Murphy PMPS +2 76 (What is going on?)

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missmurphy2010

missmurphy2010

Member Since 2011
I'm really getting worried about Murphy becoming a non-regulated kitty. Her vet did suggest that by lowering her Lantus to 1.5 units twice per day, that this was a tricky spot for us, and we started her on her new diet about 2 weeks ago. This a.m., she had a pretty good reading right before breakfast, then super high about 1 hour after. Tonight, before dinner, she was almost 200, and 2+, now down to 76. I can't figure the One Touch Ultra thing out. From what I understood from talking with her vet, the closer she gets to 200, the more in tune the #s are between the two different meters. The lower (i.e., below 100) mean that she is actually reading lower than my One Touch Ultra. Am I understanding this correctly? Did I read the protocol correctly? This is scary stuff. Maybe my meter is not reading correctly any longer. I cannot figure this out. And, after she eats and I shoot, within one half hour, she screams -- weird. She did that this a.m and tonight.
 
Unless your vet is using a human glucometer, the One Touch and the vet's meter are calibrated differently. As I posted in your condo a few days ago, if you look at the 2 tables in the Rand/University of Queensland Protocol, the vet's meter will read 30 points higher than a human glucometer. Thus, on an AlphaTrack or other animal meter or a serum chemistry analyzer, a dose reduction would be earned at a BG of 80 or lower. On your One Touch, the reduction is earned at 50 or lower.
 
Hi,

I'm sorry your worried and Miss Murphy is not feeling well, the scream would be unsettling to me too. I'm not sure but I would check with your vet, can you call them in morning. If it gets worse before than maybe you might want the consider a veterinary ER. Do you have one in your area?

I was also a little confused about the veterinary alpha track and a human meter, but Sienne is right, the vets meters will read 30 points higher, it shouldn't matter if you are near 200 or 100, they vets meter should always read 30 points higher than your human one touch meter. Does that make sense?

I hope Miss Murphy will be feeling better soon.
 
Is it possible that Murphy feels her sugar dropping & as it is a new feeling, screams??--Yep I would check with a vet if it continues..Hope she feels well soon..
 
I am also wondering if the Lantus has reached its end and is now unstable. She seems okay to me, her typical self but I've also noticed in the a.m., she's acting sort of hyper. Her numbers concern me b/c she was very regulated prior to switching diets, etc. She said it was going to be a tricky turn in her diabetes. Yes, I'm calling her this a.m.
 
Initially, we had her on the Evo cat and kitten canned b/c she had lost so many nutrients (thanks to her old vet) and was somewhat malnourished, but she started backing away from the food about 2 months ago - and finally, she just didn't want to eat it. It's very rich, and basically, it is for growing kitties. We have now switched her over to Wellness grain free turkey, which she absolutely loves. We are going over diets today and my vet is speaking with her nutritionist at the hospital to see what we can do. But we also need to give the Lantus pen a chance, and I threw out the vial tonight. It is possible the vial was just at its end. But, I'm concerned she is experiencing the sogyami rebound, although I do not know much about it, but it appears that her severe immediate drops are possibly something we need to look at asap.

The other thing is the nausea, if we can find a high protein, high fiber diet, it will help to stave off the nausea she experiences so much. If anyone has any ideas on that sort of diet, please let me know.
 
Just so you are aware, there is no data that indicates that Somogyi occurs with Lantus. In fact, after having done 2 searches in both medical and veterinary journals, all that I can conclude is that there is very little research to support the existence of this phenomenon. The original research was done in 1938. A subsequent study in the 1950s failed to support the original study by Michael Somogyi. The distinction is between a bounce vs. a chronic state of rebound (i.e., Somogyi). Cats will experience a bounce on Lantus but there is not a chronic state of rebound which is what Somogyi implies. Unfortunately, the concept seems to have taken on the cachet of an urban legend despite there being very limited research to support its existence. At best, it is controversial.
 
