7/18 Max Amps 216 +7.5 544 Phooey! +11 449 Pmps 398 ???
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PeterDevonMocha
Member Since 2009
Re: 7/18 Max Amps 216 Yeah!!!
Hi guys .. well this amps is definitely better looking then last nights pmps! Those higher numbers are hard to see .. but eventually those get fewer and fewer and you start seeing some action! Have a great day guys!
Hi guys .. well this amps is definitely better looking then last nights pmps! Those higher numbers are hard to see .. but eventually those get fewer and fewer and you start seeing some action! Have a great day guys!
max&emmasmommie
Member Since 2012
Re: 7/18 Max Amps 216 +7.5 544 Phooey! ???
Thanks, Peter!
Well, with a +7.5 of 544, I'm wondering if his needs have dropped so dramatically that I am severely overdosing him now on 2.5. I was so tired last night I couldn't get up to check his blood in the night. So, I don't know how low he went, but it was probably pretty low to have bounced that hard.
On the bouncing, I was surprised that he bounced up into the black last night because it seemed that he hadn't done that in a long while. Without the nighttime and midday readings, it's hard to tell, but if he's using the insulin up over a 12 hour period, he should be at his highest near shot time. So, now he's in the black again, but at midday. I'll get some to more mid cycle tests, but my inclination is to drop the dose in a few days and see if that helps. Any thoughts?
Thanks, Peter!
Well, with a +7.5 of 544, I'm wondering if his needs have dropped so dramatically that I am severely overdosing him now on 2.5. I was so tired last night I couldn't get up to check his blood in the night. So, I don't know how low he went, but it was probably pretty low to have bounced that hard.
On the bouncing, I was surprised that he bounced up into the black last night because it seemed that he hadn't done that in a long while. Without the nighttime and midday readings, it's hard to tell, but if he's using the insulin up over a 12 hour period, he should be at his highest near shot time. So, now he's in the black again, but at midday. I'll get some to more mid cycle tests, but my inclination is to drop the dose in a few days and see if that helps. Any thoughts?
Re: 7/18 Max Amps 216 +7.5 544 Phooey! ???
I suspect this is a bounce. I'm copying a section of one of Pumbaa's condo's where Jill talked about reducing the dose when a cat is bouncing:
I suspect this is a bounce. I'm copying a section of one of Pumbaa's condo's where Jill talked about reducing the dose when a cat is bouncing:
The strategy to reduce the dose when a cat is bouncing rarely, if ever, has the desired results. If it were me, I'd be raising the dose.Jill & Alex said:
max&emmasmommie
Member Since 2012
Re: 7/18 Max Amps 216 +7.5 544 Phooey! ???
Sienne,
Thanks for your input. I had read that post with great interest last night, and I re-read it just now.
I want to make sure that the following information doesn't change your analysis. Maybe your are aware of this history, but I want to make sure: Max had his teeth cleaned on June 22, and they found that he had a pretty bad infection in his gums. He also had pancreatitis (snap test). I reduced his dose that day to 2.5 in preparation for the sitter coming on June 27. He got Clavamox from June 22 for two weeks. On June 27th in the morning (the morning we left for our trip) he was Green when the sitter tested him. The sheet says he got 2.5, but I don't think he did, because she tested him again after shot time. That is the first time in all the time I have been testing him that he was Green at shot time!
(As an aside, in terms of bouncing, I don't understand why he would go up to 356 for the next morning, then be down to 285 that night, and then go all the way up to 504 the second morning -- unless he had another low before the 504 which I suppose is possible. That is the only way it could be a bounce, right?)
Anyway, my husband took the dose back up to 2.75 when he returned after June 5th, and he got that 87 at shot time only 4 cycles later -- the second time Max had a Green at shot time. He did not shoot that 87, but shot 2.75 that night. For the next morning, Max was so close to 150 (and got 2.75) that we decided to go back to the sitter's 2.5 dose until I got home and could test him on the midcycles. This was on July 7th. Max had three more Greens at shot time (while he was getting 2.5) on 7/12, 7/13 and 7/14. I would have thought that the shed had drained from the last 2.75 shot by the morning of 7/12.
Since his last Green at shot time, Max has now had over 6 cycles of 2.5 consistently, and his numbers look so much worse than they did last week. He had no Reds and no Blacks at shot time back then, and he had some Greens. I'm wondering if the antibiotics have reduced his need for insulin. I can't find out without getting midcycle numbers, of course, but if I am overdosing him because the antibiotics have relieved the infections how will I know?
The antibiotics issue could make this a different scenario than Pumbaa's, correct? I can raise the dose, and watch him very carefully, but I'm going to be shooting through a lot of Greens I would think. Any thoughts?
Sienne,
Thanks for your input. I had read that post with great interest last night, and I re-read it just now.
