Highest Reading Ever

[Melissa and Celle]

Oh no. This isn't looking good. I know everyone has been unanimous that Celle needs more insulin, and we even have some blood work that supports an acromegaly diagnosis (high cholesterol and high liver values), suggesting that indeed she may need much more insulin than we've been giving her.

BUT... look at today's numbers! We've been slowly but surely moving up now, looking for any sign of improvement. I think things have actually gotten worse, if anything. Since 0.5 units her curves have gotten curvier, and the preshots have been going up.

We think that now the infection is cleared, and she is not on antibiotics. I'm really tempted to go back to 0.85 units, the last dose that showed promise. Could everyone please weigh in here?

And a couple of questions about doing this: How long do I need to hold the lower dose to empty the shed? If this is wrong, and 2.75 units is too little, then 0.85 units isn't going to work much at all, so what readings and when would tell me to abort this experiment? If I do abort, can I go right to 3 units from 0.85?

Celle seems fine and is eating.

Here's a graph to illustrate what has been happening with the pre-shots.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Melissa,
The link to your spreadsheet is broken. Not sure why that happened, please check it in your signature. Post it within the body of a reply with the tags around it if you can't figure it out in the signature.

Since I can't see your SSt, I can't really tell you you're right or wrong in going with a lowered dose. I don't even know what dose you are at now.

Going by the trend you are seeing, you may be right though. If you are comfortable trying a lower dose, then do it. I would only ask that you speak with your vet, so he/she knows what you are doing. There is a test for acromegaly, I recommend getting that. I don't know enough about acro to know if it progresses, does it make the BGs go even higher if there isn't enough insulin? That might be a question for the high dose group.

You are trying so hard for Celle. I'm sorry it's not getting easier. :YMHUG:

 

[Melissa and Celle]

I wanted to add a couple of additional graphs so you can see how the shape has changed.These are all on the same scale.

 

[Melissa and Celle]

The link to your spreadsheet is broken. Not sure why that happened, please check it in your signature. Post it within the body of a reply with the tags around it if you can't figure it out in the signature.

Is it fixed in the signature now?

If not, does this work: https://docs.google.com/spreadsheet/pub ... utput=html

 

[Vicky & Gandalf (GA) & Murrlin]

Ah, that little graph is enlightening. There is a definite rising curve to it as you increased the dose and it looks like somewhere in the .75/.85 range was best. So I see on what you are basing your assumption for less insulin.

I think if you don't see any change in BGs after a day, it would call for halting the experiment . 2 cycles would probably empty out the shed enough to yield a result one way or another. Although try to give the decrease minimum 3 days, unless she stays ultra high.

Can you post every day during this trial? I am around for tomorrow and part of Tuesday later in the afternoon. I'm just a little worried that she is acro and this is the wrong thing to do.

The only way you're going to be able to rule out acro is get the tests for it though. I see you received some very good info from the High Dose group. That's excellent. Do you have a plan for getting her tested?

 

[Vicky & Gandalf (GA) & Murrlin]

The link to your spreadsheet is broken. Not sure why that happened, please check it in your signature. Post it within the body of a reply with the tags around it if you can't figure it out in the signature.

Is it fixed in the signature now?

If not, does this work: https://docs.google.com/spreadsheet/pub ... utput=html

Haha, yes, the signature link is fixed, but the one in the body of the message needs the tags around it to work right because the SS links are so long.

Ugly numbers for sure. seems like anything above 2.25U causes these 500s. But I don't know enough about Acro to say that this isn't something that happens in that condition.

 

[Melissa and Celle]

Can you post every day during this trial? I am around for tomorrow and part of Tuesday later in the afternoon. I'm just a little worried that she is acro and this is the wrong thing to do.

Yes, I'd definitely appreciate some advice regularly while I do this, although I won't be around tomorrow to get any mid-cycle readings. I too am worried that this is the wrong thing to do, but I've been holding my breath this whole ride up waiting for something to get better and it just gets worse. With the 563 pre-shot and then the 501 at +9, I think I'm ready to call an end to this experiment of increasing dose.

If the lower dose doesn't show promise, I think I'm ready to go back to Lantus. I actually feel more comfortable continuing dosing changes with an insulin where we have some baseline of decent numbers to help understand what is going on and determine if Celle is now different due to the disease progression. For example, if we had these numbers at 3 units of Lantus, I'd have no problem going up because we know that at one point she had good numbers on 5 units. With Levemir, it is just so hard to say. But what would you recommend doing if the lower dose doesn't work?