Looks like we may be looking at yet another diet change to Purina DM. I am a believer in Purina veterinary diets as they helped my Siamese, Oscie, and kept him free of struvite for 10 years. Apparently, and I could be mistaken, the Wellness grain free turkey has sweet potatoes, cranberries, and a few other simple carbs that Murphy may be having trouble with. If anyone has any ideas of if this is fact or fiction on Wellness, please let me know. Poor baby. However, her BG this a.m. was 176, so it appears she may be backing off the high BG before eating. In addition, I did purchase one Lantus Solostar pen last night and got rid of the vial, as I was thinking that the vial may be lost its stabilization, although I could be incorrect. I seem to notice the vial affecting her about 1/2-way through.
 
The Purina DM is really a poor quality food. Here are the first several ingredients: Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal, guar gum, potassium chloride....

The by-products are bad stuff. Cats also do not need a great deal of liver in their diet and some are sensitive to fish.

Wellness Core ingredients: Chicken, Turkey, Chicken Broth, Chicken Liver, Chicken Meal, Turkey Liver, Dried Ground Potatoes, Natural Chicken Flavor, Guar Gum, Carrageenan, Cranberries, Ground Flaxseed, Salmon Oil, Taurine, Dried Kelp,...

There are a small amount of higher carb elements -- potatoes and cranberries -- but the overall carb count on Wellness products is low so the relative contribution from these sources is negligible. If Murphy is sensitive to these foods, that's a different story. The bottom line is that the Purina products are a very poor quality food due to the lack of muscle meat and a reliance on animal by-products. Even Fancy Feast is a better choice with respect to the quality of ingredients. You are also paying for a prescription food when other commercial foods are of a much better quality.
 
I'm in a real pickle with the diet thing. I do not think that she is getting enough protein and am wondering what to do about this. Tonight, pre-meal, she was 227, and she wasn't this way "fluctuating," prior to starting the Wellness. She just won't eat the Evo cat and kitten. I'm not sure what to do. Someone have any ideas? She seems to be sensitive to the fruits and maybe the sweet potatoes.

Help!!!
 
Fancy Feast Classic varieties do not have fruits or veggies. Several are gluten free as well. You just need to look at Janet & Binky's food charts, pick low carb foods, and then read the ingredients. Alternatively, you could make your own raw food.
 
Murphy's vet wants to do a blood test that will measure the amount of glucose she is actually producing suspecting that just after eating and shooting, she may be going low because she is producing, which would be a very good thing. We are not going to make any changes just yet, as she wants to also do a curve in about 2 weeks. I think really the trigger is yes, while she may be making her own glucose, the Wellness does contain fruits and veggies that would cause her to be elevated. I'll be curious to see if she is producing again. Which would so terrific. My other thought is to slowly switch her over to Wellness Core.
 
Just be aware that many cats experience vet stress and the results of a curve done at the vet's office are not reliable. Often, the end result is that the dose is raised to an unnecessarily high level based on artificially high numbers and you overdose your cat. My vet does not ask that I bring Gabby in for curves nor does she run fructosamine levels since I have adequate data from home testing.

What test is your vet planning on doing that will tell you if Murphy's pancreas is producing insulin? Are you planning on withholding insulin for a period of time in order to determine this?

Regarding the Wellness: I was feeding Gabby primarily a raw diet. I ran out of pre-mix and was feeding Wellness. There was absolutely no change in her numbers. I've continued to feed Wellness (chicken or turkey) with good results. Every cat is different and maybe Murphy is unusually carb sensitive. I would point out, though, that the EVO cat and kitten food that you were feeding also contains fruit (apples) and veggies (carrots), the latter of which are high glycemic index.

I also think you need to be a bit more attentive to what's going on in the cycle. The 76 last night probably required that you get some additional tests in. The jump up to 196 this morning may be a bounce which signals, at least to me, that you don't know just how low Murphy went last night. You are lowering doses by a greater amount that the dosing protocol specifies (e.g., from 2.0 to 1.0u). This will also cause numbers to be less than ideal.
 
