Sputtering pancreas help

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Darlene & Jack

Darlene & Jack

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Hi, just looking for some info/explanation of a "sputtering pancreas." It has been mentioned to me a few times for some explanation of why Jack's numbers are all over the place sometimes. Do Jack's numbers indicate that this is possibly a cause of his erratic numbers? Today he ranged from 58 to 522. Rose from 142 to 491 in just a few hours after being in a normal range for the better part of a day, the first time in a long time.

How is a sputtering pancreas controlled? Will it ever get more under control? Any advice or explanation on this is appreciated. Thank you!
 
Hi Darlene,

I have followed your SS on the Levemir board and it always seemed to me that your insulin dose was maybe a little too low. I think you have upped it to an effective level now.

On the 27th, you got the nadir of 58 then a rebound to 522. The 58 is a perfectly normal blood sugar for a non-diabetic cat but Jack's body hasn't seen a number like that in a long, long time and is thinking, "PANIC!, PANIC! That's LOW!" and his body starts pumping out the hormone glucogon to raise his blood sugar and his liver starts converting fat to sugar and dumping it into his bloodstream. I really think you should have held his dose steady. Jack's body needs to get used to the 58 as a normal number. You are able to test during his cycles so you can easily treat any number that falls into the 30's. Once his body gets used to normal low numbers, you should not see those huge rebounds and his curve should flatten out.

Lana
 
Hi Darlene

If you do a board search you may find other references about a sputtering pancreas that may explain the term. I think most people use it to indicate a regulated cat that starts getting wonky numbers when s/he starts needing less insulin (on the way to remission).

I have to say, generally speaking:
Lana & Yoyo said:
On the 27th, you got the nadir of 58 then a rebound to 522. The 58 is a perfectly normal blood sugar for a non-diabetic cat but ....
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I'm just not comfortable with this. (Lana this isn't directed right at you.) Is this the common board wisdom now? Yes it'd be ok in a non-diabetic because there isn't any exogenous insulin in there, but for a diabetic I've shot with insulin, I don't want to see a 58.

...Jack's body hasn't seen a number like that in a long, long time and is thinking, "PANIC!, PANIC! That's LOW!"
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Which is perfectly reasonable of Jack since he's not secreting the insulin that's dropping him.

Jack's body needs to get used to the 58 as a normal number. You are able to test during his cycles so you can easily treat any number that falls into the 30's. Once his body gets used to normal low numbers, you should not see those huge rebounds and his curve should flatten out.
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I am not sure if everyone is aiming for 60 with their cats, or if that's the TR goal here, but I'm uncomfortable with that. A normal number for a cat with a normal endocrine system is and should be different for a cat with an abnormal one (diabetes), esp. when we factor in that a lot of cats have other concurrent issues -- triaditis, pancreatitis, hyperthyroidism, etc. Why does an insulin-dependent cat have a normal of 60 rather than 80-90-100? Anyway you can't always treat at home when you get low numbers -- long-acting insulins can drop low and hold despite feeding, and yes you can have problems in a cat who is acting otherwise normal. I just don't see why the goal has to be so low as run the risk of hitting the danger zone for arrhythmias and brain damage (30s).

Moderator, feel free to move to Think Tank once I get a pile-on of indignant responses.
Jess
 
Jess,

This is by no means an indignant response, just a thought for you to ponder. A 58 at nadir, allegedly the lowest point of the day...is nothing to worry about right? It is granted, lower than what we 'think' of as normal, but there are a number of cats who show those kinds of numbers when they are otj.
Most recently is Phil and Garfunkel.
I know Tom who spent 2.5 years otj was occasionally in the mid to upper 50's.

Having said that, it is never a number I would intentionally aim for. But it is a number a cat who is generally high would likely bounce off of.

My Tom has a sputtering pancreas. He is quite capable of dropping 200 points in an hour after a meal in the morning when his numbers used to run high. This would be pre-shot.
Now that he is regulated and running low I don't see much evidence of a sputter as much as a disabled pancreas. Still able to work, but slower than the other pancreases in his class :mrgreen:

When he was a sputterer he would hit like 36 2 hours after his shot based on a 320 amps. So clearly a sputter.

I want to look at Darlene's sheet now and see if I recognize sputter in there.
Having Tom as a sputterer back in the beginning and also his 2nd time around.

Lori
 
Thanks for the responses. It is all still confusing for me. If I was home all day, maybe I could treat the low numbers easily. But as you say, Jess, I hate to take that chance on him dropping so low. During the week I leave the house at 7am and get home around 5 or 5:30. My daughter checks him at 9am for the +3 reading before she leaves for school (she's 19) and my son checks him the other times (he's 16). I can't always be calling home to check and also to leave my son with that responsibility to care for a hypo reaction like that. So though I can usually get readings easily, it's not as easy to manage a hypo.

