Corduroy's BG Keeps Rising. What to do?

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blove7

blove7

Member Since 2013
Hi all,

I hope everyone and their kitties are doing well!

I'm trying to make sense of the protocol on raising the dose, but I'm still not sure. Corduroy's BG levels have been crazy lately, now at PMPS raising to 512. I thought about raising his dose to 1 unit last night, but after reading the protocol, I didn't. So, I'm wondering if I should wait for five days before I raise the dose to 1 unit or do it now?

Thanks for listening.
 
I was just thinking about you Brigitte!

You don't necessarily have to wait 5 days to increase...that's mostly for that first week when you're starting on Lantus to build the depot (there are other times it's appropriate too, like when you start to get good numbers at nadir)

That being said, I think it's possible this is a bounce...On yesterday's AMPS cycle, he dropped from 291 to 118 in only 2 hours....that's one heck of a drop! Bounces don't only happen when they go too low, they also happen when they drop quickly like that.

Also, it looks like you've been changing dose as well as not taking reductions when they were earned. It looks like a lot of times you're giving .5 one cycle and .75 the next (or vise versa) Lantus needs to be dosed the same for each cycle. Remember, dose is based on the nadir, not the pre-shot number.

On several occasions, it looks like you also didn't take a reduction when it was earned. (like back on 3/22 and 4/3)

Hopefully others will chime in soon, but I think I'd continue holding the .75 dose and see if/when he clears this bounce. Keep testing as much as possible and let's see where he's at in a few days.

Hope you're doing well, and that Corduroy will start to show better numbers for you soon!
 
Brigitte:

I'm not sure what confused you about raising the dose. It's likely that Corduroy is bouncing off of the almost 200 point drop from 291 to 101 yesterday. In most cases, we suggest that you don't increase until the bounce clears. While that's not spelled out in the TR protocol, you were wise to not increase since if the bounce broke, there could be a good deal of momentum behind the dropping numbers and even more momentum if you increased.

It it was the notion that if you were seeing nadirs that were mostly less than 200 then you hold the dose for 10 cycles, you've held the dose longer than that. On the whole, I think you've held on to the 0.75u dose for longer than you needed to. Overall, if the nadirs aren't where you want them (i.e., blues and greens), then it's time to increase the dose. You might want to take a look at the section of the TR Protocol used on the German Lantus forum on Holding the Dose.
 
Hi, thanks for responding Chris and Sienne! Chris, I've been keeping the dose at .75 lately, so I'm trying to eliminate the problem of going back and forth between .50 and .75. Also, I guess I completely didn't even think to lower the dose on 3/22 and 4/4 because his pre-shot numbers were so high. I thought I was "shooting through the bounce." I guess I'm still not clear on that :sad:

Sienne, the part that I am paying attention to in the dosage increase protocol is this:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

Since I get numbers under 200 sometimes, I then start my 3 days all over again at that number. For instance, when I got 101 at +4 on 4/26, I started my 3 days from there as opposed to the 146 on 4/24. I shouldn't do this? It sounds like you're telling me that I should increase the dose right away due to the fact that my nadirs aren't in the blues or greens, correct? However, Chris suggests that I keep it at .75 because of the possible bouncing. I guess I get confused at this too. For instance, on 4/24, when he went from 354 down to 175 in 3 hours, would you consider his PMPS of 401 that evening to be a bounce from that drop? If so, then I shouldn't increase? Or should I? Then again, on 4/26, would you consider the PMPS to be a result of the drop earlier that day from 291 to 101? Should I have increased then or not?

I'm sorry for so many questions. It's just that I often get so many different answers and I really want to do the right thing by Corduroy. It's just scary when you're not sure nailbite_smile With that said, I know everyone here is trying to help and I really do appreciate that.

Thanks,

Brigitte
 
Let me see if I can help..and hopefully Sienne will come along later too because I hate to speak for her.