She did better on the Evo cat and kitten and had more regular numbers on it, but she won't eat it, and I can't have that. The Wellness grain free turkey also has zuccini, sweet potatoes, blueberries and cranberries, so maybe the food is just taking an adjustment for a few weeks. I did 4 tests on her last night and after the first number, she goes back up, but gradually.

I trust Murphy's vet 200%. She is an internal medicine vet and has every acronym behind her name, and we didn't lower the Lantus from 2 to 1 units, just 2 to 1.5 units. And that was b/c her fructosamine was terrific. She has specialized in feline diabetes for over 20 years and I trust her judgment. I'm not sure what the test is, but I believe it checks the BG/insulin ratio. No, we don't have to fast her, just bring her in in the morning and have the blood test done, feed her at the same time, and she'll be good to go. She actually does very well at the vet's office b/c they use a private room all to herself. Her numbers are usually pretty well.

As far as attentiveness is concerned, I am offended at this -- my entire life revolves around her health and welfare and I have done everything in my power to make her feel better. I have went w/out this year and last year to see that her health was tended to and that she received the best care possible. She has suffered from severe MRSA infections, she has feline asthma, she had a severe round of d. cati which took 6 months to get rid of, so I believe I am as well aware and attentive as a person can be. Although I am still learning about feline diabetes, I am a very alert owner and will disregard your comment because I clean my own kitchen first. This is not just a kitty with diabetes. She is a very ill, yet managed kitty who I'm trying to give just a few more years to. I defer to this forum for certain advice, but on changing dosages, etc., I will defer to her vet only.

I certainly do not want to come online and have someone tell me that I'm not attentive.
 
I do not believe Sienne was suggesting at all that you are not an attentive pet owner. Rather, she was indicating that, when numbers are low in the cycle, it is good to continue to test so you can determine how just how low Murphy is going in the cycle. The nadir info is critical for you to make good dosing decisions... whether it be you making the decision based on the data or the vet. I've only been here for a couple months, but I assure that Sienne is just trying to help you get the most data for Murphy and ensure that he is safe during the cycle. I have literally trusted Sienne with my Willie's life more than once, and she has never steered us wrong.

A Fructosamine test simply measures the average BG for the past two weeks. Our vet offered one today when we went in and I asked for a full blood work up, and we declined. Because we fastidiously home test, doing a fructosamine simply duplicates the data I already have in my spreadsheet. That is $200 better spent on other aspects of Willie's care. And Sienne is right. Curves at the vet aren't always going to be accurate as cats often have elevated BGs from the stress of being at the vet. A curve at home is a much more accurate and inexpensive method of getting the information you need.

I understand completely wanting to trust your vet. Please keep in mind that Lantus is a relatively new insulin and isn't even FDA approved for feline use, so vets are all using it off label and passing info along to each other. Willie's IM specialist who also has a million acronyms after her name prefers using a protocol I'm not comfortable with because it calls for only pre-shot testing and bases dosing solely on those numbers with no attention paid to how low a cat can go when on Lantus. She's using a PZI approach (with which I believe she has tremendous experience and expertise) to an insulin that simply doesn't work the same. I'm not at all suggesting you disregard your vet's advice. I would suggest you make it a dialogue. It sounds like you have an amazing vet that may be open to learning more about the lantus experience.

Good luck.
 
Regarding to the diet, you might also consider using some of the Merrick foods...they are high in protein, lower in fat and low carb. While they also have some of the ingredients you are concerned about, they are also in small quantities, like Wellness and EVO. Also, have you tried the EVO 95% foods?

With regards to what Sienne was talking about....I'm quite sure her intent was not to offend you, she was pointing out the possibility that Murphy may have dropped lower than the 76, and suggesting that you should continue to test to ensure that he is not dropping much lower from there....both from a safety standpoint and from a dosing decision standpoint. I agree with her. When you see a big drop like that, I would certainly suggest continuing to test. Pointing that out to you is not intended to upset or offend you, but to help you keep Murphy safe... please take it in the spirit is intended. Please understand that the welfare of the cat is my first priority. It would be nice if I never had to say anything that upset anyone, but if I need to say something that will upset someone, but it will keep the cat safe, I will say it..no regrets....because the cat's safety comes first. I hope you can understand that.
 