I want to make sure that the following information doesn't change your analysis. Maybe your are aware of this history, but I want to make sure: Max had his teeth cleaned on June 22, and they found that he had a pretty bad infection in his gums. He also had pancreatitis (snap test). I reduced his dose that day to 2.5 in preparation for the sitter coming on June 27. He got Clavamox from June 22 for two weeks. On June 27th in the morning (the morning we left for our trip) he was Green when the sitter tested him. The sheet says he got 2.5, but I don't think he did, because she tested him again after shot time. That is the first time in all the time I have been testing him that he was Green at shot time!
(As an aside, in terms of bouncing, I don't understand why he would go up to 356 for the next morning, then be down to 285 that night, and then go all the way up to 504 the second morning -- unless he had another low before the 504 which I suppose is possible. That is the only way it could be a bounce, right?)
Anyway, my husband took the dose back up to 2.75 when he returned after June 5th, and he got that 87 at shot time only 4 cycles later -- the second time Max had a Green at shot time. He did not shoot that 87, but shot 2.75 that night. For the next morning, Max was so close to 150 (and got 2.75) that we decided to go back to the sitter's 2.5 dose until I got home and could test him on the midcycles. This was on July 7th. Max had three more Greens at shot time (while he was getting 2.5) on 7/12, 7/13 and 7/14. I would have thought that the shed had drained from the last 2.75 shot by the morning of 7/12.
Since his last Green at shot time, Max has now had over 6 cycles of 2.5 consistently, and his numbers look so much worse than they did last week. He had no Reds and no Blacks at shot time back then, and he had some Greens. I'm wondering if the antibiotics have reduced his need for insulin. I can't find out without getting midcycle numbers, of course, but if I am overdosing him because the antibiotics have relieved the infections how will I know?
The antibiotics issue could make this a different scenario than Pumbaa's, correct? I can raise the dose, and watch him very carefully, but I'm going to be shooting through a lot of Greens I would think. Any thoughts?
Pumbaa
Member Since 2012
Dale:
After all of those wonderful numbers after the dental and the antibiotics, is there any chance that the infection came back?
Max was doing GREAT until a couple of days ago. 7/16 to be exact. And this could be because he didn't get any insulin at some cycles on 7/12, 7/13 and 7/14. His shed needs time to refill over the next couple of days, and the high numbers you are seeing could be due to so many things, including those missed shots. (Not to say you should have given him his full dose at 76, but I have read that even a partial shot at low numbers - called a BCS, or Big Chicken Shot - keeps at least some insulin in the shed for the future. I wish I had bookmarked some links to this discussion to share with you.)
I have to interject some commentary about the quote from Pumbaa's condo posted above. For weeks, Pumbaa had been exhibiting one day of low numbers followed by six days of high numbers. Sheila (of Beau and Jeddie fame) looked over Pumbaa's SS and saw this pattern, and suggested that I drop his dose as he appeared to be experiencing Somoygi rebound. I did drop him from a fat 2.0 to 1.5 on 6/29, and was very pleased that this nasty pattern finally went away. (I'm now a firm believer in Somogyi rebound, that is for sure! But it will rear its ugly head over weeks, not just in a few cycles.) There are people here who truly believe that red and black numbers, when the cat in question, pre-insulin, never exhibited numbers like that, are a sign of too much insulin, not too little. The problem for all of us is that the symptoms of too much insulin and too little insulin are too similar. Many people would say "increase the dose", and others would say "decrease the dose". You have to try what you feel comfortable with. And then know when to react if the action you took isn't providing the desired results and before subjecting your cat to ketones, etc. For some people, reducing the dose has worked great! And that is all that counts since ECID!
Anyway, these high numbers again for Max are very recent. Max was doing good on 2.5U until 7/16. What changed? Did the infection come back? Are you still dealing with the missed dose of 7/13? And the late dose this morning? Trust me, I've sabotaged myself several days running with late shots and fur shots, and then couldn't figure out the numbers Pumbaa was giving. *LOL* And I know your Max has other medical problems that Pumbaa doesn't have, which increases your detective work time.
At this time, i would say don't increase. Let his shed refill from the missed doses and the late shot, and get him back on the antibiotics in case they failed to clear all of the infection. Then sit back and relax, and wait for better numbers to happen once all of the above takes place. Geez, he was having <100 preshots on the 2.5U dose. That, to me, doesn't call for a dose increase. It does call for detective work on what has caused his numbers to spike in the last few cycles.
Hang in there, Dale! You're doing great, and I probably didn't tell you anything you haven't already considered.
Suze
After all of those wonderful numbers after the dental and the antibiotics, is there any chance that the infection came back?
Max was doing GREAT until a couple of days ago. 7/16 to be exact. And this could be because he didn't get any insulin at some cycles on 7/12, 7/13 and 7/14. His shed needs time to refill over the next couple of days, and the high numbers you are seeing could be due to so many things, including those missed shots. (Not to say you should have given him his full dose at 76, but I have read that even a partial shot at low numbers - called a BCS, or Big Chicken Shot - keeps at least some insulin in the shed for the future. I wish I had bookmarked some links to this discussion to share with you.)
