Duke Updates

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B

Bone Daddy

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Good Afternoon

I am starting a new post as recommended.

AMP 548
1.5 U 7:00 AM
+6 268 1:00 PM

I've read and have heard from y'all about the Somogyi effect. Our diagnosing vet has never used this term during the time he was treating Duke. It seems odd in retrospect since during one episode that saw Duke hospitalized. I've written about this episode before, but not sure about all the details.

After being administered Humulin the night before by the vet due to high BG, we brought Duke in the next day for observations and test. We were told his value when brought in was 135 but later that day it had shot up over 500. He was again administered Humulin to bring his values down. I'm not 100% positive of the exact details, but this is the gist of what happened. I don't want to play the second guessing game, but this seems to suggest rebound?

Question:

1) Is a vet obligated to release Duke's medical records if requested? I ask once before about releasing an x-ray and was told they couldn't do it because it was part of his hospital records. Having Duke's file in front of me would make it easier to determion exactly what happened.

2) Since I'm in the process of switching vets, will they release all of Duke's records to the new vet when requested?

BTW Duke and I played a nice little game of feather on a stick. All our cats love this game.

Thanks a million
 
Yes to questions 1 and 2
and it looks like that fast drop and zoom up did not convince you that there is too much insulin in his system...that rebound causes the body to be ultra sensitive to insulin. once again it looks like a decrease is called for. how many times has this cat hypo'd?
IMHO cut dose in half...very skinny 1u and wait it out.
you can't look at those numbers and not suspect he's rebounding.
 
Thank you.

PMP Hi 7:00 prefood

This worries me, we've never seen this reading before.

I continue to give small meals spaced apart.

I tested the meter on me and it read fine.

Based on a previous recommendation regarding rebound, I cut his dose back by 25% from 2 u to 1.5 u for his AM and PM shots. I will cut it back to 1 u in the morning.

I don't know how many times he has hypo'ed. This continues to bother me because every time we had an emergency and took him to the vet we were told his BG was too high and more insulin was administered. At his highest dose, the vet had him on 3 units.

I made a rice sock tonight and used it for this reading. I will do a +3 and a +6.

Question:

What should I expect reading wise if cut back to 1 u? So I don't panic.

I will talk to our new vet tomorrow.
 
hi there! I haven't been on the board much lately so haven't followed Duke's progress very well, but just wanted to say hello! I wouldn't stress too much about the HI. I know it seems awful, but if they are rebounding it can take a couple days for the higher #s to clear their system, that's why you want to take some deep breaths, pick a dose that is low enough you don't risk perpetuating any rebound, and stick with that (barring new low #s that suggest a further reduction).

When they get reboundy #s like that, it can be hard to know how much is due to liver-training, and how much due to Somogyi rebound. Somogyi is tough because you can get in a see-saw pattern that can be hard to get out of. I agree it's a good idea to ease off the dose some and get a better idea where you are. When Somogyi rebound is clearing, if you shoot less insulin, you should see the #s start coming down some. If it's liver training, the #s won't come down on their own without more insulin until their liver gets on board and stops throwing fits. I wouldn't worry about that for now, just mentioning it for reference. If I were you I would probably try 1u for a couple days and see how it goes, and if the #s aren't coming down, raise up to 1.25u.

Your vet should release anything to you - I've had them give me x-rays before, and you can have the new vets call them to get the records faxed over (or you can ask for a copy of everything). They shouldn't give you a hard time at all, I have moved several times and switched vets and no one has ever blinked - I think it is common practice that they share records.

p.s. do you have a profile set up with info about what happened pre-spreadsheet? and/or earlier #s you can put in the ss? it sounds like there is some history here I have missed... maybe I just didn't see it, I'll go check again! :)
 
BD, I apologize for coming across curt...I know it is soooo hard watching our kitties with those HIGHS. I was going by some of your past experiences where you had mentioned hypo's and 'crashing' which here on the board equals hypo.
I do think your vet has a professional obligation to give you the xrays altho he also has the right to ask you to return them.
Your WCR (whole cat report) sounds good. Is Duke doing the five P's? peeing, pooing, playing, preening and...I gotta find out the fifth, could it be purring?
It will be tough going for a few days perhaps as you've been on a high dose...and since you were'nt testing it's not really clear if that dose was appropriate.
Then you've done a few tests after feeding, so those tests don't count too much.
Think of this as starting anew. We all generally start on 1u, we don't expect to see much immediately....in your case may take longer than usual. Feed only low carb, do not feed for at least an hour, perhaps 2 before amps and pmps. shoot the 1u. give a curve, wait a day if you can stand it and give another curve.
This will be hard I know.
Also your vet visit is bound to raise Duke's bg's as that stress factor always does so be prepared for that. The vets don't always seem to take that into consideration.
Love your Duke to pieces like your already doing and check in each day with a WCR and all numbers ok.
A curve btw will be a +2, +4 +6, +8 ok.
Lori
and tomtom (a former otj boy who had a close hypo 2.5 years ago)
 
Lori and Tom I didn't interpret it as curt at all. I interpreted as concerned and that is appreciated more than I could ever convey.

