Hi guys! I decided to take Costello to a vet that specializes in cats, tomorrow, and get a costly blood work-up to see if there are any other problems causing his numbers to stay high. Still having a hard time. Seems no methods are working. On Monday the numbers came down a little, (on 2nd day at 3u), to amps 303, pmps 374. Tues: amps 439, pmps 383. Wednesday raised dose to 3.5u after amps was higher (453), pmps 412. Thurs., still 3.5u, amps 442. Just wanted to let you know. confused_cat
Costello update
- Thread starter london2z
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bookw0rm
Very Active Member
Honestly, it looks like he might be getting too much insulin. The fact that his numbers go up when you increase seem to point that direction to me. That's what happened with Cass; when I reduced his numbers improved. They're not perfect by a long shot but much better. Just my $0.02, though.
Good luck!
Good luck!
Sue and Oliver (GA)
Very Active Member
I hope you have luck with the new vet.
If you want help from us, we would want you to update your spreadsheet (I will send you the URL for it to your email) and we would want to see some midcycle numbers.
I agree that it is possible that Costello is getting too much insulin but we'd need some numbers to be sure.
If you want help from us, we would want you to update your spreadsheet (I will send you the URL for it to your email) and we would want to see some midcycle numbers.
I agree that it is possible that Costello is getting too much insulin but we'd need some numbers to be sure.
all4mymarine
Active Member
It's totally possible that you are raising dose based on a PS that might be from too much insulin. If at all possible, some mid cycle numbers would help you soooooo much! When I raised Lucky's dose, almost all his PS's were reds and his nadirs were pretty sad looking. I've lowered the dose, as small of a change as it was, and he's getting such better numbers, nadirs and PS's! I wouldn't have known to lower the dose if I didn't have mid cycle numbers indicating that maybe the dose was too high!
Sometimes less is MORE! Good luck with the new vet! If all checks out, I would bet that it is the amount of insulin that is to blame.
Sometimes less is MORE! Good luck with the new vet! If all checks out, I would bet that it is the amount of insulin that is to blame.
Actually, I raised the dose to 3.5 after the Wednesday amps was 453, up 14 points from Tuesday's. Thursday the amps actually decreased from 453 to 442, a day after the dose increase. And back when I was dosing at 1.5 u, even though the BG's went lower, they ended back up around the same range as now, again. Then I went to 2u, and for several days the BG went lower, into the 200's, then climbed up again, to 364. I also tried decreasing from 2.5 u to 2 u for one day, just last Saturday, and the BG went up at the pmps. Maybe when I was at 2u the first time, I should have stayed at it longer than 3 1/2 days, as 364 may have just been a temp. small bounce up.
I thought I would just give you all the latest, and I'll see what the vet suggests, tomorrow. I know I'm using different methods, longer-term doses, (except for that more recent attempt at 2 u), And I feel I really should hold the doses out even longer, if it really does take the pancreas one week to adjust. And I'll try and do some nadirs, but don't like to test too much. Thanks again.
I thought I would just give you all the latest, and I'll see what the vet suggests, tomorrow. I know I'm using different methods, longer-term doses, (except for that more recent attempt at 2 u), And I feel I really should hold the doses out even longer, if it really does take the pancreas one week to adjust. And I'll try and do some nadirs, but don't like to test too much. Thanks again.
all4mymarine
Active Member
Sorry, double posted and can't delete!
all4mymarine
Active Member
But you have to understand that the meter is going to give a variance. So that drop you perceived may not be a drop at all, just a variance in the meter reading. I wouldn't consider a 15 point drop a reason to think that an increase is working. Now, a blue nadir would be a reason to celebrate! lol
Up and downs are going to happen. I never would have known by my 421 PS tonight that Lucky went into the blues today (because I've lowered the dose, btw) and was bouncing. I would have just said, crap! not enough insulin and increased it back up. You never know what is going on mid cycle unless you test. 3 tests a day is pretty conservative, IMO. If you don't know what's going on at peak, then you are blindly adjusting dose. And for some reason, some cats PMPS is always lower than the AMPS. Lucky is that way too. And another good piece of advice is that sometimes a rebound can last a couple of days, IF you keep the dose the same. If you increase, you are possibly causing chronic rebound and high numbers like you are experiencing. But you wouldn't know if you don't get a mid cycle test every once in awhile......
The only different method you are using is increasing based on PS and maybe increasing in .5 units. I increase in .1 units because even a drop can make a huge difference. Can you try using U100 syringes and a dose conversion chart? If you are interested in this, I can share with you what syringes I get and the link to the chart. I've printed it out and taped it to the inside of my cabinet for reference. You might have better results with smaller increases/decreases. Just a suggestion! I know how frustrating it is to get things sorted out so I'm just sharing some info that I've learned along the way.