I thought I was "shooting through the bounce." I guess I'm still not clear on that
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Shooting through the bounce....If you get a low number (like you did on the AM cycle 3/22 and PM cycle 4/3) and the next cycle's Pre-shot is high, than yes, you can shoot the same dose that just caused the low for the next cycle only...then you take the reduction on the next cycle

on 4/24, when he went from 354 down to 175 in 3 hours, would you consider his PMPS of 401 that evening to be a bounce from that drop?
Click to expand...

Yes, I would..that's over 50 points an hour, so at that point, you're in "bounce mode". You hold the dose until the bounce clears because no matter how high they bounce, when the bounce clears, it can happen quickly and if you ALSO increased just because of that high number, you could be asking for trouble.

Then again, on 4/26, would you consider the PMPS to be a result of the drop earlier that day from 291 to 101? Should I have increased then or not?
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Yes, the PMPS being that high was most likely due to the fast drop...so he was bouncing....again, you never increase on a bounce because there's no way to know when it will clear and increasing then might cause him to go really low again (Which would just set him up for another bounce)

Since I get numbers under 200 sometimes, I then start my 3 days all over again at that number.
Click to expand...

Personally, I think it might be clearer to have this say "Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are MOSTLY less than 200 before increasing the dose by 0.25 unit." One nadir under 200 doesn't start the count over.

However, Chris suggests that I keep it at .75 because of the possible bouncing
Click to expand...

Sienne agreed this was probably a bounce too... "In most cases, we suggest that you don't increase until the bounce clears" and "you were wise to not increase since if the bounce broke, there could be a good deal of momentum behind the dropping numbers and even more momentum if you increased"

At THIS point, it looks like he's bouncing off that drop, so for now, we wouldn't want to increase...BUT after this bounce breaks, we'd need to re-evaluate the need for an increase. Sienne is saying that since he wasn't getting nadirs under 200 MOST OF THE TIME, you should have probably increased sooner instead of holding the .75 so long

If you can post more often, we can help advise you on when to increase, when to decrease and when to hold the dose and see if we can get some better results

Hope that made some sense...it's a little too early for me without any ~O) yet....lol
 
Thanks Chris,

Okay, so this morning, he seems to have stayed pretty high, from last night's PMPS at 512 to 376 at +2, 377 at +4.5 and 352 at +9.5. I'm sure it will be high at his AMPS, which is coming up here in about 45 minutes. From what you're saying, it seems as if I need to increase it this morning. Am I correct in thinking this? Because he didn't seem to bounce, right?

And, I will try to post more often again. I was doing really well at it, and then thought that I could handle it on my own. :roll:
 
No, you wouldn't increase yet

Bounces can take up to 72 hours to clear, so today's cycle is only the 3rd one after that fast drop on 4/26. (He IS still in the bounce from this fast drop)

If you were to increase this morning and later in this cycle the bounce "broke", he could come down fast...then the increased dose would kick in too and send him even lower...which would just set him up to bounce again...understand?

Hold the .75 for now

I have to leave soon so I'll leave you with this...Just hold the .75 for a few more cycles (unless he drops below 50) and then let's see where he's at and then discuss if he needs an increase in another cycle or two (or 3...lol)
 
Thanks Chris,

I read your post before I gave him his shot this morning and only gave him .75 again. I forgot about the bounce lasting for 72 hours (so much to remember!). I will hold this dose for a couple or few more cycles.

Thanks again,

Brigitte
 
Hi, Brigitte

I took a look at Corduroy's SS, and noticed that you kept switching from 1 dose amount to another about a week or so ago. That isn't going to allow Corduroy's #s to improve on their own, and will only make them go wonky like they have been, and make you very frustrated in the process. Keep the same dose amount until the next adjustment is required, and then stick with that amount until the next dose adjustment, and so on. Doing so otherwise will constantly drain the shed, and then you're having to fight to build it back up again, resulting in the wonkiness. In order to go down in #s, you need to go up in doses. It's a very, very slow process, but it will work.

If you're ever unsure about anything before doing something, please continue to ask questions, no matter how redundant they may seem to you. We all want to keep him as safe as possible as much as you do.