Thanks for the suggestion about doing a search on the topic. Still just trying to learn what I can, and try to make some sense of Jack's crazy numbers! Sputtering or rebounding, I have no idea how to tell the difference.

Thanks for taking a look Lori. I guess from your explanation of the sputtering I'm not sure if he has that but I'd like to see what you think!
 
ok. me? I don't see sputters in here. I do see unwarrented dose hopping. I think you could have stayed with the 1.2 and kept an eye on it.
the thing with levemir that I notice is that every drop counts big time. the difference between 1u and 1.2u is alot more than you think.
another thing with lev that I personally have experienced is that h/c can take hours to show up in numbers. and that lev can move your numbers so slow it's like watching paint dry...and that is a good thing.
so......on 5/16 when some h/c was offered for no real good reason and showed up later you reduced dose. I think that was a mistake. and heavens, on 5/27 when you dropped from .8 to .3 WHOA!
from my own personal experience levemir works best on consistancy. I had to learn that the long way, the hard way, thru seeing it myself and not listening to these no-nothings ( :lol: :lol: ) tell me so.
but you can save yourself the trouble and listen to the experience.
stay consistant, don't overreac to a number....stick it out. things look better now. stay with a single dose until you have just tooooo much evidence than says change dose.
and btw, unlike pzi.....dose changes at your late stage in this dance should not be dramatic. point by point.
but no, i don't see a sputter, i do see too much dose hopping.
IMeversoHO
Lori
and tomtom too!
 
Darlene,

I am not going to try to respond to Jess's post. I think it would be pointless anyway.

To clarify for you.... I am not saying to aim for a low, low nadir. I am saying that many of the numbers you are getting are within the normal range of a non-diabetic cat. If you hold the dose, you may well not get a number that low the next day and if you do get a green number, Jack is much less likely to rebound off those numbers. Once he stops rebounding off lows (that are in a normal BG range), then his curves will start flattening out.

I simply used a BG of 30 as an example of an emergency to draw a contrast to Jack's 58. I am certainly not advising you to purposely aim for ultra low nadirs as a matter of course.

Lana
 
Thanks Lana for further explanation. I didn't think you meant to aim for really low nadirs, but it still hard to manage those by phone without panicking my poor son!
Rebounding was explained as a reaction to a dose that is too high, so you need to lower. That's why I did lower. I didn't have time to post and wait for responses as I had to turn around and leave the house again to be somewhere. I tried to make the best decision I could at the time.
 
Hi Lori

I don't want to start a whole big thing, so just to clarify, my point is just about cats that are on insulin.
lori and tom said:
A 58 at nadir, allegedly the lowest point of the day...
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How can I be sure a nadir is a nadir when using insulin? That's the issue.
It is granted, lower than what we 'think' of as normal, but there are a number of cats who show those kinds of numbers when they are otj.
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Which is a whole 'nuther story. If I tested my (never-diabetic) Dillon right now, I wouldn't care. He doesn't have an external source of insulin -- his endocrine system is normal. If I had given him insulin, I can't know if he's at a true nadir or not so I do care. I wouldn't aim for a low 'non-diabetic' normal if he was diabetic.

I know Tom who spent 2.5 years otj was occasionally in the mid to upper 50's.
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See above :-)

Having said that, it is never a number I would intentionally aim for. But it is a number a cat who is generally high would likely bounce off of.
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Agree with both.
 
Gotcha ;-)
Ya know Jess, we've been seeing a remarkable number of first test hypo numbers lately.
Thing is, it's just not likely that was the FIRST hypo number on these cats as they were all using insulin already.
I think 2 of these recent ones tested in the 20's...maybe 28 or 29.
Makes me wonder about the likelihood of any cat really going full steam hypo on the doses we use here.
Just thinking and know you are highly experienced....thoughts?
Lori
 
Darlene wrote, " If I was home all day, maybe I could treat the low numbers easily. But as you say, Jess, I hate to take that chance on him dropping so low. During the week I leave the house at 7am and get home around 5 or 5:30. My daughter checks him at 9am for the +3 reading before she leaves for school (she's 19) and my son checks him the other times (he's 16). I can't always be calling home to check and also to leave my son with that responsibility to care for a hypo reaction like that. So though I can usually get readings easily, it's not as easy to manage a hypo. "
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I thought you were doing all those BG tests! I didn't know everyone in the family was helping. That does make it very stressful.

Darlene wrote, "Rebounding was explained as a reaction to a dose that is too high, so you need to lower."
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Quite right. That certainly happens. But a cat who is used to BG's in the 300's and 400's will rebound off a BG of 130 because its body perceives that as an unusually low number. In the case of Jack's 58: I think in that situation you need to hold the dose for several days to determine if it is too much, too little, or a good dose that he will settle into --- If it is possible in your situation with multiple testers to manage it. Once he starts settling into a good dose, his curve will flatten out and that will take a lot of pressure off of you.

