5/9 Penny AMPS 355 Calling anybody who dealt with glucose toxicity

Status
Not open for further replies.
Robyn and Penny

Robyn and Penny

Member Since 2013
Am I on the right track by continuing to increase? I have to slow down the increases (ie from 3u to a skinny 3.25u)..she is on Levemir and several of us have noticed that we have to handle increases more slowly to cut down on the bouncing (usually with increases she shoots up into 400s on pre shots). But I am increasing and it's doing NOTHING! I remember seeing somebody's cat was up to 6u before he broke through that "glass bottom". I guess I just need reassurance I'm doing the right thing. I also hold the doses a little longer until her numbers flatten out before I increase.

She eats the same amounts every day, FF pates and YA Zero Carb kibble to snack on. I know YA has spiked some cats but last night she ate a little kibble (usually about 8 pcs at a time) at 9pm, her number at 8pm was 402 and by 11:45p she had dropped to 342. So I don't think the YA is spiking her. I don't log exactly when she eats but will be logging which wet food flavors she's eating that day to see if that provides any answers.

I'm just getting frustrated and switching insulin really isn't an option. I originally had her on Lantus when she was first diagnosed and she was so reactive to the sting on injection (at less than a unit) that she would JUMP a mile and it became impossible to give her insulin, which is how I originally started with Levemir to begin with. PZI is near impossible to get in NJ these days and it's much more expensive than the Lev pens I'm getting from Mark's Marine in BC. Before we put her back on insulin when she relapsed, I did have her checked out for any possible infections. I found a great new vet who helped me with a stray last month so I do want him to check her out next month and do blood work, but i'm still recovering from the $2000 in vet bills our stray Checkers had racked up, so I do have to wait until June.

I guess I'm looking for support from those who have been there with glucose toxicity that I am doing the right thing and decreasing her dose would work against us at the moment. Please help?
 
I have 2 thoughts. But I think I'm saying the same thing every time I post . . . so maybe you don't think these will help you.

1. i'd get a mid-cycle test in every cycle, including the pm cycle. Just a test before you go to bed will let you know a lot. Or perhaps in Penny's case, she may have lower numbers in the early morning. When I see 4/26 amps 179 I wonder how low she went in the night cycle before she came up to 179 at preshot. She's now at 0.5u more than she was at that point. Maybe she got to green in that night cycle. We don't know. If she did, you would've wanted to hold the dose longer.

2. Skootching up in dose rarely works unless you're already basically at the right dose and you're just fine-tuning. That's not your situation with Penny at this time. Bouncing isn't a terrible thing, and if a cat ends up in green because they've gotten to a good dose, they will eventually stretch out the amount of time they spend in green numbers as their body gets used to it. When I started here the saying was "keep showing them the green and they'll get used to it." In weighing out pros and cons, i think the pro of giving the full dose increase, even if it induces bouncing, outweighs the possibility of it increasing bouncing. A cat will always stop bouncing if you reduce their dose enough, but that leaves them high - which is not a good thing. Reducing bouncing isn't the goal. Getting the blood sugar under control is the goal. That only happens if you keep trying to get them in normal numbers.

There is always the possibility that Penny has a high dose condition. There is nothing to say or even suggest that she does, but I'm just mentioning that because many people think their cat "ought" to be regulated on a small dose. We wouldn't suggest that she has any reason for you to consider a high dose condition until she passes 6u per shot, but i'm just throwing that out there for you to consider so you don't get overly attached to the idea that she ought to need a small dose.
 
Thanks Julie! My next question was when would I consider acromegaly a possibility so you answered that. She has been losing weight (she's on a strict portion control and exercise program) although her weight loss has been stalled out the past few weeks. I have to change my mindset towards regulation rather than flat numbers. It's just disheartening to see Levemir acting like Lantus in my cat.

I do get some before bed tests and I know I need to be more disciplined in getting an overnight test but it typically takes me an hour to fall back asleep if I get up in the middle of the night to test her. I'll have to go back to 4/26 and look now. I know that her nadir has been "floating", which I believe Levemir is known for. Anywhere from +6- +12h and a lot of people whose cats are on Lev have the same thing happen. A lot of us Lev users over on FB had noticed that the strict .25u increases were a bit much for the cats, which is why I had been doing it this way, but it's not helping her. I guess I'll do the full increase but maybe wait till day 5 for her to "settle" before increasing again?
 
The thing about waiting 5 days is that if the dose isn't getting her into green, that's a lot of time spent in higher numbers. If you're following SLGS, then it's a week at a dose. But you've got "relaxed TR" in your signature line - I'm not sure exactly what that is or how you define it.

