Confused and frustrated with increase results

[Misterbeesmom]

I had posted this on main board around 7:30 am but it was kindly suggested i might get better response here.

Original post:

I'm going insane.

Its been 48 hours after an increase. Before the increase we were stuck in the 300's and now after the increase we are STILL stuck in the 300's. Lantus. Alphatrak.

What the hell am i doing wrong!?!? Its been 6 months since his diagnosis and we STILL cant get him regulated. I feel like throwing up.

This cant be NDW at this point. Should i lower his dose? We increased it because he was in the 300's. No idea what to do.

UPDATE: its +2 275. Never thought i'd be so happy just to see a damn yellow, though its still hyper. Will continue testing throughout day..... +4 264....

 

[Wendy&Neko]

Here is your last post here: http://www.felinediabetes.com/FDMB/threads/in-honor-of-a-yellow-day.157244/ Adding those links helps us go back and see what was discussed before and it helps us help you and Mr. Biddles.

I see you've now gotten a yellow, so the title isn't correct anymore. On the first post of your thread, on the upper right you'll see a drop down menu called Tread Tools. Click on that to edit the title and add or remove a prefix like the ?, if things change throughout the day.

Not sure if you still have a question about pinks, but I'll see if I can answer anyway. There are some secondary conditions that make it harder to get regulated. Pancreatitis and hyperthyroidism are two such secondary conditions and I see Mr. Biddles has them. It's still possible to get regulated, but not as easy.

I think that some of the problems with getting regulated may be the way in which increases have been done. We decide how to increase, and even whether to incease based on how low a current dose is taking the kitty. When kitty is getting low blues, like Mr. Biddles was getting on 4.5 units, we only go up by 0.25 units, if an increase is warrented. It's too easy to bypass a good dose and end up on too much insulin when a current dose is pretty good. On May 9th and 10th, you were getting some pretty good numbers, especially since those low blues were on the AlphaTrak.

The other thing that you absolutely have to try to do is to get tests before giving insulin. You have to know whether it's safe to give insulin. Every once in a while here we see someone who shot too low, and it's a scary time. The second thing you need to try to do is to get some more mid cycle tests, especially those at night. I know @Chris & China has said this before. You are missing half your data. Many cats go a lot lower at night during the day. Neko once went a stretch of three months bouncing during the day and going low (and earning reductions) during the night. If I would have looked at just the daytime data, I would have increased her when she actually needed less insulin. Please try to get test every night before you go to bed. It could be he's going blue and green overnight and bouncing to pink during the day. But we don't know that without testing.

And lastly, since Mr. Biddles +2 test was less than his preshot, that can indicate a more active cycle today. I would plan on gettng a +4 or +5 at least today.

 

[tiffmaxee]

Wendy said it all. Max is another one that drops at night.

 

[Misterbeesmom]

Here is your last post here: http://www.felinediabetes.com/FDMB/threads/in-honor-of-a-yellow-day.157244/ Adding those links helps us go back and see what was discussed before and it helps us help you and Mr. Biddles.

I see you've now gotten a yellow, so the title isn't correct anymore. On the first post of your thread, on the upper right you'll see a drop down menu called Tread Tools. Click on that to edit the title and add or remove a prefix like the ?, if things change throughout the day.

Not sure if you still have a question about pinks, but I'll see if I can answer anyway. There are some secondary conditions that make it harder to get regulated. Pancreatitis and hyperthyroidism are two such secondary conditions and I see Mr. Biddles has them. It's still possible to get regulated, but not as easy.

I think that some of the problems with getting regulated may be the way in which increases have been done. We decide how to increase, and even whether to incease based on how low a current dose is taking the kitty. When kitty is getting low blues, like Mr. Biddles was getting on 4.5 units, we only go up by 0.25 units, if an increase is warrented. It's too easy to bypass a good dose and end up on too much insulin when a current dose is pretty good. On May 9th and 10th, you were getting some pretty good numbers, especially since those low blues were on the AlphaTrak.

The other thing that you absolutely have to try to do is to get tests before giving insulin. You have to know whether it's safe to give insulin. Every once in a while here we see someone who shot too low, and it's a scary time. The second thing you need to try to do is to get some more mid cycle tests, especially those at night. I know @Chris & China has said this before. You are missing half your data. Many cats go a lot lower at night during the day. Neko once went a stretch of three months bouncing during the day and going low (and earning reductions) during the night. If I would have looked at just the daytime data, I would have increased her when she actually needed less insulin. Please try to get test every night before you go to bed. It could be he's going blue and green overnight and bouncing to pink during the day. But we don't know that without testing.