I just want everyone to know that yes, I have been testing her around the clock, I do not and have never overlooked my duties when it comes to her (yes, Murphy is a she) health. It's been 3 days on the new Solostar pen, and she is not dropping, which may be indicative of the unstable Lantus vial since I was over half-way through the vial. We aren't running fructosamine again, it is a BG/insulin ratio production test, but now that I see her numbers starting to stabilize, it very well could have been the vial of Lantus.

I understand all of your opinions, and I will take those in the spirit as intended, but want everyone to know that I am on top of Murphy's situation, have been keeping her on a very tight schedule, fluids, feeding, injection, and including all of the diabetes and pancreatitis with a cat that has feline asthma. My schedule is full of Murphy and I'm doing all I can to help her be comfortable and enjoy her time with me. I believe 95% of her numbers show my commitment to her.
 
I have a question....what is a BG/Insulin ratio production test? I have worked in the Clinical lab setting for many years and have never heard of this specific test. I did some looking on-line and can find information regarding the use of insulin pumps in humans -- but not a specific blood test. It has to do with carb intake and the insulin bolus required to deal with them. If there is a specific test - I have just never heard of it.
 
I also think you took Sienne the wrong way. The people on this group are selfless with their support and knowledge. They do so to help us owners and improve the outcome for cats with diabetes. They don't type things just to type things. They do so to be helpful. So in the spirit of the forum, you should take this into account also. Most of us here are not 100% confident in our vets. Maverick almost died from vet care and we manage his asthma and diabetes 100% with the assistance and generosity of people on forums. People may be shell shy to help in the future if they worry you will be defensive. I know I would be. I would pick this forum over a vet that went to school for 8 years any day.
 
Seriously, of course anyone would take offense to "I think you need to be a little more attentive," because it is a tone, not just words, and now to receive an email from someone saying that we'll shy away -- what kind of support is this on this forum? If I had something like this to say to someone, I would surely send them a private email to keep things offline with others so as not to involve them. So, what I have just experienced these last two days are laypersons who put you into a position where you start doubting your vet, you are made to doubt yourself and the things you do to take care of your animal, and that you will not receive assistance and guidance on this forum, which is why I joined in the first place.

Murphy is having significant changes in her behavior now, excessive drinking, excessive peeing, and something else is going on, so I would prefer to end this dialogue before it gets more out of hand. If I am being too sensitive, then it is with good reason. Thanks.
.
 
Your vet sounds like a wonderful and very experienced vet and you sound like an awesome mama to Murphy. I to trust my vet 200% but she'll be the first to admit that she has no experience with Lantus other than a couple articles she's read. I told her of this board and she was willing to write the prescription for Choco to use Lantus because the things she had read were positive things. Her instructions for Choco were to start him off at 2 units twice a day but with all the data I've gotten over the weeks and suggestions from the very knowledgeable and helpful people on this board, Choco is now down to 1 unit twice a day. I brought the spreadsheet in to my vet yesterday and she was very impressed with all the data and had no problem with Choco's dose being reduced to 1 unit. In fact, she thought he was doing great and I was doing very well with everything. I will now start sending her his spreadsheet once a month just so she can see his numbers and progress and also so that she can learn a little more about how Lantus works. Choco went through a DKA episode at the start of all of this and I have to be very careful to make sure that doesn't happen again. I can only tell you that I love my vet but if it had not been for the people and advise on this board, Choco would have been getting too much insulin all this time and who knows what kind of shape he would be in. I know without a doubt that the reason Choco is stable is because I've had the help and support of others on this board that know much more about Lantus than I or my vet. I definitely am willing to take advise from the people I trust but in the end, it is my choice who I choose to listen to because Choco is my child and I am responsible for his well being. With that being said, I hope that you will stick around and learn everything you can from all these wonderful people who only have the best interest of your cat in mind.
 
