same rebound issue

[Marci and Buddy]

Same old issue with my same od Buddy( 16-17 y.o.) now...haven't kept his #'s for a while, but suffice to say whenever
he is blue, red follows for a day or 2 . this pattern continues, even with dose increases/decreases.
is it possible rebound in some cats, esp.older ones, may be unaviodable? I keep feeling like i'm not doing something right,
but almost 3.5 years later I have tried evrything. He lives a stress-free life, no other health issues,raw food diet.
I know these ups and downs will weear him out but what to do? Any thoughts very welcome.

 

[Sheila & Beau GA & Jeddie GA]

Hey, Marci - haven't seem you around in a while....

is it possible rebound in some cats, esp.older ones, may be unaviodable?

Possibly - ECI, as they say.

However, It doesn't look like you have ever tried any dose below 1u, right? I seem to rem,ember suggesting that early this year. It's what I would try at least. He looks like 1u is near a good dose, so maybe .9u or .8u would work. You could try .75u, give it a good long time to settle - like 10 days - and see what happens.

 

[Marci and Buddy]

Hi Sheila--I have tried below 1u--- he gets continual high (mid 300's) #'s...he needs more than that.
I have been checking in sporatically, really need to update ss and come back more often for help.
Your book is a deeply touching and wonderful way to keep the memeory of Jeddie alive -loved it!

 

[pamela and tigger]

Same old issue with my same od Buddy( 16-17 y.o.) now...haven't kept his #'s for a while, but suffice to say whenever
he is blue, red follows for a day or 2 . this pattern continues, even with dose increases/decreases.
is it possible rebound in some cats, esp.older ones, may be unaviodable? I keep feeling like i'm not doing something right,
but almost 3.5 years later I have tried evrything. He lives a stress-free life, no other health issues,raw food diet.
I know these ups and downs will weear him out but what to do? Any thoughts very welcome.

Hi Marci! I am glad to see you. I am sorry you are still having trouble getting Buddy regulated. It breaks my heart since I know you love him so much.

It is hard when dosing with Levemir to get a good picture when you have schedule changes and have to dose early or late, and also when changing the dose according to a preshot value.

Levemir just doesn't work very well this way unfortunately, especially with kitties that are still trying to find the right dose. I know you know this, and you are just trying your best to get Buddy into some good numbers. It has been a long, hard process for you, I know.

I am wondering if there is something more that is going on here though. You said at one time (I think I remember this) that the vet said he needed another dental? Maybe this is why he bounces all over the place and can't seem to settle into one dose? Can you update on this?

Also, what raw food are you feeding him? Does he have a good appetite?

It is hard to know what goes on with any one cat and what is happening in their day to day life. I know you are trying hard and people here want to help.

If there are many schedule changes that you have no control over, maybe a switch to Prozinc insulin would be more suitable for Buddy? I don't know....and now I understand there is a shortage, but I haven't kept up with that.

Please keep us posted Marci. We can brainstorm this and see what we can do. Get your spreadsheet updated and then let's go from there. I know how much you love your Buddy. There are no easy answers unfortunately with some of these kitties.

 

[Marci and Buddy]

Pamela-thanks so much for such a thoughtful reply. Buddy is healthy , good appetite and no teeth issues.But I think
you may have hit on something-the change of times in dosing is not due to a schedule chnage(I work at home)
but when his # is very high, i shoot early.
I spoke with Dr. Lisa one time last year and she said as long as i know it's like a
dose increase and I stay home to monitor him, it should be ok.
for awhile there i was shooting him every 10 hours . However, since I increased to 1.25u , he seems to be stabilizing and ps' s are lower.
ess th ereason why every 10 hours he was so high is because it wasn't enough of a dose. I'm praying that's the case.
thanks again..

 

[pamela and tigger]

Pamela-thanks so much for such a thoughtful reply. Buddy is healthy , good appetite and no teeth issues.But I think
you may have hit on something-the change of times in dosing is not due to a schedule chnage(I work at home)
but when his # is very high, i shoot early.
I spoke with Dr. Lisa one time last year and she said as long as i know it's like a
dose increase and I stay home to monitor him, it should be ok.
for awhile there i was shooting him every 10 hours . However, since I increased to 1.25u , he seems to be stabilizing and ps' s are lower.
ess th ereason why every 10 hours he was so high is because it wasn't enough of a dose. I'm praying that's the case.
thanks again..

Again, this insulin doesn't work very well that way. Yes, it is like a dose increase, but in the case of Levemir and Lantus, it does tend to build up in the system and create a carryover effect. That is why they are considered long acting insulins in the human world. They are used in conjunction with a short acting insulin for meals like NPH or even Regular (among others). Then these longer acting insulins act in the background to carryover between meals.

