9/20- Lucky- Not sure what to do anymore

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all4mymarine

all4mymarine

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This cat is just confusing the heck out of me :YMSIGH:

Can someone please take a look at his SS and tell me what you think?

This morning his AMPS was 366. I shot 1.1, which is very very very close to the s1.2 I was shooting. I just checked his +4 and he's at 320 :? I'm checking him again in 2 hours.

Yesterday was a fur shot, I'm positive. I think the needle went through the other side because his fur was wet. But this morning, I'm positive that it wasn't because I checked when I inserted the needle and felt no wetness and there was no insulin smell.

Either he rebounds with some doses or his numbers do hardly anything when I lower the doses. I'm just at such a loss here :sad: I want to do what's best for him but I have yet to figure out what that is exactly.
 
Just a hypothetical here, not saying you should do this. I'm just looking for input from the group.
What would happen if you increased to 2.0?
Anyone got any theories?
carl
 
He is a puzzle. I like your numbers around that 1.2 dose (it looked like we were getting somewhere) although he does seem to bounce whenever you get a blue even in the higher ranges of blue and then he moves up in the higher numbers. Food has stayed the same - down in the lower range of lo carb. No sign of infections? Recovered well from dental? (see it on the SS but not sure if it happened?)

Hmmmm. I would not raise the dose substantially. Maybe try 1.3 again. He didn't stay there long. Or maybe 1.5? He has not had low blues or greens in awhile.

I know this is a discouraging process. You are adjusting the dose by a little and he seems to react so differently each time. But don't lose sight of how little insulin you are giving, and that he has been in pretty good numbers (except for that shooting back up stuff). Wish we had a magic answer and a formula that worked for everyone.

I agree with a dose increase but would stay with a little one. If nothing happens in 3 cycles or so, then another small increase.
 
Thanks guys.

To answer questions:

Food has stayed the same. Either FF beef, chicken, turkey and giblets or chopped grill.
No signs of infection that I can tell. He doesn't feel warm or anything.
Dental went well, had 2 extractions and antibiotics

If you look at some of his +7 -+10's, you'll notice a significant (and not so significant) jump in numbers and then by the PMPS, he goes back down. That made me think rebound and that the dose was too high. Seems there is a fine line for Lucky between not enough and too much. Before the dental, I had gotten up to 1.4 and didn't really see the results I wanted. Before that, he was doing soooo well on just 1u some days! But not on others :roll: You would think that he needed a higher dose but he showed such great results on just 1u and 1.1u and not so good results on anything higher than 1.2. By good I mean blues and greens.

I may go to a f1.2 and see what happens for a few cycles. Since he responds to little changes, I don't want to skip right up to 1.3. I'll try to stay on top of checking those +8's and +10's for anything that looks like rebound.
 
Just to explain why I put 2.0 out there ...
The greens I saw came after 1.8 doses. And, you have plenty of room to go lower than he normally goes lately.
That's where it came from.
That aside. . . I don't.understand something about the drop from +10 to +12 (not just with him but in general). Where does the sugar go? Why does kitty go lower? Is it because they don't eat in the three or so hours before a PS? Is it the pancreas sputtering? Why the drop?
Carl
 
Who knows, Carl? It may fall into that ECID - he may get a little food and that might do it. Or he might be hungry and get no food and that might do it. Keep in mind that 20% variance, though. Technically 422 and 372 are within the variance so it could be looked at as a surf, not a drop......

I wouldn't suggest the 2 units because it is a big change, and leaves a lot of doses in between that might be the right one. (Hah, who knows about the right one!) And Lucky does seem to react to pretty small increases and decreases. The thing for me is that I don't really understand why he reacts the way he does....YET

Read Kim's post on Miss Kitty today. She has been through so much with that kitty and just hung in there, trying to figure her out. And she finally feels like she has. She understands how the insulin works with her unique body and set of issues, and she can make some predictions about what is happening. It was a long process with lots of experimenting and testing. The frustrating part of this whole dance are those few kitties who just go into remission with little effort. Who knows what makes the difference?