I have to interject some commentary about the quote from Pumbaa's condo posted above. For weeks, Pumbaa had been exhibiting one day of low numbers followed by six days of high numbers. Sheila (of Beau and Jeddie fame) looked over Pumbaa's SS and saw this pattern, and suggested that I drop his dose as he appeared to be experiencing Somoygi rebound. I did drop him from a fat 2.0 to 1.5 on 6/29, and was very pleased that this nasty pattern finally went away. (I'm now a firm believer in Somogyi rebound, that is for sure! But it will rear its ugly head over weeks, not just in a few cycles.) There are people here who truly believe that red and black numbers, when the cat in question, pre-insulin, never exhibited numbers like that, are a sign of too much insulin, not too little. The problem for all of us is that the symptoms of too much insulin and too little insulin are too similar. Many people would say "increase the dose", and others would say "decrease the dose". You have to try what you feel comfortable with. And then know when to react if the action you took isn't providing the desired results and before subjecting your cat to ketones, etc. For some people, reducing the dose has worked great! And that is all that counts since ECID!
Anyway, these high numbers again for Max are very recent. Max was doing good on 2.5U until 7/16. What changed? Did the infection come back? Are you still dealing with the missed dose of 7/13? And the late dose this morning? Trust me, I've sabotaged myself several days running with late shots and fur shots, and then couldn't figure out the numbers Pumbaa was giving. *LOL* And I know your Max has other medical problems that Pumbaa doesn't have, which increases your detective work time.
At this time, i would say don't increase. Let his shed refill from the missed doses and the late shot, and get him back on the antibiotics in case they failed to clear all of the infection. Then sit back and relax, and wait for better numbers to happen once all of the above takes place. Geez, he was having <100 preshots on the 2.5U dose. That, to me, doesn't call for a dose increase. It does call for detective work on what has caused his numbers to spike in the last few cycles.
Hang in there, Dale! You're doing great, and I probably didn't tell you anything you haven't already considered.
Suze
max&emmasmommie
Member Since 2012
Thanks for your support, Suze. It means a lot to me.
Max has a few fleas. The sitter didn't want to give him a topical cure, but she used her flea comb on him everyday. I haven't done that or taken any steps to find out what topical is safe for him. Any ideas, anyone, for a cat with CRF and FD and who is 16. I wasn't particularly concerned about using one of the topical, but the sitter made me think twice.
Yeah, I thought about the infection coming back. It really shouldn't in his teeth because they were able to do an excellent job of cleaning them despite the fact that he was only sedated. However, they were unable to do any digital xrays. I may need to find a vet who is experienced enough to do digital xrays under sedation and who is willing to risk Max biting into the camera. If he has a bad tooth, the infection could definitely come back. I could do more to try to get his teeth xrayed, and I could get him back on antibiotics.
I've also, with great worry, thought about the fact that Emma and I came back home. Max doesn't seem overly stressed by her. In fact, he seems much less wary of her than he was when she first took greater interest in him. We've been very successful in teaching her to be gentle with him. Nonetheless, she cries a lot. It stresses me and the Hubs quite a bit, so it would stress Max, too. I'm going to join a group today that I hope will help me learn to discipline Emma in a way that will improve this crying problem. I want to be gentle with her, and I need some new ideas. She's really testing us these days. At least she's normal! ;-) I'll tell you, I have a newfound respect for people who have diabetic kids. That would be so difficult.
In the catagory of things I can't fix there is the possibility of the pancreatitis being incurable. If the antibiotic didn't clear up the pancreatitis or can't, in the long run, we've got quite a road ahead of us.
I don't intend to change his dose without getting the midcycles, but I wanted to be prepared with some theoretical discussions in advance. Things are so crazy around here, and I'm so busy that if I don't take the time to get prepared days and days will pass without me taking any action when the moment for action finally occurs.
I wish my husband had been willing to get on this board and try to give Max insulin during those Green pre-shots, but he wasn't. He doesn't want to take any risks with this cat because he knows it would devastate me if he was indirectly responsible for anything happening to Max.
On the plus side, Max's numbers have been good for the last 8 hours, he looks beautiful with fluffy, soft fur and bright eyes. He clearly feels better than he did last night. All I can do is give it a few more days and hope that we continue to see Blues!
Max has a few fleas. The sitter didn't want to give him a topical cure, but she used her flea comb on him everyday. I haven't done that or taken any steps to find out what topical is safe for him. Any ideas, anyone, for a cat with CRF and FD and who is 16. I wasn't particularly concerned about using one of the topical, but the sitter made me think twice.
Yeah, I thought about the infection coming back. It really shouldn't in his teeth because they were able to do an excellent job of cleaning them despite the fact that he was only sedated. However, they were unable to do any digital xrays. I may need to find a vet who is experienced enough to do digital xrays under sedation and who is willing to risk Max biting into the camera. If he has a bad tooth, the infection could definitely come back. I could do more to try to get his teeth xrayed, and I could get him back on antibiotics.
