Settling In After Dad's Death - An Update - How To Proceed Advice Needed Please

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Sweet Spot

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Good Morning -

I don't know if you remember me and my sweetheart "Spot" - but here is the last thread I posted before hitting the road. The following is long - and I apologize - but our lives are now able to shift the focus to healing Spot...and just needed to get the support from you on the best way to proceed, if you don't mind.

We "made it" and are finally settled down, going nowhere now all summer. To recap, Spot was diagnosed right before my father passed away. We left Seattle May 22nd and drove to Illinois - staying in Illinois in various motels through June 12th - then another 2200 mile trip back to Seattle. One week of handling my father's affairs, then a 3 day trip to our final "home" in NW Montana. We rv full time and stay on friend's 500 secluded, mountainous acres...quiet and peaceful. Spot LOVES it here......no urban noises, no going anywhere (and we like it, too). This is the perfect place to focus on healing him now.

Basically, Spot has been through absolute chaos for over one month solid. Though his numbers still aren't good, I can tell you that he is doing so well otherwise and, though good days and bad, he held pretty steady overall. He is now so social, no weight loss, normal appetite, normal thirst, normal urination - you wouldn't know he has diabetes if not for his awful numbers. He made it through! Now we have to get down to business....getting those numbers down....and we need some advice, please. We are very confused by his response to insulin to date.

A week ago we took him to the vet again just to be sure the trip didn't take too big a toll on him. Fortunately, his lab work was great, weight loss stopped, liver/kidneys perfect....so that was a relief.

The vet suggested that we not up the dose until giving him a good week to settle down, in case stress was elevating numbers. As you will see, however - with his acting like "normal" Spot again (seems healthy and normal) came a surprise during this "wait and see" week, an INCREASE in numbers this week.! They broke the mold after our boy, of this I am certain.

So...the questions........if you don't mind:

QUESTION 1:

Spot is acting so normal that he is back to grazing like he always did. He doesn't go off and sleep for six hours. He will catnap for an hour, then come eat a bit - rinse and repeat - like he always has before diabetes. So could the surprising increase in numbers be from rarely getting a reading not affected by food spikes?

QUESTION 2:
We were conservative increasing his dose on the road, for obvious reasons, as our spreadsheet reflects. We did the best we could with what we had to work with at the time. Now we are getting into tight regulation. However, we have noticed that Spot always has a good bounce (and bad symptoms) for a few days whenever we have upped the dose. With that in mind, should we still up the dose by .5u or, due to his consistent bounce effect, should we be more gentle at .25u (even though tight regulation calls for .5u with his numbers)?

QUESTION 3:
I treated the insulin like a precious, fragile gem on the trip - and tried to keep it consistently cool. But it is hard to keep it at a perfect temperature on the road, as you know. It isn't cloudy and was never frozen or subjected to heat...but you know travel can be rough and inconsistent. We do have a new prescription for Lantus pens that we could fill (we liked the idea of drawing insulin from the pens...lasting longer using one pen at a time). I guess I am thinking about a fresh start, a fresh insulin, true tight regulation protocol.....would you suggest the "fresh" insulin given all of our travels?

QUESTION 4:
This one drives us mad: How can his symptoms get better (honest, nearly zero symptoms now) yet numbers get worse as we increase insulin? The stress we have been through certainly plays a role and I think we need some "normal time" to sit back and see what his body does...but his numbers were better on a lower dose. We don't understand this...should we really be upping the dose?

QUESTION 5:
When he curves at all, it always seems the nadir comes LATE to the party - like 2/3 into the cycle or more. Is this significant (a physical problem symptom perhaps?) when combined with the other oddities we are dealing with?

I think these were the big questions we had, now that we have had time to sit and think. We are ready to increase by .5u, per tight regulation protocol, but would feel so much better doing so with the blessing of others more experienced on this forum.

As I said over a month ago, thank you so much for getting us through this.....now on to healing Spot!

Forever grateful,
Robin
 
Hi and welcome back. I'm very sorry for your loss and glad Spot did well and you're back home safely. I'm not in a position to really answer your questions. With it being a holiday weekend responses may be a little "light". Hopefully this will bump your post and others will stop by sometime today.
 
Thanks Doodles and Karen!

Yep - no hard feelings - I know it is the holiday weekend. Just considering going to 3.5u now after settling in, but would feel better with a bit of input if someone is out there! Very glad to be back here on the forum - so glad it is here....
 
I'm only hesitant to say "go up" because of the lack of testing (understand the circumstances though). Although it does look like he needs more juice. I might try a .25 increase for 6 cycles and get those tests during the day and night time. Once answer about when you increase. He's not bouncing when that happens but an increase can cause New Dose Wonkiness causing numbers to go up in the first few cycles but usually resolves in less that 24 hours. I'm running out the door but will be back in a bit and find the post on NDW and give you that link.
 
