Sputtering pancreas and bouncing!

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nancy and payne

nancy and payne

Member Since 2010
Even though I use PZI I am posting here because I need your collective minds and know they
are here, you may remember me and my Payne from when we tried to switch to L a year ago?

At that time she had already had three (3) DKAs (sigh) but we were finally starting to get it
with her and thought the change would be good .... a week into the change she went into DKA
once again. She has been well for a year and looks and acts terrific!

She has always been a big gulper (10-14u a day) prone to ketones that can quickly turn to
DKA. We shoot her 3x a day to keep her #s low and test her before each shot where she has
always been on the high side, VERY few low #s.

So things have been good, she weighs 14 lbs. and her coat is thick and shiny, her eyes are
clear, and like most sugar kitties rules the roast. Then about 8 weeks ago she started throwing
a really low # once in awhile. And then of course she would bounce. And then the lows
started happening more frequently and the bounces higher. I didn't shoot into the bounces
and that helped some .... I realize her pancreas is sputtering but how do I stop the
low/bounces?

I guess what I'm needing to know is how do I deal with this new aspect of this dance? My SS
is not up to date but I do keep very detailed data in Payne's notebook and she needs the high
dose of insulin to keep the ketones at bay >>>> to keep DKA away? I'm not looking for dosing
advice as much as an understanding of what is happening and what can I do?

I have read everything I can find on sputtering pancreas and the advice is? I need the in the
trenches stuff because I cannot EVER do another DKA!
Thanks
Nancy and Payne
 
is the notebook online or somewhere we can look at? or could you add the past week or two worth of numbers to the ss so we could look at it? it's kinda hard to know how to help without being able to actually see what you're talking about.

just generally speaking, most cats have sputtering pancreases, that's why so many are able to go off of insulin. i don't think i would necessarily give credit to a low number to the pancreas. bounces are caused by the liver and the insulin is usually responsible for the low number.

i don't know what you mean by you "didn't shoot into the bounces and that helped some." can you explain that?

i'd like to be helpful, but i really don't have a good picture of what you're talking about. if you could say a little bit more and get some numbers onto the ss, that would be super helpful in filling out the picture.

good to hear that payne is doing so well! yuppers, we all don't want any more evil ketones coming his way!!
 
Im new-ish but I have a similar problem with my cat being in high #s most of the time then randomly throwing really low numbers and bouncing from them.

I recently got some advice on how to avoid the low dips. You can read about it at this link and see if you think it might apply to your situation or help at all: viewtopic.php?f=9&t=107815&p=1141367#p1141367 (Libby's post has most of the pertinent info)

good luck!
 
Hi, Nancy.

I agree with Julie -- it would be helpful to have a visual of what you're describing. If you could transfer a couple of weeks of data to Payne's SS, that would help.

I'm not terribly familiar with PZI so please take any of my comments as theoretical. There are some experienced folks who are on the PZI board so I'd also suggest that you open a discussion there.

There has always been some controversy about bouncing vs. chronic Somogyi rebound. From what I've read, I'm not in the Somogyi camp. I do think that kitties bounce. The difference here is that if you believe in Somogyi, the strategy is to reduce the dose. We've not typically seen bouncy kitties respond well to a dose reduction. Rather, it's a matter of making a decision on the dose based on where the nadir falls. If the nadir is outside of normal range, then more insulin may be needed. If the nadir is where you want it, hold the dose. If Payne's numbers indicate a reduction then reduce. It is a matter of waiting for bounces to clear before making a dose increase, however -- at least with Lantus or Lev.

There are some folks here who have really bouncy kitties. I'd suggest that you take a look at Dyana's J.D's spreadsheet. J.D. is a big bouncer. Dyana will use Humulin R as a means of helping with the bouncing. If you want to consider R as a tool to add to your kit, please work with someone who's experienced with it's use. It's a very potent, short-acting insulin and you work with very small doses and need to curve each new dose. Timing of the R injection is also critical since you don't want R and your basal insulin (e.g., PZI) to overlap. That said, I don't know if R is a tool that is used with any frequency with PZI. (I also suspect that Payne has had R before. It's typically used to get numbers under control in cats who are experiencing DKA when they are hospitalized.) I've not used R and wouldn't feel comfortable assisting you with it but there are others here, including Dyana, who can help. There may be folks on the PZI board who can help you, as well.

Again, without seeing numbers I don't know whether any of this makes any sense.
 
Nancy,

Disclaimer: I am not as familiar with PZI as with the Ls, so I'm theorizing.

insulin needs can change, so I think the first thing I would do, if I were you, would be to sit down and really study your data. See if you can find any patterns that tell you when the lows are going to happen, then think about what you would need to do to solve the problem. It's possible that he really is ready for less insulin, especially if the lows are happening more often. That would be my first instinct, without seeing the numbers. If that's not it, you can try some other tweaks.

