Esse and Eeyore updating 6/11

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Michele and Esse

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Hi, All!

I hope a lot of you have had a chance to go see Eeyore's revetting thread over in health - he's really come round...done a lot of recovering and health improvement stuff...and with the vet and I, we've dropped his dose to 0.5U. She and I both believed he was in chronic rebound, so we took him off for a day, and then restarted him on 0.5. We will stay at the dose until next Monday, and perhaps on Tuesday bring him to 0.75 or 1. Not sure yet. But in any event, his vet report is phenomenal - hop over to health and see for yourself! WOOT!

Now, as to the Essemama. We've had an interesting week...take a peek at her ss, and please note all the blues and greens she's had...day after day of them. YAY Mama! She was far too low to shoot tonight - 66 - so I will see where she is in the morning. Considering I caught a 43, she will have a decrease to 2.75 the next time she's over 100 (she's still at 85 @ +18 hours).

They're both doing well...and I'm just so thrilled with their overall progress. No, we don't have the right dose for Eeyore, but he's done so much healing of the other issues over the last 11 or so weeks that it's a whole different cat. And Esse has just been so cheerful and energetic...it's a pleasure to see her like this.

Anyway, just thought I'd update...

Hope everyone has a great Friday!!

Best-
Michele
 
I'm glad your babies are doing well and what a great report on Eeyore!

I completely disagree on the "chronic rebound" thing (please don't take this as a criticism towards you - I don't mean it that way)...we simply DON'T get chronic rebound when following this protocol. Also, while Eeyore's spreadsheet is very different from an acro cat, have you considered getting the IGF-1 and IAA tests performed, just to rule things out? Might be worth it.

I hope things are going better for you, and I really did enjoy the vet report on the boy!
 
Esse's numbers are indeed lovely.

Eeyore -- not so much. It looks like you have the answer to Somogyi -- it's a negative test. I hope you are testing for ketones given the high numbers Eeyore is giving you on 0.5u and your note in Health that he has an infection brewing. As you no doubt know, high numbers, not enough insulin, and an infection are a recipe for ketones. Given how well the rest of his labs are, the ketone test will be a way to insure he's safe.
 
I'm not understanding why chronic rebound (rare) was suspected. Am I missing something? When Eeyore was getting 1.5u he was getting nice numbers. Then there was a dose reduction on 6/2, not sure why it was given. I think I must be out of the loop here. Chronic rebound is so rare I can't think of a kitty who had that in LL -- I'm curious has anyone seen a cat here with chronic rebound?
Bounces, yes of course but chronic rebound is a whole other beast.
 
Hi Michelle,

I did see Eeyore's revetting in health and loved the update. You've done a great job with him, he is a very lucky boy.

Harley is hoping to get numbers like Esse's soon.

Peace,
Robin
 
Sounds like progress al around, Michele! I hope things continue to go well.

What IS chronic rebound? Just curious; not questioning your judgment since I don't even know what it is.
 
I know that a lot of you will disagree with the vet and my decision to reduce Eeyore. That's all right. But please don't give me grief (that's why I haven't been posting; I don't want the grief). And no, Sienne, it's not a negative test yet. It's not over. Zero dose was obviously not the dose, but that doesn't mean that 2U was the dose, either.

I have done a ***whole lot*** of research. One of the hallmarks for chronic rebound is a repeated 'checkmark shape' on the graph. I graphed a lot of days, and most of them showed a checkmark shape. Some were less steep than others, but they were still checkmark shape.

Another hallmark of chronic rebound is that there is a few days' high numbers after a low. If you look at Eeyore's ss, you can see that he'd hit green, then be red for several days. Then throw a green, and then be red for days, and so on.

And another hallmark of chronic rebound is a number at apex of the graph that is *higher* than the preshot number (eg AMPS 390, low number of 200, PMPS 450)

And a hypo event does not need to be part of the checkmark for it to be chronic rebound, either. Any sudden drop in number can trigger it; anything which will trigger the endocrine system to release cortisol, epinephrine, and other hormones which make the liver produce glucagon...which sends the sugars higher. These hormones can last for 72-96 hours - but if the same amount of insulin is given, the drop will occur again - and so will the counter-hormone release, and the cycle is established. It then becomes a 'habit' or pattern of the body, and the overreaction from the endocrine system to the higher dose of outside insulin is repeated, but at a higher number.

The difficulty in identifying chronic rebound is that it looks almost exactly like simple high numbers...and our instinct is to give more insulin. Which may trigger a faster drop, with a subsequent bounce and checkmark shape on the chart. The only real way to test for this is to reduce the dose, leave the cat there for a while, and see what the cat does.

Back to Eeyore. When he came here, he was in bad shape. I put him on 1U immediately, and almost immediately began raising it. I never gave the new diet a chance to work, and did not take into account how bad his body condition was (of course). He did look much better at 1.5, and we can go back there gradually. But now that his body is soooooo much better than it was, the situation needed to be reassessed, and possible changes implemented.

In response to the thought that Somogyi/Rebound is rare, it may not be as rare as we think. There is a lot of data that shows with home testing of cats, it's becoming "more common", but I doubt it's actually increasing but rather it's a matter of consistent data gathering and education. My vet is the one who, way back at the original vetting, thought we might be creating a somogyi effect.

I am feeling really defensive...I know that most folks don't believe that chronic rebound exists. I am doing what I think is right for Eeyore; I don't believe anyone can think that I'm not doing my best with him. Sometimes, thinking outside the 'box' is a good idea...