And lastly, since Mr. Biddles +2 test was less than his preshot, that can indicate a more active cycle today. I would plan on gettng a +4 or +5 at least today.

Had to take a while to process the above. Thank you for all that information. I did get a couple of night readings but not recently and not enough.

I think i have to manage my expectations. I thought i could get him regulated sooner, thus healing his pancreatitis. Silly me.

Now i'm debating, depending on the rest of todays readings, that i might drop down to 4.5 or a fat 4.5 at least.

 

[tiffmaxee]

Max has had chronic pancreatitis for 6+ years. I have not been able to get him into remission but at least he is pretty tightly controlled. I'm not suggesting you won't have better luck but I do think the healing might take a while

 

[rhiannon and shadow (GA)]

hmm....
Is he on any pain medication?
Pancreatitis is painful... arthritis is too...
My sweet GA Shadow had severe arthritis and hid it very well but once we addressed her pain.... her numbers went down.

the best one is bupenorphine....
your vet can call it in or fax a prescription to www.diamondbackdrugs.com

I was getting 10 mL for $41 ( including shipping)

Shadow didn't tolerate pain medications very well so she got 0.1 mL morning and night.
The normal dose is 0.3 mL ....

It would certainly be worth a try and you could at least make him feel a little better.

 

[Misterbeesmom]

hmm....
Is he on any pain medication?
Pancreatitis is painful... arthritis is too...
My sweet GA Shadow had severe arthritis and hid it very well but once we addressed her pain.... her numbers went down.

the best one is bupenorphine....
your vet can call it in or fax a prescription to www.diamondbackdrugs.com

I was getting 10 mL for $41 ( including shipping)

Shadow didn't tolerate pain medications very well so she got 0.1 mL morning and night.
The normal dose is 0.3 mL ....

It would certainly be worth a try and you could at least make him feel a little better.

His spec fpl at dx was 7. It went up to 9 earlier this year and is now 12.

Initially we put him on bupe just in case he was in pain, though it didnt seem he was (i know its hard to tell with cats, i know) but the bupe didnt seem to affect him except make him spacey, restless, and constipated. For all those reasons, we stopped it.

Tried Oncior for a few days and, like the bupe, he didnt seem any more or less happy. I was nervous on that one and we stopped it. Good thing too cuz he did develop liver upset.

He is on adequan for arthritis.

We have seen several vets MANY times since nov 2015 and none have recommended pain med, other than that first trial with bupe. Same vet was aware and in agreeement when we stopped.

 

[Misterbeesmom]

Max has had chronic pancreatitis for 6+ years. I have not been able to get him into remission but at least he is pretty tightly controlled. I'm not suggesting you won't have better luck but I do think the healing might take a while

My biggest fear since dx has been that this is just going to be one long unpleasant road and then i'll lose him to some diabetes related illness despite all our hard work. So i get cagey when i see we've made little or no headway in 6 months. Mr b is a senior of uncertain age, so its unlikely we have several years to work this out. Know what i mean? This has been excruciating, and i'm his sole caretaker, so we're on our own. I get really distressed, like this morning. I feel a little better after seeing some yellows today.

It really is consistent to say, if mr b doesnt feel well, neither do i.

 

[Sienne and Gabby (GA)]

I think Wendy outlined the issues eloquently. The other consideration is that even if your cat goes into remission, it's no guarantee that his pancreatitis will be cured. The pancreatitis is likely what caused or contributed to the diabetes, not the reverse.

 

[Critter Mom]

Shadow didn't tolerate pain medications very well so she got 0.1 mL morning and night.

Hi Rhiannon,

I saw this and I'm giving Saoirse buprenorphine at the moment. I wonder, did you give Shadow bupe every day long term? I can't get much input from our vets on this but I think Saoirse could benefit from it if it's possible to administer a low dose of bupe on a chronic basis.


Mogs

(@Misterbeesmom - Jen, please excuse the slightly off-topic post.)

.

 

[Wendy&Neko]

@Critter Mom - Neko has been on buprenorphine for over two years for her arthritis and other acromegaly related pain.

Jen - sometimes it takes playing with the amounts of buprenorphine to find a dose that works long term for a given cat. I have two cats currently on bupe, both are very similar size/weight. One is on twice the dose of the other. One short term, one long term. You may not need to give in all the time, but it's good to have around if they are having a pancreatitis flair.