PM +6 497

spreadsheet updated.

I have been feeding right up to the PMP. We've moved evening dinner to 7:00 to coincide with the 7:00 shot for all the cats. I'll hold food an hour before the shot. I weighed Duke tonight (scale reads in .2 increments, me on scale, record value then me and Duke on scale so it's not very accurate, but good enough for rock and roll?) and he clocked in at approx 7.4lbs. 5/21 he weighed in at 6.8 lbs. This is the lowest we've ever seen. Outwardly it looks like he's putting weight back on. He feels more solid. He felt quite strong when I picked him up to weight him. He does not like to be picked up at all.

We are very aware of the stress factor associated with the vet and Duke. She knows I will not leave him there for the day to do a curve. The numbers will not be real. I'd like her to look at him and discuss what's been going on since we saw her last. I have a good feeling about her.

He is peeing. I checked him tonight just after he peed and it was a normal amount of pee not like some of the huge amounts we've seen in the past.

Duke is not really a big purrer, although he does purr. He has purred a little for us today. Duke is a talker. He trills like a canary when he's looking for attention, enjoying contact with the peeps or looking for food. He is talking to us. He is not hiding - which immediately tells us something is wrong when he does. He is making the rounds and settling into his old favorite spots. He is nowhere near 100%, but he is acting like Duke.

I used the rice sock again tonight and got a good stick. Thank you again to everyone who encouraged me to try it. I went out to Kmart to buy baby socks tonight and was miffed at first that they only sold them in sets of 3 (or 2 for the expensive ones), then I remembered my kids and socks (and shoes for that matter) and it all came flooding back to me.

Wishing all a peaceful night.
 
Hi there and welcome. We could use more good kitty "daddy's" around here :-D Hmm, but "bone" daddy's??? Zoiks! :? [trying not to be too scared] :shock: lol

I'm just going to be really quick here and suggest you get your Profile [as described in the Tech Support forum] together and get it linked you your sig too. You've been getting a lot of great input.

Maine Coons... are the most awesome cats EVER :smile: . 7# does sound small for a male. 8-10# is normal for a female. H was 15#+ and he was not a big one. I did enjoy reading "That Yankee Cat." Try not to let the vets hassle you about heart problems [vets seemingly get that automatically in their head about Maine Coons].
 
Just checking in to see how everything is going. I have been out of town, so I am sorry for my lack of posting! Those high numbers can be very very scary too, but I do also believe they are rebound numbers from the 54 and should clear in the next day or two. The most important thing at this current moment is that Duke's clinical signs are good since we can't go by the inflated numbers. Keep up what you are doing and I would hold that 1.5u for another few days until the rebound clears to see where he is at. If the rebound doesn't clear by then, then drop it down again to 1u.

Good call on moving the feeding times to 7 and 7. That will give you a better idea of his pm ps#.

Keep up the good work! cat_pet_icon
 
I never do this, but always wish I would ... write down the questions you want the vet to address. I always think I'll remember and then I get there and go totally blank. I do that with my doctor and the pediatrician too.

I would find out for sure too, if Duke's past problems have been DKA or hypo or both. It can affect how aggressively to treat the high numbers.

A vet should provide you will your cat's full medical history/records. Imagine if you had to go to an emergency vet. That information could be very helpful.
 
I'm posting this during lunch at work so haven't had time to read everyone's posts yet.

AMP 383
1.5 u 6:00 (needed to give shot 1 hour earlier because of work)

spreadsheet updated.

Duke did not eat turkey treats after morning test. This is the first time in days. I also saw him hanging by the water bowl twice. I have no report yet how Duke did for breakfast. This is observation (though scary.

More later.

Thank you again for all you do.
 
Duke is not doing well.

He did not eat breakfast and I was told he was hovering around the water bowl. He did not eat turkey treats when I got home. This is the first time he hasn't eaten in days. He was eating several times a day - basically whenever he was given food. He is listless. His behavior is diametrically oppose to what it was before we switched to 1.5 u.

I'm waiting for my rice sock to cool down and will take a BG reading and post it.

Should I be panicking?
 
Do you have Ketostix? Have you been testing for ketones?

Yes, I would be concerned. A call to the vet wouldn't hurt. Panicking won't help. So don't! Just stay calm, check on Duke.
 
+7 266

+ 7 266

spreadsheet updated.