If I were in your shoes and finding things that I was doing now frustrating & not working, then I would try something different. I'm not sure if you've ever tried to follow Tight Reg, but that's what I'd do. We see a lot of success with it. You only hold a dose for 3 days if the nadirs are over 200, then increase by 0.25u. If you've got nadirs under 200, you hold 6-10 cycles, 3-5 days.

As far as the timing goes for getting nadir checks, that's why I never switched to Lev. Too early in the morning! What you might consider is adjusting her shot time to make it easy for you to get some midcycle checks closer to +10. Like if you shoot at 8/8 now, could you shoot at 10? That would put +8-10 about 6-8. I have no idea if that would help or not, but it's just a thought.

Another thought about her dose - you've got "spinal arthritis" in your signature line. Pain can drive up blood sugar. Is she getting anything to relieve that? Punkin also had arthritis and he got Bupe twice a day for months to relieve it. We tried acupuncture and cold laser therapy too, also adequan shots. The other common reasons for needing a higher dose include pancreatitis and hyperthyroid.

But really, I kinda think changing your style of dose increases by giving a full 0.25u increase, and not waiting too long between dose increases, would make a difference in what's going on with her blood sugar.
 
BJM said:
The human sleep cycle is about 45 minutes. If you want to make it easier to wake, do so on a multiple of 45 minutes, like 1.5 hours, 2.25 hours, 3 hours, and so on.
Click to expand...
Oh wow BJ so you're gonna make me do math now? lol!! That makes sense though, especially since muscles need 7 sleep cycles to recover and when I'm sleep deprived do I EVER have a tough time recovering from the previous day's workout! I'll try that! So if I go to bed at midnight, get up from 3-3:45a to miss a full cycle and get 3 before and 5 after. Ideally I would want 7 continuous cycles but I also want control of Penny's numbers.

Just thinking in text lol
 
julie & punkin (ga) said:
The thing about waiting 5 days is that if the dose isn't getting her into green, that's a lot of time spent in higher numbers. If you're following SLGS, then it's a week at a dose. But you've got "relaxed TR" in your signature line - I'm not sure exactly what that is or how you define it.

If I were in your shoes and finding things that I was doing now frustrating & not working, then I would try something different. I'm not sure if you've ever tried to follow Tight Reg, but that's what I'd do. We see a lot of success with it. You only hold a dose for 3 days if the nadirs are over 200, then increase by 0.25u. If you've got nadirs under 200, you hold 6-10 cycles, 3-5 days.

As far as the timing goes for getting nadir checks, that's why I never switched to Lev. Too early in the morning! What you might consider is adjusting her shot time to make it easy for you to get some midcycle checks closer to +10. Like if you shoot at 8/8 now, could you shoot at 10? That would put +8-10 about 6-8. I have no idea if that would help or not, but it's just a thought.

Another thought about her dose - you've got "spinal arthritis" in your signature line. Pain can drive up blood sugar. Is she getting anything to relieve that? Punkin also had arthritis and he got Bupe twice a day for months to relieve it. We tried acupuncture and cold laser therapy too, also adequan shots. The other common reasons for needing a higher dose include pancreatitis and hyperthyroid.

But really, I kinda think changing your style of dose increases by giving a full 0.25u increase, and not waiting too long between dose increases, would make a difference in what's going on with her blood sugar.
Click to expand...
Julie, when I first joined in 2013 there were instructions for "relaxed TR" which was pretty much tight regulation but a little simpler. I have them copied and pasted somewhere. I followed TR the first time around but I didn't shoot really low numbers on the PM cycle b/c her numbers tended to go lowest at night. Now they run higher at night but I haven't even been faced with that decision yet.

Her nadir most of the time is at +6, which is more like Lantus, but sometimes when I dose increase her nadir backs up to closer to +12, which, for me, would be PERFECT lol. She hates to test so unless I have a low number I'm trying to bring up I won't be testing every hour. I shoot 8 and 8 on her feeding times because she's impossible to shoot without her head in a bowl of food. Unless her head is in a bowl of catnip but she won't sit still enough then lol.