 

[Misterbeesmom]

@Critter Mom - Neko has been on buprenorphine for over two years for her arthritis and other acromegaly related pain.

Jen - sometimes it takes playing with the amounts of buprenorphine to find a dose that works long term for a given cat. I have two cats currently on bupe, both are very similar size/weight. One is on twice the dose of the other. One short term, one long term. You may not need to give in all the time, but it's good to have around if they are having a pancreatitis flair.

Ok here's a stupid question. How would i know if he was having a pancreatitis flare? How does a cat behave when that happens? Tnx

 

[Critter Mom]

Neko has been on buprenorphine for over two years for her arthritis and other acromegaly related pain.

That's really helpful, Wendy! Thank you so much!!! I'm sorry that Neko needs it but I'm very glad it helps her.




Mogs
.

 

[Critter Mom]

How would i know if he was having a pancreatitis flare?

With Saoirse, she becomes lethargic, has low mood, retreats somewhere after eating, sometimes likes to park herself on a cooler surface (e.g. stone/tiled floor), and she sits in a tense meatloaf or semi-crouched position (tell tale is if her shoulders look raised/tense and her 'elbows' are pointed backwards). She's on anti-nausea meds full time but before that she would perform exaggerated yawns and lip-licking after eating something and also she would be reluctant to eat - some foods more than others. I found the following nausea symptom checker immensely helpful as an aid to learning how to 'listen' to her better. I also found the IDEXX pancreatitis treatment guidelines helpful.


Mogs

ETA:

Another sign I forgot; some days she just seems not right in herself.

 

[Misterbeesmom]

With Saoirse, she becomes lethargic, has low mood, retreats somewhere after eating, sometimes likes to park herself on a cooler surface (e.g. stone/tiled floor), and she sits in a tense meatloaf or semi-crouched position (tell tale is if her shoulders look raised/tense and her 'elbows' are pointed backwards). She's on anti-nausea meds full time but before that she would perform exaggerated yawns and lip-licking after eating something and also she would be reluctant to eat - some foods more than others. I found the following nausea symptom checker immensely helpful as an aid to learning how to 'listen' to her better. I also found the IDEXX pancreatitis treatment guidelines helpful.


Mogs
.

Excellent info. Thank you.

 

[Doodles & Karen]

It really is consistent to say, if mr b doesnt feel well, neither do i.

You've come to the right place as we all understand and feel the same way! Keep reading the stickies and post as often as you'd like. Very knowledgeable and like minded people here for support. This is one of my favorite links that I refer to often and keep it book marked. Where Can I Find Keep asking questions and hang in there.

 

[Critter Mom]

Excellent info. Thank you.

Glad I could do some little thing to help, Jen. Pancreatitis sucks. Big time.

A thought: I didn't know that pancreatitis could potentially affect the eyes. I'd recommend to anyone whose cat has pancreatitis to get regular eye checks. (Saoirse lost an eye to uveitis earlier this year and her opthalmologist is fairly certain it was connected to the pancreatitis; the latter started to flare up quite badly towards the end of last year (knocked her out of remission) and the Spec fPL taken prior to her eye problems was >50. I had never heard of uveitis before.

WRT remission, as soon as Saoirse's Lantus treatment was withdrawn her pancreatitis symptoms started to re-emerge. Even though she was still in the normoglycaemic range after a couple of months I wanted to reinstate her Lantus treatment (once daily token dose) to give her pancreas the little bit of support it needed. Unfortunately our own practice referred Saoirse out to a specialist centre and one of their vets put a block on her getting another Lantus Rx on the grounds that it's not safe to give a cat insulin unless its preshots are over the renal threshold. She may be a feline specialist but she hasn't a clue about how Lantus works. <sigh> Furious doesn't even come close to how I felt then and I feel a lot angrier toward her now; if she had not been so arrogant and inflexible Saoirse might not have lost her eye - and gone through an awful lot of potentially unnecessary pain as a consequence.


Mogs
.

 

[rhiannon and shadow (GA)]

Mogs,
I would've found another vet... but we all are on a learning curve here.... hindsight is always better than what we are going thru at the time.

Yes. Shadow was on the bupe long term.... she just couldn't handle a normal dose.... she would get dysphoric.