I have a vet appointment for 4:00. It originally was just a follow up to show her how much better he was doing compared to the last time she saw him (5/18). I'll bring his numbers with me and make arrangements for her to get his records shipped over from the old vet.

I'm sure she'll test for ketones. He doesn't smell like ketones. When he was really sick, I could smell him mingled in between the vet clinic smells.

He is still able to walk with no problem.

I'm going to syringe feed him a bit when I do a +8. Then a + 9 before going to the vet. She is only a few minutes from the house so the travel stress on Duke won't be much. Our old vet was 20 minutes or so from the house depending on traffic.

It's interesting that his numbers are coming down and are actually in range - but without the dip into the green zone - with values when he was getting 2 u, but his behavior is so different.
 
I understand exactly what you are saying about the very different behavior while in the greens! Right now his body is figuring out what is going on and his glucose numbers are doing some wild swings. That alone can cause Duke to not feel so well. It could also be that the optimal dose right now is somewhere in between 1.5 and 2u. As long as there are no ketones present, another few days at 1.5u will tell you which way to go with the dose. Glad to see he is getting a half way decent drop today.
 
My heart goes out to you guys. Hang tough.

Personally, I would be much more worried about shooting too little insulin rather than too much. 56 isn't a truly scary number, unless it is early in the cycle and bg is still heading down. The worry was when you saw it at +5 that the nadir might possibly be yet to come. It's equally as possible that Duke has an early nadir as opposed to a late nadir. Only a full curve would tell.

Though with such a huge drop, it looks like the liver's response kicked in and rebound happened anyway.

Good luck, and keep us posted.
 
BD aside from duke not feeling well (most important thing) this is a nice curve for starting over with new dose. let's not confuse his not feeling well with dose and bg's...it could be something entirely different, it could be he's not used to a steady amount of bg's coursing thru his body....let's keep the dosing simple. the numbers are good---for now.
continue trying to get him to eat...tuna juice, parmesan cheese, do you have bonito flakes?
 
PMP 387

PMP 387

spreadsheet updated.

I'm quite pleased with this number seeing how it follows a visit to the vet. Short drive is much easier on Duke. Saw our 3rd vet in the practice and second tech and they were both great. It's a new office for them so it is sparking clean and doesn't smell like dog (I have nothing against dogs, I had one for many years, but let's face it they smell)

Assessment:

I showed them the numbers from my spreadsheet.

I requested no BG be taken. Duke just stresses out at the vet and I told her I didn't think the number would be valid. She was cool with that.

Was not concerned about the numbers. Thought they were pretty good actually.

Keep the 1.5 dose for a couple of days and see what happens.

Vet stressed that I should call if something comes up and to keep them updated (gotta love that).

I mentioned I had spreadsheet and would email them the link if interested and they were.

They are making arrangements to get medical records transferred.

I finally feel like an active part of a team working together to get Duke better. I also feel we are more proactive than reactive.

Duke ate enough, so I gave him his shot. 1.5 u

So far, I feel good about today.
 
+2 315

+2 315

spreadsheet updated

I will take a +5.

At 9:00 He ate approx. 2 oz of Core Salmon/Whitefish/Herring. The stinkiest stuff we had. I added about 1 tsp water to help keep Duke hydrated. BTW his hydration is excellent. I'll continue to give him small meals tonight.

Duke is looking much better. He's walking around and talking for food. I was able to bribe him into the bathroom where we test by holding the bowl under his nose. He isn't hanging out by the water bowl. He's sitting in one of his usual haunts: the rug in front of the TV. Duke's the only one of the kittens that sits on that rug. His other haunt is what we call his patrol. He sits by the french door leading to the front porch and watches for intruders. The most recent Dukie alerted us to was a bunny. We feel safe with Duker guarding the house.

I'll rest a little easier tonight.
 
I have not read all of the posting leading up in regards to Duke's progress, but I wanted to let you know that I am sending you guys good & healthy vibes. :smile:

I could be wrong by mentioning to try this? since I do not know all the details about Duke, but are you able to shoot at +10 or +11 as long as he's on the raise? Maybe the insulin just isn't holding out enough for Duke to go 12/12. I know Pru had this problem. I also know that NOT everyone can do TID, but I just thought maybe once you can get a full curve and see Duke's numbers.. it could be an option to shoot a little early ie: +10 or +11 You would just need to keep in mind that there will be overlap of insulin if you do this. Hugs to Duke cat_pet_icon
 
Thank you. This scenario hasn't been presented up until now. Our AMP is actually a little before 6:00 AM which would be +11. I leave for work at 6:00 AM. H gives him his shot at 7:00 after breakfast. Tonight's goal is + 6, but it may end up being a +5. I'll get a +10 tomorrow morning.

There's always more to think about isn't there?

It is my deepest hope that Duke has been given too much insulin in the past and this has caused many of his problems.