She was on gabapentin and you can see her numbers SHOT UP when I increased her gaba dose, so I decided to treat the underlying cause rather than get her hooked on painkillers. Long story. I have reservations about using narcotics over the long term. I've seen people go through withdrawal, including my ex husband who died as a result of addiction. I was having bad dreams of not being able to afford her bupe and shooting her with heroin for her pain. It did a number on me mentally. Of course if I felt she needed it I wouldn't hesitate. But since she started Adequan (she had a 2 month loading period and is on monthly injections) and lost 3 lbs so far, (knock on wood) she hasn't had one 'episode' (she sleeps on her back and would wake up yowling-happened 3 x which is how we found out). She's on a daily exercise program running up and down a flight of steps 10X twice per day, which does wonders for lubing the joints (synovial fluid), and she is doing things now that she had stopped doing the whole year before her diagnosis, like jumping to the top of our 5' cat trees, she's more playful now than she's ever been since I adopted her 3 yrs ago (she's 6 1/2 now), sleeping on the computer chair on her back again. Just a different cat. Except for her numbers and large pee balls in the box, you'd never know anything was wrong with her.

I do want to get her blood work done in June once I recover from Checky's vet bills. From what I understand, we would KNOW if she had pancreatitis and being that we are working SO hard to get her to lose weight (strict portion control and tons of exercise) I doubt it's hyper T. we did full blood work before we put her back on insulin last Fall.

I looked at 4/26 and that low AMPS and yeah I see where maybe I should have held that. her shot times were off that weekend due to my schedule so that test and shoot was an hour early, which is why I tested again at +1.5h that day. So even if she's still bouncing like a ball after 6 cycles I should still increase?

I'm still very inexperienced even though she was diagnosed in 2013 b/c most of that time she was in remission so when it comes to dosing, etc I'm a total newbie!
 
I completely agree with Julie. She's provided solid information. Increasing by a full 0.25u will, in the long run, help you to break through glucose toxicity if that is, in fact, what's happening. I'd also point out that i suspect what you're calling a bounce is in some cases, new dose wonkiness (NDW).

BJ is accurate about sleep cycles. Of course, you have to count the 45 minute interval from when you actually fall asleep. That works wonderfully in a sleep lab but it's not so easy to figure out at home.
 
Sienne and Gabby said:
I completely agree with Julie. She's provided solid information. Increasing by a full 0.25u will, in the long run, help you to break through glucose toxicity if that is, in fact, what's happening. I'd also point out that i suspect what you're calling a bounce is in some cases, new dose wonkiness (NDW).

BJ is accurate about sleep cycles. Of course, you have to count the 45 minute interval from when you actually fall asleep. That works wonderfully in a sleep lab but it's not so easy to figure out at home.
Click to expand...
I typically fall asleep within 10 mins of my head hitting the pillow so I'll add 10 mins to the time that I actually lie down to sleep and hopefully I figure it out before I knock out! lol!!

I knew it wasn't really a bounce in the truest sense of the term but due to the dose increase but I couldn't remember the "official" FDMB term for it! lol!! I have to try it because obviously what I'm doing isn't working. Nothing's working. I mean, eventually I have to break through it, right?
 
When I started Jojo was just leaving the board, but one of her "Jojoisms" stuck with me - "Be the tank. A tank gets where it's going."

I was worried about Punkin and the bupe too, but the vet pointed out to me that in weighing priorities, it was more important to get him out of pain than it was to be concerned about giving him a med for the rest of his life. He got the bupe for the rest of his life, twice a day, every day.

I think SLGS was the dosing method that was in a sticky in the Relaxed forum.
 
Julie, with as active as penny has been and how she's doing jumps she hasn't done in a year and the way she runs up the steps 2 at a time, I really don't believe she is in pain. She's more active now than she's ever been since I adopted her 3 years ago. I do have some bupe from December if I need it. I don't know how long you can hold on to it before it expires, though.

Chris, you use Levemir, don't you? A lot of us Lev users have noticed that increasing every 3 days is too "bouncy" with Lev. What's your experience?
 
Max is one of those cats that go up pretty high when his blood sugar is too high for a few days. After diagnosis, we went up to 7U before we hit the tipping point, then reduced quickly down to 3. Recently, because I let him get high for a few days while I was changing food brands, we had to go up to 5 again to break through, again reducing to 3. I assume this is because of the glucose toxicity.

If I were to go slow, he would require even more insulin at that breakthrough I imagine. His sugars are like flipping a light switch, we are 300-400, then hit a certain dose, and everything starts to be green, then I have to watch him carefully for reductions.

Check out his SS, it's like a roller coaster.
 
RobynWilson said:
A lot of us Lev users have noticed that increasing every 3 days is too "bouncy" with Lev. What's your experience?
Click to expand...
I use Levemir with Neko and this is definitely not my experience. If she is seeing yucky numbers I want to get her out of there as safely and quickly as possible. The longer she lingers in yucky numbers, the longer it takes her to settle down once she gets to good dose where she is seeing the nadirs I want (in the 70's). If she's not getting green nadirs, I increase by .25U at a time and every 3 days.