Edited to add: there is absolutely nothing wrong at all with holding dose to obtain data and then make a move based on data! If you look at my SS, I have periods where I held dose to see where it went and then adjusted from there :mrgreen:
Up and downs are going to happen. I never would have known by my 421 PS tonight that Lucky went into the blues today (because I've lowered the dose, btw) and was bouncing. I would have just said, crap! not enough insulin and increased it back up. You never know what is going on mid cycle unless you test. 3 tests a day is pretty conservative, IMO. If you don't know what's going on at peak, then you are blindly adjusting dose. And for some reason, some cats PMPS is always lower than the AMPS. Lucky is that way too. And another good piece of advice is that sometimes a rebound can last a couple of days, IF you keep the dose the same. If you increase, you are possibly causing chronic rebound and high numbers like you are experiencing. But you wouldn't know if you don't get a mid cycle test every once in awhile......
The only different method you are using is increasing based on PS and maybe increasing in .5 units. I increase in .1 units because even a drop can make a huge difference. Can you try using U100 syringes and a dose conversion chart? If you are interested in this, I can share with you what syringes I get and the link to the chart. I've printed it out and taped it to the inside of my cabinet for reference. You might have better results with smaller increases/decreases. Just a suggestion! I know how frustrating it is to get things sorted out so I'm just sharing some info that I've learned along the way.
Edited to add: there is absolutely nothing wrong at all with holding dose to obtain data and then make a move based on data! If you look at my SS, I have periods where I held dose to see where it went and then adjusted from there :mrgreen:
C
Carl & Polly & Bob (GA)
Guest
Wally,
A couple of people have already mentioned "meter variance" to you but I'll echo what they have said. You are basing dose increases and decreases on numbers that are probably virtually the same.
With a BG reading of 400, and a meter variance of up to 20%, that "400" can really be a number anywhere between 320 and 480. If your BG readings are within that range, then you are making a decision to up or down on the dose for no real reason. It is no wonder that you are not seeing any big changes, because you are adjusting when an adjustment is not indicated by the data. The recent "strategy"? It isn't working.
Again, if you are not testing at any point in between shots, you have no idea whether the dose is right, too high, or too low, but you are making an adjustment (mostly an increase) anyway. The chances of Costello improving at all are minimal using this strategy. He could be going below 100 every shot. Likewise, he could be going over 500 after every shot, no matter what his PS reading is. One is caused by too high a dose, and the other is also caused by too high a dose. You can't tell if the dose is too high. You also can't tell if the dose is too low, but you are reacting as if you know that it is by continually upping the dose without justifiable data. Every time you up the dose without a mid-cycle reading, you are putting Costello's health and his life at risk.
I'll say it as plainly as I can, Wally. No matter which vet you see, and no matter what that vet says, if he tells you that his way is better than "our way", he's mistaken. Unless he has a record of remissions that is higher than the rate of remission on this board, he's not helping you, or Costello, and all you are doing is wasting money, and making it harder on yourself and most importantly, on Costello. On the other hand, following FDMB advice costs you nothing, and has Costello's best interests as the primary focus. The only benefit you will get from tomorrow's vet visit is that if the blood tests show something beyond diabetes is causing Costello's numbers. That would be great to find out actually, because otherwise, he's just going to tell you to keep upping the insulin which will probably cause more harm than good.
As Sue said, unless you can maintain a spreadsheet, and follow the test-before-every-shot and at least once per day around nadir time, we can't help you, or Costello. If you can't do that, then you are putting Costello at risk, period
Sorry, tough love, but somebody had to say it.
Carl
A couple of people have already mentioned "meter variance" to you but I'll echo what they have said. You are basing dose increases and decreases on numbers that are probably virtually the same.
With a BG reading of 400, and a meter variance of up to 20%, that "400" can really be a number anywhere between 320 and 480. If your BG readings are within that range, then you are making a decision to up or down on the dose for no real reason. It is no wonder that you are not seeing any big changes, because you are adjusting when an adjustment is not indicated by the data. The recent "strategy"? It isn't working.
Again, if you are not testing at any point in between shots, you have no idea whether the dose is right, too high, or too low, but you are making an adjustment (mostly an increase) anyway. The chances of Costello improving at all are minimal using this strategy. He could be going below 100 every shot. Likewise, he could be going over 500 after every shot, no matter what his PS reading is. One is caused by too high a dose, and the other is also caused by too high a dose. You can't tell if the dose is too high. You also can't tell if the dose is too low, but you are reacting as if you know that it is by continually upping the dose without justifiable data. Every time you up the dose without a mid-cycle reading, you are putting Costello's health and his life at risk.