Sienne, you must not believe I am aware of ketones, or haven't read the comment section of my ss. I've tested him repeatedly, and so has the vet - no ketones are there. For pete's sake, give me a modicum of credit, all right?

I was speaking with someone here about not posting, and explained why. I didn't want to hear how horrible I am, how I'm chasing a dragon with chronic rebound; I didn't want to feel unsupported and put down. Unfortunately, that's exactly how I feel right now.

When did ECID stop applying to Eeyore and me?

As for Esse, she's phenomenal. A tad high this morning, but she's only 240 at +24, so I can't be at all concerned. She got insulin this morning, a reduction to 2.75. I've got to believe that her pancreas is healing - that's a long stretch at below 100 numbers yesterday. Go, EsseMama!!

I hope that you guys can have a relaxing Friday...

Best-
Michele
 
There's no intention to give you grief, we know you check for ketones, I saw that on your ss comments, it was just a friendly reminder ok?
Noone's saying terrible things Michele, we do care about your kitties and just relaying keeping on top of ketones testing.
We just care Michele, as we do for all the kitties.
 
Hi Michele,

Thanks for that explanation. That's all news for me. It's hard not to feel defensive when, there you are, on the ground, and you have to make decisions that you know will seem "off" at a distance, but that look right when viewed up close and personal, so to speak. You have to do what you think is sensible, and ECID most certainly DOES apply to Eeyore. I think everyone knows you are doing a phenomenal job and I repeat what I said--it's progress for both your kitties in my eyes.

How have you been doing? I'm not here as consistently as I once was. I check in nearly every day, but post only here and there and don't read everything. I do know it's been a tough spring for you.

Please don't stop posting. And I hope Esse continues to go go go!
 
If you think I was giving you a hard time -- I wasn't that would be like.... what is that saying? me calling a kettle black or something? Anyway, I'm posting my "chronic rebound" check -- I did it too and probably from reading similar things. I was hyper sensitive to thinking lots of cats on the board were in chronic rebound. I was wrong.

I'm sorry I put Noisy through that "check". When I look at his SS now I think wow, that was a bad idea, look how long it took me to make it out of that "check" -- 2 months. He was subjected to higher numbers then he should have been. I was learning then -- I know much more now -- when I see a kitty that is not in chronic rebound and is having a chronic rebound check, I have to speak up. One of the things I love about this board is there are people here who have had similar good and bad experiences -- we try to connect on that level, how cool is that?

We have to do what we have to do -- I don't want you to feel under attack. I'm not going to criticize you, I'm here to support you rebound check or no rebound check. I was hoping it would help you to hear from people who have been where you are and have studied SSs long enough to "see" them.

Picture%206.png
 
There's so much to respond to here -- this is a good thread to talk about rebound, chronic rebound, bounces -- they all have similarities but are different.

If someone finds a SS with chronic rebound in it please find me, I want to study it.

I must get back to making my Mr. Liver movie. These are a few sketches:

class-one.jpg


2-class.jpg


4-a-new-low.jpg
 
Michele and Esse said:
I am feeling really defensive...I know that most folks don't believe that chronic rebound exists. I am doing what I think is right for Eeyore; I don't believe anyone can think that I'm not doing my best with him. Sometimes, thinking outside the 'box' is a good idea...
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Hi Michele,

I'm sorry you're feeling so badly right now...I completely understand and I hope you will not quit posting. I know you are doing your best for the boy, I know you want to try this, and I respect your decision. I don't agree, that that's okay! People with kitties that are not doing as expected get a lot of flack, no matter what they try. I know on the high dose-side, people get judged harshly, constantly.

I really do hope your experiment proves successful and I hope you'll have the fortitude to continue to post no matter what people say.
 
Hi Michele,
The point of my post is not to "give you grief" at all. I would like to add that I have been doing this a very long time, with multiple diabetic cats and an acrocat. I am a heavy poster, SS translater and reader on this board, and I quite literally study diabetes, both human and feline. I am not paid to do this, nor have I gone to school for it. It's just something I do. I was previously very active on the Lantus, PZI boards and Health boards, though I've been taking it easy for quite sometime. I am telling you all this so you don't think this is coming from an inexperienced person. You probably have never seen me, because I pretty much exclusively work with the "problem cats", cats who are high dose or have problems contributing to their diabetes.

I understand you feel completely unsupported, and I feel badly for that. Unfortunately I also can not support this test and hold pattern, but I very much support YOU. I understand questioning responses, and I do that too. I think people will agree that I am more known for going off-protocol than pretty much everyone on this board. I don't want you to think you need to leave.

Chronic rebound is pretty much an idea that has been tossed around the board, yes even by me, at length for many years. It is basically unheard of in low dose lantus/levemir cats because the dose is not high enough to trigger it and the slow action of the insulin does not allow the liver to become resistant to it, as is often the case with other insulins.. the basis of somogyi. This is something that dates back to the days when we were all shooting PZI 3 and 4 times a day... and further to other older, no longer manufactured insulins. The "classic" sign of it, the "inverted curve", is also a very clear sign of insufficient insulin, a point that seems to never be considered. The checkmark shape is most likely, and most often, a sign of either (a) early nadir or (b) the insufficient insulin showing it's inability to keep up with rising bg's. Conversely to your statement about it becoming more common, both the veterinary community and our community are finding that Somogyi is LESS common, especially in cats following this protocol. I can not think of one single case on LL in the entire time I have been posting on this, and the old, board. That is a lot of cats who did not have it.

