Java 12/04 AMPS 405 left ear (right ear 493)

[javasfambam]

viewtopic.php?f=9&t=129116

Hi Guys

It just seems like javas numbers are getting worse, not better. I increased him to 4.75 this morning. At what point do I look at another insulin? It seems like he was doing a lot better down on 3.75?

At what point do I start to look at too much insulin looking like too little? He's been back up over 4 for about a month now and no greens, very little blue or yellow. Mostly pinks. Whereas 3.75 looked better than more insulin now? Don't know where to go from here feeling quite sad for Java. He's ok, still a hungry muncher!

Help?

Charlene

 

[julie & punkin (ga)]

Hi Charlene!

I'm not seeing that he looked better at 3.75 than at 4.0. One thing I'm noticing though, is that when he starts to make progress and get into better numbers, you've reduced the dose. Normal blood sugar for a cat on insulin is considered to be 50-120. It looks like you've reduced when he's even in the 160's. There are no numbers under 50 on his spreadsheet that I can see, so if you're following Tight Reg, he hasn't "earned" any reductions. If you have concerns about shooting low because you're going to be gone or can't monitor, then you could give a one time reduced dose, but you would return to the previous dose with the next shot.

Are you hoping to work for remission or are you just wanting to maintain him on insulin? It would be helpful to know what your goal is.

If you're wanting to work for remission, or wanting to protect his organs from the damages of high blood sugar, I'd encourage you to familiarize yourself with how cats typically respond to normal numbers. I wrote up a little and put in some spreadsheets for Darin a while ago. That post is here. I'm thinking that you may be worried about shooting lower numbers because you anticipate that it might send Java really low. Take a look at that post and look at the spreadsheets of the cats that have had that happen. Or current posters that shoot a full dose into normal numbers regularly include Marje/Gracie, Wendy/Neko, Sienne/Gabby, Elise/Max . . . there are more, but those are the ones that are coming to mind immediately.

As far as his dose right now, I think you're on the right track. One thing I learned with a high dose cat (punkin had acromegaly) is that the important numbers are the blood sugar, not the size of the dose. So I'd encourage you to not be concerned about the size of his dose - cats need what they need. It looks like he's gotten into blues the last couple of nights, so you're getting closer with the dose. I'd give the 4.75 a week or so to see what Java can do with it - hopefully you'll see some greens!

Hang in there, Charlene! It can be really discouraging to not see your kitty respond to the insulin like you'd hope. I think the first thing that would help you is to look at some spreadsheets of cats that have gotten their full dose while they were in normal numbers. If you feel more confident about not backing down the dose when Java gets into better numbers, I think that's really going to help things.

 

[Wendy&Neko]

Hi Charlene, sorry Java is being so stubborn about his numbers right now. I think he was starting to look better when he got to 4.25U, but then his increases got derailed. Once he started seeing the higher numbers, there was a chance that he started to develop some glucose toxicity. Once that happens, you have to keep increasing to overcome it. I find with Neko that as little as 3-4 days in higher numbers, then she gets used to them, bounces more and I need to stay on top of the increases to bring her down again.

Good job on the increase today. As long as he's still seeing just blue nadirs, I'd keep increasing every 4 days or so. From the protocol:

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

As Julie mentioned, shooting those lower numbers is really key. It most often leads to a flatter cycle and more time in good numbers. It is counter intuitive at first. I know that the first times Neko gave me blue nadirs, she just bounced and went up after that so it was a non event. Same thing happened the first times she gave me greens. Now I know that if she's going to do an all green cycle, it'll be very flat.