9/8 KT AMPS 334 Can't get him back to 200's

[Squeaky and KT (GA)]

I haven't posted in a couple of days so there's no 'yesterday' to link to.

I'm becoming a little disheartened with Lantus - it can't seem to get KT down out of the pinks. At least we were getting down to the 200's during the day with Humulin N altho' it was definitely a huge up and down swing. Could we have started at too HIGH of a dose? We're at 2.25u.

I tried a pm+2 but his ears just flat refused to bleed enough....we poked 4 times and didn't get enough. Wasted 3 strips trying. His ears were good and warm. Not had that happen since we started....by the 4th problem, we were both in agreement that that was enough trying. He flinched at the sound of the lancet being cocked this morning but didn't pull away...such an Angel about all this...

Todays AMPS was 334

 

[Sienne and Gabby (GA)]

You may not have found the "right" dose yet. You're seeing very flat numbers. If this were too much insulin, you wouldn't see a flat curve. With nadirs above 300, you can increase the dose by as much at 0.5u if you will be able to monitor.

One trick with poking -- if you're having trouble getting the ear to bleed, try to give a second poke as close to the first as possible.You want to get the 2 not so good droplets to pool so you will have enough blood for the strip.

Did you get my PM from yesterday?

 

[Squeaky and KT (GA)]

Morning Sienne and the rest of LLand!

We normally don't have a problem getting his ear to bleed - usually only have to poke once. That's what made this so frustrating for both of us last night. Until this diagnosis, he didn't care for his ears to be rubbed or really messed with. As soon as we had the dx and prior to getting the meter, I started messin' with them - took about a week before he accepted it just as anything else.

So are you saying up it to 2.5 or 2.75? I'll be able to monitor more if I wait until Sat. to increase it.

I just replied to your pm......

 

[Squeaky and KT (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

Question this afternoon. Why would KT's BG go up to the 300's when we raised the dose by .25 units? As you'll see, I haven't seen a yellow AMPS for days. I see that it's flatter - is that a better thing that the swing?

 

[julie & punkin (ga)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

i think the answer is that sienne is saying if you want, you can increase .5 to 2.75.

 

[Squeaky and KT (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

But why would it go UP when I raised the dose on Sept 5th?

Yes I'm going to raise him Saturday. I'll need to do more tests when I do and have enough strips to add 2 extra tests a day if I wait. I can't get more strips until Monday.

 

[Jessica & Boo Radley]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

Boo did the exact same thing on my last few dose increases. He was flat just like KT but only yellow and as of recent...we've been in pink land more and more as I increase. I reason that his body has gotten "used to" being higher, so as I increase the dose, he's reacting by putting out more sugar. The pattern/cycle will break it's just a matter of when.

I'm glad you are going to take the 0.5 increase and hope it is the catalyst you need!

 

[julie & punkin (ga)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

i don't know the exact reason you're seeing that. but in some ways i think you are at a disadvantage to having your prior experience of FD to compare to. it could be that KT is having an entirely different experience this time and you may have to think only of what's working this time around.

what i do know is that we often (maybe always?) have to go up in dose inorder to go back down. you have to find that sweet spot dose that moves KT down into the 50's - and personally, i wouldn't worry about what that dose is, i'd just go for it to keep her from sitting in high numbers too long.

 

[julie & punkin (ga)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

ah, so you saw what i originally posted in the earlier comment about new dose wonkiness. after i posted that i decided that that likely isn't what you're seeing right now (and i edited my comment) because it's been several shots since you increased KT's dose. that NDW shows up pretty much immediately with a new increased dose.

so i'm not sure, but it's good for you to know about it anyway - if you increase on saturday then you may see it, and it's good to know that you just hold the dose til the wonkiness passes.

 

[julie & punkin (ga)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

sorry to keep reposting - but i know you're online and don't want to mess you up. it very well could explain why the numbers went up after 9/5 - i don't know why they haven't come back down, because my guess would've been that NDW would've cleared by now. but possibly not. i'm not really confident on that part. if you're waiting til saturday to increase, and you see KT's numbers come down by then, it will tell you that KT takes a little longer to clear NDW. that would be good information to know.

 

[Squeaky and KT (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

.............. The pattern/cycle will break it's just a matter of when.

What is that cycle doing to their bodies when they dump all that extra sugar?