Thank you for your nice email. I do take some of the advice I receive here, and like you, I email Murphy's SSs actually once per week, every Friday so she can review and keep in her chart. Murphy is having a weird day, 146 prior to breakfast, 99 3 hours later (not awful), and at 1:00 she was at 67. So, I'm going to have this blood test done tomorrow morning and then see if we can reduce the Lantus. She looked glossy eyed and I knew she was going down in numbers. She very well could be starting to produce her own insulin, but now I have the issue of I'm seeing her drinking tons of water and peeing quite a bit more. I don't know if these same things can happen when a cat has hypoglycemia, but there are many things I have to speak with her about tomorrow. If she's producing her own insulin, that would be terrific, but also tricky (said my vet).

I do trust her 200% and I think it is also because she has a diabetic doggie and kitty, so she's got her hands full. She will only trust Lantus for long-acting. And, she has spent over half of her life specializing in diabetes. She has, after all, taken very good care of Murphy and they all love her to pieces there.

We'll see what goes on tomorrow.
 
Do you have the strips to check her for ketones? Also, how has her appetite been? You said you're going to be going to the vet tomorrow to have some blood work done? I love your vet if she is open on Sunday's. We don't have that luxury here where I live. My vet is open until noon on Saturday and then it's the emergency vet where it is $94.00 just to walk in the door. ;O/ Of course Choco went into his DKA episode on a Saturday afternoon so it was off to the emergency vet we went. He stayed until Monday and you can imagine how much that costed. :cry: Oh well, I'm grateful that they are there because if not, he most likely would have died (at least that's what my vet said if I didn't get him immediate help).
 
I have been looking at your spreadsheet. I don't see any severe drops. If you look at some of the kitties here (i.e. Mannie, Gracie, Gabby just to name a few) you will see severe drops and you will also see where they bounce from those drops. I also see that some AMPS and PMSP numbers are missing but you shot 2u. Did you shoot blind without checking the BG? When Murphy has screamed after a shot, did you perhaps hit a muscle? Where do you give her shots?

I don't believe Sienne was being critical. She was pointing out that you have no evening tests after+2. A lot of kitties drop in the evening. Lantus is based on the nadir (lowest point in the cycle). You don't have enought information to know when Murphy's nadir is. Yes, they can bounce with low numbers. The liver panics and the bg goes up. Cats can go into remission (OTJ) from diabetes. We have quite a few. My cat is alive because of this forum. My vet had all kinds of letters behind his name. He is a Diplomat in Veterinary Medicine. He also was "experienced in feline diabetes". He also had my cat on 10u 2x daily of Lantus. He knew nothing about Lantus he had used PZI.

We open a daily condo (thread) one per day per cat. Date: Cat's name, AMBG ###, +2 etc. PMBG ###, +2. It is helpful if you follow that format because if everyone continued using the same condo for 3 days, it would become to lengthy to follow. Also by posting in the normal format, anyone can see immediately how the kitty is doing. We also suggest a before bed check to see where your kitty is going.

Purina does not have a reputation as being a "good food". It is poor quality ingredients. There was also just an article in Veterinary Practice regarding a webinar on "Raw Diets for Small Animals". It appears they may be catching up to what has been know here for quite a while. You would have to purchase the supplements to add to the raw diet if you decide to make your own. They are readily available.

"There are several studies that support the feeding of low carbohydrate diets for the management of cats with diabetes mellitus. These foods contain higher concentrations of both protein and fat in order to reduce the amount of carbohydrate in the diet. Cats are carnivores and their systems are designed to digest and metabolize foods high in protein. Due to the limited amount of carbohydrate in these diets, the consumption of such foods may reduce the elevations in blood sugar concentrations following a meal, or reduce the amount of insulin needed for the body's cells to be able to use circulating glucose. If they need additional sugar beyond what is supplied in these low carbohydrate foods, the cat can take the protein and fat from the diet and turn it into glucose to meet their body's needs." Quoted from University of California, Davis Vet School article about feline diabetes diets.

There is a lot of information to absorb on this forum. It takes time to understand all of it. The stickies (* items at the top of the board) are full of useful information.

