AMPS = 622; Please take a look

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Melissa and Celle

Melissa and Celle

Member Since 2011
I'm losing faith. Should I still stay the course with 4.5 units? I keep wondering if the end of the vial was not at full potency and we're way overdosing now.

UTI check was negative, and she seems fine.
 
I don't have an answer, but I'm bumping you for more experienced eyes. BTW, using the little question mark icon will draw more attention to your condo when you have something that needs to be answered!

I'm glad Celle seems fine despite that really high number. Hang in there :YMHUG: ...
 
I could really use some advice. I raised the dose from 4 to 4.5 based on the recommendations on the board and now I'm not sure if this was the right course.
 
Hi guys .. Not sure if we've been in your condo before so if not, welcome from us! I don't have any dosing advice for you but I sure hope celle comes down soon .. I know these high numbers are scary to look at .. hang in there, it will get better!
 
celle's bouncing, melissa. when you see a high, like that 622, look backwards along the spreadsheet and see if there is something lower than normal - in this case, the 200's yesterday afternoon and evening. you'll want to hold this dose for at least 6 cycles unless you see a less than 50.

it really does help if you can get anything mid-cycle at all during the week. even a just-before bed would help fill out the picture. i don't mean to nag, but it makes a huge difference in knowing what's going on.

for now though, i think this is ok. i would try not to worry about the 622 because it's bounce-caused. just stay the course. let it settle in so we can see the whole picture. there is absolutely nothing visible to suggest she needs less insulin. if anything, she needs more insulin, not less, but give it the 6 cycles to see what happens.
 
(You've probably answered this on your other posts, which I've not read.)

What are you feeding and when are you feeding? I don't see any notes about that on the spreadsheet; it may help clarify part of what is going on.
 
melissa if you can keep most of the food being eaten in the first 4 or so hours of each cycle, you'll likely see better numbers. some cats do fine free-feeding, though - this is one of those "ECID" things. but many cats do better if the food is there when the insulin action is strongest. just depends on the cat. if i recall correctly, you work long days, so perhaps it's better to have the food out & available when you are gone.
 
When she eats, is she a grazer, a bolter, or something in between?

When I zoom the spreadsheet to 50%, I wonder if I see a pattern emerging - that for each dose increase, it works for a bit, then after a couple of weeks it doesn't and you increase again. Although you aren't at an extreme dose, I am wondering if insulin autoantibodies (IAA) are a possible explanation for what is happening.
 
I guess I'd say she's more of a grazer. I don't know how we could provide food for only the first part of the cycle while at work. The amount she eats varies a lot, but with two cats I can't track it when not at home.

What would we do if antibodies were to blame?
 
Melissa --

I'm sorry I didn't respond sooner. I wanted to give your question and Celle's SS more thought and do some brainstorming with a few people.

Food may or may not be an issue. Insulin autoantibodies -- too soon to know. I'd set that aside for the moment.

Here's what I think is going on.When you switched from Lev to Lantus, you drastically reduced your dose. In fact, you started over. This had added a great deal of time to the process. I think I've commented a number of times that I believe you've been holding on to doses for too long. What I strongly suspect you're running into is glucose toxicity. Julie put together a number of resources in this post if you want to do some "light" reading. Basically, what happens is Celle's body has reinterpreted what "normal" BG levels are. Unfortunately, these are higher than normal ranges. When this happens, it makes it hard to get the numbers to come down and there's an understandable amount of bounciness. It makes sense if you're cat "thinks" normal is in the pink range. All you can really do is to steadily and systematically increase the dose until you get a breakthrough. But, you will need to not get stuck at a dose that's not working. I'd be chipping away at the numbers by raising the dose every 3 days.
 
It just seems odd that she has breakthroughs and then loses it after a couple of weeks. Just two weeks ago 100s were no problem. Thanks everyone for the help.
 
I've been going through the same thing with Trix...it's one of the annoying mysteries of FD. Trix was well-regulated on about 1U for many months, then all of a sudden late last fall, she fell out of regulation. Now, she's on F2.75, and still isn't as well-regulated as she was this time last year. FD is frustrating and fickle, but we're all here for you!
 
(((Melissa))) I can feel your frustration. Look at my Lucy's spreadsheet - she went up and down in dose a few times before she finally decided to settle in good numbers and eventually go OTJ. I would do dose reductions too quickly or before she was ready for them, and when I did too many dose reductions she would lose momentum and her numbers got worse again. Then I had to start increasing the dose again. In Lucy's case, her first breakthrough dose was 4.25u. When I had to start increasing again, again she had to go all the way to 4.25u to get another breakthrough. Sometimes, when glucose toxicity starts to set in, we see cats that have to be increased beyond their original breakthrough dose before things kick into gear again.

I remember that time with Lucy very well. I tried different food, I got new insulin, I even got a new meter and test strips thinking I had somehow damaged those! But it was just that her insulin needs had changed. It's frustrating, I know.

Celle has had breakthroughs at around 4.5 units before, so I don't think you are out of line. Also, if she was over dose you would be seeing some signs that she is dropping at times, but she actually looks pretty flat so I don't think you are missing any action. It looks like she started losing it when you started reducing at 3.75u. Usually the most successful course of action in this case is to just keep increasing the dose according to protocol until you hit a new breakthrough. Be prepared that when she does hit that breakthrough, she will probably start needing dose reductions again. You can test and you are capable of handling her numbers, so you'll be fine.

You can think about testing for IAA if you want to. At this point I don't think there is enough data to make me extremely suspicious, but it is a possibility and would also explain her patterns. I just know, from personal experience, that it is possible for a cat to have this particular type of pattern without IAA too.
 
(((Melissa))) Just offering support. I've also been there several times. I find that it is a constant up-down-up and not getting married to a single dose or being afraid to take her up to get to that breakthrough dose. It's just the dance. We've been through weeks of solids blues/greens and then out of nowhere....her numbers go up. So I take the dose right up and get her back down again.
 
Thank you for the support everyone! It is so hard to see her so high and not know how to help. I'm even out of town now and can't give her any love. Husband is taking care of her. At least she was low 400s pmps yesterday.
 
Hi, I havent posted to you yet, but just wanted to say that I was out of town too this weekend & Moonie's BG went up to 302, which is very very unusual for her...But STRESS can cause the bg's to go up as well, so that could also be the cause of this 622 as well--AND this is just One number One day...perhaps it will be totally gone by tonite or tomorrow...Yse FD is a mystery--Hope your fur baby comes down..Hugs from us!
 
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