I'm so sorry for your loss. Hopefully, all of the chaos is behind you.

Q1: The reality is that the numbers aren't all that different. Remember, you need to account for meter variance -- about +/- 20% between tests. Other than you're being in one place, are there any changes? Is Spot eating the same food? Is there any chance he's getting into contraband? I would strongly suggest getting some PM tests in. Sometimes, numbers run lower at night.

Q2: Bounces are a normal part of the process. You were actually seeing more "new dose wonkiness" than bouncing with this last increase since he never got out of the pinks. And yes, I would evaluate Spot's dose every 3 days. You need to get him out of the pinks and below renal threshold.

Q3: Do you have any more pens? You could try an unopened pen if you have one. Have you been using the same pen this entire time? (FYI: many members are purchasing their insulin from Canada given the ridiculous price that is being changed in the US for Lantus.)

Q4: If your meter is working correctly, you need to increase the dose. Spot is way over renal threshold and I suspect his body has adjusted to being in higher numbers which would account for the reduction in symptoms. You may want to get a back-up meter (which is good to have in any event) and double check your readings. I suspect that Spot's labs at the vet show similar BG values so I do think that validates your meter.

Q5: Not every cat has their nadir at +6. My cat's nadir was usually at around +3 -- very early. In this case, nadirs can and do change. It doesn't have an effect on anything except when you sleep if you are waiting to make sure your numbers are OK and you can go to sleep.

 
It's nice to hear from you again, Robin, and I'm glad to know that all of you survived the odyssey of thousands of miles of travel and the stresses of saying goodbye to a beloved family member. It sounds like your lives have entered a more quiet phase which will allow all of you to heal and rest. :):):cat:
I'm sure others will come along who can help you figure out what to do about the dose as I'm just too new at TR to help you there. But I did want to offer you some encouragement :bighug::bighug::bighug: It's a tricky business trying to understand what the insulin is doing inside the cat and what an appropriate response should be to help the cat feel even better.
One suggestion I have for you is to try to get some more testing in now that you are in one spot for a while. I was able to understand Radar's response to the insulin so much better when I understood this tool better. Think of your spreadsheet as being like a puzzle. If you only have the edge pieces done, it's hard to get a handle on the actual picture you are constructing. When I was just beginning to test more, I tried to find pieces of my puzzle to fit in the blank spots/gaps. Then I started to see trends and could fine tune my testing to answer specific questions I had like when does the insulin begin working? And when does it begin to wear off? When does the insulin tend to drop the BG the most- aka the nadir. I learned from my testing that sometimes Radars nadir is at +5, sometimes at +6 and sometimes at +7. I hope this makes some sense to you. It took me a while to understand how to do this but once I got started I could see the value of the data I was collecting and how much it helped me understand what I could do next to help Radar.

Please keep asking your questions. We are happy to help you as you learn the steps in the sugar dance. :bighug:
 
Hi Robin and Spot:bighug::bighug::bighug:
Welcome back.
My deepest condolences.

QUESTION 2:
We were conservative increasing his dose on the road, for obvious reasons, as our spreadsheet reflects. We did the best we could with what we had to work with at the time. Now we are getting into tight regulation. However, we have noticed that Spot always has a good bounce (and bad symptoms) for a few days whenever we have upped the dose. With that in mind, should we still up the dose by .5u or, due to his consistent bounce effect, should we be more gentle at .25u (even though tight regulation calls for .5u with his numbers)?

What do you mean by bad symptoms?
When we up a dose, sometimes, as the depot for the new dose settles we see numbers go up instead of down. We refer to this as New Dose Wonkiness NDW.
If you are following Tight Regulation you would take him up to 3.5u as he has no numbers below 300, that said though you need to make sure you get those pm tests, in like you have the last couple of days, I would recommend at least a +1 and a before bed test, this is to make sure that you are not missing any lows at night, and perhaps do that today just to be sure that he hasn't been dropping low at night and then bouncing by am on the days when you haven't got those pm tests.

This one drives us mad: How can his symptoms get better (honest, nearly zero symptoms now) yet numbers get worse as we increase insulin? The stress we have been through certainly plays a role and I think we need some "normal time" to sit back and see what his body does...but his numbers were better on a lower dose. We don't understand this...should we really be upping the dose?