Most cats will meatloaf when they are in pain.... and there is an attitude that goes with it.
Shadow wasn't one to meatloaf so much but she would go find a hard surface to lay on... towards the end, she spent most every moment
under the dining room table. She wouldn't come to bed at night anymore after years of doing so....
She didn't even come wake me to say feed me.... or come bite my chin.
That's when I knew. All her normal daily behaviours changed.....
Some cats start hiding more... in closets... under the bed....

 

[Critter Mom]

@rhiannon and shadow (GA)

(((Rhiannon)))

.

 

[Misterbeesmom]

Glad I could do some little thing to help, Jen. Pancreatitis sucks. Big time.

A thought: I didn't know that pancreatitis could potentially affect the eyes. I'd recommend to anyone whose cat has pancreatitis to get regular eye checks. (Saoirse lost an eye to uveitis earlier this year and her opthalmologist is fairly certain it was connected to the pancreatitis; the latter started to flare up quite badly towards the end of last year (knocked her out of remission) and the Spec fPL taken prior to her eye problems was >50. I had never heard of uveitis before.

WRT remission, as soon as Saoirse's Lantus treatment was withdrawn her pancreatitis symptoms started to re-emerge. Even though she was still in the normoglycaemic range after a couple of months I wanted to reinstate her Lantus treatment (once daily token dose) to give her pancreas the little bit of support it needed. Unfortunately our own practice referred Saoirse out to a specialist centre and one of their vets put a block on her getting another Lantus Rx on the grounds that it's not safe to give a cat insulin unless its preshots are over the renal threshold. She may be a feline specialist but she hasn't a clue about how Lantus works. <sigh> Furious doesn't even come close to how I felt then and I feel a lot angrier toward her now; if she had not been so arrogant and inflexible Saoirse might not have lost her eye - and gone through an awful lot of potentially unnecessary pain as a consequence.


Mogs
.

That is just incredibly tragic and awful. I am so sorry! That cannot be an easy situation to cope with.

If that was a medical doc for humans, it'd be malpractice.

Both vets plus a neurologist have checked his eyes. I was thinking more along the lines of diabetes putting them at risk, not so much the pancreatitis. Either way good to know!

 

[Misterbeesmom]

Here is your last post here: http://www.felinediabetes.com/FDMB/threads/in-honor-of-a-yellow-day.157244/ Adding those links helps us go back and see what was discussed before and it helps us help you and Mr. Biddles.

I see you've now gotten a yellow, so the title isn't correct anymore. On the first post of your thread, on the upper right you'll see a drop down menu called Tread Tools. Click on that to edit the title and add or remove a prefix like the ?, if things change throughout the day.

Not sure if you still have a question about pinks, but I'll see if I can answer anyway. There are some secondary conditions that make it harder to get regulated. Pancreatitis and hyperthyroidism are two such secondary conditions and I see Mr. Biddles has them. It's still possible to get regulated, but not as easy.

I think that some of the problems with getting regulated may be the way in which increases have been done. We decide how to increase, and even whether to incease based on how low a current dose is taking the kitty. When kitty is getting low blues, like Mr. Biddles was getting on 4.5 units, we only go up by 0.25 units, if an increase is warrented. It's too easy to bypass a good dose and end up on too much insulin when a current dose is pretty good. On May 9th and 10th, you were getting some pretty good numbers, especially since those low blues were on the AlphaTrak.

The other thing that you absolutely have to try to do is to get tests before giving insulin. You have to know whether it's safe to give insulin. Every once in a while here we see someone who shot too low, and it's a scary time. The second thing you need to try to do is to get some more mid cycle tests, especially those at night. I know @Chris & China has said this before. You are missing half your data. Many cats go a lot lower at night during the day. Neko once went a stretch of three months bouncing during the day and going low (and earning reductions) during the night. If I would have looked at just the daytime data, I would have increased her when she actually needed less insulin. Please try to get test every night before you go to bed. It could be he's going blue and green overnight and bouncing to pink during the day. But we don't know that without testing.

And lastly, since Mr. Biddles +2 test was less than his preshot, that can indicate a more active cycle today. I would plan on gettng a +4 or +5 at least today.

Here is your last post here: http://www.felinediabetes.com/FDMB/threads/in-honor-of-a-yellow-day.157244/ Adding those links helps us go back and see what was discussed before and it helps us help you and Mr. Biddles.

I see you've now gotten a yellow, so the title isn't correct anymore. On the first post of your thread, on the upper right you'll see a drop down menu called Tread Tools. Click on that to edit the title and add or remove a prefix like the ?, if things change throughout the day.

