PAM & ALLEY - Are you frustrated yet?

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Sheila & Beau GA & Jeddie GA

Sheila & Beau GA & Jeddie GA

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Hey, Pam, are you frustrated yet? :mrgreen:

I saw the 400 this am. Here is my thinking - based totally on my experience with Beau. Alley has had high flat numbers for the last 24 hours or so on the 3 drop dose. Prior to that, on the 4 drop dose, he was swinging from 400 to 50 and back. That 350 point swing is huge for a cat on a very good, very low carb diet like he is. He was rebounding on the N.

What I found with Beau (what I thought at the time) was that one dose (.5u) was too much and sent him down to 40s and back to mid to upper 300s. When I reduced his dose to .4u, just a smidge less, his numbers settled into mid-upper 100s to mid-upper 300s. That seemed to me to mean not enough insulin and according to Tilly, I should increase back to last dose, which I did. And I was VERY frustrated at this point!

On .5u again, second cycle, he dropped to 33. And then zoomed back to 350. At that point, I was convinced it was rebound (the "it isn't proven in cats" according to Tilly phenomenon). So I started re-reading info on Somogyi rebound and found this:

A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin, but it doesn't always happen.) (bold is my edit)
Click to expand...
From: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

I dropped the dose to .3u and almost immediately (middle of second cycle) his numbers were getting better. From there I just followed him down, or maybe led him down in .1u increments to .05u for a few weeks and after 6 weeks he was in remission.

My point being that the first tiny reduction (20% of the dose) didn't reveal a clear picture, but when I reduced a bit more (40% of the dose), it did. I can't guarantee remission, but Beau was supposed to be one of those "too long a diabetic" to achieve it.

So hang in there!
 
Paws crossed for some blues today....

BTW, my post (above) has me re-looking at Jeddie's numbers. I need a LOT more spot checks, but I am wondering about the high flat numbers when he has had a beautiful cycle, on the same dose, just a few weeks ago. He was in remission for 3-4 months after I adopted him (off of vetsulin), but he has gained back all his lost weight (he needed it) since then. I just wonder if he can gain remission again.
 
PHTTTTT! Bad day, no reason except that he may have gone a little low last night with those great numbers all day long, and he rebounded a little? Will ride out this series and hope for better numbers tomorrow. He hasn't exactly settled in except for 1 day. Alley spent most of the afternoon ripping up my tissue paper for gift wrapping. He is ornery!

Sheila, I sure hope Jeddie can go into remission again. I can't imagine how great that is!

Pam
 
I doubt that he went too low. My guess is that he is still getting too much but not enough to drop him very low. This is the pattern of numbers that Beau had when I reduced just a little bit (not enough). There will be others that say to increase back to 4 drops because that brought his nadir down. However, it also raised his PS numbers into the 400s.

I think you could go to 2 drops tomorrow (tues), but be sure to be testing for ketones.

I am trying a dose reduction with Jeddie to see how he does.
 
Hey Pam-just want to say you and Alley are in the same boat as me and Buddy. so you are not alone in your frustration.
At least here we find great help (and the price is right!) sorry i cant offer anything more .
 
This is so hard! Just after 5 days on 3 drops I thought we were doing good, until I look at the numbers and realize that he never left the 200's. I am thankful Sheila has had the experience with the same problems and I have learned so much from her. Actually Alley was not at low numbers, but I was so excited to get him out of the red, I needed another set of eyes to help me see.
Everyone is so kind on this site, and I thank you all.
On to the next round!
 
I sure wish he's quit the 400s already. But you did just lower the dose so he still needs to adjust to that.

I was looking at Beau's SS and see that he didn't get below about 250 all day when I first started to lower the dose.

Pam, you are testing for ketones aren't you? Now that you are doing things in "drops", how many drops do you think the dose was when you did ".25u or less"? I'm just curious where he is now compared to that dose.
 
