (RIP Zoey) but too much was happening at that time, so I never got her test results. Now that Zoey has GA I do not want to bother her.

Tuxie does not show the thinning skin, but from readings I have done it does not always show up right away. I do know that since his U/S beginning of January, he has had virtually NO hair regrowth in the shave areas. When I asked about that I was told that diabetes can also slow down hair growth/regrowth.


On the other hand I have watched Tuxie's numbers and I also am concerned about duration with the Levemir. I actually started a thread on "Think Tank" about this but it did not go very far, other than to say that because ECID, some cats may not get the full 12 hour duration.

http://www.felinediabetes.com/FDMB/...ir-dont-actually-last-a-full-12-hours.137669/


So there are still a couple of ???? in my mind. I am still watching and testing often and trying to keep his numbers either flat and stable or on the downside. Sometimes I wonder if I have missed something though????

 

[Meya14]

I still would consider increasing the lev. as long as you have wiggle room, because you will get longer duration. Adding R with the lev is probably the next step. Lev is going to have the longest duration of the available insulins so switching to a new insulin twice a day probably won't help. The other option would be to do a three times a day dosing, but this would work better with a non-depot type insulin such as prozinc. If the high numbers are from a hormone issue/surges, then the R+long acting is probably the best choice.

The problem with the spot urine test for cushings is that the cortisol level increases and decreases in a twice a day cycle. At times, the cortisol could be in normal range, at other times, very high. If a cat is urinating a lot (such as in diabetes) the time the urine remains in the bladder might be only a couple hours. If you test at a time where the cortisol has been the normal range you might get a false negative. A few tests at various times of day might be necessary to catch it. In humans, we collect all the urine in a 24 hour period to account for the cycles, but you cant really do that with a cat.

There's also a disease called Conn's syndrome associated with adrenal hyperplasia. This causes the abnormal release of aldosterone (which has similar effects to cortisol). You might see this on lab work as low potassium/high sodium.

 

[Tuxedo Mom]

I still would consider increasing the lev. as long as you have wiggle room, because you will get longer duration. Adding R with the lev is probably the next step. Lev is going to have the longest duration of the available insulins so switching to a new insulin twice a day probably won't help. The other option would be to do a three times a day dosing, but this would work better with a non-depot type insulin such as prozinc. If the high numbers are from a hormone issue/surges, then the R+long acting is probably the best choice.

The problem with the spot urine test for cushings is that the cortisol level increases and decreases in a twice a day cycle. At times, the cortisol could be in normal range, at other times, very high. If a cat is urinating a lot (such as in diabetes) the time the urine remains in the bladder might be only a couple hours. If you test at a time where the cortisol has been the normal range you might get a false negative. A few tests at various times of day might be necessary to catch it. In humans, we collect all the urine in a 24 hour period to account for the cycles, but you cant really do that with a cat.

There's also a disease called Conn's syndrome associated with adrenal hyperplasia. This causes the abnormal release of aldosterone (which has similar effects to cortisol). You might see this on lab work as low potassium/high sodium.

Thank you for all the extra information, I had the UCCR done on it's own one time and again on a two day averaging when I had the HDDS testing done..one reading was 10 and the other was 14. These were done at separate times and the second one was done with the averaging of two collections, over a 2 day period, then the third test after 3 doses 0f dex. So I am going to assume that Tuxie's UCCR readings are accurate, but since there is no established references ranges (other than for dogs) I still question the negative test result.

Tuxie's electrolytes are good...last testing was done end of January when his numbers were all in the blacks and reds. His sodium/potassium levels were smack dab in the middle of normal.


I have considered trying a 10 hour dosing cycle with the Levemir, but I don't know if I would be able to do it on an on-going basis. It really leaves no time for sleep (in between shots and testing) and definitely no time for a social life. (which I really have none of at this time anyway). It is more the sleep deprivation that worries me. I asked here a while back about using R at the AM and PM shots, but was told that it was not necessary and just to continue increasing his dose. But sometimes I still go back to that thought. I guess in the end it is how well we know our own kitty. I don't think I could provide any better testing than I do at this time and sometimes you just have to go with your gut feeling, as well as the data.

 

[Meya14]

The R is probably not a bad idea if you can monitor it -very carefully-. It's higher risk than longer acting insulins due to the steeper curve. If in fact it's just duration and glucose toxicity, you might not have to do it for a long time, just long enough to get her in some better numbers and for her pancreas to heal some. I think the 10hr dosing might be hard as the shot times would "migrate" during the day and this might skew the BS readings due to the normal daily hormone variations. Every 8 hour dosing would be better for consistency sake. Again, it might be temporary thing until the BS gets better.

I never thought I'd get max under control, it took about 6 months. We were up to 7U with NO response until then, at the start of the year, but once the sugars got better, we were able to reduce the dose rather quickly. He now at 2.5U and still going down. Most of this was glucose toxicity, some was bad teeth.

