Tom AMPS ~301 Need some advice

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Ilkka and Tom

Member Since 2010
Hi guys. Tom's at 301 PS this AM -- not that this is such a disaster BUT it is the first time he has had a pink number in three weeks, and I have been gradually increasing the dose. For the last few days he has not been acting right - lethargic, not happy at all.

I should give a word of preface because I have been off the reservation in terms of procedure, one of the reasons I did have not been posting "condos" -- did not want to confuse newbies and I don't have the energy to defend what I have been doing. In a word, there has been method, maybe even sound method, except my execution sucks. Ok so my judgment is not always the best either. But now something else is going on, and I have no idea what it is.

Short story
1) 2/26/2011 Tom comes out of remission.. we start out in the mid 400s. I see pretty early on that he is good old Tommie, still very responsive to insulin. We leave the 400s quickly.

2) Tom produced nice numbers in mid cycle and then sharp "ends" around preshots, generally in the 300s. There were a few visits to real lows, and one to ~25 which of course got my attention. So far so good.

3) as everyone knows I am not tolerant of red or pink numbers, so I decided to try something I had read about: TID. The idea being that I would take the total 24 hr dose, and divide it into three shots instead of 2. Objective: I would get the curve flat by shooting through the highs, injecting at +8 when the slope rises, and once the whole curve was flatt-er, I would go back to BID. And guess what? it WORKED.

4) I believed then if I had a more consistent schedule, Tom might be regulated on TID (60-180) -- maybe even tightly (nothing over 120). But I wasn't concerned with that -- what I want is for him to re-experience normal levels as much as possible to re-set him. (I have this goofy theory that T2 diabetes is not physical (or "hardware") but an information disorder -- a "software" problem that over-writes endocrine memory and creates autoimmune system reactions.) But here's the thing. On TID I had been giving .6 or .65 every eight hours. When I went back to BID, I kept the dose the same and the numbers stayed the same. In other words he got 33% less insulin per 24 hours and produced the same BG readings, pretty much.

5) good things were starting to happen. For instance, the other night while I was feeling pleased about the transition back to BID, I completely missed the PM shot. By the time I was able to give it, it was +14 or +15. So rushing to get the insulin in (exhibiting my usual patient nature, with minor arm waving and shouting) I gave the full dose (.6) and THEN took his bg. Ooops. It was ~87.

6) there were a couple of other days recently where he had these nice overhangs down to the 50s and such, where shot had to be delayed, but now for the last few days there is a noticeable rise in the BG and he has been looking dragged down and listless. IN fact I thought he might be in hypo -- but he was in the 200s. I took him to my favorite vet, who presented me with the choice of either doing a blood panel or putting him on a course of antibiotics. I chose the latter, so now he is on his third day of Clavamox 62.5 mg BID.

So any thoughts on this? (Pamela: his liver issue -- remember the last time when the readings were marginally worrisome? -- has not been resolved... )

Many thanks,

Ilkka


*** PS word of explanation re my goofy theory, which I have been noodling about for six months or longer. There is I think a major revolution afoot in biology -- true, I may have been watching too much TEDMED, genomics and proteomics etc. and may be letting my job (involved in nanoscience and nano-bio) interfere (though I am not a doctor or a lab scientist). But in my own defense I just saw that there is new data coming out of Stanford, the U of Toronto and elsewhere that is, indeed, making it increasingly likely that Type 2 diabetes is going be reclassified from a metabolic disorder to an autoimmune disease along w Type 1. That would be huge. If it is an autoimmune disease it then is specifically involved in messaging, which I have been blathering about for a while -- i.e., not just about the physical condition of organs, but what the biology regulatory IT is telling those organs, which are now like smart switches on a network, to do. I.e., if there is pancreatic damage, it may be as much the result as the cause of the high BG and associated hormonal disorder. The endocrine systems that control BG are a "virtual organ," just like bone marrow is now considered an organ by some scientists. I've been looking at it from an endocrine-hormonal or homeostatic memory over-write angle -- thinking of "systems biology" (Dr. Craig Venter: "DNA is software that builds its own hardware").
 
Hi Ilkka, I am in kind of a hurry but found your post interesting so just wanted to comment quickly on the autoimmune part.

I would have thought they would have made this distinction that type 2 is an autoimmune disease a long time ago. I knew that thyroid conditions were autoimmune related (I am hypoT) but when I just now Googled autoimmune diseases there are over 80 of them classified - one site said it was closer to 100 (that site listed Type 2 as being one of them).

It seems they are linking insulin resistance to autoimmunity which would make sense since we all know that IR leads to diabetes in our kitties and in people, in however form it is presented, like with people being over-weight, plus their unhealthy lifestyles and what they eat. Same with our cats. Or some medical problem.

