White Flag up! Wrong way? UPDATE

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owlgal

owlgal

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Ok, i surrender. I JUST DON"T GET IT! Went up on higher dose (1.4u) and now he is in the high 300's. The insulin always brings him down. Positive no fur shot. What is going on? Is this a bounce? Too much insulin? As i increase in dose, his numbers just keep getting higher and flatter and the ps numbers are higher. So this means i should reduce now? I thought i was going in the right direction and went very slow. All variables I can control (food, no stress, excercise) are consistant. What really stumbles me each time is when he throws these occasional blue's. Makes me think i'm getting close to magic dose, but NOT!

Really need some input on his SS. I just feel so depressed over it all. I hate seeing him so bad off. Think i'm helping him. Maybe i'm not.

Thanks!

Recap: 1.4u given (2nd cycle)
amps@344
+4@267
+7@269
pmps@314
+4@324
+6@286
 
Re: White Flag up! Wrong way?

Good morning Lori,
I only have a minute.
I think "not enough" for two reasons, but you need more opinions....
1- I don't see any numbers recently that would be causing a bounce.
2- I don't see a green for a ling time.
Gotta get dressed for work. Back later.
Carl
 
Re: White Flag up! Wrong way?

I would tend to think more as well...but Copper has only been on the 1.4u for two cycles so I'm hesitant. Although, Copper seems to be the type of kitty who shows immediately the effects of raising a dose, then slowly increases his BGs back to the higher numbers. Silly kitty.

If you're going to be around to monitor, and keep in mind I tend to be heavy handed on dosing, I'd be tempted to shoot 1.5u or 1.6u and gather data.

What do you want to do?
 
Re: White Flag up! Wrong way?

Lori
this might help you while you are contemplating.


Have a sunshine day!
Carl
 

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Re: White Flag up! Wrong way?

THanks all! I guess i was just so tired last night and when i got the 200's flat and then the high pmps and high +4 i just felt like giving up. I have been thinking all along he should be higher too, but then the numbers started getting higher as i went up. Why would he have gotten such lower ps's and lower throughout the day with 1u then? Just very strange.

Amps@299
Guess i will try the 1.4u for 2 more days because of schedule. Then on tuesday of next week i can increase. I just want to make sure i'm going the right direction and not messing him up worse by increasing, which looks like it to me.

THanks again!
 
Re: White Flag up! Wrong way?

Hi Lori,

A few questions for you....when was Copper diagnosed and when did he start on insulin? Does he have any history of other health problems, DKA/ketones? I see a note about URI symptoms a couple of weeks ago...has that resolved? Has he had those symptoms before, any history of herpes virus? I also see a note in January about him peeing in a corner...that could be a sign of urinary tract infection/inflamation...was he checked for that? Has he ever had a dental or has the vet looked in his mouth and said he needs a dental? I'm just trying to get some background because I don't know his history.

I see you recently changed Copper's diet. Part of what you are seeing *may* be related to that change....sometimes it can make their numbers wonky for a few weeks, or even longer. It's definitely an ECID thing though, so I just thought I would throw that out there to be taken into consideration.

It looks to me like Copper isn't getting enough insulin right now. It could be he just needs more insulin, or he could have something brewing that is elevating his numbers, or the food change is affecting his insulin needs, or ? I'm not seeing a lot of high bounces recently, it looks more to me like flat numbers because of not enough insulin or an infection. He has had some pretty dramatic bounces in the past, but mostly when he was on a higher dose and seeing big drops. I understand that you don't want to increase if you can't monitor, but I don't see anything to indicate that his dose is too high, so I wouldn't decrease, and I would increase when you can unless his numbers come down in the meantime. I would also consider a vet visit to see if something is brewing.
 
Re: White Flag up! Wrong way?

owlgal said:
I guess i was just so tired last night and when i got the 200's flat and then the high pmps and high +4 i just felt like giving up.
Click to expand...

Hi Lori, I just wanted to add that his +4 really wasn't outside of Copper's pattern. It appears that his +4 has been higher than his PMPS # on many occassion and it's not just a blip on the radar. Seems to me that that is the case more often than not.