Your statement about the few days high after a low, is not chronic rebound, but acute rebound. There is a HUGE difference. Acute rebound is temporary, as I am sure you know if you have followed the Lantus Protocol used on this board for even 1 day. You must shoot through acute rebound, as it is temporary and only the result of an alarmed liver.

I understand the personal need to respect your veterinarian, however some things are not being considered here that are very disturbing to me.

First, the rebound check IS over, whether you want to continue practicing it or not. It is quite obvious to me that there is insufficient insulin, and that the cat is now in danger of developing ketones. He already has an infection, no? Infection and insufficient insulin are the predecessors of ketones. Ketones can and will develop into DKA very quickly in a sick cat, which he is.

You state that the dose was increased rapidly upon you getting him. I do not see that. I see:
2 doses at 1u
7 doses at 1.25u
3 doses at 1.25uF
7 doses at 1.5u
7 doses at 1.75u
7 doses at 2u
3 doses at 2uF
1 dose at 2uS
9 doses at 2u
13 doses at 2uF
1 dose at 2uS
4 doses at 2u
2 doses at 2uS
12 doses at 2u
etc etc etc.
This is not speedy, in fact to me it shows that you don't feel his correct dose is over 2u. I don't know if I'm off here, but do not think there is something wrong with your cat because he needs more than 2u.

My advice? I understand you may choose to disregard it, but I recommend you return to 2u and return to protocol. I expect you will find him responding well somewhere in the vicinity of 2.5-3u. I do not believe this cat is acromegalic, IAA or Cushings. I do not see any resistance indicators, I see only insufficient insulin. The proof is in the spreadsheet, Michelle. Look when you started, look at the colors, and how they smoothly transitioned from Red and Pink on to Yellow, Blue, Green and Pink at the 2u mark. Then look how they went right back to Red and Pink when you reduced.

We are not ganging up on you. We are offering you our experience and our help and there is a difference. Should you choose not to accept it, that is your choice. Every bean is different, and we understand that. However, our collective experience is telling you that there are always at least two ways to look at every situation. If you don't follow our advice, we will understand, but we are here for you to call upon if you need help. Always know that.

This site is often responsible for people feeling unwanted, unloved, unsupported, when in fact, people are only trying to help. Please don't take offense, none is intended. ((((hugs))))
 
I'm sorry if you are feeling defensive but my comments were not meant in that vein. Nor am I questioning your devotion to your herd! And, I'm supportive of you. What I am doing is raising several points and/or questions.

There are any number of people who read condos and do not open SSs. There are lurkers and newbies and it helps to be very explicit about your reasons for undertaking an approach that is at variance with the protocol and/or what is generally recommended here. Asking about ketone testing in a cat with high numbers and possibly both an infection and insufficient insulin informs others, if not reminds someone who may already be knowledgeable, about a potential risk. If you have never had a cat go through DKA, you can't begin to imagine what that is like. I would prefer to spare anyone and everyone the anxiety and the expense (both emotional and financial). And yes, ECID is true for every cat here including Eeyore. When I undertook a manipulation of Gabby's curve with food, Jill reminded me to note it on my SS and to mention it in my condo when appropriate for the reason stated. Likewise, those beans who have cats on high dose protocols change their signature to reflect what they are doing as do those who can't get tests during the day, etc. There are people here who will read something in a condo and apply it to their cat when they haven't weighed the pros and cons of their decision as you evidently have.

If you have come across references regarding chronic rebound in cats on Lantus could you PM me with the references. I'd like to add it to my stockpile of articles (and do my homework). The only citation I've come across is very old and wouldn't be applicable to long-acting insulin.

I am wondering, though, when you mention the duration of influence of counter-regulatory hormones, if that is specific to cats? The duration of their effect is what I'm used to seeing in humans, not felines. I'm also curious, based on your research, how one differentiates a "bounce" (i.e., acute rebound) vs. chronic rebound? From what you described (i.e., the "check mark pattern" of numbers), Gabby and many of the other kitties here would qualify as being in chronic rebound. Or is it cycle next to cycle of this sort of pattern vs. an isolated cycle here and there?
 
michelle, i'm happy to hear eeyore is doing so well! ultimately, the decisions for his treatment lie in your hands. no one is giving you grief. concerns have been expressed... and rightly so. eeyore has an infection brewing, insulin was withheld for 2 days, and then the dose was more than cut in half when imho, it appears he was already under dose. the stage has been set for diabetic ketoacidosis, but i'm not telling you anything you don't already know. i'm glad you're testing for ketones frequently. i'm sure you'd rethink this plan if eeyore starts throwing ketones.

i am sorry you're feeling as if we're not being supportive. we do support you and we all want the best for eeyore.
we can support and yet still have differing opinions or thoughts, right? :-D

however, it is important to point out for the benefit of those reading this thread today and in years to come, this practice can be very risky. if a "rebound check" is attempted, urine/blood must be checked for ketones frequently.

lantus and levemir users who are following the tight regulation protocol followed by most in this group will often see acute rebound. not chronic rebound (if it exists). kitties WILL bounce when their sugar drops into levels their body is not used to. this is normal and to be expected. we don't do rebound checks when the doses have been increased systematically (in small increments) based on nadirs. we don't do them because they only lead to unnecessary and unhealthy hyperglycemia. consistency is how we overcome bounces.

