Black again

[Melissa and Celle]

Celle may be getting a tiny bit better action mid-cycle (her +8 today was the best we've had in a while), but she's sky high by the time of her next shot. 500s are so depressing to see.

If the data indicate that she just needs more insulin, could someone explain what is thought to be happening phyisologically? Can the insulin be used up? This looks to me like Pro-Zinc where the insulin is just not active beyond a certain time. We've never had good pre-shot values no matter the dose. It's just getting hard to see how we're ever going to get Levemir to work if she can't hold on to it long enough to make it to the next shot. How does more insulin help her to do that unless there is some sort of process that consumes the insulin throughout the day until it is gone?

Of course, I also keep seeing that her pre-shots are higher the higher the dose. I know everyone is convinced this isn't rebound, but I don't understand why we'd see this pattern if it isn't. Can anyone think of a spreadsheet where this pattern of a sharp increase to 500 at the end of a cycle was corrected by an increased dose?

I'd be grateful for any thoughts on this. I feel like I keep asking the same questions, but I just don't get it yet.

 

[pamela and tigger]

Melissa, all I can say is that the rapid climb back up could very well be due to the infection that your vet is treating with the Baytril. Hopefully you will have some answers from the culture that is due back.

BTW I was under the impression that doing a culture after starting antibiotics resulted in inconclusive results. I believe Dr. Lisa has said it would be better to be taken off the antibiotic for a few days and then get a culture. Can you ask your vet about that? Also, maybe also a switch to another AB depending on what the culture shows of course. Dr. Lisa is not that crazy about using Baytril.

I know five's aren't fun to see. But those two's today are encouraging. Hang in there, okay? See what the vet says this week.

 

[Melissa and Celle]

BTW I was under the impression that doing a culture after starting antibiotics resulted in inconclusive results. I believe Dr. Lisa has said it would be better to be taken off the antibiotic for a few days and then get a culture. Can you ask your vet about that? Also, maybe also a switch to another AB depending on what the culture shows of course. Dr. Lisa is not that crazy about using Baytril.

Yes, the vet said that often the antibiotic can interfere with getting anything to grow, but she wanted to culture anyway to see if there would be something that maybe isn't being treated by the Baytril.

Melissa, all I can say is that the rapid climb back up could very well be due to the infection that your vet is treating with the Baytril. Hopefully you will have some answers from the culture that is due back.

Do you mean just that infection can cause wonky results (as Vicky says), or because this pattern specifically is seen with infection?

 

[Lana & Yoyo]

Melissa,

Looking at your SS as a whole, you have tried everything to find a good dose. I am curious, though. I could not find anywhere on your SS where you have a BG where Celle has not gotten insulin. Most of us do some fur shots from time to time and, as a result, know what happens to our cats when they do not get an insulin shot. It might provide some helpful information to know if Celle hits 500 without insulin like she does on insulin. Might wait until her infection is cleared up to try anything experimental, though.

Lana

 

[Melissa and Celle]

Looking at your SS as a whole, you have tried everything to find a good dose. I am curious, though. I could not find anywhere on your SS where you have a BG where Celle has not gotten insulin. Most of us do some fur shots from time to time and, as a result, know what happens to our cats when they do not get an insulin shot. It might provide some helpful information to know if Celle hits 500 without insulin like she does on insulin. Might wait until her infection is cleared up to try anything experimental, though.

That's an interesting question. I haven't had a fur shot in a while -- not since starting Levemir anyway. And I didn't check her BG when I did get a fur shot in the past because I had never thought of it as useful information. The only exception was back in March. It was her first week on Lantus at 1 unit. I got a fur shot and followed up with 1/2 unit. At +10.5 she was 490. She eventually went all the way to 5 units of Lantus, and I never had anything that looked like rebound on the way up. So... it was a while ago and only one data point, but I think it suggests that yes, she very well might hit 500 with no insulin.

That actually helps a lot to reassure me that this isn't rebound now. Thank you! But I'm still confused why she essentially has no Levemir in her system late in the cycle if it's supposed to be long acting.

 

[Lana & Yoyo]

I'm still confused why she essentially has no Levemir in her system late in the cycle if it's supposed to be long acting.

Celle is taking a drug. It is impossible to factor in if it might have some effect on her blood sugar -- we don't know. Her infection is also likely having an effect.

I asked about BGs after missed insulin because it is unusual (well to me, anyway) to see a spreadsheet where there is not much difference in BG at 0.5 units and 2.50 units. You would expect to see some tiny difference at least (numbers better or numbers worse) but Celle is mysterious --- as cats like to be, I guess.

Lana

 

[Vicky & Gandalf (GA) & Murrlin]

Wow, her cycle today does not make much sense. You got enough tests in to tell there was never a time that she went low. In fact, you have done very good data gathering recently! If you have another day to go on 2.25U, (for 3 days on dose) she might respond better tomorrow. If she's still in the 200s midcycle tomorrow like today, you should probably raise the dose again.

I'll just throw this out there because I know for a fact that it effects some cats, but we just had the full moon Friday in to Saturday I believe. I've not known or heard of it to produce 500s in a cat, but I suppose it's possible. But I don't think that would still be effecting her numbers tonight. I just thought it seemed interesting her first 500 in quite a while was on a day of the full moon.