 

[Tuxedo Mom]

The R is probably not a bad idea if you can monitor it -very carefully-. It's higher risk than longer acting insulins due to the steeper curve. If in fact it's just duration and glucose toxicity, you might not have to do it for a long time, just long enough to get her in some better numbers and for her pancreas to heal some. I think the 10hr dosing might be hard as the shot times would "migrate" during the day and this might skew the BS readings due to the normal daily hormone variations. Every 8 hour dosing would be better for consistency sake. Again, it might be temporary thing until the BS gets better.

I never thought I'd get max under control, it took about 6 months. We were up to 7U with NO response until then, at the start of the year, but once the sugars got better, we were able to reduce the dose rather quickly. He now at 2.5U and still going down. Most of this was glucose toxicity, some was bad teeth.

All the information you have given me is so much appreciated. I have made it my mission over the last 6 months to learn all I can and do the best for my Tuxie. I am a dedicated caregiver and will devote all the time that is needed to treating and monitoring Tuxie's levels. I keep seeing "maybes" and "almosts" and even though I have learned to be patient..tough one for me...I am not happy just doing dose increases and seeing how it goes. The longer he stays in the higher numbers the more potential for organ damage there is. I think I will set a "ceiling" of 6.5 units following more or less the TR protocol. If I am not seeing positive responses then I think I will try using R in addition to the levemir. Since I am in Canada I do not need a prescription. Is there a "better" one to start with? I can ask for assistance with dosing and be available for intense monitoring if/when I make the decision to add this to Tuxie's treatment plan.

Thanks again for a very open and frank discussion

 

[Wendy&Neko]

I posted this article once on Zoey's condo. The second half of the article deals with Cushings and has reference ranges for cats.

I think I'd play with slowing the drop as Bron suggested first, before trying R. Tuxie's SS looks worse than others because the AlphaTrak reads higher. And he does like to do steep drops.

We have several people here experienced with R and cats, and I suggest that you wait for one of them to work with you when you try it out. It's available OTC in the US as well.

 

[Tuxedo Mom]

I posted this article once on Zoey's condo. The second half of the article deals with Cushings and has reference ranges for cats.

I think I'd play with slowing the drop as Bron suggested first, before trying R. Tuxie's SS looks worse than others because the AlphaTrak reads higher. And he does like to do steep drops.

We have several people here experienced with R and cats, and I suggest that you wait for one of them to work with you when you try it out. It's available OTC in the US as well.

Thanks for adding your input. I don't plan on adding R to Tuxie's treatment at this point but it is definitely something I am looking at in the (near) future.

Tuxie has the pot belly, organomegaly (enlarged pancreas, kidney and adrenals) and generalized alopecia., but does not have the thinning skin at this point. When the vet who did the ultrasound (different vet than his regular, since there are only 2 places here who do US) gave his write-up it was his subjective opinion that Tuxie may have pituitary based Cushing's. That was the beginning of January this year. Unfortunately the reference ranges are established more based on studies for dogs than cats...which may or may not be accurate. I actually phoned MSU and talked to an endocrinologist there who said that there is really no definite reference ranges for cats as there have been so few studies done. Once the levels are to the point that it is obvious it is rather advance. In the earlier stages trilostane may be useful for cats as it is for dogs. So all in all because there si no really accurate range for cats, this is still in the back of my mind. I know with Rose and her (RIP) Zoey the diagnosis was made but by then Zoey had the thinning skin and all.

I have been following Bron's method whenever Tuxie does any appreciable drops and it does seem to help...temporarily. I have also become very good at "re-reading" the AT numbers in terms of human numbers, and although his numbers are not terrible, the big swings really bother me.


Once I decide, if necessary, to try R I will for sure get lots of input from experienced members before I even consider trying it. The thought scares the bejeebers out of me, but I will try it if it looks like a good road to take.

 

[julie & punkin (ga)]

If I were you, Mary Ann, I'd increase Tuxie's Lev dose and use food carbs to support his lower numbers to keep him over 68. That's a very effective way to bring down the entire range of blood sugar. I just think your Lev dose isn't high enough yet.

I think i've mentioned it before but am not sure if you've had a chance to try it yet. The details for doing this are in a thread called "Feeding the Curve, Tashie" on the lower half of the "Where Can I Find?" post.

I wouldn't add R to the mix when you have nadirs that are in normal range.

Sending you a big hug - i know you are discouraged, but you test a lot and you know Tuxie well!

 

[Tuxedo Mom]

If I were you, Mary Ann, I'd increase Tuxie's Lev dose and use food carbs to support his lower numbers to keep him over 68. That's a very effective way to bring down the entire range of blood sugar. I just think your Lev dose isn't high enough yet.

I think i've mentioned it before but am not sure if you've had a chance to try it yet. The details for doing this are in a thread called "Feeding the Curve, Tashie" on the lower half of the "Where Can I Find?" post.

I wouldn't add R to the mix when you have nadirs that are in normal range.

Sending you a big hug - i know you are discouraged, but you test a lot and you know Tuxie well!

