Gandalf the Enigma

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Vicky & Gandalf (GA) & Murrlin

Vicky & Gandalf (GA) & Murrlin

Member Since 2009
Pamela has me convinced he had some glucose toxicity going on and a number of days at a steady dose has caused a break through. Have a look at his spreadsheet.

I'm flying a bit blind at this point 'cause on the one hand I don't want him going too low and experiencing those jumpy liver 300+ BGs (you can see he has 300s after recent blues), on the other I don't want to back slide and cause more toxicity to set in. Add in the fact that I need to shift his shot times earlier and it's all sorts of trouble/confusion.

Today I think I did good with the .75U dose, but could I have given more? Probably. That's why I raised tonight to .9U to counteract the rise, even though it was a +10.5 shot.

For those of you thinking I'm changing doses in response to preshot numbers, it is not. It's in response to the whole cycle, which was upward, jumping nearly 100 points in the last hour and a half before I gave the PM shot. That tells me the .75U was not enough because it barely lasted through his normal nadir time.

Wanted to share because I guess I'm probably the only one shooting this low of green here. I would have had a problem this morning had it been tomorrow when I need to leave for work. At least I was able to get home from errands to get good spot checks today. They are invaluable, especially when you have changes going on. Please note, I wanted to shoot early (+10) this AM, but waited until I saw a rising number and I didn't see it till +12. That's really all you need to do if you get a lower than normal AMPS. Also, if you get a spot check at +11, you can use that information to decide to shoot a lower than normal preshot at +12 because if you see a rising number, it should be fine. This applies more to those who have seen some signs of regulation, not necessarily newbies.
 
Vicky & Gandalf said:
Pamela has me convinced he had some glucose toxicity going on and a number of days at a steady dose has caused a break through. Have a look at his spreadsheet.

I'm flying a bit blind at this point 'cause on the one hand I don't want him going too low and experiencing those jumpy liver 300+ BGs (you can see he has 300s after recent blues), on the other I don't want to back slide and cause more toxicity to set in. Add in the fact that I need to shift his shot times earlier and it's all sorts of trouble/confusion.

Today I think I did good with the .75U dose, but could I have given more? Probably. That's why I raised tonight to .9U to counteract the rise, even though it was a +10.5 shot.

For those of you thinking I'm changing doses in response to preshot numbers, it is not. It's in response to the whole cycle, which was upward, jumping nearly 100 points in the last hour and a half before I gave the PM shot. That tells me the .75U was not enough because it barely lasted through his normal nadir time.

Wanted to share because I guess I'm probably the only one shooting this low of green here.
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Hi Vicky,

You will be shocked to learn that what you did in response is what I would have done.. ;) Anyway, Gandalf has a loooong history and no one can just glance at the spreadsheet and come up with something resembling constructive insight. As far as shooting to a ~65 when the previous shot was at 1.1 to a ~326, and with the history in the last 10 days or so, I would have done exactly what you did - .75... maybe even less. But in that ballpark. What is of concern, to me, about Gandalf's numbers is the range between high and low and a sort of capriciousness by means of which he flips from one to the other.

So, I don't understand the "glucose toxicity" reference -- my understanding is that "glucose toxicity" is a somewhat inexact label for the phenomenon where a consistently or chronically high glucose level is accompanied by a resistance to other things that might bring the bg down -- the insulin protein being at the head of the line -- because of the dehydration associated with hyperglycemia (among other factors) and the resulting damage . . It is a concept that is closely related to insulin resistance. I don't see that in Gandalf - his responses to insulin are too on too much of a hair trigger, and you have to worry about hypoglycemic episodes in response to even slight dosing errors to the upside; so it's not that you can't bring the bg down, on a relatively low dose (less than 1u) but that you have trouble managing the consequences.

I know this is no great help -- just wanted to say I don't buy the toxicity concept in Gandalf's case.
 
well I just thought I would pipe in and say I shoot the greens...so you are not alone. and at first glance at your SS my very first reaction was 'hey, is'nt Vicky the one scolding me for dose hopping' but maybe it was not you and i do understand your point.
it would take me about 45 minutes of really looking at your chart to even gather any thoughts. but i doubt i have any thoughts that you have'nt thought of already ;-) so basically just poppin in to say hi and yes i would like to study your ss and think it over when it's not so late and i'm ready for 'seinfeld' and then bed. :lol:
 
.....and i always do that little number too if i suspect he'll be low at shot time i check an hour earlier cause as long as he's on the rise i know i have at least a couple of hours before his new dose kicks in. at night time any way. he kicks in a bit quicker in the am.
would'nt you say all the lev kitties could feel safe shooting a low but rising number. i mean once they have at least some data?
 