 

[Jessica & Boo Radley]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

.............. The pattern/cycle will break it's just a matter of when.

What is that cycle doing to their bodies when they dump all that extra sugar?

Keep in mind, this is only my opinion. These are type 2 kitties, which means they do have some pancreatic function (or at least most of them do). I think you're asking what is going on when they dump the sugar.

In the world of diabetes...the pancrease has two types of cells, alpha and beta cells. Alpha cells secrete glucagon (which stimulates the liver to convert glycogen to glucose for use) and beta cells secrete insulin. In a non diabetic world, high blood glucose levels stimulate the release of insulin. Insulin allows glucose to be taken up and used by insulin-dependent tissues. Conversely, high insulin levels stimulate the release of more glucagon so that more sugar can be released. Thus, glucagon and insulin are part of a feedback system that keeps blood glucose levels at a stable level.......in a normal patient that is.

Now, enter diabetic world....the whole feedback system isn't working correctly. If I think about Boo, he was probably showing me signs of diabetes for at least 3-4 months before we were "diagnosed". That means his pancrease (and body for that matter) got used to high blood sugars without adequate insulin - he functioned for quite a long time before he went into crisis.

Then along comes the magical diagnosis of diabetes and we begin injecting insulin - something that's needed, but something that has been foreign to his body for some time. I would surmise that the longer a cat has gone undiagnosed, the more used to high levels they are. So conversely, the longer it will take to retrain that pancrease and liver.

As you know, we start low with Lantus. We add a little bit at a time to their broken feedback systems and because it's broken, they react to something that would lower than blood sugars the only way their body knows how right now...but producing more sugar (glucagon).

Say for example your cat is used to running at 200 and runs that way on 1 U of insulin. If I up the dose to 1.5, more sugar is going to be used (because it takes insulin to make sugar "work) and their body's are going to say "What is going on....my blood sugar is dropping and could drop further than I'm used to so I need to make and release some extra sugar to keep myself at least at 200, or hey maybe a little bit higher (bounce) just in case....and the cycle begins.

Think of yourself as the coach and your cat's in training.....a time will come when you've outlasted the cycle. It took 3-4 months I'd say for Boo's body to get used to high numbers. I sure hope it doesn't take 3-4 for it untrain, but it would make sense to me if it did....

And there you go....Opinion 101 by Jessica :lol:

 

[Squeaky and KT (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

Even ANOTHER question.... how long can a cat go undiagnosed and still be healthy looking and acting?

 

[Jessica & Boo Radley]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

Even ANOTHER question.... how long can a cat go undiagnosed and still be healthy looking and acting?

The answer you don't want to hear....ECID ;-) :roll: ;-)

 

[Sienne and Gabby (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

Probably for quite some time. It all depends on how low or how high the BG levels are and whether there are complications. I suspect Gabby was symptomatic for some time and I was oblivious. I was dealing with a 20+ yo dying cat, and then a new kitten. I didn't know who was eating what. By the time Gabby was diagnosed, she was very ill -- DKA, pancreatitis, and hepatic lipidosis. She's always produced a good amount of urine so it didn't dawn on me that this was as excessive as it turns out it was. I'd actually had her in for a check up several months before and her BG was normal (I think).

Great explanation by Jessica!

 

[Squeaky and KT (GA)]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

I asked because KT has drank massive amounts of water and peed gallons since he was a kitten. That wasn't one of the things that made us think there was something wrong. Looking back, I've wondered if he was diabetic since then, 8 years ago. He was an EXTREMELY active kitten when he wasn't locked in his room for some of his stunts. His life was nothing but chaos his first 2 years - moved 4 times, traveled in motorhome, lost our 2 elderly dogs within months of each other and rescued a 2 year old ShihTzu doll. I read someone somewhere say anything bigger than a peach in the lb is too much - his are sometimes cantalopes... :YMSIGH:

 

[Libby and Lucy]

I would definitely increase KT's dose, and I also would increase more aggressively than you are. The longer they sit in higher numbers, the more insulin it usually takes to break through those higher numbers. That's why the protocol suggests holding doses for (in most cases) 3-4 days. By then you should have an idea of whether the dose will work, and if not, you move on to the next dose. The goal of a tight regulation protocol is to get them into good numbers as quickly as we safely can. Re-read the Tight Regulation Protocols sticky for a refresher, and try to follow those guidelines. It has been 7 cycles on 2.25u and nadirs have been in the 300s, so you can increase to 2.75 units BID. If you're uncomfortable with 2.75, then I would try 2.5 for three days and then see if he needs another increase.