"bounces" from numbers a cat who is not used to being in lower numbers is a very different thing from a cat with very high numbers due to being over dose. we know they're not over dose when the protocol is followed.

by using the very logical and methodical dosing approach with lantus AND levemir as suggested in the tr protocol... we do not do rebound checks. we shoot right through the bounce... training the liver to eventually accept these lower numbers as "normal". why? because the body has been in high numbers for so long... it forgot what "normal" really feels like.



again, for the benefit of those reading this thread, i'd like to post the ACVIM abstract (2008?) for this study:

THE SOMOGYI EFFECT IS RARE IN DIABETIC CATS MANAGED USING GLARGINE AND A PROTOCOL AIMED AT TIGHT GLYCEMIC CONTROL.
K Roomp1, JS Rand2. 1Max Planck Institute for Informatics, Saarbruecken, Germany. 2Centre for Companion Animal Health, University of Queensland, Australia.

The Somogyi effect is defined as hyperglycemia caused by the release of counter-regulatory hormones in response to insulin-induced hypoglycemia, and it is widely believed to exist in diabetic cats. However, studies in human diabetic patients over the last quarter century have rejected the common occurrence of the Somogyi phenomenon.

The aim of this study was to determine the frequency of the Somogyi effect in diabetic cats treated with glargine. Fifty-five cats diagnosed with diabetes mellitus were included in the study. Data were collected over 20 months, and were obtained from owners who joined the online German Diabetes-Katzen Forum, and followed a protocol of intensive blood glucose regulation using glargine. The aim was to achieve euglycemia (50-100 mg/dL as measured using a portable blood glucose monitor) using twice daily insulin dosing. Owners performed an average of 5 +/- 2 blood glucose measurements per day, and supplied spreadsheets recording all blood glucose concentrations.

The Somogyi effect was defined differently in cats that had good glycemic control compared to those that were not well controlled. For cats that were well controlled and had their nadir concentrations in the normal range (50-80 mg/dL) on an almost daily basis for >=2 weeks, a Somogyi effect was defined as a glucose concentration of <=40 mg/dL, followed by a fast, steep rise in blood glucose concentration to >=400 mg/dL, and/or concentrations that were at least 150 mg/dL above the usually measured higher concentrations. The two subsequent insulin doses showed almost no effect, and the glucose concentration remained elevated for >=24 hours. In cats that had never had a glucose concentration in the normal range or only had nadir glucose concentrations in the normal range for several days, a Somogyi was defined as a blood glucose concentration of <=70 mg/dL, followed by a fast, steep rise in glucose concentration to >=400 mg/dL and/or concentrations that were at least 200 mg/dL above the usually measured higher concentrations for that cat. The two subsequent insulin doses showed almost no glucose lowering effect, and the glucose concentrations remained elevated for >= 24 hours.

Asymptotic or biochemical hypoglycemia was common and most cats (93%) had blood glucose concentrations >=40 to <50 mg/dL measured at some point during the study, 84% had glucose concentrations >=30 to <40 mg/dL, and 51% had some glucose concentrations >=20 to <30 mg/dL.

Although biochemical hypoglycemia was common, the Somogyi effect was very rare in this cohort of diabetic cats. Based on the criteria, only 4 single events were identified in 4 different cats. We conclude that that the Somogyi effect is rare in cats treated with glargine on a protocol aimed at tight glycemic control, despite the frequent occurrence of biochemical hypoglycemia.



afaik, the only paper describing original research into Somogyi in cats (besides the abstract above) is this paper:

McMillan FD, Feldman EC. Rebound hyperglycemia following overdosing of insulin in cats with diabetes mellitus. J Am Vet Med Assoc.
1986 Jun15;188(12):1426-31.

if you can get your hands on a copy (it's difficult), it's worth reading. kirsten (tillydiabetes.com) sent me the following notes after reading this paper:
"Specifically look at the insulins used, the doses, the dosing intervals, the lack of proper blood glucose monitoring, the lack of documentation of food type, amounts and feeding times, etc. And no counter-regulatory hormones were ever measured. And suddenly they identify something called chronic rebound, which doesn't even exist in the human literature."


to sum things up, nadirs are the most important factor in determining whether a dose is appropriate or not. when following the TR protocol with lantus or levemir and the numbers are consistently high, generally speaking, rebound checks shouldn't be done... nor should insulin be withheld.

fwiw, just my thoughts...
 
I just wanted to say that I'm happy to hear that Esse and Eeyore are doing well. And that you're comfortable in what you've decided to do for them.
 
See, this is what I mean.

Here, in this thread, I say I'm reluctant to post because of getting grief. This doesn't exist, this isn't happening, this is simple LTS. You're going to send your cat into DKA!! Run, the sky is falling! LOL. See what I mean? I don't want to post (and thus feel exceptionally alone...) because of exactly this.

If this happens, as one person said, to a lot of people on this board, then...maybe it's time to look at the mirror and see if there's something that can be done. I am all for teaching - I think you guys know me well enough to know that; I am all for making sure the cats are doing well - again, I think you all know that. But if people feel like they're unsupported, perhaps one should look and see what they're contributing to the issue, instead of making it a place where someone can come, say "I'm having difficulty with this, I'm gonna try that" and maybe get some advice about what to look for, when to call the experiment, what parameters to use, and so forth. But no, instead, the pattern repeats itself, and another member feels like crud.