I hope you get the culture results tomorrow. Glad you're getting the ketone testing down! You're doing everything you can for her at this point, she's getting more insulin which it sure looks like she needs and she's on an antibiotic, so I think you're doing well for her. I'm just sorry her BGs aren't responding in kind!
:YMHUG:

 

[pamela and tigger]

BTW I was under the impression that doing a culture after starting antibiotics resulted in inconclusive results. I believe Dr. Lisa has said it would be better to be taken off the antibiotic for a few days and then get a culture. Can you ask your vet about that? Also, maybe also a switch to another AB depending on what the culture shows of course. Dr. Lisa is not that crazy about using Baytril.

Yes, the vet said that often the antibiotic can interfere with getting anything to grow, but she wanted to culture anyway to see if there would be something that maybe isn't being treated by the Baytril.

Melissa, all I can say is that the rapid climb back up could very well be due to the infection that your vet is treating with the Baytril. Hopefully you will have some answers from the culture that is due back.

Do you mean just that infection can cause wonky results (as Vicky says), or because this pattern specifically is seen with infection?

Both....the infection muddies the whole picture. You can Google infection and diabetes and you will find tons of results. It is pretty common they go hand in hand as far as effecting bg numbers. Getting the infection cleared up (if there is one since we don't know without the culture), is the most important thing to pursue right now before anyone can offer any other conclusions for her high and erratic numbers.

I hope she is eating and feeling okay still. That's important.

You know what I would do? I would ask my vet what she thinks. Have you shown her Celle's spreadsheet? Maybe if not anything else except maybe to get her attention and also her opinion. Just a thought.

 

[Melissa and Celle]

I asked about BGs after missed insulin because it is unusual (well to me, anyway) to see a spreadsheet where there is not much difference in BG at 0.5 units and 2.50 units. You would expect to see some tiny difference at least (numbers better or numbers worse) but Celle is mysterious --- as cats like to be, I guess.

I know that I'm totally confused!

If she's still in the 200s midcycle tomorrow like today, you should probably raise the dose again.

I unfortunately won't be able to get a midcycle today. I was planning to raise it this evening on the basis of the weekend's numbers. No one seems to have an idea of why she's getting 500s, and we know decreasing didn't allow her to settle on a dose that worked, so increasing seems to be the only other thing to try.

One thing I've noticed is that she gets the 500s following a full curve. Could the stress of so much testing be part of the problem? She doesn't object to the set-up as we prepare for the ear prick. She gets lots of love and a treat afterwards (EVO wild cravings). But she is getting more and more bothered by the prick itself. She's starting to really jerk her head as I go to prick and making it all the more difficult to do. Any suggestions on how to do a more gentle prick?

I hope she is eating and feeling okay still. That's important.

Yes, she seems to feel OK and still has an appetite. She may be a little more lethargic at the highs than the lows, but that's all I've noticed.

You know what I would do? I would ask my vet what she thinks. Have you shown her Celle's spreadsheet? Maybe if not anything else except maybe to get her attention and also her opinion. Just a thought.

She doesn't have any thoughts on dosing at this point. I think Celle's numbers are sufficiently confusing that she's not sure where to go from here either. She doesn't have many patients who do the amount of testing that we do (if any), so her experience in looking at a lot of data is kind of limited I think. We may also be her only cat on Levemir. She usually uses Lantus, and others in the practice use ProZinc. We pushed to try Levemir when that wasn't working. Her recommendation was to look for what else might be going on. So in addition to the urine culture we did an xray to check for bladder stones that can cause recurrent infections. The xray was negative. An ultrasound would be needed to definitively rule that out though. We also did a full blood panel. We both were a little surprised to realize that we hadn't done one since long before the diagnosis. We have 4 cats, each with their own suite of issues, so it seems like we've been doing nothing but blood panels in the last 6 months, but never for her. The results should come in today or tomorrow I think.

 

[eeraby]

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[pamela and tigger]

We also did a full blood panel. We both were a little surprised to realize that we hadn't done one since long before the diagnosis. We have 4 cats, each with their own suite of issues, so it seems like we've been doing nothing but blood panels in the last 6 months, but never for her. The results should come in today or tomorrow I think.

Good! That should help answer some questions. Glad she is finally doing one (be sure to get a copy for yourself if you don't already).

I know this is grabbing at straws, but what length needles are you using? I had some limited success at one point when I went from the 5/16s to the 1/2s. My vet was mildly shocked I was using the short ones. Theory is that the short ones were only going into the skin and not under it. I've seen a few other posts here and there where the 1/2s made a difference.

Beth, I was thinking that exact same thing earlier when I was thinking about Celle, but I had forgotten it until you mentioned it. But come to think of it Melissa, I think you gave a link earlier for the Monojects that you are using and they were 1/2"(?)

 

[Melissa and Celle]

I know this is grabbing at straws, but what length needles are you using? I had some limited success at one point when I went from the 5/16s to the 1/2s. My vet was mildly shocked I was using the short ones. Theory is that the short ones were only going into the skin and not under it. I've seen a few other posts here and there where the 1/2s made a difference.

Yes, we're using 1/2" needles. But thanks for the thought. Any ideas are helpful at this point.

 

[eeraby]

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[Vicky & Gandalf (GA) & Murrlin]

K, so it's not the length of the needle.

Vicky: I know absolutely naught about split dosing. Nothing at all. But... would that be something to be considered here?

Not really. My kind of split dosing is only to extend duration a couple hours. With Melissa's limited ability to test, I wouldn't recommend TID dosing either. That takes a very detailed approach and you should know where the BGs are headed and how fast before each shot. Unless someone has a very experimental approach and can consistently gather data, it's not something I would recommend.

The idea at this point is to keep increasing until she has a break through. I see she had her lowest PMPS in quite a while tonight. That's the right direction at least!

 

[eeraby]

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