I'll say it as plainly as I can, Wally. No matter which vet you see, and no matter what that vet says, if he tells you that his way is better than "our way", he's mistaken. Unless he has a record of remissions that is higher than the rate of remission on this board, he's not helping you, or Costello, and all you are doing is wasting money, and making it harder on yourself and most importantly, on Costello. On the other hand, following FDMB advice costs you nothing, and has Costello's best interests as the primary focus. The only benefit you will get from tomorrow's vet visit is that if the blood tests show something beyond diabetes is causing Costello's numbers. That would be great to find out actually, because otherwise, he's just going to tell you to keep upping the insulin which will probably cause more harm than good.
As Sue said, unless you can maintain a spreadsheet, and follow the test-before-every-shot and at least once per day around nadir time, we can't help you, or Costello. If you can't do that, then you are putting Costello at risk, period
Sorry, tough love, but somebody had to say it.
Carl
Angela&Henry
Very Active Member
Actually, although the AMPS and PMPS numbers are still higher than you want, you want the PMPS to be just slightly lower than the AMPS rather than like my cat's BGs; always a lot lower at PMPS than AMPS but he is on a 10/14 schedule.
Some cats do great on a sliding scale or more frequent increases but slow and steady works very well for others. I think its fine to hold the dose a little longer and see what happens. Just keep checking for ketones and observing for any change in appetite, drinking, peeing, etc.
You would get more information if you checked him around +6 to gather data, sometimes my Henry starts off in upper 400's but drops down into blues or once in awhile greens at nadir. I wouldn't have caught this if I didn't check and then not realize he may be dropping low and then bouncing or staying high and flat all day.
Its hard to predict which way they are going without some mid cycle checks in.
Some cats do great on a sliding scale or more frequent increases but slow and steady works very well for others. I think its fine to hold the dose a little longer and see what happens. Just keep checking for ketones and observing for any change in appetite, drinking, peeing, etc.
You would get more information if you checked him around +6 to gather data, sometimes my Henry starts off in upper 400's but drops down into blues or once in awhile greens at nadir. I wouldn't have caught this if I didn't check and then not realize he may be dropping low and then bouncing or staying high and flat all day.
Its hard to predict which way they are going without some mid cycle checks in.
Sue and Oliver (GA)
Very Active Member
It looks high and flat. (inverse would usually have a mid cycle number higher than the preshot.). But both can be caused by too much insulin. Here is some info on rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound.
So if either a higher nadir or lower nadir can be caused by too much insulin, then there is no way to tell if it's too much or too little? By the way, his AMPS today was 390. Still heading down, assuming the meter reading is fairly accurate.
I am going to play devil's advocate and say that it seems like with the more frequent dose changes, even as much as once or more per day, and that if the meter readings were a 20% variance, that it would be much riskier and you'd be more likely to have false doses from false readings more often. In fact, why even take readings, if the variance is so great that you really don't know what the true reading is? Alpha Trak meters are very accurate, specifically for cats and dogs, but very expensive. I'm going to see if the vet, today, can do a comparison test with my Relion meter.
And All4mymarine, thanks, but it just seems like doing changes in .1 units would be too insignificant, and take too long to determine, anyway.
I am going to play devil's advocate and say that it seems like with the more frequent dose changes, even as much as once or more per day, and that if the meter readings were a 20% variance, that it would be much riskier and you'd be more likely to have false doses from false readings more often. In fact, why even take readings, if the variance is so great that you really don't know what the true reading is? Alpha Trak meters are very accurate, specifically for cats and dogs, but very expensive. I'm going to see if the vet, today, can do a comparison test with my Relion meter.
And All4mymarine, thanks, but it just seems like doing changes in .1 units would be too insignificant, and take too long to determine, anyway.
Sue and Oliver (GA)
Very Active Member
The variance is true for all meters and impacts human diabetics as well as feline ones. You are looking for trends and patterns. Costello's general pattern is high and flat.
I don't see anyone advocating changing the dose daily. I think we are advocating doing a trial at a lower dose, doing ketone testing and testing often.
I don't see anyone advocating changing the dose daily. I think we are advocating doing a trial at a lower dose, doing ketone testing and testing often.
all4mymarine
Active Member
Sue is absolutely right about looking for trends and patterns. Yes, you can find out if it is too much insulin. Have you read the links on Somogyi Rebound that have been posted for you to check out? You had an inverse curve. You are giving too much insulin. You have your proof by checking a +6. I had a feeling that was it because I've seen it within Lucky's SS. Costello may need a much smaller dose but it's all trial and error and listening to experienced advice. We all deal with this feline diabetes on a DAILY basis, the vet doesn't. The vet uses a one protocol fits all and doesn't see what we see everyday.