You mentioned earlier that you know some Lev users that just fatten the dose. That just takes longer to get you to a to a good dose. If you aren't seeing green, I'd go up by .25U. It could be that the people who see progress with fattening are either seeing some green, or on a lot smaller doses. Think of the increase as a percentage of the dose. Where Penny is now, .25U makes sense. For someone on less than one unit of insulin, a smaller increase may make sense.
 
Okay Wendy...thanks! They were fattening up the dose to flatten out their numbers and reduce the swings because sometimes we see big swings with Penny and they've found that with their cats. But I feel like I'm just making things worse by waiting for her numbers to flatten out before increasing. So then I increase, see higher numbers, and panic and slow down the increases, so I kinda feel like I'm adding fuel to her fire. I am gonna try it per TR but I'm also setting her up with a new vet as soon as June gets here. I'm still recovering from Checkers' vet bills so trying to hold out till June b/c I want blood work, urine culture, everything!
 
Meya14 said:
Max is one of those cats that go up pretty high when his blood sugar is too high for a few days. After diagnosis, we went up to 7U before we hit the tipping point, then reduced quickly down to 3. Recently, because I let him get high for a few days while I was changing food brands, we had to go up to 5 again to break through, again reducing to 3. I assume this is because of the glucose toxicity.

If I were to go slow, he would require even more insulin at that breakthrough I imagine. His sugars are like flipping a light switch, we are 300-400, then hit a certain dose, and everything starts to be green, then I have to watch him carefully for reductions.

Check out his SS, it's like a roller coaster.
Click to expand...
Meya it's not letting me scroll down past Jan 17th on his 2015 SS and I'd really like to see it because i need that confidence that I'm doing the right thing when I increase lol
 
I'm not sure why it's doing that. Here's a PDF of it. It took us about 6 months of blood sugars in the 400-500 range to get him under control initially. Partially due to a tooth infection and also due to the glucose toxicity. We were up to 7 units twice a day before he broke through. Initially, it wasn't until that last change to 7U that I saw any change in BS at all, then all of a sudden he was at like 40s. The second time, I caught the high blood sugars early, and it didn't take as long to get them under control. I wish I had found this board earlier as I would not have let a week or two pass between increases. Also, if you are dealing with doses higher than 3U and you are seeing numbers >300, you are better off increasing by 0.5ml because otherwise it takes forever to get to a higher dose.

Once you do hit that point where you are getting green numbers, you'll find he'll probably need a reduction after a little bit. Don't worry so much about wacky numbers if you don't see any low ones in there. It's not bounce, its just unregulated.
 

Attachments

Meya; can I ask, is Max an IAA or Acro cat? I don't see that in your signature lines.. but I'm in a similar problem w/ my kitty Oren; he just passed the 6.25 u mark and I was told to check for IAA or Acromegaly; took him to vet recently and she did neither, just urine culture and CBC, other blood work. Did turn up mild pancreatitis, but now I'm in a battle w/ her about dosing and food etc. She is NOT a fan of the protocol and short turnaround increases.
 
We were about to test him, when I noticed his mouth bleeding, so I told the vet to test after the dental. Lo an behold, that last increase and the dental kicked his sugars over the edge and we started to see some better numbers. So, we never did get that test. Max has other health issues tho. He is a rumpy manx with neurological issues - probable spina bifida, hyperestesia, and seizures, lots and lots of seizures.

We are using levemir, I've seen others using it that had to go high, then reduce a bit. Maybe it takes lev a little more to get the ball rolling. Lantus wasn't doing anything for Max, we got up to 6 with lantus before we switched, but maybe the dose wasn't high enough. The insulin switch made us start from scratch and waste a lot of time, but I do like lev better - no stinging for max. The lantus was triggering his hyperestesia.

Rule out infection with high dose before all the other testing.

I had a frank conversation with my vet (love her) regarding testing, and basically the result was, it might be nice to know, but treatment ultimately is more insulin, and I could do that without testing. I didn't know that I'd be ready to do any more treatment for Acro if he had it, so why open that can of worms.
 
Last edited:
Meya14 said:
so why open that can of worms
Click to expand...
There are issues caused by excess growth hormone that should be monitored. A couple of examples, acros have soft tissue growth that can affect airways, and if they undergo anesthesia, may need smaller breathing tubes. Another example, it can cause organ growth, for example the heart, which can lead to hypertrophic cardiomyopathy, which may not present with any signs until it is too late.
 
Status
Not open for further replies.
Back
Top