I've also, with great worry, thought about the fact that Emma and I came back home. Max doesn't seem overly stressed by her. In fact, he seems much less wary of her than he was when she first took greater interest in him. We've been very successful in teaching her to be gentle with him. Nonetheless, she cries a lot. It stresses me and the Hubs quite a bit, so it would stress Max, too. I'm going to join a group today that I hope will help me learn to discipline Emma in a way that will improve this crying problem. I want to be gentle with her, and I need some new ideas. She's really testing us these days. At least she's normal! ;-) I'll tell you, I have a newfound respect for people who have diabetic kids. That would be so difficult.
In the catagory of things I can't fix there is the possibility of the pancreatitis being incurable. If the antibiotic didn't clear up the pancreatitis or can't, in the long run, we've got quite a road ahead of us.
I don't intend to change his dose without getting the midcycles, but I wanted to be prepared with some theoretical discussions in advance. Things are so crazy around here, and I'm so busy that if I don't take the time to get prepared days and days will pass without me taking any action when the moment for action finally occurs.
I wish my husband had been willing to get on this board and try to give Max insulin during those Green pre-shots, but he wasn't. He doesn't want to take any risks with this cat because he knows it would devastate me if he was indirectly responsible for anything happening to Max.
On the plus side, Max's numbers have been good for the last 8 hours, he looks beautiful with fluffy, soft fur and bright eyes. He clearly feels better than he did last night. All I can do is give it a few more days and hope that we continue to see Blues!
carolynandlatte
Member Since 2009
Hi Dale-
Max goes outside, right? Is there a possibility he is getting into things on some days? A neighbor thinking they are being kind and feeding him treats?
Sorry about Emma. I love working with children and feel I have a ton of patience. BUT, I also get to go home everynight. I'm not sure how good I would be if I was with them 24/7. Parenting has to be one of the TOUGHEST jobs in the world!
Max goes outside, right? Is there a possibility he is getting into things on some days? A neighbor thinking they are being kind and feeding him treats?
Sorry about Emma. I love working with children and feel I have a ton of patience. BUT, I also get to go home everynight. I'm not sure how good I would be if I was with them 24/7. Parenting has to be one of the TOUGHEST jobs in the world!
Pumbaa
Member Since 2012
Well there you go, Max is back down in the blues! Hooray!!!!
Carolyn brought up a good point about Max maybe having gotten into some high carb food outside of the house.
I hope those high numbers were just a fluke you may never be able to explain!
Suze
PS: Dale, just to clarify, I'm not advocating you shoot anything for those low PS numbers, unless you are prepared to test, test, test and test some more, to make sure that Max doesn't drop too low. I did a reduced dose/Big Chicken Shot one night when Pumbaa's PS was 81, and he dropped to 38 at +2. It was that quick. But before I gave the insulin, I was prepared for a long night of testing, and had the honey and higher-carbed food out on the counter, ready and waiting.
Carolyn brought up a good point about Max maybe having gotten into some high carb food outside of the house.
I hope those high numbers were just a fluke you may never be able to explain!
Suze
PS: Dale, just to clarify, I'm not advocating you shoot anything for those low PS numbers, unless you are prepared to test, test, test and test some more, to make sure that Max doesn't drop too low. I did a reduced dose/Big Chicken Shot one night when Pumbaa's PS was 81, and he dropped to 38 at +2. It was that quick. But before I gave the insulin, I was prepared for a long night of testing, and had the honey and higher-carbed food out on the counter, ready and waiting.
A couple of things...
Somogyi is a soapbox issue for me. I've researched it. I routinely read clinical research. I have access to both medical and veterinary databases. The strongest statement that can be said about chronic Somogyi rebound is that the original research, which was done in 1938, has never been replicated. At best, the phenomenon is controversial. More likely, it does not exist and has taken on the proportion of urban legend. I have an exceptionally difficult time when people make statements that ignore research evidence and that that happens all the time when it comes to this topic. There is no research data, none, zero, zip, nada that supports the existence of chronic Somogyi rebound in humans and there is even less that addresses Somogyi in cats. And to further ice the cake, the original research was not done with a long acting insulin such as Lantus or Lev. The 1938 study in not generalizable to cats on Lantus.
The following is from a Wiki article on Chronic Somogyi Rebound. While I do not consider Wikipedia to be a definitive, scientific resource, I have gone to the original research and read what's out there.
The difficulty with trying to make sense out of Max's numbers is that you hadn't been getting PM cycle tests. Looking at your data from last night tells you that Max's numbers do come down during the PM cycle. This increases the possibility that he's bouncing when you see a high AMPS. The assumption that those high numbers are due to a bounce is pure speculation. The only way to know if the hunch is accurate is for you to get at least one test during the PM cycle.
Max's insulin depot probably had been depleted by the morning of 7/12. However, the skipped shots and reduced doses all play havoc with the numbers. Since the last skipped shot was the PM cycle on 7/14, you have had 9 cycles at this dose. Max has finally seen some blue last night. IMHO, he needs a dose increase.
I think your instincts about post-dental x-rays are good instincts to have. Especially if there were extractions, there is the potential that a root may have been left and any resultant inflammation or infection is having an effect on numbers.
With respect to pancreatitis, in many cases, an antibiotic is not necessary for treatment. Unless lab tests indicated there is an infection present, the pancreas may be inflamed but not infected. An antibiotic will not help unless there is an infection.