George's symptoms improved right from the start though we didn't see yellow numbers for about 6 weeks. The numbers seem to be pointing to an increase, but as I have already said above, he may have been having lower cycles at night which you have not been able to gather data for (just pointing this out, I realize that this has been a difficult time for you and you have been doing the best you can) I think taking an extra day to gather data, will allow you to increase with confidence (if you get those pm cycles).
You have been holding on to doses (understandably given the circumstances) a little longer than is ideal, this may have resulted in a degree of glucose toxicity, (body gets used to high numbers) which may ultimately mean that you will need a little more insulin to break through into better numbers


QUESTION 3:
I treated the insulin like a precious, fragile gem on the trip - and tried to keep it consistently cool. But it is hard to keep it at a perfect temperature on the road, as you know. It isn't cloudy and was never frozen or subjected to heat...but you know travel can be rough and inconsistent. We do have a new prescription for Lantus pens that we could fill (we liked the idea of drawing insulin from the pens...lasting longer using one pen at a time). I guess I am thinking about a fresh start, a fresh insulin, true tight regulation protocol.....would you suggest the "fresh" insulin given all of our travels?
How old is the insulin vial?
If you kept it fairly consistent it should be ok especially if it's not cloudy, but I do understand your feeling for a fresh start.
If there is some doubt about the efficacy of the insulin vial in your mind I would swap to the pen, if you decide to do that it might be wise to hold the dose for a 3 days just in case the insulin is off and you get a strong reaction to the new insulin.


QUESTION 5:
When he curves at all, it always seems the nadir comes LATE to the party - like 2/3 into the cycle or more. Is this significant (a physical problem symptom perhaps?) when combined with the other oddities we are dealing with?

It's good to note these things, you may find it changes when he starts getting into better numbers. Overall he seems to have been high and flat.
 
Welcome back, Robin. My deepest sympathy on the loss of your father. :bighug:

You have already received plenty of answers, so I will just add that we are glad you are able to get back to concentrating on Spot now, and good job keeping him safe while your life was in such turmoil. We will do all we can to help you. Keep asking questions - the only dumb question is the one you don't ask!
 
Cannot thank you all enough for taking so much time to help us.........my husband and I read these over and over......so much helpful information....so here are our replies to each of you:

SIENNE AND GABBY
Q1: No changes at all, same food (only one he loves!), no contraband to get (no treats and snacks, just loves grazing on his FF Chicken)...and yes, we absolutely need to do more PM tests now
Q2: I didn't think we were new dose wonkiness material because it went on/usually happened past the 24 hours? Also, are you stating in your opinion we should do tight regulation and step it up a bit - like every 6 cycles instead of 10 cycles, to break through? My fear is that he always had hard adjustments to new doses for a few days. Can't imagine upping dose on day 3 if he is having his usual adjustment issues (see reply to Gill and George below for specifics)
Q3: We are still using the same vial from when this started in May. Switching to pens for convenience - haven't filled the prescription yet. Didn't know about Canada or "how to" with that one!
Q4: We do have an Alphatrack as well - should we try to test from the same drop of blood then I assume?

JAN RADAR
Such great advice!! I love the idea of filling in those holes/boxes more to paint a clearer picture. Definitely will get on that!

GILL AND GEORGE
The "bad symptoms" always creep up for a few days after a dose increase. He becomes more vocal, urinates more, drinks more, eats more....it takes a few days for him to settle back down. It makes us nervous when we up the dose. Like now - we know for his health we have to increase, but he is so calm and content - hate to stir him up again, but know we have to. And GLUCOSE TOXICITY was so incredibly helpful! That makes such perfect sense - thanks for introducing us to this topic!

TRICIA, CINCO AND HARVEY
Thanks so much for your kind words and thoughts.........

You've all been amazing, thanks so much!
 
And to add to the confusion......

I hadn't used the Alphatrack since the beginning, as my spreadsheet shows.........and (gulp) here is why......
Please keep in mind our Relion Micro was in sync with the vet...vet was just a wee bit higher....

Just did a +6, just now - used same drop of blood:
Relion Micro: 344
Alphatrack: 482

Will add that I think we are going to try raising dose tomorrow morning, getting some more PM's in tonight and using the same vial of insulin we have been. Don't want to change too much at once.
 
Q3: We are still using the same vial from when this started in May. Switching to pens for convenience - haven't filled the prescription yet. Didn't know about Canada or "how to" with that one!

May was only 2 months ago, so it should still be fine, but if you want the information on buying from the place the rest of us are in Canada, the information is in this "Insulin from Canadian pharmacies" post

Marks is great!!

Just did a +6, just now - used same drop of blood:
Relion Micro: 344
Alphatrack: 482

If you add the 20% meter variance to the Relion, that could be as high as 413
If you subtract 20% from the AT, that could be as low as 386

So they're actually closer than they look
 
Chris and China -

Thanks so much for the Canadian info and the 20% math "reality check!" Such great info from everyone.......
 
We did do dose increase and I started a new thread to show what happens (wonkiness) - and wondering if we should up again tomorrow morning, following the tight regulation protocol guidelines and his numbers........thanks everyone
 
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