Eleanor - Dose help Please!!!

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Julie and Eleanor (GA)

Julie and Eleanor (GA)

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http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=70571

I was wondering about reducing Eleanor's dose because her bg had gone high and her PU/PD was really bad again. I thought I might have been giving her too much since increases were based only on PS and what I thought was her nadir (I did a late spotcheck and got a much lower number than I had gotten at her "nadir", so I don't know when it is now).

I was trying to figure that out when I gave two furshots in a row. Her numbers came down but most of all she was socializing and cuddling and sleeping sprawled out in the middle of the floor as opposed to being lumped up behind the couch as she had been for the past couple weeks. So I decided to reduce her dose by half.
The PU/PD which had gotten so bad again stopped.

She had been on that dose 5 days when I raised her to 1.75. I did this because her numbers were obviously still too high and the PU/PD started again. I'm just getting a lot of conflicting information on what her numbers mean, and I'm completely lost and confused. I thought I'd try the small increase and see. Now she has flat high 200's.

Can someone PLEASE help me straighten out what I've done and help me know what to do? Continue with 1.75? Go back to 1.50, which obviously isn't enough. Or is it too much?
I have absolutely no idea what to do.

I haven't tested her yet this morning, I give her shots at 1:30, her shots were supposed to be at 11, but over the last 3 months I've been late and am now at 1:30 pm for her AM shot - I know, it's confusing, I'm trying to work her back up.
 
Going back and looking at her spreadsheet it looks like she was starting to give you a lot of blues and even a sprinkling of greens on 1.25u...then the more you upped the dose the worse the numbers got. You already cut her dose in half from the 3u to 1.5 and started seeing better numbers but comparing those numbers to the ones she was getting at 1.25 makes me wonder if she still isn't getting too much.

I think is was one of mine I would take her back down to the last place she was giving you good numbers..i.e. the 1.25u Just my 2 cents worth.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
I think I am going to disagree with Mel (sorry Mel!). When you saw better numbers with the lower doses, you stuck with each of those doses for at least 3 cycles of higher numbers before you raised by .25u. I think that this would indicate the dose increase was appropriate.

I think sticking with 1.75u for a few more cycles and continuing to increase is warranted. You're seeing mostly flat numbers, and no indication of bouncing. Just curious, why did you lower the dose from 3u to 1.5? It looked like you were finally starting to get some action on the 3u, and then suddenly cut the dose in half.

You also might want to consider tight regulation. You're testing enough to do TR safely and correctly, and you might see some better results as it is designed to give you better control over her BG than SLGS.
 
Her numbers were in the 300's with 3u! I'm not seeing the action you're talking about Julia.

Mel, she was on the 1.25 for quite awhile and her numbers weren't consistantly lower, she would have blues but then right back up. I thought the idea is to have consistantly lower numbers.

I'm not trying to be argumentative, I'm trying to understand.
 
And we are trying to help you understand, but there are several schools of thought on this and well it isn't an exact science.

Yes, ultimately consistant lower BGs is perferred, especially if there is a chance that the cat will be able to go into remission and become diet controlled..but before remission can happen if it is ever going to happen the first step is regulation...regulation is different than striving for remission. I don't have the numbers on hand right now (posting off cell phone) but I can tell you that a well regulated cat is staying below renal threshhold of 240ish at preshots and usually dropping into the 100s or double digits at nadir.

Of course the longer we can hold them in 'normal' numbers the more rest the pancreas gets and thus the better chance to heal...but not all cats just like not all human diabetics are going to become diet controlled and really I personally don't see any harm in settling for a well regulated diabetic first and then trying for remission if possible.

I got lucky with my Maxwell, he went into remission quickly, Musette flirts with it, but if it never happens for her I'm going to be happy to have her well regulated and the same goes for my Autumn...if either of the girls go off insulin great, if they don't and are just happy healthy diabetics great as well I'm not going to love them any less nor am I going to throw in the towel on them because they didn't go OTJ.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
When I started giving Eleanor insulin, all I wanted was for her to be regulated. I figured if she could get to that I'd be happy, then maybe try for remission.
 
I'm talking about 5/3, 5/5 and 5/6 when she went down into the 100s. Her numbers were not really that different on the 3u than they are now on the 1.5u. Remember that there is a +/- 20% variance in meters, especially at higher numbers, so high 200s and low 300s are pretty much the same thing.

However, I would not recommend jumping right back up to that dose. That's why I suggested you might want to try TR, where you can raise every 3-5 days instead of every 7. In my opinion, I think your problem is that you're holding doses that aren't working for too long, and because of that you're watching her insulin need creep up over time because of extended hyperglycemia.

Also, once you do get to a breakthrough dose, it's likely you'll see some lower BG numbers and some higher BG numbers than what you're currently seeing from bouncing.
 
MommaOfMuse said:
Of course the longer we can hold them in 'normal' numbers the more rest the pancreas gets and thus the better chance to heal...but not all cats just like not all human diabetics are going to become diet controlled and really I personally don't see any harm in settling for a well regulated diabetic first and then trying for remission if possible.