Somogyi is a soapbox issue for me. I've researched it. I routinely read clinical research. I have access to both medical and veterinary databases. The strongest statement that can be said about chronic Somogyi rebound is that the original research, which was done in 1938, has never been replicated. At best, the phenomenon is controversial. More likely, it does not exist and has taken on the proportion of urban legend. I have an exceptionally difficult time when people make statements that ignore research evidence and that that happens all the time when it comes to this topic. There is no research data, none, zero, zip, nada that supports the existence of chronic Somogyi rebound in humans and there is even less that addresses Somogyi in cats. And to further ice the cake, the original research was not done with a long acting insulin such as Lantus or Lev. The 1938 study in not generalizable to cats on Lantus.
The following is from a Wiki article on Chronic Somogyi Rebound. While I do not consider Wikipedia to be a definitive, scientific resource, I have gone to the original research and read what's out there.
There is a fundamental difference between chronic Somogyi rebound and a bounce. Many of the people who bandy the term "Somogyi" about are actually talking about a bounce. You don't deal with a bounce by reducing the insulin. If you reduce the amount of insulin, you're going to get potentially flatter numbers but they will be high. Once you have a cat sitting in high numbers for an overly long period, you have to deal with glucose toxicity and greater long term risk for organ damage.
The difficulty with trying to make sense out of Max's numbers is that you hadn't been getting PM cycle tests. Looking at your data from last night tells you that Max's numbers do come down during the PM cycle. This increases the possibility that he's bouncing when you see a high AMPS. The assumption that those high numbers are due to a bounce is pure speculation. The only way to know if the hunch is accurate is for you to get at least one test during the PM cycle.
Max's insulin depot probably had been depleted by the morning of 7/12. However, the skipped shots and reduced doses all play havoc with the numbers. Since the last skipped shot was the PM cycle on 7/14, you have had 9 cycles at this dose. Max has finally seen some blue last night. IMHO, he needs a dose increase.
I think your instincts about post-dental x-rays are good instincts to have. Especially if there were extractions, there is the potential that a root may have been left and any resultant inflammation or infection is having an effect on numbers.
With respect to pancreatitis, in many cases, an antibiotic is not necessary for treatment. Unless lab tests indicated there is an infection present, the pancreas may be inflamed but not infected. An antibiotic will not help unless there is an infection.
max&emmasmommie
Member Since 2012
Ah ah, okay, that is great to know that Sienne is using "bounce" differently than synonymous with "rebound," and it makes perfect sense that a cat can bounce without being overdosed. ("Even" the vet used the term Somogyi effect when we were talking about the high BGs Max had.) Now, I feel more confident about raising the dose. Thank you, Sienne and Carolyn! I'll get some more PM mid cycle tests first.
Max did not have any extractions. If there is a bad tooth in there, it could still be causing infection. No one knows what causes pancreatitis. It could be an infection, and it might not be; its probably a different cause in each case. I wanted to try antibiotics before getting that very expensive test for it.
High carb food is unlikely, but possible. We are surrounded by dogs on all sides. Four to the left, three to the right and three in the back. I've never seen him leave the property. We have coyotes, owls, hawks, golden eagles, skunks, possums, woodrats, gophers and racoons galore. So, the neighbors don't leave food outside for their dogs. What about the food that horses eat?
Max is not allowed out after dusk unless we are with him. He shows no interest in people food unless it's meat or corn chips (where do you think he got the idea that corn chips are food? from dry food, of course. He looooves them!). If he's crossing the road and getting corn chips from the park I'd be very surprised. Although the birds do drop discarded parts of sandwiches on our property, Max doesn't like bread.
Emma is great if you tired her out every single day. She gets bored very easily, and then everything is something to cry about. Of course, there's teething and tummy aches, dirty diapers and being too tired all mixed in for good measure. It's all worth it -- It's like loving your cat even when he just peed on your best mattress!!!
Max did not have any extractions. If there is a bad tooth in there, it could still be causing infection. No one knows what causes pancreatitis. It could be an infection, and it might not be; its probably a different cause in each case. I wanted to try antibiotics before getting that very expensive test for it.
High carb food is unlikely, but possible. We are surrounded by dogs on all sides. Four to the left, three to the right and three in the back. I've never seen him leave the property. We have coyotes, owls, hawks, golden eagles, skunks, possums, woodrats, gophers and racoons galore. So, the neighbors don't leave food outside for their dogs. What about the food that horses eat?
Max is not allowed out after dusk unless we are with him. He shows no interest in people food unless it's meat or corn chips (where do you think he got the idea that corn chips are food? from dry food, of course. He looooves them!). If he's crossing the road and getting corn chips from the park I'd be very surprised. Although the birds do drop discarded parts of sandwiches on our property, Max doesn't like bread.
Emma is great if you tired her out every single day. She gets bored very easily, and then everything is something to cry about. Of course, there's teething and tummy aches, dirty diapers and being too tired all mixed in for good measure. It's all worth it -- It's like loving your cat even when he just peed on your best mattress!!!