Good luck to you and Murphy. I wish you well. I'm sorry you are so offended by what is meant to be constructive information in caring for your diabetic cat. Nobody gives more to their kitties than these wonderful people. Yes, feline diabetes is an inconvenient illness. It is very restrictive for the caregivers. Your life does revolve around a 12/12 schedule with a sugar kitty. That is just the way it is.
 
I haven't updated her SS in 2 days or so. I've been checking all day and from 9:00 a.m. until about 5:00, she was hitting about 65 or so, then right b/4 dinner, she was at 114, but that was because I gave her a few little kibbles to get her BG up. As far as eating is concerned, she is doing wonderfully and she loves the Wellness grain free turkey (wet). Eats it all up. I did not shoot tonight and her vet called me again to check on her and we discussed the possibility that she may be approaching or in a honeymoon. Her pancreatic tests came back perfect, and it could be possible that she may not need insulin for a while (wouldn't that be nice). We're doing her curve on Wednesday of next week as well. This test she will run tomorrow will be able to show just how much, if any, insulin her pancreas is producing (BG/insulin ratio). I'm remaining optimistic.

As far as diets, I have to disagree on Purina Veterinary Diets b/c with Oscie, my struvite kitty, he remained crystal free for 10 years. Now, today, had I known that there were actually foods out that there were good quality and even better, possibility I would not have went the prescription route, but it did its job for him for a very long time.

Murphy is now curled up in her little beddy and snuggling with her blankies. Once I give her puffs for her asthma, I will check her again, but we did not shoot tonight.

L
 
Hi, I don't have any advice on the dosing but wanted to make a suggestion that you start a new condo everyday. Put the date, Murphy and then amps etc.

2/27 Murphy amps ... +1... +2... then if you have a question at some point in the day you can type in QUESTION after his numbers. That way, people know you have a question and then when your question has been answered, you can go back and take the word QUESTION off from the subject line. Everytime you want to add or delete something from the subject line, you will need to edit from the subject box of the first comment that you made that day. Because I posted on your condo yesterday, I am still able to see your condo fairly easy on my list. The rest of the folks aren't going to know you have a question because this condo is from last Tuesday and it's way down on the list. I hope I explained it cleary enough. Just some helpful advice from this newbie. Hope you and Murphy are doing well today. :razz:
 
Well, I did forget to mention that anytime someone posts on your condo no matter how old it is, it goes to the top of the list but it is still better to start a new condo everyday. Also, cut and paste the previous days condo onto the new one so people can look at what happened the previous day if they want to. :mrgreen:
 
See what the bg is right before the usual shot time. Typically, you want the test, and the insulin shot within about 15 minutes time if it is safe to give it.

And of course, on your regular every 12 hour Lantus schedule, within 1/2 hour of the 12 hour point.
Lantus (you've probably been told this or read it a million times already) works most optimally when you stay closely to the 12 hour dosing interval.

If, at 12 hours, the bg is still below 100, review the sticky on LANTUS & LEVEMIR - DATA READY TO SHOOT LOW NUMBERS?. What I see on your spreadsheet seems to indicate that the bg will continue going up.

You didn't quite meet the low criteria for a dose change (a bg < 50) described in this sticky: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL though you are very close. You may need to hang in another 3-6 cycles at 1 unit because you're working out the shed (insulin build up) remaining from the previous 1.5 unit doses. After that, the bg will stabilize at a new level and you'll be able to see if 1 unit is optimal for your cat.
 
Thank you for updating your SS, that helps. :-D I saw that you skipped the shot last night and shot 1.0u this morning. I'm not sure why you reduced the dose? What happened with the test at the vet? You have shot numbers lower than 96 before so I'm not sure I understand why you are thinking you should skip the shot?

It would be helpful if you would start a new condo each day, as Maria suggested, with the date, Murphy's AMPS and any further tests after that. That way, the condo isn't so long and anyone trying to help would know what the situation is without having to search for data. I'm not trying to give you a hard time, LL is a very busy place and that's the way we do things here to keep it manageable. Also, changing the subject line to indicate that you have a question helps draw attention to your condo.
 
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