I got lucky with my Maxwell, he went into remission quickly, Musette flirts with it, but if it never happens for her I'm going to be happy to have her well regulated and the same goes for my Autumn...if either of the girls go off insulin great, if they don't and are just happy healthy diabetics great as well I'm not going to love them any less nor am I going to throw in the towel on them because they didn't go OTJ.
Click to expand...

Regulation and remission are not two opposing goals. Regulation is the first step to remission, and better and sooner the cat is regulated, the more likely it will reach remission.

TR offers better control over BG, which allows you to regulate more quickly.

I believe remission should always be the goal, since that is the healthiest and safest condition for a diabetic cat to be in. Some cats will not be able to reach remission for various reasons, and of course you wouldn't give up or stop loving those cats. But even in those scenarios you should still try to regulate to the best of your ability to keep your cat in the best health possible.
 
And, what should I think about Eleanor seemingly feeling so much better on the lower dose?
She isn't behind the couch, she isn't fighting the shots or crying out when I stick the needle in. Instead she is out walking around, playing, cuddling with me, and she is even lying down and letting me give her her shots.
 
Many things can make a cat feel better or worse--correlation does not imply causation. Based on your data, it does not not appear to me that her dose was too high. You did not raise the dose by too much or too quickly--in fact, you did the opposite and held doses for 7 days. Her numbers have been mostly consistently flat. In my opinion, this implies that the dose needs to be increased.

I'm signing off for the night, but I would recommend you cross post this in the Lantus forums, so that some more eyes and opinions can contribute and hopefully answer some of your questions.
 
PU is polyuria or excessive peeing and PD is polydypsia or excessive drinking of water.

Julie...in this case, I agree with Julia. You halved her dose...that's pretty significant. It is often observed that FD cats seem to feel better at higher numbers because that is what their body has become used to.....Gracie was the same way but as she started spending more time in normal numbers, she is a lot more like her preFD self. So you are not observing anything different in Eleanor than others have seen in their kitties.

I think it is a good suggestion to leave her at the 1.75u dose for six cycles and if she doesn't start getting into blue numbers, start increasing the dose according to the TR protocol. I know you started with SLGS but I believe you switched to TR after you realized you were testing enough for that protocol.

Also, the increases are not based on the PS. I'm not sure why you think we had you increasing based on the PS....we didn't.

She went up on 5/3 p.m. cycle and on 5/6 a.m. cycle because, I believe, she was bouncing from the blue numbers which she was not used to.
 
I have a question....

I'm looking at the 5 days that Eleanor got 1.5, and I can see pretty flat cycles, so I understand the advice to increase to 1.75 (whether it's for 3 days, or 7 days). The number I don't "get" is that pink number in the middle of yesterday''s cycle. Is that just an oddball "meter variance" number, and she's still flat? I don't see any number anywhere that would have caused a bounce.

What I find encouraging is all the comments in the "comments" column which all seem like positives. Yes, it could be coincidental that they all took place after the halving of the dose. But they are all good "whole cat report" notes.

Another question regarding the halving of the dose and the shed. When you cut a dose in half like that, how long until the shed "readjusts" to the lower dose? How much of what happened over the first few days on 1.5 was (or was it?) residual effects from the shed emptying (for lack of a better word).

I'm trying to understand too...

Carl
 
No, she went into pinks on the 3u, THAT was when she was feeling bad and hiding. It was after the furshots and subsequent yellows that she started feeling good again.
 
Good questions Carl.
That pink was weird, I actually rechecked that. I figured she was going to continue up and was surprised when I tested later and she was yellow again. She hadn't eaten, been jumped by the other cat, or anything else to trigger that!
 
The shed from a higher dose can influence the BG for up to six subsequent cycles. It doesn't in every cat....some it's only 3 or 4 cycles but it can be six and may be more depending on the cat, the dose, or other variables.

I have no idea where that mid cycle pink number came from; it's a little out of meter variance and so I wouldn't get too focused on that one number.
 
Julie, I'm as confused/flummoxed by Pumbaa's numbers as you are by Eleanor's, so I am going to be watching how you and Eleanor deal with this. A few weeks ago, I, too, reduced Pumbaa's dose after seeing continually increasing numbers with dose increases. I wanted to start over, work harder to prevent fur shots, and wait longer for Pumbaa to get over new-dose-wonkiness and bounces and settle into a dose where I had data that, to me, was going to be easier to interpret. It was for a short time, but now he's confusing me again. *LOL*

Anyway, I have no advice for you, but just wanted you to know that I understand your frustration, and hope that you and I find the perfect dose that will keep our babies under 200, regularly. Then we can move on from there. :)

Suze
 
I'm jumping on the bandwagon and agreeing with Julia and Marje. I suspect the pinks you were seeing at 3.0u were the results of bounces off of the blues or a fur shot. At this point, I would encourage you to continue to gradually increase the dose.
 
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