Pumbaa
Member Since 2012
Sienne and Gabby said:
Sorry, Sienne, but I know what Pumbaa was experiencing, and know for a fact that reducing his dose stopped the pattern of one day of lows followed by 6 days of highs. This went on for weeks, and it was only after Sheila pointed out the problem that I did more research about Somogyi and I reduced his dose and we broke his previous pattern. As per other posts on this BB where other cats were going through the same thing.
I truly don't know why you can't accept that Somogyi Rebound truly exists in some cats. I don't need research papers to tell me that Pumbaa responded well and broke that pattern of one day of lows followed by 6 days of highs after I decreased his dose. I don't rely on research papers to tell me how to live my life, I rely on real time data.
All I care about right now is that Sheila pointed me in the right direction, and Pumbaa broke his pattern, and we are moving forward.
I appreciate your opinions, Seinne, and your research, and experience, but I think that you need to be more open minded about things that work for some cats, but not for all. ECID!
Suze
There are phenomena that are unexplained. The formal definition of Somogyi does not hold up to scrutiny. Until you can collect sufficient data from a sufficient number of cats vs. an N = 1 phenomenon, you can't justify what you experienced as Somogyi. It may be something but it's not Somogyi. Don't take what I'm saying as gospel. Go read the literature -- the original literature and subsequent data-driven, scientific attempts to replicate the original study and then draw your own conclusions.
Let me use a very different example. Mitral valve prolapse is a heart arrhythmia. For a long time, it was thought that MVP was the cause of panic disorder. Then, researchers looked at the base rates of MVP in the general population and in individuals who were carefully diagnosed with panic disorder. The base rates were not significantly different. There was no cause and effect relationship between the two conditions. Some people with MVP became panicky due to their arrhythmia and some people who had panic disorder were later diagnosed with MVP; but, MVP does not cause panic disorder.
You're in essence saying that MVP causes panic and don't confuse you with the data. It may for you (or your cat). However, that's makes the one person an outlier. It may be true for that person but until there is more data, you can't generalize.
The research on Somogyi is bad research. Until someone can reliably prove the phenomenon exists and it can be replicated both inside and outside of the laboratory in humans and/or cats and in those species using long-acting insulin, to call what you're seeing chronic Somogyi rebound is incorrect and perpetuates misinformation.
Let me use a very different example. Mitral valve prolapse is a heart arrhythmia. For a long time, it was thought that MVP was the cause of panic disorder. Then, researchers looked at the base rates of MVP in the general population and in individuals who were carefully diagnosed with panic disorder. The base rates were not significantly different. There was no cause and effect relationship between the two conditions. Some people with MVP became panicky due to their arrhythmia and some people who had panic disorder were later diagnosed with MVP; but, MVP does not cause panic disorder.
You're in essence saying that MVP causes panic and don't confuse you with the data. It may for you (or your cat). However, that's makes the one person an outlier. It may be true for that person but until there is more data, you can't generalize.
The research on Somogyi is bad research. Until someone can reliably prove the phenomenon exists and it can be replicated both inside and outside of the laboratory in humans and/or cats and in those species using long-acting insulin, to call what you're seeing chronic Somogyi rebound is incorrect and perpetuates misinformation.
I don't want to hijack this condo, but, Suze, I looked at Pumbaa's SS, and I only saw one time where he got into green and had six days of high numbers after. That was 6/22. He did have some greens on 6/15 but he also came back down into blue on 6/16. You reduced his dose on 7/6 and still had five cycles of high numbers before he came back down. And then you took him back up. Sometimes we interpret things on our SSs that just aren't there....I've done it myself; or I've failed to see something that was clear to experienced eyes. I call it my "forest for the trees" perception. I wouldn't read so much into one or two episodes of long bounces after low numbers. There are just too many variables including the fact that absorption rates from dose to dose can vary enormously. So if you add that on to a bounce AND the inaccuracy of the syringes .....you have alot of variables to account for; to say it is Somogyi is just not founded upon anything at all. I also don't think there's really been much change in his SS overall by taking him down and then back up. He still hit black on 1.25u.
I'm sorry, but I'm just trying to be honest with you.
I'm sorry, but I'm just trying to be honest with you.
Jill & Alex (GA)
Member Since 2009
when following the TR Protocol which is specific about making dose adjustments by using a very systematic and methodical approach... we do not find it necessary or desirable to break patterns by doing rebound checks which only allow a cat to remain in hypERglycemic numbers for weeks or even months. instead, we focus on nadir. the goal is to bring kitty's numbers down as quickly as safely possible.Pumbaa said:Except for the fact that Pumbaa was stuck in pattern that reeked of Somoygi Rebound, and we broke this pattern after decreasing his dose.