In general, the factors we can play around with are insulin, food, and time.

Time: you are already using time to your advantage by shooting TID. With PZI, you might be able to shoot even earlier than +8 if you see a bounce starting. I'm not very familiar with the insulin, because while I did use it for a little while, I never took the time to "learn" it. I remember the old TR PZI group shooting after +6 if the number was rising. That makes for a nutso schedule, though, and I'm not sure any of them ever slept. Maybe you could try it just in the cycles when he is starting a bounce, if he is rising really fast. I'll leave that to you, since you know a lot more about PZI than I do.

Insulin: unlike the Ls, PZI lends itself well to sliding scales. It's easier to make dosing changes that affect just this cycle, instead of having to think about several cycles at a time. If you can figure out the patterns, you can try a lower dose just in the cycles when you think a low number is coming. Or, you could consider lowering your basal insulin dose and using R to steer the numbers. Either of these methods would allow you to give more insulin only when it is needed.

Food: the other way you can control a cycle is with food. Michele linked the conversation I had with her the other day. Look for a way to predict when he is going to drop, then look for a way to control that with food. Ideally, you would play around more with the timing of meals with his regular food instead of increasing the carb %. If that doesn't work, then playing with the carb % (as I suggested to Michele) might be appropriate. Increasing the carbs so you can give more insulin is an advanced technique, so would require you to monitor a lot to keep Payne safe. I know you already know that but I have to say it. ;-)

Just a few ideas to get you thinking.
 
Hi Nancy,

By what you've said, can I assume you are still using a sliding scale (10-14 units per day) depending on Payne's preshot numbers?

And by "didn't shoot into the bounces", does that mean that you didn't increase the "scale" dose when you felt that the high preshot was because of a bounce (as opposed to a "real" high number)?

I've seen Dr. Lisa refer to bounces as falling into two categories. Warranted and unwarranted bounces. Only she uses the term "rebound"...
Also, we need to consider the issue of warranted or unwarranted rebound. If warranted? ( a number truly too low or the drop too fast)..... Lower the dose. If unwarranted? (a cat over-reacting to a safe number) Stay the course and push through it. Don't just look at a high number and assume warranted rebound.
Click to expand...
That whole thread is worth a read if you've never seen it. And the kitty in question was on Prozinc.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=57769
I guess it comes down to what sort of numbers you are seeing as "lows" with Payne. Are they mid-green "hypo territory" lows? And are the drops steep and/or fast?

I totally agree with the "3 things" that Libby listed that can be manipulated in order to steer the numbers. Insulin, food, and timing of both.

Are you seeing the bounce-causing lows in one cycle predominantly, or is Payne doing the "cat thing" and just doing it at random times and in all three cycles? Is there a "routine" or "pattern" in your data that leads you to think that predicting a low is possible? And could you "change" something to preempt that from happening?

I did things a little differently with Bob when he went OTJ. First off, I only shot twice a day, so I didn't really adhere to a strict shot schedule time-wise. 11 to 13 hours apart, based on when I could get home to shoot him. I wasn't as locked into a tight schedule as you must be shooting 3 times a day. I'd think there is less wiggle room for you than there was for me.
I also didn't pay very much attention to whether a preshot was due to a bounce. Primarily because I didn't test often enough mid-cycle to know whether the preshot was due to a low number that might have caused a bounce. You have the advantage of more data than I collected, I'm pretty sure.

I used a sliding scale for the whole time Bob was on PZI (only 10 weeks), and I based the dose on the preshot, period. Bounce or not. To me, a 400 was a 400, and I didn't consider where it came from. I just knew I wanted it to go away. In hindsight, that was stupid and due to ignorance. I'm just fortunate that it worked out okay.

Carl
 
Thank you for the responses and now I have no idea what is going on :) I thought it was a
sputtering pancreas and now, I don't know .... I feel like a newbie again.

I have updated my SS and added the last two weeks which have been the worst, in which
she had a hypo ... even during the worst of her being sick she never had a hypo.