Thank you for the link. I have been trying to "feed the curve" when I see an active cycle with Tuxie. I have been following and talking with Bron and her method with Sheba and basically trying to do the same thing. It does help to keep Tuxie from falling too low into a reduction range, but he still ends up bouncing back up into higher number for 1-3 cycles after. I use LC, MC, HC and small amounts of syrup depending on how fast he is falling. I totally understand and agree with the principle behind this method..it is too bad that Tuxie is not more co-operative with my efforts though.

I tend to go a little longer than the TR protocol for changing doses, since I find that Tuxie can take up to 5 days to stabilize on dose increases. But he is basically at that point now so I will see what his numbers are in the morning and consider an increase.

This would have been the perfect night to get to bed early....BUT..my son is moving the rest of his stuff from the old apartment and I have another 1-1 1/2 hours before he is done. I just can't catch a break

 

[julie & punkin (ga)]

Jill wrote a great explanation of it for Tashie, far more thorough than what i've said.

Once you've gotten to a good Lev dose, the bouncing will lessen. The additional Lev will allow longer time spent in normal numbers, and that will help Tuxie's body become used to it. The saying when I got here was to "keep showing them the green" in order to reduce bouncing. So far the longest he's been in green (on this ss tab) is 3 hours. The good news is that this last bounce was only 2 cycles long - that's not too bad! It'll get better!

Hope you get some rest tonight.

 

[Bron and Sheba (GA)]

Hi Mary Ann,
I just wanted to add that I was feeding the curve and trying to stop the rapid drops for weeks before I managed to see any dramatic change. At first the bounces were just a bit shorter. I fiddled with the food several times to try and find the right combination as well. It is very frustrating I know but perseverance is the key. I think getting the food right in the +2 or 3 meal, using the honey instead of food(because it's effects are quicker), testing a lot from onset of insulin to when it slows and giving the higher dose of insulin but stopping the reductions were all part of why Sheba starts to get really good numbers.
Sheba is still a work in progress and I know we will have setbacks along the way

 

[Marje and Gracie]

I think I'd give it more time before using R. And Bron is right....if you can experiment to find the best way to feed and then do it consistently, it will help. If you use his regular food to manage the curve, you can flatten the curve. Then if the dose needs to go up, you can raise it.

 

[Tuxedo Mom]

Jill wrote a great explanation of it for Tashie, far more thorough than what i've said.

Once you've gotten to a good Lev dose, the bouncing will lessen. The additional Lev will allow longer time spent in normal numbers, and that will help Tuxie's body become used to it. The saying when I got here was to "keep showing them the green" in order to reduce bouncing. So far the longest he's been in green (on this ss tab) is 3 hours. The good news is that this last bounce was only 2 cycles long - that's not too bad! It'll get better!

Hope you get some rest tonight.

Thank you I have read that higher doses of Levemir should give longer duration. Because I use the AT meter my goal is to have Tuxie run in the lower blues, touching on green. My readings on May 24 AM are in the area of where I would like to see him through most of the day. A little lower but in that general range. He does seem to be getting better at clearing the bounces quicker. This morning (Sunday) I have increased his dose by .25 units and will see how that goes. Thanks again for your input.

 

[Tuxedo Mom]

Hi Mary Ann,
I just wanted to add that I was feeding the curve and trying to stop the rapid drops for weeks before I managed to see any dramatic change. At first the bounces were just a bit shorter. I fiddled with the food several times to try and find the right combination as well. It is very frustrating I know but perseverance is the key. I think getting the food right in the +2 or 3 meal, using the honey instead of food(because it's effects are quicker), testing a lot from onset of insulin to when it slows and giving the higher dose of insulin but stopping the reductions were all part of why Sheba starts to get really good numbers.
Sheba is still a work in progress and I know we will have setbacks along the way

Thank you Bron. I KNOW I need more patience. It is sometimes frustrating to start to see a good trend starting then have it go downhill the next cycle. But I have watched Sheba's numbers going along wonderful then bouncing through the roof, so I will have to get myself an extra pair of patience pants, while I figure out what food/syrup combination works best with Tuxie.

 

[Tuxedo Mom]

I think I'd give it more time before using R. And Bron is right....if you can experiment to find the best way to feed and then do it consistently, it will help. If you use his regular food to manage the curve, you can flatten the curve. Then if the dose needs to go up, you can raise it.

I think the idea of using the R is more me thinking out loud right now. It is still something that I am considering as a future add in, but for the time being I will continue with increases. But the idea of R is still sitting in my mind IF I don't get a slow, but steady improvement overall. I really like the idea of using food/syrup to flatten the curve. This just makes good sense to me. Thanks for your help.

 

[Sienne and Gabby (GA)]

I want to add an additional note to everything others have said: Cats bounce until they don't. Trying to get a cat's body, or any creature's body for that matter, to do something it doesn't want to do is going to get you inordinately frustrated. I'm not saying to stop feeding the curve. It's something I did with Gabby but the results were not immediate. It took a few weeks for things to begin to change. Given all of the options consideration and thinking things through is a great strategy. Just give it all more time than you were anticipating in order to evaluate the results.