Not sure if you still have a question about pinks, but I'll see if I can answer anyway. There are some secondary conditions that make it harder to get regulated. Pancreatitis and hyperthyroidism are two such secondary conditions and I see Mr. Biddles has them. It's still possible to get regulated, but not as easy.

I think that some of the problems with getting regulated may be the way in which increases have been done. We decide how to increase, and even whether to incease based on how low a current dose is taking the kitty. When kitty is getting low blues, like Mr. Biddles was getting on 4.5 units, we only go up by 0.25 units, if an increase is warrented. It's too easy to bypass a good dose and end up on too much insulin when a current dose is pretty good. On May 9th and 10th, you were getting some pretty good numbers, especially since those low blues were on the AlphaTrak.

The other thing that you absolutely have to try to do is to get tests before giving insulin. You have to know whether it's safe to give insulin. Every once in a while here we see someone who shot too low, and it's a scary time. The second thing you need to try to do is to get some more mid cycle tests, especially those at night. I know @Chris & China has said this before. You are missing half your data. Many cats go a lot lower at night during the day. Neko once went a stretch of three months bouncing during the day and going low (and earning reductions) during the night. If I would have looked at just the daytime data, I would have increased her when she actually needed less insulin. Please try to get test every night before you go to bed. It could be he's going blue and green overnight and bouncing to pink during the day. But we don't know that without testing.

And lastly, since Mr. Biddles +2 test was less than his preshot, that can indicate a more active cycle today. I would plan on gettng a +4 or +5 at least today.

I took several readings today. Lowest was 264 at +4
I decreased tonight to 4.5u, taking a gamble that somehow that might help.
Will try to get overnight readings. Its hard cuz my sleep is so screwed up.

 

[Critter Mom]

That cannot be an easy situation to cope with.

Last year was very hard. Just after Saoirse went into remission she was so well! She was in flying form; her fur was kitten soft and jet black. She was relaxed, happy, and climbing trees! Within a few weeks of cessation of insulin treatment her nausea symptoms worsened and in less than 3 months her fur had started to rust again. I spent months watching my beautiful girl deteriorating again and it was agony knowing that there was a treatment available that had helped her before which stood a good chance of continuing to help her but she was being denied it out of professional arrogance and ignorance. Our own main vet trusts that I know what I'm doing but his hands were completely tied because of the specialist's intervention. What adds insult to injury is the fact that Saoirse wasn't even referred to her for anything to do with her diabetes.

It's not the first time a cat of mine has paid for veterinary mistakes.

I was thinking more along the lines of diabetes putting them at risk, not so much the pancreatitis.

Same here, Jen; I never knew that pancreatitis could have an impact on eye health. I'm really glad to hear that Mr Biddles is getting his eyes checked.


Mogs
.

 

[Jan Radar (GA)]

Jen, I'm so glad that you've gotten some assistance here today. These are for you and scritches for your sweet kitty. Breathe and know that you are not alone... none of us are alone with the care of our sweet kitties because we have each other.

 

[Wendy&Neko]

Will try to get overnight readings. Its hard cuz my sleep is so screwed up.

If you can get at least a +2 test, that will tell you if you need any later tests. Usually if the +2 is a lot lower than the preshot, more testing is a good idea. I hear you on the screwy sleep - I have a later nadir kitty, so I'm often setting an alarm for 4:30 to catch it.

 

[julie & punkin (ga)]

Just a reminder that since you reduced the dose tonight, the depot from the 5.0u could still be affecting numbers for as many as 4-6 cycles after the reduction.

Whenever things are confusing, I think getting more information is what is going to help clear up the matter.

I"m glad Wendy mentioned the problems when a kitty has other medical issues going on, like the hyperT and the p-titis. Many, many of the cats here have other chronic illnesses as well, so it doesn't mean that you can't get them under control. It just may take a little longer. With Mr. Biddles, if you think he still has a good quality of life then it's time well spent. We have a saying here, "it's a marathon, not a sprint." While I found it a bit annoying, it is, unfortunately, a very true statement. This is a one day at a time disease - there's no way to look very far down the road with it.

 

[Misterbeesmom]

+2 is 244
Not sure if that tells us much
I've been up since 4 so i dont think i'll be getting more tests tonight
Thanks all for your help and words of encouragement. Now if you will excuse me i'll go pass out