I'll even throw in an extra pair of Patience Pants for ya! :-D Hang in there, it WILL happen. :-D
 
Hi Angela,

Thanks for the "patience pants." I'm really in need :lol:

I've been continuing the .75 dose, and plan to until I need to reduce or raise, but I think he is still in a bounce from April 26th. I think today's AMPS will be his 6th cycle since the big drop on that day, from 291-118. Is this correct to you? And, from what the protocol on raising the dose says, plus advice from Chris and Sienne, after this cycle (at PMPS time tonight), I should raise the dose to 1. Does this sound correct as well? Chris mentioned to hold the dose for 3-5 days (6-10 consecutive cycles) if the nadirs were mostly under 200, but they don't seem to be.

Thanks to all of you for the help!

Hope you and your kitties are having an excellent day! :mrgreen:

(It's raining cats and dogs here ;-) )
 
Morning, Brigitte

I do agree with what Chris and Sienne have suggested about raising the dose to 1u, and if Corduroy was my kitty, I'd do the same thing. Usually, the new dose is held for about 6-10 cycles (3-5 days), or sometimes longer if needed for the kitty to get used to the new amount, and for a bit of extra time for the bounce to clear. Some kitties will clear a bounce quickly, whereas others, like Blackie, will take longer to clear them. Hence the reason why sometimes you may need to hold the dose for a bit longer than the 3-6 cycle window. If you take a look at Blackie's SS, you'll see that I've had her on this current dose of 1.25u since PMPS 03/30. Why? Simply because she's a long term diabetic, and for her, I'm not working with adjusting the insulin amounts unless it's necessary; ie. when she gets 3 #s between 40-50, or she drops below 40 once. In the meantime, I'm also working with food amounts, and managing her weight. Please do NOT follow what I'm doing for Blackie. After 4 years, my goal for her is still remission. If/when I'll ever achieve that remains to be seen.

Just remember that every time you raise the dose, you're going to experience some wonkiness with the new amount, and that usually lasts for about 72 hours, give or take. And every time you raise the dose, you will also start to see the #s improve, but over time. Nothing about FD is ever quick.
 
Okay, thanks Angela, I plan to raise the dose to 1 unit tonight because it doesn't seem to be going down very much.

Have a great night! :YMPEACE:
 
I'm glad you went ahead and raised the dose, brigitte.

one thing i would encourage you to do is to get comfortable shooting lower numbers. i like to think of those lower preshot numbers as a gift - Corduroy is giving you an opportunity!! i see you backing away from the full dose when you've got a blue number less than, say 150. It looks like that's your strategy - am i reading it right?

With Tight Reg, and especially testing as much as you do, you can shoot the full dose for most any number over about 50. The exception might be if you see a preshot number that is significantly less than the nadir of that cycle, you might post and ask for help deciding what to do. If you have a bounce clearing and the numbers are coming basically straight down for the previous several hours that could mean that it's good to go to plan B (stalling, maybe waiting for the BGs to begin rising and shooting then).

However, what we know is that shooting lower can allow a cat's entire BG range to drop down. If you'd shot the full dose with the previous 120's and 130's, you might've seen Corduroy's numbers flattening out. Have you seen spreadsheets where people shoot low? The saying here is "Shoot Low to Stay Low!" It's counter-intuitive, but it seems that if you shoot the full dose into a lower number, the Lantus cycle will flatten out into more of a line instead of a curve.

When you give insulin to high numbers, you can have peaks and valleys in the spreadsheet, ie, Corduroy drops 200 points in a couple of hours. But when you give the same dose of insulin to low numbers, the cat's BGs might only move a few points over the entire cycle.

So I'd encourage you to give it a try when you're going to be available to monitor. Shoot the full dose into the 120, then always get a +1 and +2 when you've shot a new low. I think you'll be pleasantly surprised. Work your way down gradually if you need to, with progressively lower preshots until you're shooting 50's. Post here and ask for help deciding if you are nervous about it.

Have you seen some of the spreadsheets of the cats where people do this? Look at Davidson's ss beginning on Feb 3 when Shawna began to shoot lower numbers. See how his entire range came down? That's a typical response. First you get green nadirs with higher preshots, but before long blue and green numbers take over the whole spreadsheet. then it's a matter of working down the dosing scale. Cats vary on that part, but pretty consistently, if you shoot a lower number, you'll see the range come down.
 