Otherwise, I agree with everything Laurie has said.

Hope Copper gives you a nice cycle today.
 
Re: White Flag up! Wrong way?

Laurie,

Copper officially Dx in mid Oct. Changed his diet right away to wet and his numbers dropped. THen had to go to another vet because the one vet wanted to give him humilin N and didn't know anything about prozinc. So didn't start on Prozinc until Nov. He has never had DKA or ketones. Just recently checked ketones are neg. No he has never had a URI and they did all his blood work and all came back ok. CHecked urine for white cells and neg. Yes, peed in corner one day because didn't go to cat litter all day. I forgot to bring him downstairs to it that morning. He is having trouble walking bc of neuro so he avoids going downstairs as much as possible. He usually will go outside if he has a choice. But been cold, so doesn't want to go outside.

Yes, i have changed the food gradually. I tsp at a time with regular food and then i halfed it. He loves the raw and i think gives him more energy. Today i went to only canned and 0%carbs to see if it is the food issue. His +4@307. Amps @299. So flat again, but high.

So if he needs more insulin, then why was his numbers lower on the 1u? That is what i don't understand. So if i go up on a dose and he still has the high flats, i need to keep going up?

THanks all for your input!!!! I really appreciate it!
 
Re: White Flag up! Wrong way?

Lori,

I went back in time and searched for this, and I'm just going to copy/paste it so we can all read it again.

Here's my opinion, not just concerning Copper and you, but with every kitty and every bean who is currently wrestling with small incremental dose adjustments.

To me, any adjustment of less than .25 units if unfathomable, because I never did it. The smallest adjustment I ever made in a dose was .25u. For probably the last four weeks of Bob's dance, I am almost sure he never got the same amount of insulin for two consecutive shots. I was using a self-created sliding scale based on each PS I got, day and night. He rarely got the same dose day and night, or day to day. He went from 4u BID to zero in about 4 or 5 weeks. The last shot I ever gave him was .5u at PMPS after he had gotten no shot at AMPS. His BG when I gave him that .5 was either greeen, or low blue, but it was less than 120 if it was a blue. A "non-diabetic" number.

I am NOT SAYING that anything I did was right. I do not want ANYONE to dose their cat the way I dosed mine. But I do not believe that any adjustment of .1 has any effect whatsoever on any cat no matter what his BG is. There are multiple "non-insulin" factors that are taking place in a cat's body every hour of every day. And we have zero control over them. None. You can give your cat the same exact dose of insulin every shot and every day for two months, and I will guarantee you that you will not get two cycles that match.

Here is what Dr. Lisa posted on PZI a couple of months back. I believe it beyond a shadow of a doubt. I have read it a hundred times. This is the reason I tend to avoid advising discussions about mini-dose adjustments. I might agree with someone on the .1 up or down, but not because I really think it is going to make a big difference. I agree because I am trying my best to be reassuring to people who just aren't convinced that what they are thinking is "right". If the result of the mini-adjustment "works well", I am thrilled that it worked. But although I am thrilled, I really don't believe that the "result" had much if anything to do with the adjustment. I think it had to due with a half dozen other things, and was coincidental.

This is NOT meant to be critical to anyone, not at all. It pains me, it breaks my heart, to see so many people agonize over tiny insulin adjustments. It makes me sad when someone goes up .1 for a couple of days, then is heartbroken, sad, or confused when they don't see the progress they were hoping for, or it works for a couple days and then stops working, and they have to go through the same process three days later.

Anyway, here's Dr. Lisa's words:
I have been so busy lately and have not been following Copper's saga but I want to reiterate the above because I often see folks on this board getting so caught up in the insulin dosage (down to overdone minutia....driving themselves crazy....) as if that is the only issue...and as if 0.1 (not even measurable...) or 0.2 units (highly doubtful that this level is accurately measured...) is the end all...be all...'deal breaker' for the cat's situation when it simply is only one TINY (at that level of change) piece of a very complicated puzzle.

Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.

(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)

Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:

*Exogenous insulin absorption

*Endogenous insulin production

*Intracellular uptake of exogenous and endogenous insulin

*Insulin degradation and elimination - different for exogenous vs endogenous

*Intestinal glucose absorption

*Endogenous glucose production

*Tissue glucose uptake and utilization

and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....

....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)

When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.
Click to expand...

http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=61241&p=663242&hili

I'm sorry if this offended anyone. I love you all.
Carl
 
Re: White Flag up! Wrong way?

Not to hijack the thread, Lori, and I don't want to disagree with the science guy, Carl, but I think the overriding principle of this dance is Every Cat is Different. If you look at Lisa's Cassie, it is pretty clear that .1 unit does make a difference, in her cat. Maybe it doesn't in every cat but I think it can in some.

We encourage .25 changes in cats that are high or need a bam dose. But I like being able to dose in smaller increments for cats in whom it seems to make a difference or who are new to the dance. Bless U100 needles. :mrgreen:
 
Re: White Flag up! Wrong way?

And this is why we have "peer review". If we all agreed on everything, there'd be no reason for any of us to be here. They'd have a text book for this stuff. ;-)

Carl
 
Re: White Flag up! Wrong way?

Recap: 1.4u given (2nd cycle)-Feeding only 0%carb all day
amps@344
+4@267
+7@269
pmps@314
+4@324
+6@286
+8 @277

pmps 314
Fed
Shot 1.5u

Thanks everyone for the discussion. i remember Dr. P talking about this post. Copper really seems to respond well to .1 or .2u doses, in the past. It just seems to take a little longer to settle in. So that is why i have been going so slow because he seems to respond one cycle and not the next-Crazy. But now, he doesn't seem to move at all when i change his dose. He was in the yellow's with some change on the .8u and 1u and as i moved up, his BG and ps's kept going up. Either he is getting insulin resistant or something is different about this new insulin vial. I want to go up if it will get him better, but i don't want to go up so much so fast (like 3cycles)-then he hypo on me and then i have to start all over again. Just feel that i was taking a baby step forward and 20 giant steps backwards, but at least i was going forward a little, i thought. Lately, feel like i'm only going backwards.

The only variable i've changed over the last 3wks is a new vial change and slowing switching to chicken raw diet(feline's pride). Thought maybe it might be the food variable so today i only stayed on the 0%carb canned turkey. It didn't effect the BG at all. Stayed high flats all day. He really likes the raw diet and know it is so much better than this canned food(FF). He seems to have more energy on the raw diet and a whole lot less poop. Poop doesn't smell either. It's wonderful.

Anyhoo, the opinion is to go higher so i went up to 1.5u tonight to see if i could get him to move at all. If he goes even higher or his amps is higher than i will know wrong way? Tomorrow i will be in and out all day, so really can't monitor. So not sure what i will do. I guess i will just wait and see how tonight goes.

Thank you everyone so much for responding and giving your input. i so appreciate your time and knowledge. I just feel like i've run out of steam going backwards so much and now the long hill back up again. Just don't think i can keep going this way....Got so much going on in my family and tons of stress all the time and this disease is just taking over my life. Don't know how to get it better, just keep sinking deeper and deeper. I know i sound very whinny and i'm sorry. You all have been through so much more. So i will stop now and pray things get better for Copper soon!

Thanks again!
 
Lori, I am so sorry you are feeling down. You are doing the best possible job with Copper and we all know, it is hard to do this. Maybe take a break from the numbers for awhile. Copper's numbers aren't incredibly high. Remember, he doesn't know he is sick. He knows he is getting great food, lots of attention from Mom and extra treats. For Copper, life is good!
 
Sorry I'm just getting back to your thread, Lori. Thanks for the info, it helps! Insulin needs do change, sometimes for a specific reason, sometimes for no apparent reason. I asked the questions about infection, dental (did the vet look in his mouth?) etc. because those things can really affect insulin needs. Mr Tinkles had a chronic URI that made it impossible to get him regulated, so I have some experience with that. A dental can make a dramatic difference in numbers as well, and I hate to tell you how many times the vet says the cat's mouth doesn't look bad when he takes a quick look, and then the cat ends up needing several extractions when they actually go in for the dental...x-rays really tell the story.