I need no additional proof.
from the Tight Regulation Protocol:
"Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia."
http://www.tillydiabetes.net/en_6_protocol2.htm
when a rebound check is performed on a kitty who has gone up and down the dosing scale in the systematic and methodical manner outlined in the TR Protocol, the results of a "rebound" check are similar to what you're seeing with pumbaa. it's been 4 weeks and counting since pumbaa has seen a nice string of normal numbers at a higher dose.
more often than not, we've found the caregiver performing a "rebound" check on a kitty who has carefully and systematically been brought up and down the dosing scale by following the TR guidelines will end up not only taking the dose right back up, but will have to surpass the last good dose after a so-called rebound check... and this is after kitty has spent weeks to months of unnecessary time in unhealthy numbers as well as time, money, and efforts expended on the part of the caregiver.
just sayin...
Libby and Lucy
Member Since 2009
Reducing the dose DID break the pattern of lows followed by highs. It put him into a pattern where he is just high all the time, not going low at all. As I mentioned in your one of Pumbaa's condos, it's about knowing what your goals are. If staying high (Pumbaa is mostly above renal threshold) is ok with you, then reducing the dose worked because you're satisfied with the results. If you want to work toward lower numbers, then you have stalled progress quite a bit. Pumbaa was getting green fairly often on 2.25 and fat 2.0, and now a month later you are still working your way back up to get to where you already were (and almost back to fat 2.0 and 2.25).Pumbaa said:
max&emmasmommie
Member Since 2012
With regard to bouncing and somogyi, regardless of the type of diabetes the cat suffers from the body is not a machine. When a car gets old it burns more oil, so you put a lot more in. Maybe you fix the car and maybe you don't, but it's needs shouldn't fluctuate based on factors you can't determine or understand. That isn't true of the body. I'm afraid that the truth is that the pancreas is like all other organs; it works better at some points and not at others. Unless it doesn't work at all for some reason, it is going to put out varying degrees of insulin, and we are going to see wonky numbers occasionally (or more often) depending on the efficacy. The same is true of the mechanism that allows the cells to get the energy they need. More energy gets in sometimes, for unknown reasons, and the sugar in the blood is lower at times than we would expect.
I think that for Max a key issue is hydration because of his CRF, but I'm guessing that if you talked to a human diabetic who was very diligent about regulating his/her blood sugar you would hear a similar story: sometimes it's high even for days. Then, of course, there is stress or the contraction of a virus or a bacterial infection that we have no way of knowing about. As for stress, when Max hears the coyotes, his ears perk up if they are close by. If they are further away, he doesn't seem to react. I know he hears them when I don't. They may make different sounds based on what they are doing, and they probably stress him even when they are far away if they are unusually active.
Perhaps we are over-thinking this with our need to control what is happening to our cats. They are our children, and we are going to get upset when we can't help them even if it is only for a day. We can experiment and try to stop the problem by doing something some might consider unorthodox when nothing else seems to work, but what we probably need to do for the cat and ourselves is try to relax, regardless of dosage we are using. Dim the lights, put on some calm music or turn everything off, and take a deep breath. Pet your cat. It usually works with babies; why not cats?
I think that for Max a key issue is hydration because of his CRF, but I'm guessing that if you talked to a human diabetic who was very diligent about regulating his/her blood sugar you would hear a similar story: sometimes it's high even for days. Then, of course, there is stress or the contraction of a virus or a bacterial infection that we have no way of knowing about. As for stress, when Max hears the coyotes, his ears perk up if they are close by. If they are further away, he doesn't seem to react. I know he hears them when I don't. They may make different sounds based on what they are doing, and they probably stress him even when they are far away if they are unusually active.
Perhaps we are over-thinking this with our need to control what is happening to our cats. They are our children, and we are going to get upset when we can't help them even if it is only for a day. We can experiment and try to stop the problem by doing something some might consider unorthodox when nothing else seems to work, but what we probably need to do for the cat and ourselves is try to relax, regardless of dosage we are using. Dim the lights, put on some calm music or turn everything off, and take a deep breath. Pet your cat. It usually works with babies; why not cats?
Well said, Dale!!
Actually, needs can fluctuate and it may not be solely because the pancreas is having a good or bad day. One factor can be age. The older any organism gets, the less well drugs are metabolized. In some cases, it means that more may be needed. In other instances, less is needed because the liver and kidneys aren't as efficient and the drug can build up in the system. This is why, in human medicine, children and older adults frequently have different dose needs than an adult. However, I think this is pretty much restating your point.
Actually, needs can fluctuate and it may not be solely because the pancreas is having a good or bad day. One factor can be age. The older any organism gets, the less well drugs are metabolized. In some cases, it means that more may be needed. In other instances, less is needed because the liver and kidneys aren't as efficient and the drug can build up in the system. This is why, in human medicine, children and older adults frequently have different dose needs than an adult. However, I think this is pretty much restating your point.
I agree ....very well said, Dale!
Pumbaa
Member Since 2012
I'm going to try to respond to everyone here...
Thank you for being honest.
I went back and looked at Pumbaa's SS this morning, hovering from above so I can see the entire "forest", and realized that my mind was remembering the 6 days of highs as running concurrently with Pumbaa's string of Friday night dives. And that isn't the case. But I do see two weeks of highs after those Friday night dives, 6/15 (other than the one 190 he had on 6/16) and 6/22. And yes, I agree that there were other variables involved as well. And yes, taking him down to 1.25U on 7/9 didn't help him at all, but it was an experiment worth trying since it was working for Mel's Autumn.