Hi Julie,

Thanks for the words of encouragement! I plan to stick with this even if it scares me. I guess I've been scared off before because Corduroy's numbers seem so wild, but what you and the others are saying makes sense...it's probably because I'm not following through and giving the same dose at lower pre-shot numbers; therefore making the numbers wonkier than they would be if I'd just stuck with it.

I'm really still working on, and hoping for, Corduroy to go into remission again. I know it's way more unlikely the second time around (he went into remission for the first time a couple of years ago), but I'm still gonna give it a shot!

Thanks again and I hope you have a great day! :smile:
 
Morning, Brigitte

I'm glad to see that you're feeling more confident in shooting lower #s. If it makes you feel any better, I had an episode where Blackie was 66, and I stupidly stalled as I was afraid to shoot that low. In fact, I could've as I would've been here to test anyway. Now, I've learned my lesson, and will shoot as low as 50's, but nothing lower than that. For now, though, she's mainly in the 80-90 range on a few mornings/evenings. I remember when I hit the first 120's, or slightly lower. I had to swallow my fear, and shoot. :lol: From that point on, I felt more at ease shooting those #s, and now it's second nature. I get disappointed if I don't see lower #s, though. :lol: It is what it is.
 
Good morning! ~O)

After giving Corduroy 1 unit for five cycles, his blood sugar doesn't seem to be going down too much. I mean, this is good and not good to me...good because it's not all over the place, bad because it's not going down low enough. Do you think after tonight's cycle, during which I'll give him 1 unit again, I should raise the dose to 1.25? That's what I'm thinking, but just not sure. I will also have to see what his BG is at AMPS after coughing up that furball last night. Sometimes this causes his BG to raise.

Thanks and have a great day! :mrgreen:
 
Hi Brigitte! When I look at Corduroy's spreadsheet, and I read your notes about the dental visit, it looks to me like there was a change in his spreadsheet starting on 4/27. The blues, greens and even yellows are gone. Before the 27th, he was having some high numbers, but almost every cycle he also had blues and greens.

This makes me wonder about his mouth, the crunching sound you are hearing, and any possible effects from the shot (is he showing any signs of allergy?)

Convenia was developed for skin infections. As far as I'm aware, it's not indicated for mouth issues. Did you have a specific diagnosis about his mouth? Because from the description, this sorta looks like just throwing an antibiotic at him without knowing whether or not he has an infection, and whether or not the Convenia is the right antibiotic for it. Vets like to use Convenia because it is convenient (hence the name) and people don't have to pill their cats. Nobody likes pilling a cat, so it seems like a great solution.

One caution about Convenia is that if a cat is allergic to it, it lasts for 2+ weeks in the body and can really be a problem. I think if he were allergic you'd have seen some allergy symptoms by now, but i am puzzled as to why his blood sugar has gone up following the dental visit in spite of you increasing his dose. That says there is something wrong to me. Either there is an infection and the Convenia isn't treating it, or there is a reaction to the Convenia.

Here is a link to the CatInfo site - Dr. Lisa, who runs that site, is a vet who posts here on FDMB sometimes, and she compiled the information on the nutritional/carb content of cat foods. I'm not giving it to you to scare you, but just in case there is something going on in Corduroy that is related to the Convenia. If there is, it would be better for you to know asap. I would check in with your vet about this, because his numbers are awfully high and not responding to your insulin increase.

http://www.catinfo.org/?link=convenia

I do think it's ok for you to increase his dose tonight, but do so knowing that if he gets another antibiotic and the infection/issue resolves, you may need to decrease his dose rapidly.
 
Brigitte:

I agree with Julie. I don't think this was the right AB for the problem and I'm concerned that whatever the infection is, it's not responding to the Convenia. I'd suggest getting Corduroy back in to the vet or at the very least, talking to your vet.
 