Flat pink numbers like this mean that you haven't gotten to his dose yet. You'll get there!

 

[Jessica & Boo Radley]

Re: 9/8 KT AMPS 334 Can't get him back to 200's QUESTION

I asked because KT has drank massive amounts of water and peed gallons since he was a kitten. That wasn't one of the things that made us think there was something wrong. Looking back, I've wondered if he was diabetic since then, 8 years ago. He was an EXTREMELY active kitten when he wasn't locked in his room for some of his stunts. His life was nothing but chaos his first 2 years - moved 4 times, traveled in motorhome, lost our 2 elderly dogs within months of each other and rescued a 2 year old ShihTzu doll. I read someone somewhere say anything bigger than a peach in the lb is too much - his are sometimes cantalopes... :YMSIGH:

The reason we have a shot at getting these cats into remission is that type II is not a total loss of function. Anything's possible. KT may have never been playing with a fully functioning pancreas but functional enough to survive. If I look back, Boo has been ravenous his whole life - 4 years. This cat would eat anything (and I mean it....broccoli, pickles, peas, corn, Doritos, and on and on.....). It was almost a joke around our house. We'd sit down to the dinner table and Boo had own seat. He'd sit there, in a seat just like us, waiting in the hopes that he got a sampler plate. Not normal behavior and now in hindsight...probably a big sign that he was always struggling to be able to use sugar correctly - after all......he was always starving.

If KT's pancrease isn't completely on, digestion can be affected and that may explain the large poos. Do they look "fatty" to you, or seem to have an unseemingly foul smell?

 

[Squeaky and KT (GA)]

LOOK AT OUR SPREADSHEET!!! A YELLOW PMPS!!!!!!!!!!! I just had to tell it I was disappointed... ;-)

It's his pees that are large amounts that are the cantelopes. His poop smells AWFUL terrible and is semi-soft part of the time. The poop problem seems to surround what he eats.

I AM going to increase to 2.75u saturday....

 

[Jessica & Boo Radley]

"Squeaky and KT" His poop smells AWFUL terrible and is semi-soft part of the time. The poop problem seems to surround what he eats.

You two are not in any sort of crisis, but when things have settled down....I'd encourage you to check in with your vet armed with some thoughts about the following:

There are two types of pancreatitis, chronic and acute. Both are inflammations of the pancreas, a gland that we know produces Insulin and glucagon (as we discussed above), and also digestive enzymes, which the body uses to break down the foods we eat. Chronic pancreatitis may cause the loss of the ability to secrete insulin (diabetes) and also the enzymes the body needs to digest foods. The resulting condition, known as pancreatic insufficiency, is signaled by weight loss -- either gradual or sudden-- and foul-smelling stools or diarrhea and can also lead to diabetes (polyuria - peeing, polydipsia- thirst, polyphagia- hunger).

It would definitely take some tests to truly diagnose this in KT and he very well may not be a pancreatitis kitty....and as mentioned before, you're not in a crisis state, so this isn't "urgent". As your getting the blood sugar figured out, do some research on how chronic pancreatitis is treated and diagnosed (especially in humans because the science is much more advanced than what I've seen in animal medicine), so that you are cued into what your vet should be looking for.

Chronic pancreatitis is treated through preventive medicine - the goal being to prevent flare ups.....The bottom line is......knowledge is definitely key and like anything else, the more you know.....

You're doing great and know right now you have plenty on your plate getting the blood sugar in line. KT is a patient kitty and sounds like he's on board for this journey! Hurray for the yellows today :RAHCAT :dizcat

 

[Squeaky and KT (GA)]

Chronic pancreatitis sounds ominous.....but fits so much of what's happened to him over the last 4 months or so. I'll study more.

 

[Marje and Gracie]

What a great and informative condo today.

Lyresa...I know this is discouraging and difficult. We've all been there at some point or another but it doesn't help because it's your kitty that is affected. Just hang in there...you will get to his breakthrough dose. Don't hold his doses too long....Libby has the best suggestion on that. It'll happen.

Let's see....has Julie told you the old LL saying: "it's a marathon, not a sprint". :lol: :lol: Sending you hugs!