I was taught if your cat was bouncing don't increase your insulin on the high #, maybe
that is not right. I have used R quite a bit but she has been really sensitive to it lately, so
for now I can't use ..... :(

If I knew when she was going to go low I could use food but it is for me, out of the blue.
To be truthful I would rather deal with the high #s than the lows. Also she reacts
badly to high carb food and her diet is really clean .... FF pates, no fish and poached
chicken and turkey meat. Any ideas once you have seen my SS are appreciated.
Nancy
 
I posted before I saw your post Carl, I shoot according to her pre-shot # and I can't predict when
she will go low, it seems I have lived in the world of ketones, DKAs and high doses that I can't
seem to wrap my head around these lows and bounces. ohmygod_smile

As soon as I fix dinner I'll read your link and you sound good, thanks for posting I know this is a
hard time for you.
Nancy
 
i'm just starting to look at his ss, but my first reaction is that few people, other than those with high dose conditions, would use 1uR other than in a veterinary hospital. typically people use somewhere between 0.1u and 0.5u. the goal i used with R is just to hold numbers flat until the Lantus took hold - to prevent the high from happening and reduce the whole range of numbers.

so yeah, he did have quite a response to the R. in 3 hrs it dropped him 210 points. if you decided to continue using R, i'd try 0.1u when you were on a cycle where the nadir of the PZI had passed - so perhaps at +5 or +6, when you anticipated he might be rising too much, just to hold him flat rather than to move his BGs down.

i know so little about PZI that i think i'll leave it to others to suggest dosing - because i have a Lantus mind-set i'm looking at the ss and thinking "hold the dose!" :lol: but i know that's not necessarily appropriate with PZI.
 
Around her DKAs I used R quite a lot, sometimes 1u 3x a day, so I am very experienced
with using it, and normally 1u is needed to move the #s. On the 6th I had given her 1u
right before her hypo, weird she is like a different cat. I am trying to read everything
but this is very confusing! So I am staying away from R right now.

And actually I did learn to use R in a vet hospital, UC Davis. During her first 3 DKAs she
was in ER for a total of 6 weeks, most of the time I camped out there and was part of all
the students coming around discussing Payne :( no one got it and and they never could
regulate her. I learned to walk the tightrope keeping her in good #s by taking some of
this and some of that but it's not working now.

I would agree that maybe I am dosing too high, cats do change and she was just weaned
off pred a few months ago. Thank you everyone for your answers meanwhile Payne
is NOT liking the extra attention especially since she feels so good :)
 
heehee pets to Payne! and i'm sorry for calling her a he - i hope she wasn't too offended. cat_pet_icon

it might be that she's become more sensitive than she was before because of the low numbers she's had. my understanding is that cats who have had a symptomatic hypo can be significantly more sensitive to insulin than they were before. perhaps that's a factor in her changing response.
 
There is nothing worse than a cat that feels great getting poked and prodded :)
AND there is nothing like
going into a post with one opinion and to be turned around and around and .....

I read everything last night, updated my SS, well last 3 wks. and my mindset is open.
I think I am still looking at Payne as a sick diabetic cat, filled with pred and R and
SQ fluids and ketones, tittering on the edge of DKA and dying.

BUT stepping back and reading all your words, looking at her with open eyes, she is
not that frail kitty anymore, thank God! She is 14 pounds! and could be a poster cat
for diabetic health, or any kind of cat health! Plus she is young, only six and has
no other health problems .....

Maybe it is as simple as I am over-treating her? hovering when I should be letting go
some? I think from everything being said that she is getting too much insulin and I
am going to reduce .... maybe in time I could shoot BID a day! oh no don't get
carried away!!

Thanks to everyone who took the time to answer, I think I'll be sticking around some,
seems I have a lot still to learn about my healthy diabetic kitty ohmygod_smile
Of course this new phase is better than sleeping on a cot in emergency at Davis!

And Julie, Payne doesn't mind what you call her as long as you call her for meals!
she is a REAL stomach cat, thank God!
Nancy
 
Maybe it is as simple as I am over-treating her? hovering when I should be letting go
some? I think from everything being said that she is getting too much insulin and I
am going to reduce .... maybe in time I could shoot BID a day! oh no don't get
carried away!!
Click to expand...

Nancy, what I see at times on her SS is that it looks like some cycles just appear to run "long", where you just get a slide from one PS to the next. Nothing drastic as far as too much drop, but just that downward slope. That can mean a dose that is a little too high (but the times I've seen that, it's been more obvious because the cats are BID rather than TID). But it does look like Payne can get more than 8 hours out of a dose on some cycles.

Maybe for now, keep on the TID schedule, but just adjust your scale downward by .25 or .5u? Even if you drop it all by .5u, that's only a reduction of 1.5u per day total. And see if you get more consistent cycles in terms of drop and duration?

Carl
 
Hi Nancy

Great to see you and Payne and hear she is doing so great clinically. I've never used PZI so this has been very informative for me.

I just wanted to tell you "hi" and I'm happy she's well :-D :-D :-D
 
Hi Nancy,

I don't have any wisdom to offer, just my sincere admiration for all you're doing for Payne. How wonderful she's responding so well to treatment! Congratulations!
 
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