D, your providing me your personal experience and a screenshot of your ss is very interesting, and I appreciate your time. There is a difference between Noisy's ss and Eeyores, and that is the dramatic difference in nadirs, timing of nadirs, and elevation of spike postdrop.

Someone else said that I had Eeyore off insulin for two days. Nope. Not even one. If one looked at his SS, they'd've noted that when he hit 500, I gave him some insulin. That happened about 16 hours from the last insulin injection...and he's been on 0.5 since. With the full knowledge of my vet.

You all also seem to think he's got an infection brewing - as I did. But you apparently didn't read down through the thread, to where I said I spoke with my vet, and she didn't think it was anything to be concerned about, and has not given ABX. I was comfortable with that answer, because I didn't see the numbers I would expect with an infection going, either, but was concerned when I saw the labs. She's clarified the issue, and that is what I'm going with.

BTW, I **have** studied diabetes in school...and deal with it on the floor a lot with people. There **is** literature that somogyi occurs in humans as well as felines. It is not a terribly common thing, but it does occur - less in humans than in felines, but it does in fact occur. The regulatory hormones are the same, the pituitary is triggered by the same things, and the adrenals produce the same things...

My goal and purpose with this is to find the right dose for Eeyore. I have Esse on 3 units (well, she's not there anymore...), and if they needed 5, 10, or more units, I'd happily give it to them. But if the answer is somewhere else, then I need to pursue that, as well.

If you guys are worried that newbies will follow my lead, then PM me and tell me to post a comment in my sigline. There's no need to do it publicly. Ripping me apart, telling me there is no such thing, basically calling me either a fool or a liar, in public, is a bothersome event.

Yes, I've had a really hard spring. This has been part of it; taking in a very sick cat, and getting him turned around...and then trying to find the dose he needs. I have learned so very much here, and I very much appreciate that. I am also feeling very attacked, and that doesn't feel fun nor supported. I mean, Esse is doing so very well, and not one of you seems to have noticed and commented on that, nor cheered her on. Poor Esse, you know?

I am a good - damned good - cat mom. I would like support, but if none is forthcoming simply because I'm doing something a bit differently than you would do it, well, then I can just go on about my business and not post.

Michele
 
Iorwen & Tray said:
I just wanted to say that I'm happy to hear that Esse and Eeyore are doing well. And that you're comfortable in what you've decided to do for them.
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Thank you, thank you, thank you!

Best-
Michele
 
I mean, Esse is doing so very well, and not one of you seems to have noticed and commented on that, nor cheered her on. Poor Esse, you know?
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sorry Michele, but Esse has been acknowledge in this thread a few times.

Good luck to you and know LL is here for you either way.
Differences aside, people care - even those who don't know the full history.
 
Michele and Esse said:
See, this is what I mean.

Here, in this thread, I say I'm reluctant to post because of getting grief. This doesn't exist, this isn't happening, this is simple LTS. You're going to send your cat into DKA!! Run, the sky is falling! LOL. See what I mean? I don't want to post (and thus feel exceptionally alone...) because of exactly this.

If this happens, as one person said, to a lot of people on this board, then...maybe it's time to look at the mirror and see if there's something that can be done. I am all for teaching - I think you guys know me well enough to know that; I am all for making sure the cats are doing well - again, I think you all know that. But if people feel like they're unsupported, perhaps one should look and see what they're contributing to the issue, instead of making it a place where someone can come, say "I'm having difficulty with this, I'm gonna try that" and maybe get some advice about what to look for, when to call the experiment, what parameters to use, and so forth. But no, instead, the pattern repeats itself, and another member feels like crud.

D, your providing me your personal experience and a screenshot of your ss is very interesting, and I appreciate your time. There is a difference between Noisy's ss and Eeyores, and that is the dramatic difference in nadirs, timing of nadirs, and elevation of spike postdrop.

Someone else said that I had Eeyore off insulin for two days. Nope. Not even one. If one looked at his SS, they'd've noted that when he hit 500, I gave him some insulin. That happened about 16 hours from the last insulin injection...and he's been on 0.5 since. With the full knowledge of my vet.

You all also seem to think he's got an infection brewing - as I did. But you apparently didn't read down through the thread, to where I said I spoke with my vet, and she didn't think it was anything to be concerned about, and has not given ABX. I was comfortable with that answer, because I didn't see the numbers I would expect with an infection going, either, but was concerned when I saw the labs. She's clarified the issue, and that is what I'm going with.

BTW, I **have** studied diabetes in school...and deal with it on the floor a lot with people. There **is** literature that somogyi occurs in humans as well as felines. It is not a terribly common thing, but it does occur - less in humans than in felines, but it does in fact occur. The regulatory hormones are the same, the pituitary is triggered by the same things, and the adrenals produce the same things...

My goal and purpose with this is to find the right dose for Eeyore. I have Esse on 3 units (well, she's not there anymore...), and if they needed 5, 10, or more units, I'd happily give it to them. But if the answer is somewhere else, then I need to pursue that, as well.

If you guys are worried that newbies will follow my lead, then PM me and tell me to post a comment in my sigline. There's no need to do it publicly. Ripping me apart, telling me there is no such thing, basically calling me either a fool or a liar, in public, is a bothersome event.

Yes, I've had a really hard spring. This has been part of it; taking in a very sick cat, and getting him turned around...and then trying to find the dose he needs. I have learned so very much here, and I very much appreciate that. I am also feeling very attacked, and that doesn't feel fun nor supported. I mean, Esse is doing so very well, and not one of you seems to have noticed and commented on that, nor cheered her on. Poor Esse, you know?