Goodnight and sleep well everyone.
 
You're doing great and I am sure Duke knows he's in good hands. Things will get better... you'll see. I will keep Duke in my thoughts and check in on you guys daily. Get some rest.
 
261 +5

Thank you for the ongoing support, it helps us get through.

+5 261

Duke ate some of the fish core overlayed with Gerber Turkey and Gravy.

All and all, Duke looks pretty good. Me on the other hand may be loosing it. It seems I took the container of turkey meat out of the fridge for a snack and for the life of me I can't remember what I did with it. It must be somewhere .....................
 
From one of your comments, I am inferring that Duke has a ketone history, did I get that right? If so, please be sure you are checking with the Ketostix pretty aggressively (daily or more often), especially if he is still acting a little off, or not eating well. I agree with your decision to syringe feed him some, and to add water to his food. I always recommend that people put a note about that in their signature so that anyone giving advice will know their cat is ketone-prone, as it does affect how aggressively you need to approach dosing.

As I understand it, ketones result from a combo of too little insulin (not high #s per se), and either not eating well, or infection. So if he does have that history, eating is extra-important for him. If his #s aren't continuing to come down further on their own (yay for these improved #s!!!) I would raise the dose to 1.75 tomorrow. If ketones do show up, you will have to be more aggressive with shooting more insulin, so I wouldn't stay too long at any dose that isn't enough.

This dose looks to me like not enough, but I'd be hesitant to jump to 2u given the overly-good response he has gotten on that at times. More or less, with PZI you want to see about a 60% drop from PS to nadir. You are getting less than that on 1.5, but way more than that on 2u (at least for some cycles), so it looks like a good dose for him may be somewhere in between the two. It looks like the rebound is clearing nicely, but the #s seem more stable today (rather than continuing to come down), so I'm thinking that might be about it for improvement in #s from rebound clearing. The not acting well on the lower dose worries me (ketone suspicion) but if he is eating better & acting improved, hopefully that isn't an actual issue. Just thinking you shouldn't stay at this dose for a few days, like one might do for a non-ketone-history kitty, where there is the luxury of taking more time with dose adjustments.

Great job keeping up with all the confusing things that FD brings! Hope you are getting some rest, and that Duke is continuing to feel better! Shooting early like Michelle suggested is a nice trick you can do with PZI if needed. With PZI, you can shoot anytime in the later 1/2 of the cycle as long as the #s are rising. It can get confusing to figure out how to handle adjusting the doses & the timing, and I wouldn't recommend it if you can get him in pretty good #s without doing that, but it might be something to consider if needed as a way to keep him in good #s for a longer stretch of time if you can't achieve that with 12/12 shooting.
 
AMP 215

Thank you.

This mornings AMP is actually a PM +10 215.


I tested at 5:00 AM. He was fed and given his shot at 7:00. I'll do a BG as soon as I get home, approx 3:30 this will be + 8.5 or so.

Duke was diagnosed with ketones in February. After that, I'm unclear abut what actually happened. I should have known better than to not take detailed notes during each visit. Duke was always viewed as an enigma. They cold not get a handle on what was going on. We were told they were doing "vet round tables" to discuss his symptoms and treatments. Duke was being treated since early February until the end of May without marked improvement. I finally decided to get a second opinion about 2 weeks ago. I should have done this months ago. I have requested that Duke's med history be transferred to our new vet. I'm anxious to review it with her and see what she thinks of his past treatment. My gut feeling is that the treatment across the several months may have done Duke more harm than good. But this unsubstantiated at this point in time.

A new thread has been started.

There were so many changes in insulin types and doses. Vetsalin to PZI to PZI compounded. 1 unit to 2 units to 3 unitsEmergency shots of Humulin to lower BG #s quickly.
 
Don't beat yourself up about the history - lots of people here have similar stories. I had Bix on dry food for over 6 months after his diagnosis, 2 different insulins, several redos to check for rebound, months of blind shooting, etc., etc. It's typical that you wouldn't really know what exactly was going on with him - vets often seem to take the perspective that we won't understand, or don't care to know, or whatever it is, and don't give us a lot of the details unless we push for them.

The good news is that you are learning more every day, home testing, and making progress! Although there can of course be permanent damage from the diabetes, I don't know that there would necessarily be lasting side-effects from the treatment he's had so far. Cats seem to heal pretty well from a lot of things, and the things that are irreversible - well, it happens to a lot of us. Many cats aren't diagnosed right away, and can be in high #s for weeks or months before a problem is recognized, so often some permanent damage is inevitable, except for a few cases where everything goes really well from quick diagnosis to optimal treatment. I'd say that's the exception rather than the rule though.

Good luck with your new vet, hopefully you will have things straightened out soon.
 
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