There is still a lot to learn but I really get the feeling that you are being resistant to all the advice and great knowledge that is being given here :YMSIGH: Trust me, it's Costello that feels the effects. You've been given such great advice, the same advice I was given when I came here. It takes listening to advice, research, and also some common sense and gut feelings to deal with this stuff.
You don't have to do frequent dose changes. I have been doing this long enough to feel confident enough to use a sliding scale that is *just* for Lucky. Before, everyone kept telling me, hold dose, hold dose, get data! I was SO bound and determined to do this on my own but you know what, after realizing that what I was doing wasn't working, I started listening a lot more carefully!!!
And YES, absolutely .1 unit is enough to make a difference! There are even skinny and fat doses that make a difference. If you don't check to see the difference, then of course you'd never know. Just a drop of insulin is a lot for some cats. I don't think you understand how insulin really works. I'm afraid you are going to find out when it's too late for your kitty. :sad: As far as meter variance goes. If you were consistently getting Reds in the 400-450 range, then I would consider those the same. A change in that range wouldn't be significant to me at all and I definitely would not increase dose because I got a 400 one day and a 430 the next. Now if you saw a change from 430 to 350, yes that would be significant. The only time I would feel I would need to change dose significantly downwards is if I saw an inverse curve or saw a pattern of high and flat number Consistently. Consistent is the key word. I would change a dose upwards if I saw that there were no inverse curves, no bounces and the pattern was pretty stable. If the increased dose does nothing but give you high flat results and doesn't improve nadirs, then that is suspicious for a too much insulin. If you get a green or even blue nadir and your PS shoots up, then you know it's a bounce and not to increase on a bounce. Hold dose and let kitty get used to it and clear the bounce. I feel that and you are in chronic rebound situation now and the only way to get out of it or to tell if that is the case is to lower for a few days and see if things improve.
Everyone really cares here. They really do and it's frustrating to see a situation and give advice based on experience and knowledge but there's nothing we can do about it. Good luck Wally, really, I do mean that. I sincerely hope you figure things out.
Oh I forgot to mention that ALL meters have variance, including that super expensive Alphatrak that is marketed for animals. It's all about patterns! I have a Relion also and it works just fine. It's not human meters that are the "problem", all meters do the same thing ;-) Sorry, just saw that Sue mentioned this....well, I second what she said!
There is still a lot to learn but I really get the feeling that you are being resistant to all the advice and great knowledge that is being given here :YMSIGH: Trust me, it's Costello that feels the effects. You've been given such great advice, the same advice I was given when I came here. It takes listening to advice, research, and also some common sense and gut feelings to deal with this stuff.
You don't have to do frequent dose changes. I have been doing this long enough to feel confident enough to use a sliding scale that is *just* for Lucky. Before, everyone kept telling me, hold dose, hold dose, get data! I was SO bound and determined to do this on my own but you know what, after realizing that what I was doing wasn't working, I started listening a lot more carefully!!!
And YES, absolutely .1 unit is enough to make a difference! There are even skinny and fat doses that make a difference. If you don't check to see the difference, then of course you'd never know. Just a drop of insulin is a lot for some cats. I don't think you understand how insulin really works. I'm afraid you are going to find out when it's too late for your kitty. :sad: As far as meter variance goes. If you were consistently getting Reds in the 400-450 range, then I would consider those the same. A change in that range wouldn't be significant to me at all and I definitely would not increase dose because I got a 400 one day and a 430 the next. Now if you saw a change from 430 to 350, yes that would be significant. The only time I would feel I would need to change dose significantly downwards is if I saw an inverse curve or saw a pattern of high and flat number Consistently. Consistent is the key word. I would change a dose upwards if I saw that there were no inverse curves, no bounces and the pattern was pretty stable. If the increased dose does nothing but give you high flat results and doesn't improve nadirs, then that is suspicious for a too much insulin. If you get a green or even blue nadir and your PS shoots up, then you know it's a bounce and not to increase on a bounce. Hold dose and let kitty get used to it and clear the bounce. I feel that and you are in chronic rebound situation now and the only way to get out of it or to tell if that is the case is to lower for a few days and see if things improve.
Everyone really cares here. They really do and it's frustrating to see a situation and give advice based on experience and knowledge but there's nothing we can do about it. Good luck Wally, really, I do mean that. I sincerely hope you figure things out.
Oh I forgot to mention that ALL meters have variance, including that super expensive Alphatrak that is marketed for animals. It's all about patterns! I have a Relion also and it works just fine. It's not human meters that are the "problem", all meters do the same thing ;-) Sorry, just saw that Sue mentioned this....well, I second what she said!
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