I am a good - damned good - cat mom. I would like support, but if none is forthcoming simply because I'm doing something a bit differently than you would do it, well, then I can just go on about my business and not post.

Michele
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I did look at Esse's SS and did not note to you about it because I felt her dose is too high for what appears to be possible pancreatic action, and I felt one cat at a time would be appropriate, since she is quite obviously in good hands.

I do not understand the lashing out. Do to your schooling in feline diabetes, you must know far more than me, my mistake. Good day to you, and good luck with your babies.
 
Michele and Esse said:
D, your providing me your personal experience and a screenshot of your ss is very interesting, and I appreciate your time. There is a difference between Noisy's ss and Eeyores, and that is the dramatic difference in nadirs, timing of nadirs, and elevation of spike postdrop.
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I should have included the whole beginning. I thought maybe showing a little of it would prompt looking at the whole spreadsheet. Here is the beginning of our LL journey. You might see why I thought he was in chronic rebound by the highs and lows in the beginning. The earlier shot I showed you only showed what happened -- high numbers. ETA: I know our numbers are not the same, I wasn't suggesting both SSs were similar, more just wanted to share my experience with a "chronic rebound check". I'm still wanting someone to find me a SS that has chronic rebound in it -- that statement is not meant to be confrontational -- I am extremely interested in seeing one. ETA 2: Note to all Lantus kitties -- it is good to look at other SSs even if the kitty isn't like yours -- you will be amazed at how much you can learn.

Funny to see that "no BG 11u" The night I came here everyone was telling me I had to drop Noise's dose, to like 1u -- I was a little skerred to do that so I dropped it to 10u :lol: I think by the time I woke up the next morning I got the picture, we needed to listen to FDMB. :mrgreen:

Picture%207.png
 
.... making it a place where someone can come, say "I'm having difficulty with this, I'm gonna try that" and maybe get some advice about what to look for, when to call the experiment, what parameters to use, and so forth.
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Hi Michele. I'm not perfect. So.... Can we start again? Hi, I'm CD, welcome to FDMB, glad you are here!

This is your kitty, you rescued him, you love him and I know you will do your very best.

I think many have told of their experiences above and you've read them. Now I'm sure you will think about all of that information, study it and add it to what you already know and what you've learned and go forward. I wish I could offer some concrete advice on what to look for in your experiment except that after a certain number of cycles with no improvement in the numbers, I'd suspect that the insulin has cleared out and you begin again.

Without any scientific studies or anything ... I'd be willing to say it's time to think of Eeyore as if you recently discovered he's diabetic. If he was my kitty I would at least begin him at 1 unit and start increasing every 4 or 5 cycles. The 0.5u doesn't seem to be doing much. He has a good diet now and is way healthier than when he first came to you so those 'issues' have been resolved.

Or you could treat this as going back to the last successful dose after a failed reduction and begin him at 2 units. Anyway those are the only parameters I can suggest. I had very little experience with bounces. (I know, I know... I was really lucky!) :-D

Hang in there, good luck! (((Hugs)))
 
Carolyn and Spot wrote:
I did look at Esse's SS and did not note to you about it because I felt her dose is too high for what appears to be possible pancreatic action, and I felt one cat at a time would be appropriate, since she is quite obviously in good hands.

I do not understand the lashing out. Do to your schooling in feline diabetes, you must know far more than me, my mistake. Good day to you, and good luck with your babies.
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Carolyn, I do not know far more than you due to my schooling. I know my cat far better than you because I've spent a ton of time with him, and you haven't. I also believe that Somogyi happens, whether or not you think so. Can't someone believe elsewise than you, and still be considered a valuable member?

As for Esse, yes, I believe she has some pancreas action going on. But I'm following protocol with reducing her dose. Is that why you didn't think you should mention it? Because I'm playing by the "rule book"?

As for the lashing out: let me explain a bit about my life at the moment. My father is terminally ill. He gave me a check to help with summer costs, and it bounced. I didn't know that, and am now overdrawn by $1100. He's out of the country, so I can't remedy the situation. That was yesterday. When he's in town, I cook for him and help him handle his meds often. My Daddy is dying, and it's killing me.

My best friend's boyfriend has been having a ton of stress; his sister is in a psychiatric facility, and the stress triggered his addiction issues. He was sitting in my house the last two days coming down from a crack and coke binge.

My mother is selling her house from across the country. She's in NJ, and the house is in my neighborhood in the Los Angeles area. She has no money, and I'd been sending her some to help - but haven't been able to because of the mix-up with my father. She calls and yells at me regularly. At least the house has sold, but since I'm in the area and she's not, I'm handling the sale of the house. The realtor is a dear friend of mine from when I was in real estate, so it's a bit easier than it might've been, but still...it's stressful.

My brother is finally working after 6 months without any work. His wife is stressed out. I'm very worried for the state of their 21 year marriage.

I did not pass the 4th semester in nursing school; so now have to repeat the semester.

And so on. Hope that helps explain the 'lashing' out a bit. I disagree with it being 'lashing', however. I see it far more as being honest and telling you like it is...I'm upset, don't want to post because I am concerned I won't be supported, and right now, don't need the extra aggravation. I suppose I'm stupid for posting...

I have a ton of stress in my world...and I see a problem with Eeyore. I'm trying, all right? I'm doing my best by him. Ditto with Esse.