Read the Wiki on glucose toxicity. It's not just caused by high numbers. I think the element of the tissues not being able to use insulin properly after periods of hyperglycemia is what leads to the capriciousness of his BGs which you mention. Or it could simply be concurrent disease processes, as he has a lot going on. He is going to be 18 next month, so the arthritis and lumps he recently had removed are to be expected.

Glad we can agree on something, Ilkka. :lol:
 
Can my boy Buddy join your Enigma Club? at least i'll know he's in good hands.
thanks for letting us in on your thinkning in such a detailed way..have to set aside time after work tonight to read his SS again.
How is Gandalf doing today?
 
Marci and Buddy said:
Can my boy Buddy join your Enigma Club? at least i'll know he's in good hands.
thanks for letting us in on your thinkning in such a detailed way..have to set aside time after work tonight to read his SS again.
How is Gandalf doing today?
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Yeah, sure, it's open enrollment period in the Enigma Club.

He rode the 300s all day and is almost 400 tonight because .9U is probably not enough to hold him now. I gave him some sub-Q fluids tonight. I'm hoping for something less than 300 in the AM.

Thanks.
 
Vicky-do you always give sub q fluids when he goes high? is that something you would reccomend for Buddy? How does that work-the hydration regulates the blood?
 
Marci and Buddy said:
Vicky-do you always give sub q fluids when he goes high? is that something you would reccomend for Buddy? How does that work-the hydration regulates the blood?
Click to expand...

I would not recommend it without veterinarian approval. Gandalf is kidney insufficient and has been at the same just barely above normal kidney values (both Creatinine and BUN) for about 3 years now. Would I recommend it for a diabetic cat who has elevated kidney values like Gandalf, absolutely, yes. I feel the periodic fluids have kept his kidneys at these levels far longer than they would have stayed had I not. But it should be both levels, as BUN can be elevated from the diabetes alone if they have too much sugar because they spend to much of the day over the renal threshold, which varies from cat to cat but probably occurs at BGs over 250.

The fluids help the kidneys, but yes, there is an effect on BGs as well. I give them to help the kidneys though, not lower BGs.

I have a university vet to thank for it too, not our regular vet. When I presented Gandalf in 2008 to the University of IL Vet school for possible hyper-T, he was found to be very dehydrated and a resident vet there prescribed a fairly large amount of fluids over the course of a few days. The vet noted the kidney values and unregulated diabetes and concluded that he needed a flush, is the best way I can describe what we did. I had to take him in to our local vet afterwards every day for several days because he needed so much. Like 400ml a day. Under other circumstances and any other cat, that could have been dangerous.

Gandalf was on Lev then too, but not doing as well as he is now because I was not doing some of the things we harp on here now to do, like stay at same dose for longer and also he told me not to move shot times like I was doing because of my work schedule, to try to keep them the same as many days of the week as possible, which resulted in my doing split doses.

Incidentally that vet told me straight up he did not think Gandalf was Hyper-T. He was not. But what he did end up having (they and our vet had noted a "thyroid slip") was a parathyroid tumor. One of only 2 cats over 10 years they treated for that. The other passed away and last summer Gandalf got free medical tests there as part of a study about the re-occurrence of such a rare tumor. He had half his parathyroid glands (one whole side) removed at the end of 2008. The other side showed slight enlargement last year and I need to get him back over there for re-evaluation as that was recommended.

Again, Gandalf the Enigma.
 
Sheila & Beau & Jeddie said:
and don't fluids always bring him lower afterwards?
Click to expand...

Pretty much. He was 149 this AM. 207 tonight. Still on .9U. I am staying there for the time being, to see how it shakes out. I have to split dose him tomorrow though, so things will probably go south. And south does not mean down in the case of BGs.
 
Wow,what a story.Your boy really has angles looking over him-you being one of them. I'm so moved by the care you provide
for him (and so many other parents here as well).
but Vicky-I just noticed something about Gandalf which is the biggest enigma of all..I'm sure no one has yet to figure out how he got to be such a handsome bugger..what a gorgeous face on him! and looks like he knows it. :smile:
 
I agree with Marci, he is a handsome boy (note: I am partial to grey cats!) and he has that Clint Eastwood look about him.
 
My favorite line from Clint Eastwood is "Do you feel lucky punk?" Which is Gandalf's look. Clint Eastwood has that attitude!

BTW, I am old enough to remember when Saturday Night Live was FUNNY! And the original "American Idol" was the GONG SHOW!
 
LOL! This is funny you guys. :)

I never realized it before but he DOES have that Clint Eastwood look about him - er, Marci, not sure about Rock Hudson though. ;)
 
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