So when you inject early, you are essentially increasing the dose because you are still injecting on the previous long acting dose.

You can see that at times he goes really low. It is like the insulin is catching up with itself.

It is either that, or he is not getting the same amount of food each time you give him a shot. Could that be the case? Is he competing with the other cats for food at mealtime?

It used to be you could shoot the PZI insulin's this way...pretty much on an as needed schedule (not sure about the new Prozinc). But again with the two L's it gets harder to figure out what the true dose should be because they are constantly overlapping, or underlapping (when you shoot early), whatever the case may be for that day. I hope this makes sense. Others are better explaining this than me.

Just try to stick with one dose for a week or so and try and hold off shooting until the 12/12 time. Then go from there and see what the numbers tell you. If he is eating the same amount each and every day, and shot times are the same each and every day, then you can see if this is the right dose, and then if you need to increase or decrease.

Love you Marci and your sweet Buddy boy. Hang in there. I know you are trying hard.

 

[Marci and Buddy]

Pamela- sorry for this delayed reply--Buddy is the only cat, so no food fight here , and he free feeds , that is, eats whenver he wants.
I don't know if that contributes his to inconsistant #'s.
I do know what you suggest is the right thing to do (shoot at 12/12), but I don't feel comfortable always waiting
if his bg is 400 or even 500, like today. I am afraid with each passing hour his organs are being damaged. nailbite_smile
Can you maybe explain how it might help him for me to wait, at times like those?
I really want to do the right thing by him.
thanks so much , really apprecaite your help and support.

 

[pamela and tigger]

Pamela- sorry for this delayed reply--Buddy is the only cat, so no food fight here , and he free feeds , that is, eats whenver he wants.
I don't know if that contributes his to inconsistant #'s.
I do know what you suggest is the right thing to do (shoot at 12/12), but I don't feel comfortable always waiting
if his bg is 400 or even 500, like today. I am afraid with each passing hour his organs are being damaged. nailbite_smile
Can you maybe explain how it might help him for me to wait, at times like those?
I really want to do the right thing by him.
thanks so much , really apprecaite your help and support.

I guess the question would be why does he get these 400-500+ numbers in the first place? There has to be a reason for that. Is he on too much insulin and he is rebounding? Is there something medically wrong that is interfering and causing his insulin resistance? It can't be the food since you are making your own raw, right?

I know finances might be an issue(?), but have you had bloodwork done recently and/or gotten your vets opinion? Is she familiar with how Levemir works? If not, what insulin does she prescribe (just curious)?

I know what you are saying. I wouldn't like seeing those high numbers either. I don't know. Part of me wants you to keep increasing via the Tilly protocol, but I am not sure that is the answer either.

ETA check out Sheila's response below to Maresydotes and her spreadsheet. Something there might help.

 

[Marci and Buddy]

yes ,you are right -that is the question. Buddy has had no signs of illness so he hasn't been to the vet in almost 2 years.
anyway, you guys here know more about insulin than they do.
I couldnt find Sheila 's response -where is it? thanks.

 

[Maresydotes]

Marci,
I share your pain. Missy is the bounciest cat ever....I am thinking about trying the reduction. My vet wanted me to, but I had to start her on Lev when we had a houseguest, so didn't have the ability to monitor as closely as I would need to.
Here is what Sheila wrote to me:


Hello Marilyn and Missy - welcome to lev.

I don't really have any suggestions about dosage, but I am surprised to see such a high dose on a cat that has tested negative for both acro and IAA. It is unusual is all. Has she ever been on a lower dose - like 1u? I see she was started at 3u in the beginning and when she went back on insulin so I just wonder about the higher dose causing some resistance.

With both of these insulins, dose consistency is key so you want to find a dose that doesn't cause a really low PS where you skip or wait on a shot followed by a high PS. Usually a small dose reduction (10-20%) will help to even the PS numbers. Since you are home during the day, when she has a low PS, I would try shooting a reduced dose right away - and then monitor (test) to see how she does. Obviously, don't shoot big doses on a 50 or 60. Another option you could try is shooting tid instead of bid, but the first thing to do is to see how she handles lev after several weeks.

I bet she went OTJ because she lost weight initially, but then the FD "caught up" with her again. My Jeddie went OTJ right after I got him, but he was really thin and was gaining back needed weight and ended up back on insulin in about 3 months. He was also a tough one to regulate. What I found, with him, was that he needed a long time to settle on a dose - at least 10 days.

Hopefully the lev with help her numbers to even out. It seems to be less prone than lantus to causing bounces in some cats. And maybe she will feel better on it (we have seen that as well) and start being friendly with Phoenix again.