Maybe Tom's questionable liver issue is causing his insulin resistance leading to an autoimmune reaction? Maybe I am simplifying this too much though.

http://www.medicalnewstoday.com/articles/222766.php

I will check out Tom's SS later. Not sure if I can help in anyway that you haven't already thought of though. :(
 
Ilkka, I'm sorry I don't have any answers for you on this dilemma for Tom.

However, I want you to know I'm very proud of you for striking out on your own and doing the TID dosing. Were you aware that some members have done that on Lev? It was from those members that I got the idea to do split dosing. Do you not want to go back to TID to correct the higher BGs this time?

TID is not controversial here, remember we follow ECID and know that some cats need a novel approach to dosing. You are a very capable caregiver, although I know you beat yourself up over that +15 mishap. Hey, it happens.

I hope you get this figured out. Pamela knows a lot about liver stuff. Have you considered the liver supplements with milk thistle & same-E (S-Adenosyl)?
 
Vicky & Gandalf said:
Ilkka, I'm sorry I don't have any answers for you on this dilemma for Tom.

However, I want you to know I'm very proud of you for striking out on your own and doing the TID dosing. Were you aware that some members have done that on Lev? It was from those members that I got the idea to do split dosing. Do you not want to go back to TID to correct the higher BGs this time?

TID is not controversial here, remember we follow ECID and know that some cats need a novel approach to dosing. You are a very capable caregiver, although I know you beat yourself up over that +15 mishap. Hey, it happens.

I hope you get this figured out. Pamela knows a lot about liver stuff. Have you considered the liver supplements with milk thistle & same-E (S-Adenosyl)?


Thanks Vicky for the encouragement. I wasn't sure about the TID thing...I know a couple of people on Lantus who have tried it, and am not surprised actually that Levemir folks have also gone down that route. Levemir gives a lot of flexibility as long as there is basic structure. Actually I thought Steve (&Jock) had done TID, but someone more knowledgeable told me no. I think I misread something. As far as the liver stuff, thanks for the tip about the supplements. I think the blood panel we are about to do (see below) is going to clarify the liver issue somewhat and I do count on Pam's input there.

I would go back to TID right now, but my sense is that it is not really going to do the thing, because it is not just that the PSs are high, the whole damn curve is high. As soon as I can get an inkling of what is going on, TID is definitely a possibility. But something is amiss. This AM I shot a full unit to a ~379 (!!), and I think the nadir is going to be in the low to mid 200s at best. A lot depends on what the +7 and PMPS will be today re decisions on dosing. I called the vet, he's just plain puzzled, and he wants to stop the Clavamox and do some blood work -- Tom's due for a follow up on the liver readings anyway. I don't like stopping an antibiotic in the middle of the course, but I think I will do it. I'm just a bit freaked. No one can understand how I feel about Tom -- I don't understand it myself. We are taking care of nine cats -- three live with us -- and I love them all, but Tom has something different. Anyway, will let you guys know and thanks again.
Ilkka
 
Ilkka,
I understand completely when you say Tom has something different. I have had a lot of cats in my life, more growing up than I do now as we had a revolving door of "barn cats," mostly because my parents didn't vaccinate so a lot of kittens died.

Gandalf responds to me the way a dog does. He is in tune with what I am saying, I can tell him to sit and he will sit. He's not really trained, he just understands. And he has that Maine Coon "love my person" affection that makes him interact with me on a level which most cats don't. It's like he can focus on something beside himself. He gives affection to me rather than simply getting it from me and responding only to the attention I give him.

How long has it been since Tom's had a dental? Sorry if you've answered that previously? That can be a cause of BG rise and instability as their mouth is a breeding ground for bacteria which can easily overtake their system.
 
Vicky & Gandalf said:
Ilkka,
How long has it been since Tom's had a dental? Sorry if you've answered that previously? That can be a cause of BG rise and instability as their mouth is a breeding ground for bacteria which can easily overtake their system.

You may have hit on it.. in fact Tom has never had a dental treatment (exam, yes) and he is due for one. When I took him in to get the Lev prescription back in Feb, the vet said his dental condition is a concern but with the BG at that time in the 400s, he didn't want to start messing with the infection risk and stress of an actual dental procedure, not even a good cleaning.

Do you have any thoughts on what is reasonable or experience with this stuff? To do, to avoid? I have never had a dental anything for any of my casts, exams notwithstanding.

Ilkka
 
Oh boy. Dentals are a bit of a sore spot with me. I see so many reports on the board of cats getting umpteen teeth removed and I don't understand why that is necessary. The clinic I go to is an AAHA accredited hospital and dentals are one of their specialties. Neither of my cats who have had dentals there, Gandalf and Tigget who are 18 and 19 respectively have ever had a tooth removed there. I sometimes suspect vets use dentals as an excuse to fleece their clients. Dentals over $800 because of tooth extractions aren't uncommon.