If anyone has any ideas other than increasing the dose, I'd love to hear them. I made a promise to my vet that unless he goes to 500, I won't increase the dose until Monday. And I do intend on keeping it. I see this as starting over, in many ways. If you can't support that, then don't. But I would rather have zero responses (as I've had many times) than getting slammed about how badly I'm treating Eeyore, and coming away from this board feeling as if you all think I'm killing him.

Michele
 
Sienne wrote:
I am wondering, though, when you mention the duration of influence of counter-regulatory hormones, if that is specific to cats? The duration of their effect is what I'm used to seeing in humans, not felines. I'm also curious, based on your research, how one differentiates a "bounce" (i.e., acute rebound) vs. chronic rebound? From what you described (i.e., the "check mark pattern" of numbers), Gabby and many of the other kitties here would qualify as being in chronic rebound. Or is it cycle next to cycle of this sort of pattern vs. an isolated cycle here and there?
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The information I've read does talk about it being in cats, not just in humans.

As for the difference between acute and chronic, my understanding is that it's a repeating pattern of moderate-low-high, versus a low lasting for some time, and then a rebound, and then a clear back to a moderate number.

This repeating pattern also can escalate the high numbers, instead of reducing them after a time. In other words, look at Esse. She went through a series of rebounds, but after a time of acute rebounding, her top numbers came down; she was no longer hitting red each time she rebounded; her top numbers dropped and stabilized in the 200s (like what's happening for her right now).

That has not happened with Eeyore. His rebound highs are not moderating whatsoever; that's the chronic part. It's continuous, and progressive, with no moderation downwards to a lower number as his 'top' number. It can also be looked at by seeing a sudden green, high rebound, sudden green, and high rebound, in a repeating pattern, with escalation of higher numbers no matter the dose. At least, that's my understanding.

It is also about the timing of the lows v. highs, and the length of time it takes to "clear" it to come back to a lower number. I don't think a lot of cats have this; but then again, they didn't have the issues Eeyore did to start with. I have said before, and still say, that I did not give the diet change a chance. What I'm doing with Eeyore can be looked at as starting over; going from scratch. I'm looking for his dose, and if his dose is above 2, fine. Above 3? Fine. Above whatever; fine. Below? fine, too...I just want to find it. We may disagree on how I'm doing that, but it still comes down to me and my cat...I am doing my very best by him. It may not be good enough, but I'm still doing my best.

Michele
 
D, what I see on your spreadsheet, even back at the beginning (11 units? Boy howdy) is not a repeated pattern of a sudden drop from AMPS moderate to "low" to high in a 12 hour cycle, repeatedly, with highs lasting for several cycles, and then it dropping again in the same checkmark pattern. Am I missing it? I do see why you might've thought you were in chronic rebound, and I may have made the same error. But then again, ECID, and Eeyore didn't start at 11 units, either.

I'm going to say it again - ECID. EBID. I appreciate your sharing your ss - and yes, I did go into it. I look at lots of ss, and don't see what's happening with Eeyore on those ss, either.

Best-
Michele
 
My knee jerk is that I don't agree with your explanation but I need time to think about what you said and process what you wrote.

Everything I've seen suggests that the presence of counter-regulatory hormones in felines lasts approx. 72 hours as a cat's metabolism is double that of a human's (hence Lantus dosing is BID). If you do have the citations, I'd be very interested in seeing them. Likewise, I did a pretty extensive lit search (PubMed, Ovid, Web of Science) after you posted and found only the one article from 1986 that Jill noted along with the abstract from Roomp & Rand that she copied on Somogyi in cats. The little else that's published is specific to PZI and doesn't apply. Again, if you found more information, I'd love the citations.
 
Michelle,

Hang in there. It sounds like your life simply sucks right now and you are doing the best you can. I don't post here very often, but I comment more on Eeyore than Esse-mama simply because she's doing so well and he's still struggling with his numbers (although, he's a miracle cat in general health!). I hope that you can find something nice and calm tonight and I hope that things will get better for you - the quicker, the better.
 
Here's what's bugging me.

I have repeatedly asked for suggestions for Eeyore that were not about upping the insulin - repeatedly. Yet no one has come forth with any other than up the insulin. I've asked for ideas on food, on timing, et cetera, but no one has ever given me any. I have asked for 'outside the box' ideas, thoughts, and so on, and no one has given me anything. Just increase, increase, increase. No one even asked me why I wanted other information; most of the time, those requests were met with silence.

So when I give something a shot that isn't exactly what someone would do, then I get told that what I'm looking at doesn't exist. That it's not part of protocol; that Somogyi doesn't happen, is rare, and so forth. Well, according to the parameters Jill put up, and according to those who ran the study, Somogyi did occur in approximately 8.25% of the cats. That's not rare...that's close to 10% of cats get Somogyi. Rare is 1, 2%...not 4/52 or 8.25%. Maybe that's me thinking that in a population if 8-10% of the population gets something, that's not rare or unheard of; that's something that one should be aware of, and look for, and see if it's happening...

I asked for help before this. It did not come. So I'm doing something which you may not agree with, and you're thumping me soundly for it. But I asked for other ideas, people...and you didn't respond then. That's bugging me, a lot.

Ronnie, I know Esse has been mentioned a few times in this thread. But most of this hasn't been "wow, good work with Esse! What are you doing?" or "Look at her go!! She's really making progress", but rather "you're gonna send Eeyore into DKA! Stop and save your cat!" and "chronic rebound doesn't exist". Sigh.