Lana
 
Jack's SS is looking really, really good. It will be interesting to see if his nadirs become a little more consistent time-wise -- a lot of the time his "curves" have looked like "rick-rack." Yesterday was a nice smooth curve pretty typical of Levemir with a slight rise over the first three hours followed by a mild bowl-shaped curve. Nadirs in the +6 to +8 range of the cycle are probably the most typical on Levemir and Jack's nadir was at +9 (as far as we know -- perhaps it was at +8). It will become a lot less stressful for you if his curves can settle down and produce nadirs in that +6 to +8 range rather than anywhere in his cycle. Predictability is a very comforting thing.

Lana
 
Thanks Lana, I think his numbers are looking pretty good lately too! Though as you say, his nadirs are kind of all over the place. I really didn't get the rhyme or reason for the ups and downs on 7/1...but hopefully it is just taking a little time settling on this dose. I was really happy to see the nice day yesterday after the drop to 56 the night before. I was expecting some higher numbers. Predictability would be a very nice thing!!
 
Darlene & Jack said:
. . . . I really didn't get the rhyme or reason for the ups and downs on 7/1...
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Sometimes it can just be maddening.

The old meter I had would give me a error message if the blood droplet was too small. The meter I have now just gives me an erroneously low number. That might be some of the problem in your household with multiple testers who might not know the previous BG numbers and do a 2nd test if the number they got was unexpected.

We all check for a fur shot, feeling for wetness after a shot. But an injection into the dermis or into the muscle will not provide available insulin to the cat, either, and there is no way to check for that. Even for an experienced person, a shot can be a little problematic and, when a cat decides to be a moving target, it can be especially difficult.

Lana
 
Darlene & Jack said:
Rebounding was explained as a reaction to a dose that is too high, so you need to lower. That's why I did lower.
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There is a difference between a bounce and rebound. A bounce is what I see in this instance - the nadir went lower than Jack's body was used to seeing so the glycogen stores were released, resulting in the high rise of numbers. Classic rebound is when you see constant high flat numbers because the dose is too high.

I can see what some may be seeing as a spuddering pancreas. What I see is something similar to my Oscar's spreadsheet. It is what I have deemed to be the body going back and forth between fighting the extra insulin and letting it work. In looking at your spreadsheet - it looks like you were actually getting somewhere with the 1.2u dose. You were getting alternating days on good nadirs, and you had more yellow preshots than any other dose. Usually when I start to see a distinct oscillating pattern like that - it means I need to hold that dose because it is the body's way of telling me it may be an optimal dose but it isn't sure if it wants to allow it to work all the time. Does that make sense? Oscar is going through a similar time of unpredictableness if you want to take a look at his levemir spreadsheet.
 
I forgot to add that with a truly spuddering pancreas, you will see BIG drops within 2-3 hours of eating (like at preshots when they haven't eaten for a few hours). Lori's Tomtom is a prime example of this, which is very distinct on his spreadsheet a few months ago.
 
Thanks Kelly. I was seeing that alternating pattern of good nadirs followed by a higher one. but again, was getting confused with all the talk of rebounding and bouncing. I think I am still confused by it! We are getting more blues now on the 1 unit, but more pink preshots.

I think I will start a new Lev pen with tonight's dose and see if that makes any difference too.
 
If it has been around 2 months since you opened the current one, then it wouldn't hurt to try a new pen. I know a lot of lev users say that it is good to the last drop, but I always see a difference with a new pen after I run out (which takes about 2 months).
 
Dearest Darlene, and, of course, you too, sometimes sweet Jack,

I always reduce dose a tad with a new pen of insulin. It's just something I've learned to do. Jack's Jack. He is a cat of many colors...

It's just my humble thought in the midst of your confusion...

Much love and countless, continuing hugs for you, Jack, and the Dream Team
Deb and Nikki (mrs. nikki-jack) -- and, Giz, who taught me enough volumes to let Nikki rescue me...
 
Hmmm...well I already gave him the regular dose. :-( Do you really see a big difference with a new pen? I still kept the old one in the fridge. Maybe I should just use that one for the next few days since we won't be home during the day for tests. On vacation this week and doing day trips.
 
If you aren't able to test at all mid cycle this week, then it may be good to stay on the safe side and go down to 0.75u until next weekend. I usually see a small, but noticeable change..... but as always ECID!
 
Probably not the best idea to start a new one tonight! :YMSIGH: I think I will just use the pen I had been using for this week then start with the new one at the end of the week instead of changing up his dose again. I was still getting some pretty good numbers with the old pen, and Jack is Jack...so you never know what changes the numbers!
 
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