Sheila, we believe the .25 or less was approx 6 drops. We were measuring at zero to get 3 drops pin size. We are measuring slightly below zero for the 2 drops. Alley had a complete urine analysis workup at the vet last Tuesday and everything came back fine, even though she had me scared about his BUN numbers, they are now normal. I did a ketone test Sunday (negative) and tried today but he would not cooperate. I will get one tomorrow no matter what. Tried the aquarium gravel, he will not even go near it for hours!
Tonight he went from 411 PS to 350+3 which I am happy about. I know he will be high again in the morning for a couple of days until he settles in on the dosage. I have faith...

Thanks again for your help,
Pam
 
Pam, you're doing a great job! Hang in there.
I'm jealous of all that snow you're getting in your part of CO. We've only had a total of 2" on the front range so far this season.
 
We have 53 inches and counting! Another 1-2 feet tonight! NOW this is what I call a snowstorm!

Thanks for your support
Pam
 
Pam & Alley said:
Sheila, we believe the .25 or less was approx 6 drops. We were measuring at zero to get 3 drops pin size. We are measuring slightly below zero for the 2 drops.
Click to expand...
When you say "at zero" do you mean the top edge of the stopper is at the bottom edge of the zero line (needle facing up)? And "slightly below zero" means the top of stopper is just above the bottom edge of the zero line? I'm trying to get an idea of exactly what your drop doses are. And when you were trying the .25u or less you still had syringes without half unit markings, right?

If what I am asking is correct, I think your 2 drop dose is about .1u and your 3 drop dose is .15u, maybe .2u, and 4 drops might be .25u to .3u. That would make your ".25u or less" really about .35u. or .4u.

I am a little concerned that he has not gotten out of the 200s yet with the dose reductions. I think if he doesn't get some noticeably better numbers today that you should go back to 4 drops and give that a good long time to settle. He got a decent nadir on that, it just bounced him back to the 400s. That bounce is a type of rebound, but it could be from just going to low (normal) numbers that he is either not used to or in the recent past (on N) his body "knew" were a sign of danger.

BTW, Jeddie is on day 3 of his lowered dose (.15u) and not seeing very good numbers either. He had a nice curve (mid/upper 100s to 60-80) on this dose when I first started him on lev. But that was 10 months ago.
 
"When you say "at zero" do you mean the top edge of the stopper is at the bottom edge of the zero line (needle facing up)? And "slightly below zero" means the top of stopper is just above the bottom edge of the zero line? I'm trying to get an idea of exactly what your drop doses are. And when you were trying the .25u or less you still had syringes without half unit markings, right?

If what I am asking is correct, I think your 2 drop dose is about .1u and your 3 drop dose is .15u, maybe .2u, and 4 drops might be .25u to .3u. That would make your ".25u or less" really about .35u. or .4u."
****
Sheila, you are exactly right about the top edge of the stopper is at the bottom edge of the zero line and slightly below zero is the top of the stopper is just above the bottom edge of the zero line. That is how we are measuring. I am so glad we agree on the markings. And yes, the .25 or less was on the old syringes, not half unit markings.
I am a little concerned to go to 4 drops right away, although this is only his second day on 2 drops. Will probably switch to a healthy 3 drops tomorrow. I am concerned about the 4 drops because although he had a good nadir, I could not sleep thinking he may go too low at night. In fact, looking at his spreadsheet, we did not give him a 4 drop at night at all, and that may have been the problem. I agree he needs to see numbers in the low 200's or even high 100's would be great. He was neg on the ketones. His appetite is great. I have a question about your feedings habits with Jeddie, do you free feed? You probably already told me about this, but I forgot. Just trying to cover all the bases. Alley eats EVO canned low carb, fed in the am at 6:30, leave out and replenish until around 1 pm, take away and then feed him again at 6:30 pm with his test and shot 1 hour later. that food is left out mixed with a little water so it does not dry out when we go the bed. I pull his food at 1pm so he is hungry at 6:30pm. Sorry this is so long, your help has been amazing.
thank you
Pam
 
I do free-feed Jeddie (and all five of my cats), but what usually happens is I put down breakfast, which is almost half their food for the day, and test/shoot about 1 hour later*. The food is gone by about +6 though. I feed a small dinner at about +8 and that is usually gone in a few hours. I feed a final meal right before I go to bed, which is about +2 after his evening shot. I feed canned Friskies, Authority, Wellness, and sometimes Fancy Feast. Friskies makes up the bulk of the food right now because I am out of work. It is all below 7-8% carbs. I add a little water to it. He gets about 10-12 kibbles as a treat in the morning and pieces of boiled chicken at night (after the tests/shots/meds - he is on prozac, but Beau gets meds to for his heart and hyper-T).