Could it be like the two humans diagnosed with the same cancer at the same age and same time, and one does great and the other doesn't? Gosh, I am ridiculously philosophical today.
 
Carl, if it weren't for the +10 jumps, I probably would have already been well on my way to working up to 2u. I looked at his chart at the 1.8's and I didn't see any greens? He hasn't seen a green since 7/29 before his dental :sad:

I'd like to know why the drop too!

I just checked +6 and he's at 292 :YMSIGH:
 
Food schedule is after AMPS, after +6, after PMPS, and after evening +4 before I go to bed. So he's being fed 4x a day. Pretty much the same schedule he's always been on.
 
Oh crap, I'm sorry! I swear I thought I saw 1.8 those days! It was actually a1 and a.9.
So much for that idea. Smartphones and spreadsheets don't work well together...
carl
 
It's okay Carl ;-) It all gets confusing. I won't even admit to how much time I spend looking at his SS every day trying to figure things out and I still get confused lol
 
I empathize with you. I really do.
One thing I think we sometimes forget is that what might work one day might necessarily work another as far as the insulin dose is concerned.
 
+8 was 364

It just keeps getting worse today ohmygod_smile Watch, his PMPS will be less than 364.

Thanks Ginny. I know that needs change but geez, I'd love to be in the ballpark for once! ;-)
 
Ginny & Alex said:
I empathize with you. I really do.
One thing I think we sometimes forget is that what might work one day might necessarily work another as far as the insulin dose is concerned.
Click to expand...
Good point Ginny,
What I try to tell people is this :
Don't assume that just because something worked in the past, that it will still work now. And,
Just because something failed in the past, don't assume it won't work now.
I find that important to remember when people start doubting themselves, and look back at their SS and say, but 2.5 gave her all wonky numbers 3 months ago, so I already know that won't work.
Kitties' bodies change, stuff heals as time goes by. Other conditions may have existed then, or now, that weren't in the picture a few months ago. Trying something a 2nd time sometimes works. I know the first time Bob was on 1u BID, it sure didn't work, but it worked really well about 2 months later (on the way down).

We would hope that we would see "like" results on the same dose for even 2 or 3 days running, but I think if we can come remotely close, we're doing pretty good.

Carl
 
Well, I was right. His PMPS was 307. I went ahead and shot a f.12

Here's a rundown again:

AMPS: 366
+4: 320
+6: 292
+8: 364
+10: 344
PMPS: 307

I didn't physically plot it out but this isn't a U curve.

Why does he keep spiking around +8 to +10? I'm not sure if anyone even knows the answer to that and I do understand the difference in monitor readings and all that but this is a consistent thing! It's not something that happens every once in awhile.
 
I found this here: http://www.felinediabetes.com/dummies.htm#glucurve



"Any hypoglycemic episode, whether or not you observed it, may be followed by some degree of rebound for some unknown length of time. It will show up as BG spikes happening before the insulin tails off, if you're doing blood tests. If you're using dipsticks, you'll see a high reading at a time when you're not even supposed to see traces. The spikes are almost as bad for the cat's long term health as sustained high BG levels, so they should be stopped. Besides the other things damaged by high blood glucose, the poor old liver gets extra stress, and the long-suffering kidneys are thrown into overdrive again.

Unfortunately, the instinct is to increase insulin when we see high BG levels. If they are caused by rebound, the answer is to decrease insulin."


I'm going to check him at +2 and +3 tonight and see if maybe he's dropping low right off the bat. If not, I don't know what the heck is going on because the description of rebound is fitting what's going on with his cycles. I can't stand to see his #'s so high this long. I feel like it's doing more harm than good and I want to figure out what's wrong as soon as I can! I'm afraid that raising his dose might not be the best thing but I don't want to continue with too low of a dose for too long either. Ahhhh!! I'm breathing....deeeeep breath!
 