Hi Julie,

After briefly reading the link about Convenia, I am very worried that there may be a problem with Corduroy due to this; however, when you say to ask our vet, it doesn't help, because no one knows very much about any of this stuff unfortunately. Our vet has actually said that we know more than him! I'm not really sure what to do or who to turn to. I don't seem to notice any other abnormal reactions, except for the high blood sugar, but nonetheless, if this drug stays in his body for two months, and he is allergic, aren't we pretty much helpless? Ugh!
 
i would still go back to the vet and pin him to the wall. figuratively speaking, of course. the question is, why did he give THAT antibiotic, and what is plan B if Corduroy isn't responding to it. You no doubt know more about diabetes than the vet does, which is common, but this isn't necessarily about diabetes. This is about a cat's oral health and possible issues with an antibiotic.

If he has a dental infection, that needs to be resolved. if he needs his teeth cleaned or has a rotten tooth, they need to be taken care of.

Then he needs an appropriate antibiotic. We had clindamycin several times because it is indicated with anaerobic bacteria (the kind that grown in no-oxygen environments) which is typically found in mouth owies.

If you can't get a satisfactory answer and help from this current vet, i'd go to another one. Tell them what has happened following that vet appointment. Dr. Lisa, who runs that site, as I mentioned, does do phone consultations. If you poke around the site you can probably find contact information, if you want a second opinion. I don't know how that all works, but there have been a few members who have seen her as their vet. Also, if you post your location here and on Main Health, it might be that someone has a vet that they would recommend in your area.

I hope you can get some help. In the meantime, i'd go ahead with that dose increase.

btw, you and Sienne posted at the same time. I want to make sure you see her post as well.
 
Hi Julie,

I will call him and ask why he chose Convenia as his first choice; however, he said that he was giving an antibiotic to see if it would resolve the crunching issues within this week. He said that if it did, then we would know that it is an infection in a tooth that looks aggravated and that he could extract it. He said if the crunching issues didn't stop, then we would have to look at other possibilities for the crunching, such as "referred pain." He said that this is something cats and dogs do when something else is bothering them, but they can't do anything to stop it, so it becomes a nervous reaction. I mentioned to him the possibility of CKD because I've read that the crunching/grinding of the jaw can be a symptom of this, and he said that it could be a possibility.

As for his BG levels, they're only staying high and I'm worried. This vet isn't open on the weekends, so I can't call them until Monday. I'm not sure that there is anything I can do anyway, especially if the drug is going to be in his system for two months. I feel like I've just given Corduroy a toxic poison and now there's no turning back. Every time I think I'm doing the right thing to help him, I'm not. :sad:
 
Should we raise his AMPS this morning to 1.5 instead of 1.25? It only seems to be going higher nailbite_smile
 
I would be tempted to have increased last night to 1.5u.

In all honesty, I tend to think that if Corduroy was having an allergic reaction to the Convenia, you would have seen it pretty quickly. My concern isn't that this is a reaction but that he has an infection and this is the wrong antibiotic. I really do suspect there's something brewing and that's the cause for the high numbers. BG level is an incredible early warning system that a cat is stressed or the system is stressed from some sort of illness.
 
i agree - you could increase with your next dose to 1.5u. Because you could've gone to 1.5u last night, based upon the previous several days' nadirs, you don't have to wait now for the typical 6 cycles to pass to see what the 1.25u will do.

just so you don't worry quite as much, i'm pretty certain punkin also got a shot of convenia before he was diabetic and before i knew anything about it. it was for a bladder infection. i think it did resolve it and he didn't have any allergic reaction to it. if you were going to see an allergic reaction, i kinda doubt you'd be seeing it start now. allergic reactions usually happen quickly after the drug hits the body. i think you'd be seeing other symptoms (respiratory, gastrointestinal, skin) besides high blood sugar if there were an allergic response. i agree with sienne, this looks like an untreated infection and/or untreated pain.

if you want to treat the pain, bupe is a good option. you squirt it on his gums, under his lip or in the cheek pocket, and it absorbs very quickly. if pain is causing his BGs, bupe may help bring them down. but i think i'd want to get the tooth issue resolved if there is any decay or infection.
 
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