D said:
this is a good thread to talk about rebound, chronic rebound, bounces -- they all have similarities but are different.
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So let's talk about that. How do you tell the difference? If this can be salvaged at all, this discussion would be a good way to start.

What is acute rebound v. chronic rebound v. rebound? What are the parameters you follow to differentiate between the three? And what is your response to that when you see it on your cat's spreadsheet?

Michele
 
I'm still trying to wake up this morning but am awake enough to say I'm sorry about all that stuff going on in your life.
BBL
 
Michele,
I am certainly not experienced enough to even begin to try to give advice.
All I can say is that you are evidently very committed to you babies, doing all the research and trying to find explanations and solutions to whatever is going on. Kudos to you. You love your babies and you want the best for them, that's what matters.

For myself, although I don't always agree with what people tell me, on this forum or elsewhere, I embrace opinions given as an opportunity to challenge my own. By challenging each other, we learn and grow no? Just my humble opinion.

I'm sorry you feel the way you do.
(((hugs)))
 
Michele and Esse said:
Here's what's bugging me.

I have repeatedly asked for suggestions for Eeyore that were not about upping the insulin - repeatedly. Yet no one has come forth with any other than up the insulin. I've asked for ideas on food, on timing, et cetera, but no one has ever given me any. I have asked for 'outside the box' ideas, thoughts, and so on, and no one has given me anything. Just increase, increase, increase. No one even asked me why I wanted other information; most of the time, those requests were met with silence.
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suggestions based on experience, data, and research have been made, but more often than not, you've appeared to meet comments, suggestions,and/or advice with resistance... indicating you can't or won't for various reasons. and that's ok. it's your prerogative, but please don't say no one has come forth with ideas or suggestions. it's just not true.

a typical scenario in this condo: “does anybody have any ideas other than xxxx? i’m going to do yyyyy.” why ask for ideas if you’ve already made up your mind what you are going to do? and then complain when you get zero responses.

So when I give something a shot that isn't exactly what someone would do, then I get told that what I'm looking at doesn't exist. That it's not part of protocol; that Somogyi doesn't happen, is rare, and so forth. Well, according to the parameters Jill put up, and according to those who ran the study, Somogyi did occur in approximately 8.25% of the cats. That's not rare...that's close to 10% of cats get Somogyi. Rare is 1, 2%...not 4/52 or 8.25%. Maybe that's me thinking that in a population if 8-10% of the population gets something, that's not rare or unheard of; that's something that one should be aware of, and look for, and see if it's happening...
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i cited research to back up the information left in your condo. you stated contrary information as fact. you were asked for sources for this information. as of yet, none have been forthcoming. "i think" is not a basis for fact.

as far as the above stats, 4 events in 4 cats over 20 months does not represent 8.25%. you're not understanding statistics to have come up with that figure. i can see where this misinterpretation is causing some confusion.

I asked for help before this. It did not come. So I'm doing something which you may not agree with, and you're thumping me soundly for it. But I asked for other ideas, people...and you didn't respond then. That's bugging me, a lot.
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michelle, you've been offered a lot of help from day one. please don't discount responses just because they weren't what you wanted to hear. each and every one of us can choose to view feedback as being "thumped on" or we can take in what is offered, weigh it, and/or view it as an opportunity to learn. none of us has to follow any advice or suggestions made. please stop shooting the messengers. we are not paid for being here. we're here because we care. we care enough to take time out of our lives to help others.

Ronnie, I know Esse has been mentioned a few times in this thread. But most of this hasn't been "wow, good work with Esse! What are you doing?" or "Look at her go!! She's really making progress", but rather "you're gonna send Eeyore into DKA! Stop and save your cat!" and "chronic rebound doesn't exist". Sigh.
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yes, you're right. most of the conversation in this thread has been about eeyore... because that's where the concerns lie today.
DKA is a very real concern here, given the circumstances. for eeyore's sake, we would be remiss not to express these concerns. not all kitties are lucky enough to survive an episode of DKA. it's a life threatening condition... not to mention very costly for the caregiver.

D said:
this is a good thread to talk about rebound, chronic rebound, bounces -- they all have similarities but are different.
Click to expand...
So let's talk about that. How do you tell the difference? If this can be salvaged at all, this discussion would be a good way to start.

What is acute rebound v. chronic rebound v. rebound? What are the parameters you follow to differentiate between the three? And what is your response to that when you see it on your cat's spreadsheet?
Click to expand...

think tank is the appropriate forum for this kind of discussion.
the parameters set up for think tank discussions by the webmaster:

THINK TANK
Please, for experienced FDMB members only. Not for individual cat questions in general.
This forum is provided for lively, provoking discussion about various aspects of the treatment of diabetes. Etiquette rules, still apply, so no personal references or flaming. By the same token, you might need a slightly tougher skin to participate in this group! Varying viewpoints should result in thoughtful, reasoned conversation, not personal affronts or attacks.
Debate on!

as a matter of fact, discussions about rebound and rebound checks have taken place more than once over the years. i encourage you to search the "old" board. it is a treasure trove of information.



i'm truly sorry you have so much stress in your life at the moment. you're not alone in that respect. many, many caregivers, past and present, have been and are currently dealing with boat loads of stressful events in their lives. these stresses certainly don't make the sugar dance any easier... for any of us.

i hope you have a good day...
 
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