I agree that the thread you found seems to describe exactly what's going on with the +8 - +10 spikes. And thanks for linking it. I just clicked on it, and it looks like a whole lot of information to digest, and it will give me something to read and hopefully understand more about FD. It's something I should have read when I first came aboard, but I'd never noticed it before.

Agree, that isn't a U curve. Actually, if you take into account meter variance, it could be pretty much a flat line. But like you said, this happens frequently, so it can't be the meter messing up the same way every time. Even if the curve is mild, he goes down, comes up and then back down, however slightly that might happen.

If you take the curve at face value, he hardly got a drop, which should indicate he needs a bigger dose. BUT, if you take it at face value, it also indicates rebound, which means you should reduce. Wow.

I'm going to go read.....
Thanks again for sharing that link,
Carl
 
What I find most interesting about the first article is the emphasis on the relationship of food and insulin. Check out Ginny and Alex's thread this am. Bigger nighttime snack equaled lower amps. If I were you, I would experiment with food. Vary the time you feed and give more or less at those times and look for patterns.

I don't see what I would call rebound or a bounce. My understanding is that both require a low and a high number. Your numbers fall within the variance. (Carl, it isn't that there is anything wrong with the meter. They can just vary from reading to reading and that can be taken into account. I don't know if it happens with one brand more than another or how prevalent it is, but it happens.)

Your boy seems as though he is going to be challenging to dose and that other variables may really affect him. But don't lose sight of the fact that you are working within small dose variances and he is not in scary numbers.

If he were mine, I would do some experimenting with the timing of food. Some PZI kitties improve with food available at night, some don't. Some need several small meals during the day; some do better with an am meal, a pm meal and a snack.
 
There are many variables in this dance, but mid day and 3 am chicken snacks was part of the equation that I believe helped us. Sue recommended that for us months ago and we have been doing it ever since. We can’t truly free feed here because our diabetic is a hoover kitty. So, chicken snacks in between his low carb (1-2%) morning and evening meals seem to be helpful in keeping him satisfied and giving us decent numbers.

That, and holding a dose until we were really really sure about what it did.

ECID but for what it’s worth....
 
Sue and Oliver (GA) said:
What I find most interesting about the first article is the emphasis on the relationship of food and insulin. Check out Ginny and Alex's thread this am. Bigger nighttime snack equaled lower amps. If I were you, I would experiment with food. Vary the time you feed and give more or less at those times and look for patterns.

I don't see what I would call rebound or a bounce. My understanding is that both require a low and a high number. Your numbers fall within the variance. (Carl, it isn't that there is anything wrong with the meter. They can just vary from reading to reading and that can be taken into account. I don't know if it happens with one brand more than another or how prevalent it is, but it happens.)

Your boy seems as though he is going to be challenging to dose and that other variables may really affect him. But don't lose sight of the fact that you are working within small dose variances and he is not in scary numbers.

If he were mine, I would do some experimenting with the timing of food. Some PZI kitties improve with food available at night, some don't. Some need several small meals during the day; some do better with an am meal, a pm meal and a snack.
Click to expand...

But is a chronic rebound not possible? Where he has just gotten into a vicious cycle of too high insulin? I was reading that some cats don't have to have a low green to rebound. And maybe the answer I'm looking for is not rebound. Maybe it's insulin induced hyperglycemia? I'm trying to find info on this but all I can find really is info on hypo.

If you look at 9/19, he was at 402 at +8 and then 317 at PMPS. I just think this is more than meter variance (and it happens too consistently) and something else is going on. I've tried increasing and holding dose and don't get regular U curves. I've tried decreasing and same thing. Either I'm not increasing enough or I'm not decreasing enough.

I'll try giving him a snack between meals even though I've gotten great numbers before all this started with the same feeding schedule and no snacks ohmygod_smile He is a hoover kitty so he can't free feed. I've got a feeder so I'll put that to use, just need to get it programmed! But AMPS isn't really what I'm worried about.....