I'm not sure if you saw the thread by Julie & Punkin about Glucose Toxicity? If you haven't, you should look at it, there's great info there. It really explains well why cats who sit in high numbers need higher doses of insulin in order to break through the glucose toxicity and bring the numbers down.

Please don't think that I'm saying that you shouldn't change the food! If you think the new diet is better for Copper, then stay with it. I'm just saying that the diet change can affect their numbers temporarily....you didn't do anything wrong!

Good luck with the dose increase!

Carl brought up a good point about dosing increments. My experience is that when the numbers are far from good, it's more effective to increase by larger amounts, but as there is less room, the increases should be smaller. It can be easy to miss the "right" dose if you go up too much at a time. I often used 0.1u with PZ when Mr T's nadirs were blue, and it worked well for us....but my cat is the poster cat for micro dose adjusting. He went from 1.5u to OTJ one...teeny...tiny....drop at a time....talk about trying your patience! So I do disagree about micro dosing not being effective. :lol: He never could have held large dose reductions. I also have seen several cats that need one drop of insulin or their numbers were yellow....with the drop, they were green.
 
Sue,

Thanks for the encouragement. I know i'll get through it somehow. What other choice do i have? NONE! I guess it's the "mom" in me that wants to make things better when they are not feeling well. Just wish so much he would feel better. He deserves it. He is such a wonderful kitty.

Laurie,

So appreciate your input. As for the dental, they looked at his teeth and said he was good. Didn't get any dental xrays. Didn't even know they had those. As for a URI, he doesn't have any white blood cells in his urine and all his Bloodwork looked good. Is there another way to tell if he has one? I really think it's more about walking up and down stairs with his neuro. He is walking on his hocks so i know it's uncomfortable. If i carry him down to the litter box 2xday he goes just fine. We have a cat door he can go in and out of for outside during the day and he usually does most of his peeing and pooping outdoors if he can. On cold or rainy days he puts up with using the litter box. Funny cat. When we first got him from the humane society he didn't even know what a litter box was. He was 7mths old. I guess the owner who turned him in let him stay outside all the time. Then he taught my other cat to do his stuff outside and he liked that idea. He prefers outside too when he has the opportunity.

I know that micro dosing does work because i've seen it happen in him. Makes sense about increase or decrease in bigger doses if further away from green nadir. It's just that he will be flat one cycle and then go in the low blue's or greens another cycle so i never know what to do half the time. JUst a gamble some of the time.

I know that the raw diet is good for him because he really needs to get his muscles back. Very skinny. I just wanted to try today and take that variable out of the equation and see if it was the food causing his higher BG. It wasn't. He still is high and flat all day.

Just got his +4 reading : 199 YEAH for this cycle

THANKS again all! Sorry i was so gloomy today. It good to know that you all understand. Don't know what i would do without this board!!!!
 
Lori,

I was thinking about what you said about the neuropathy....if Copper is in pain, that could be elevating his numbers. You might want to ask the vet about a trial with pain medication (not metacam!) to see if that brings his numbers down. You might find his numbers drop if pain is the culprit, so I would try it when you are around to monitor.

If the pain med helps, some people find that gabapentin is an effective pain management option for neuropathy. I have not used it, you might ask on health for feedback from experienced people.

Other than pain tx, it looks like you are doing all you can for the neuropathy (getting BG down, methyl B12).....it can take a long time to improve. Mr T had it but he never seemed to be in pain, and it did go away, but it took time.

I hope this helps. I know it can be very frustrating when you can't seem to make progress!
 
You might also try alternative therapy for his neuropathy.
Check to see if you can find an animal accupuncturist in your area or ask your vet if they can recommend one, it helped Henry with pain from disc problems and improved his mobility.
 
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