Here are the AAHA dental guidelines for veterinarians: http://secure.aahanet.org/eweb/dynamicpage.aspx?site=resources&webcode=DentalCareGuidelines

So I would recommend trying to find an accredited clinic and asking what their procedures are first. What condition would the cat's teeth or tooth have to be in to need an extraction? I know cats can get along fine without many teeth, but just the procedure of tooth removal seems like such trauma.

My concern for Tom would be that if he's never had a dental (his age again?) his teeth could be in pretty bad shape. I think I started getting dentals for my cats when they were 6 or 7. They have not had them every year, but often enough that maybe it avoided tooth problems so bad they need extractions.

I don't see the reasoning behind not doing a dental if the cat is unregulated. The cat could very well be unregulated because of poor oral hygiene, so the dental will surely help the regulation too. Gandalf receives a course of Clindamycin AB every month for 5 days and I think it helps tremendously with his oral bacteria. If I forget one month and then notice bad breath and I give him his Clindamycin therapy, it clears up. My vet recommends doing 5 days of Clindamycin therapy BEFORE a dental, and then we do up to 10 days afterwards for Gandalf. That is because a couple years ago he got a systemic infection (very high WBC) about 6 weeks after a dental and that was the only thing we could attribute the infection to. Clindamycin is very mild and targets that type of bacteria apparently. He did not have a problem after last year's dental.

If you schedule it, we can discuss dentals more. I think all of us here have had dental experiences with our cats.
 
I used TID with Lev for Lucy but found that the split dose worked better. My goal was a flat response pattern. With the split dose, I was able to get the response pattern I wanted and then I could adjust the dose to get the numbers I wanted.

Once I got the pattern, I went back to BID and that was that. It was like her body needed to remember the pattern and once it relearned it, it remembered. I also use a sliding scale with the Lev. On days when I have to leave home early or work late, I give a little extra, but I can do that because we don't aim at low lows. Lucy's physical comfort zone is around 70 or 80. She starts getting stressed if she drops down to 50. I also give her a little less if I need to go out after work and need to shoot early. What I've found is that once her body learned the pattern, Levemir gives us lots of flexibility. She and I are both very happy and diabetes is a real non-entity in our life these days. We struggle more with the side effects of aging.
 
Terri and Lucy said:
I used TID with Lev for Lucy but found that the split dose worked better. My goal was a flat response pattern. With the split dose, I was able to get the response pattern I wanted and then I could adjust the dose to get the numbers I wanted.

Once I got the pattern, I went back to BID and that was that. It was like her body needed to remember the pattern and once it relearned it, it remembered. I also use a sliding scale with the Lev. On days when I have to leave home early or work late, I give a little extra, but I can do that because we don't aim at low lows. Lucy's physical comfort zone is around 70 or 80. She starts getting stressed if she drops down to 50. I also give her a little less if I need to go out after work and need to shoot early. What I've found is that once her body learned the pattern, Levemir gives us lots of flexibility. She and I are both very happy and diabetes is a real non-entity in our life these days. We struggle more with the side effects of aging.

Ahhh Terri, I could not have said it better. So much what you are doing with Lucy is the same with Tigger. Not the split dosing, but otherwise, "but I can do that because we don't aim at low lows."

Neither do we. Just a nice Levimir level. Comfortable for Tigger and us at this point in our diabetes journey.

I am so happy to hear from you and to hear how Lucy is doing. You are often in my prayers (I hope you know that I mean that).
 
Ilkka, I am so sorry you are having this frustration. I think we have all been there and can sympathize.

I want to throw this out at you to consider: you have induced rebound by stepping up the dose in response to "one" higher number.

If you look at the 24th, you shot .7u on a 269 and he was at 53 12 hours later. You delayed the shot (I would have also) and shot .7u again. After that it looks like he has lost all greens and you raise the dose twice more in rapid succession to 1.1 and you start getting 300s. Suddenly he throws an 81 "out of the blue", and you reduced the dose a bit and no more 300s. Also, note that on the 19th you held the .6u on a 263 and he probably had greens mid day as he did the day before and the day after. I am looking at those 30s on the 18th and wonder if those caused a bit of bounce to get that 263 on the 19th. Holding the .6u at that point was the right thing to do, IMO.

On the dentals, giving the ABs beforehand is what my vet does even for my very young cat (who has resorptive lesions) because dentals release so much bacteria into the system and into the blood stream.
 
Just checking in for first time in a few days-Illka, sorry, nothing to add medical-wise,
just want to say i so love the way you care for Tom. Also I was at the vet recently and she said Buddy may
need another extraction(yes , bad breath), i mentioned using an AB 5 times a week each month, but she said thta will compromise his immune system (Vicky?) Not sure what to do about Buddys teeth,but since he is now (almost regulated)I 'll wait, but sounds like a great idea to get Toms teeth checked out. Good luck-let us know what vet says.
 
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