Not to mention the fact that changing to wet food and the test strips and syringes, etc are putting a strain on our budget :(
 
And I was thinking....BEFORE the dental, he was doing pretty well with just 1u - .9u, it wasn't until I started increasing to get lower PS's, that I starting getting worse results. I can see that now looking back around 7/31. Yeah, he was getting some blues but they weren't consistent.

Well, if the dental decreased his insulin needs and 1.2 was too high before the dental, wouldn't it make sense that 1.2+ (or even 1u) would definitely be too high now?

I thought a lot about this last night. I couldn't go to sleep because my mind was just racing.
 
I certainly think reducing is an option. But if you do, stay on top of ketones as well as the numbers.
It would be so nice if there was a cookbook approach for ProZinc, but it seems it works differently in every cat.

Food and food timing seems to play a role. If you gave him a lower lo carb snack an hour or so before the higher number at +8, would that smooth things out? ( for example, if you usually give 6%, give 3%?)

I would suggest making one change at a time and monitoring it for a couple days.

If you are getting incredibly frustrated, Lantus and Levemir have much more of a formula approach than PZI. Course, that's an additional expense.
 
Sue and Oliver (GA) said:
(Carl, it isn't that there is anything wrong with the meter. They can just vary from reading to reading and that can be taken into account. I don't know if it happens with one brand more than another or how prevalent it is, but it happens.)
Click to expand...

Sue, I probably said that wrong (which I'm prone to do!). I didn't mean to suggest that the meter was in "error", but was trying to say that if you consider the variance of 20% or whatever could be causing the curve to not look good, then it would need to be varying in the same direction every day (plus or minus that percentage) at the same time.
If her curve was:
AMPS: 366
+4: 320
+6: 292
+8: 364
+10: 344
PMPS: 307
and it was more or less like that for several days in a row, where she's getting a +8 that was higher than a +10 and +12, it could be that the meter was showing a + variance at +8, and a - variance at +10 and +12. But if the meter is going to be "off" by up to 20%, you'd expect it to be a random variance, not a consistent one in terms of whether it's positive or negative, wouldn't you?
An optimist could look at that curve, figure in the variances and it would look like this:
AMPS 366
+4 288 (-10%)
+6 234 (-20%)
+8 292 (-20%)
+10 310 (-10%)
PMPS 368 (+20%)
Nice shaped U curve, starts and ends at the same place with a 35% drop or so. If I got curves like that, I'd just increase the dose to bring all the numbers down and keep that nice conservative drop going.

A pessimist could do the opposite:
AMPS 293 (-20%)
+4 288
+6 281 (+20%)
+8 292
+10 310 (-10%)
PMPS 320 (+5%)
and walk away thinking, wow, kitty was flat, what do I do now?
You can even tweak the numbers to make this an inverse curve probably.
Meter variance sucks because it can drive you insane if you determine that "it must be the meter variance" because you'll tend to use the variances to explain away good or bad numbers.

I just find it odd that Lucky can frequently show a rise post-nadir, and then drop towards PMPS without there being a logical reason for it outside of meter variances. In her shoes, I'd definitely be paying someone to come in and repair the holes in my sheetrock walls that I'd made from banging my head against them repeatedly...
Carl
 
Sue thanks for the suggestion, I'll try to get the aquarium gravel and ketone strips soon. I already have an extra box to use. Ketones do worry me nailbite_smile I just haven't had the extra money (8+ cans of FF a day and blowing through strips gets expensive) and I thought if I monitored him and he was eating well then he'd be fine.

I think I will get one kind of food and stick with it. The most carbs he gets is 4%. I was giving him nothing but FF chopped grill, 2% for over a week to try to get better numbers but it didn't really make much of a difference. But I'll try the snack around +8 or +9 and see if that helps too.

I'm just really leery of blaming food because it's been the same schedule pretty much since we started this whole crazy dance.

Carl, thank you for explaining that! Seems like the only noticeable and troubling thing that could be a variance would be around the same time in the cycle. It's just too much of a coincidence and consistent thing to just blow it off, you know? Especially when overall his BG has been higher throughout the whole cycle and looking pretty flat to me.
 
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