At least we totally agree on that statement! *LOL* Thank you for getting out the 2 x 4 and beating me on the head with it, as I need that sometimes. While I still think that Somogyi can exist in cats, as I said previously, I do respect your research and opinion as well.
Jill:
Thank you for getting out that 2 x 4 as well. If you all didn't care about Pumbaa, and me, you wouldn't be nice enough to get out the 2 x 4 when I need it applied to my thick skull. And you are correct, Pumbaa's last day of really nice numbers all day was on 6/22 at 2.00U.
Libby:
No, having Pumbaa stay high is NOT my goal. It breaks my heart to see the high numbers. Yes, Pumbaa was getting green's fairly often on the 2.25 and fat 2.0 doses. Yes, we have lost time and progress. That wasn't the intent, either.
Every time he had a nice string of blues on the 1.50U I was thrilled. And when I bumped him up to 1.75U, I expected even more of the blues. But then I was late with morning doses not once, but twice, and gave a partial fur shot on 7/15 to boot. There's just too much going on in my life right now, and unfortunately, not good stuff, stressful stuff. And Pumbaa is suffering because of it. I don't like that at all, and unless I can clone myself so I can be in three places at once, I don't know how I'm going to fix this.
Suze
Marje:Marjorie and Gracie said:
Thank you for being honest.
I went back and looked at Pumbaa's SS this morning, hovering from above so I can see the entire "forest"
, and realized that my mind was remembering the 6 days of highs as running concurrently with Pumbaa's string of Friday night dives. And that isn't the case. But I do see two weeks of highs after those Friday night dives, 6/15 (other than the one 190 he had on 6/16) and 6/22. And yes, I agree that there were other variables involved as well. And yes, taking him down to 1.25U on 7/9 didn't help him at all, but it was an experiment worth trying since it was working for Mel's Autumn. Sienne:Sienne and Gabby said:
At least we totally agree on that statement! *LOL* Thank you for getting out the 2 x 4 and beating me on the head with it, as I need that sometimes. While I still think that Somogyi can exist in cats, as I said previously, I do respect your research and opinion as well.
Jill:
Thank you for getting out that 2 x 4 as well.
If you all didn't care about Pumbaa, and me, you wouldn't be nice enough to get out the 2 x 4 when I need it applied to my thick skull. And you are correct, Pumbaa's last day of really nice numbers all day was on 6/22 at 2.00U. Libby:
No, having Pumbaa stay high is NOT my goal. It breaks my heart to see the high numbers. Yes, Pumbaa was getting green's fairly often on the 2.25 and fat 2.0 doses. Yes, we have lost time and progress. That wasn't the intent, either.
Every time he had a nice string of blues on the 1.50U I was thrilled. And when I bumped him up to 1.75U, I expected even more of the blues. But then I was late with morning doses not once, but twice, and gave a partial fur shot on 7/15 to boot. There's just too much going on in my life right now, and unfortunately, not good stuff, stressful stuff. And Pumbaa is suffering because of it. I don't like that at all, and unless I can clone myself so I can be in three places at once, I don't know how I'm going to fix this. Very well said, Dale. If I could have one day of no stress and get a full night's sleep, I'd probably be thinking a lot clearer and more able to cope with everything. Sorry about hijacking your thread.max&emmasmommie said:
Suze
Libby and Lucy
Member Since 2009
The difference with Autumn is that she very likely was over dose. There are lots and lots of hints that Mel is probably missing seeing some low numbers, especially at night. She has probably missed some reductions (in fact there are some missed reductions that you can see on her ss). you are testing enough that you don't need to wonder whether there are low numbers. You would SEE them if they were there. People here used to do rebound checks all the time, but that was also back when the standard advice was to test at preshot every time and do curves sometimes. Testing mid cycle eliminates those kinds of questions.Pumbaa said:
Have to run, hope this helps!
max&emmasmommie
Member Since 2012
No worries on the 'jack, Suze. It's been a great discussion to read.
C
Carl & Polly & Bob (GA)
Awesome thoughts, Dale. I think a lot of it does come down to feeling like we have to "control" something, because this disease is so maddening, and each day so unpredictable. Last year, in PZI, Dr. Pierson posted this. I've read it a million times, and shared it with lots of people. I actually take great comfort in what she says, and I hope other people do as well. We basically have "control" over only two things - amount and timing of food, and amount and timing of insulin. What happens after we add those two things to kitty's body are no longer under our control.
Kitty's body is going to do what it is going to do with the food and insulin that you put into it. But every day, even with the dose and the food exactly the same, as everyone realizes, the results are different, and most days, they mystify us.
I don't like that at all, and unless I can clone myself so I can be in three places at once, I don't know how I'm going to fix this.
Suze, you're going to breathe deep and you're going to fix this one cycle at a time. Live it in 12 hour pieces.
Carl
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