Jeddie probably eats more than anyone else, but he is my biggest cat by about 3 lbs.

I do think you are right that not shooting 4 drops consistently may have been one of the problems, but maybe not. Remember, it is perfectly safe for him to go as low as 45 on this insulin. Probably even lower. Jeddie and Beau have both been in the 30s with no ill effects, and barely any symptoms. Beau acted a little disoriented once when he was at his lowest and I wonder if he was in the upper 20s before I realized I better test him. He had eaten some food already. Those are not numbers to "aim" for, but they are safe.

*It is best to test/shoot right after they finish eating. That way you know you are working off of a non-food spike number. Even if you can't shoot right then, it might be a good idea to get numbers right before/after he eats so you know how much he tends to rise in the first hour after eating. I have gotten off schedule with food and shots because of being out later in the evening and then I can't delay breakfast after I get up - they would eat me alive!
 
Thanks for the food tip. Pretty much what I do, too. If he has food right up until dinner, he does not eat enough for his shot. tested him at 5:30pm one hour before he ate, and again at 7:30 1 hour after he ate, from 333 to 441. Yikes, 2 drops have failed him! Knowing he was at 333 I shot 3 drops tonight.

I have company coming for the next week starting Friday so I think I will try to maintain him at 3 drops and see what happens. I want to be alone with him to do 4 drops so I can monitor him and watch him all the time. I pray he settles in at 3 good drops for a while. I will test him right before meals to get a good non-food number to shoot. I also will stay at 3/3 and then if needed 4/4, I have a real good alarm clock!! BTW I have 5 cats also!
Thanks again
Pam
 
Pam, the blues look nice today. I like your plan to stay with the 3 drops for now - let that settle and see if the numbers even out and come down overall.

Have a nice holiday with your family. My sister and mom got in town last night for a long weekend. Let the games begin!
 
Alley hit the trifecta yesterday!!!! 333 on three different tests. If only we could have placed a bet. Wondered if my meter was right or not. This morning he hit 311 BS and that is an all time morning low on Lev. Actually see blue twice so far. My early Christmas present from Alley I hope it lasts a while.

Merry Christmas to all
and thanks again for everyone's help.
Pam & Alley
 
Good boy Alley -give your mama this gift of blues all seasons-you can do it!
Pam, we both have dsh tuxedos...aren't they so handsome?
 
Yes, tuxedo cats are handsome! I have two, both grey & white, and they know they are good looking too!

Sadly enough, Alley was back in the 400's last night BS. I bought a second meter after the trifecta puzzled me and tested him using both meters, same drop of blood, 43 point difference, that is huge. I am posting this on a new thread.
Merry Christmas
Pam
 
some things to ponder-

meter variance can be 10% to 30%...

If you go with the commonly supported 10% variance, that means a meter reading 50 ( 10% being 5) and be between 45 and 55.

The higher the number the higher the variance.

So a meter reading 400 ( 10% being 40) can be between 360 and 440.

So, trust your meters...all is well.

Another thing- pick a meter and stick with it. You'll drive yourself batty using ore than one meter!

Lastly, on the red last night...on the 22nd, you bookended with reds and the stuffing was yellow....yesterday you had ONE red and the stuffing was blue....today you started with pink!

It IS actually progress.

Lev is long acting and with the shed effect you MUST allow the settle time before you judge.

Judgement is on the lowest number in the cycle, not highest. Try to focus on the pretty blues!

Sorry, short of time...didn't mean to leave out the fluff, so here it is! (((HUGS))) go YOU! :RAHCAT

Hang in there! ;-)
 
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