 

[Vicky & Gandalf (GA) & Murrlin]

I'd recommend getting the acromegaly tests, quite honestly, before deciding to go back to Lantus. Then you know that increasing the dose is the right thing to do.

Hang in there.

 

[pamela and tigger]

If the lower dose doesn't show promise, I think I'm ready to go back to Lantus. I actually feel more comfortable continuing dosing changes with an insulin where we have some baseline of decent numbers to help understand what is going on and determine if Celle is now different due to the disease progression. For example, if we had these numbers at 3 units of Lantus, I'd have no problem going up because we know that at one point she had good numbers on 5 units. With Levemir, it is just so hard to say. But what would you recommend doing if the lower dose doesn't work?

I am not quite understanding what you mean here Melissa. If she got better numbers on more units of Lantus, then why wouldn't you try doing the same with the Levemir?

If you could put your Lantus spreadsheet in your signature that would help for others to see:

https://spreadsheets.google.com/spr...yldGtoZXdBd0sxSzV1cFZxak9FallEQmc&output=html

I am for continuing to raise since I don't really see that you really had a good result with the smaller doses. To me there aren't that many mid-cycle tests with the .85 to even say that it was a good dose.

What exactly were her liver values? I know you said her ALP was high, but I don't remember if you listed the numbers. Do you have copies of her bloodwork?

 

[pamela and tigger]

Also wanted to add regarding the high cholesterol. Are you giving her extra taurine?

http://www.tillydiabetes.net/en_6importantfactors.htm

6. Taurine

Taurine is a beta-amino acid and is particularly important for cats. Cats are not able to synthesize this amino acid in sufficient quantities and are therefore required to take it up in their food. In healthy cats, a diet deficient in taurine leads to a number of serious clinical problems including retinal degeneration, dilated cardiomyopathy, platelet aggregation, reproductive failure and growth retardation, dysfunction of the central nervous system and impaired immune functioning. Prolonged deficiency over a period of several months or even years is required before clinical symptoms appear in most healthy cats. Supplementing a diabetic cat's diet with taurine would seem to be beneficial, for reasons described in the articles referenced below.

Here the most important points:

• Taurine has been found to affect blood sugar and insulin levels favorably in humans and other animal models.
• Supporting kidney function with taurine: kidney cells do not require insulin to take up glucose. The high plasma glucose levels caused by diabetes result in high intracellular levels of glucose. Via a chain of events this leads to a decrease in the taurine quantity in kidney cells. Organic osmolytes - such as taurine - play an important role in the regulation of cell volume.
• The clinical state of diabetes is often accompanied by elevated blood levels of cholesterol, triglycerides, and free fatty acids. Taurine is important for the formation of bile acids. The formation of bile acids represents the most important route for the elimination of cholesterol. Too little bile acid can entail increased cholesterol values. In studies of diabetic rats, taurine also lowered plasma triglyceride values. As many diabetic cats have elevated cholesterol and triglyceride values, taurine may help to lower them. Additionally, according to the lipotoxicity hypothesis, chronic exposure to high concentrations of lipids contribute to deteriorating beta-cell function in diabetic patients.
• Taurine has been shown to reverse neurological damage in diabetic rats.

A typical quantity of taurine that many people give their diabetic cats is 500 mg per day. No scientific studies were found to support this dosage in cats and the guidelines used by the pet food industry vary widely.

 

[Blue]

I would not change insulins; stay put with Levemir as if the acro tests are positive, you are best to be using Levemir as it better at high doses.
The curves you are getting with Celle are not as extreme as I had with both Oliver and Shadoe in early days. Oliver swung from 400s to 100s to 400s on 3u Lantus, and Shadoe was not much better.
Try to steer / lessen the curves with food early in the cycle; it may help.

 

[Melissa and Celle]

I am not quite understanding what you mean here Melissa. If she got better numbers on more units of Lantus, then why wouldn't you try doing the same with the Levemir?

If you could put your Lantus spreadsheet in your signature that would help for others to see:

I can't fit the Lantus spreadsheet because I can't figure out how to shrink the url. Here it is: https://docs.google.com/spreadsheet/pub ... utput=html
With Lantus we were able to increase the dose and see better numbers all around. As her mid-cycle got better so did the pre-shots unlike now.

I am for continuing to raise since I don't really see that you really had a good result with the smaller doses. To me there aren't that many mid-cycle tests with the .85 to even say that it was a good dose.

I know it wasn't a good dose, but it was better than now, and I keep thinking that we missed the right dose because it was masked by the infection.

Do you have copies of her bloodwork?

No. I'll have to get it.