11/18 Faya 448 : numbers are getting even uglier

Discussion in 'Lantus / Levemir / Biosimilars' started by kimouette, Oct 30, 2016.

Thread Status:
Not open for further replies.
  1. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Hi guys,

    I already posted a thread in the Main forum and people told me I should write here to get more specifidc advises. So here I am!

    Here's Faya's spreadsheet : https://docs.google.com/spreadsheets/d/1jPkBkDbcNvbrAX148vjvcbhqzTBJczjnh7MZSDM2sfU/edit?usp=sharing

    Please look carefully at Faya's results since September 15th. We kind of lost the nice stability on that day and have been struggling ever since!
    We keep decreasing and increasing, nothing seems to work. Faya's owner is going to call the vet tomorrow morning to have his teeth checked and a blood panel done. But in the meantime we dont know how to manage his glycemia...

    Please notice that Faya has vomited tonight (we have increase his dosage this morning cuz the last decrease did not show any improvement)... Sometimes we feel we might be giving him too much so we decrease the dosage (his BG values get nice and then, even more ugly than before), but if we increase the dose they also get ugly, so how the hell are we supposed to handle the situation?

    Does anyone see something by analyzing his spreadsheet? Cuz I am lost!

    Kim
    :(
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Hi, Kim!

    I have a few questions. How was Faya's owner measuring some of the doses -- 0.4u or 0.8u for example? Is Faya's owner following Tight Regulation or Start Low Go Slow? I'm asking because I'm not sure I'm following how the dose adjustments are being made.

    What might be helpful is if Faya's owner sticks closely to whichever approach to diabetes management you're wanting to use and really adhere to those guidelines. The one thing that leaps out at me is how long doses are being held. With Tight Regulation, a dose is evaluated after 3 days if nadirs are regularly over 200 and after 5 days if nadirs are under 200 most of the time. With SLGS, doses are evaluated after a week. Dose adjustments are made in 0.25u increments.

    So, looking at Faya's spreadsheet, the 0.6u dose was held for 9 days then increased to 0.7u for 4 days. After 4 days, there was an increase to 0.9u followed by a dose reduction to 0.7u for 2 days and then an increase to 1.0u. In some cases, the dose has been held for too long and in other cases, the change was made either after too short a period and not based on the information that the numbers were telling you. Dose reductions should be made only if the kitty's numbers drop below 50 if flooring TR or below 90 with SLGS.

    One thing to keep in mind is that if a dose isn't bringing numbers into the normal range (50 - 120), then you do not want to hold the dose for too long a period of time. Holding a dose that's not doing it's job can result in glucose toxicity developing. What this means is that the kitty's body starts treating those higher numbers as the new "normal." It makes it harder to get the dose to come back down. As an example, the 0.5u dose was being held from August 14 to Sept 21 and nadirs were not routinely in an optimal range. What most likely didn't help was then reducing the dose to 0.4u for several cycles. To my eyes, the 0.5u dose needed to be increased to 0.75u and not reduced.

     
    Gill & George and jayla-n-Drevon like this.
  3. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    I 2nd the words of the wise one!:bighug:
     
  4. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    I have only 30 seconds to write this answer.... but the reason why we kept decreasing the dose (and even tried again recently), is that people on this very forum told me that Faya was maybe receiving TOO MUCH insulin (which would be causing his results to be constantly high)... With that doubt in mind it was hard to ignore the fact that increasing the dose wasn't working as we were hoping.

    What you are saying "the kitty's body starts treating those higher numbers as the new "normal."" makes sens, and we do TRY to hold the dose for atleast 3 days after each change, but sometimes an alarming result of a sudden abnormal nadir makes us walk back (especially when Faya's owner gets nervous of cant be as consistant as she should).

    We are now at 1.0U (the highest dosage we've tried since a long time). So I guess NORMALLY, his nadirs should start to go down in the next couple of cycles... Should they? Even though Faya's bogy might have been treating high numbers as "normal" for a while?
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    First, if numbers are high, my first reaction (without benefit of a SS) is that more insulin is likely to be needed. There certainly are exceptions. However, I cannot immediately recall any situation where in the face of high numbers, the dose was reduce and the numbers improved. Sometimes, when a suggestion such as lowering the dose is made, it's because someone hasn't read about chronic Somogyi rebound and doesn't understand that this concept has been disproven. If may help if you try to sort out how much experience that person(s) providing that feedback has at dealing with FD.

    It may help to keep in mind that a cat needs as much insulin as the cat needs. I would never assume that just because I raised Gabby's dose that I would see the response I was hoping for. Nadirs may or may not respond to a particular dose. As soon as you think you have your cat figured out, the kitty does something unpredictable to keep you guessing.
     
    DebG likes this.
  6. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
  7. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    I just updated Faya's ss... As you can see the 2 last insuline increase are still not showing any improvement in Faya's BG levels... We'll keep increase the dose by 0.25U every 3 days until we get a normal nadir... But this is frightening, especially considering the fact that we have almost doubled up the dosage since 5 days, and still no improvement!

    Here's the link again : https://docs.google.com/spreadsheets/d/1jPkBkDbcNvbrAX148vjvcbhqzTBJczjnh7MZSDM2sfU/edit#gid=0
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Was Faya's caregiver going to get her kitty in to see a vet? I would encourage her to do so. This kind of elevation of numbers could be the result of an infection or inflammation. Please make sure she has labs run and the vet makes sure there's not a dental issue. If there is something medical, it's still important to be giving enough insulin since if you don't, it can be a recipe for ketones developing. In fact, it would probably be a good idea to test for ketones.

    If there's nothing that the vet finds, it just may be that Faya is in a phase where more insulin is needed.
     
  9. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    I agree with Sienne about seeing a vet. It would be best to rule out any possible causes for the higher numbers, such as infection, inflammation or dental issues first and make sure those issues are dealt with. The other consideration is that the insulin may be getting old and losing its effectiveness. When numbers start rising much higher than usual and there has been no change in the diet either there is an underlying cause or the kitty may need an continuing increase in insulin.

    Checking for ketones would be a wise decision as well.
     
  10. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Oh geez I forgot to mention all these things that you are asking about... Yes she has an appointment with the vet on Friday. The vet will check his teeth and gums + do a blood panel test.
    Also, Faya's caregiver has bought a new cartridge of Lantus couple of weeks ago (that's one of the first thing I wanted to rule out).
    I told her how to test for ketones at home, she will do so before Friday.
    There is currently no symptom of urinary infection (pees normally), and no symptom of Ketones (he has a very good appetite, seems playful etc...). But still, we'll make sure that these possible diseases are not present.

    If his teeth are good and the blood panel shows normal values, this is going to be very complicated to understand! Especially if Faya keeps having these pink/yellow values no matter how much we increase the dose! It's so weird!

    Thanks a lot for your help and for taking the time to answer my post!
    Kim
    :)
     
  11. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Thanks for the update. Since it is a new vial of insulin that rules out that possibility. From what you are saying at least visually there doesn't seem to be anything obvious that could be causing a problem, but an examination and BW will rule that out for sure.

    What type of food is she feeding...has there been any changes in the type of food or feeding schedule? Also what type of meter is being used a pet meter or human meter? Has there been any major changes in the household that may have upset Faya? Just throwing our some thoughts,before looking at the dosing.
     
  12. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Faya just came back from the vet...

    His blood test looks pretty good! The only abnormal result is the IPL test (the vet says that this result shows that Faya has a chronic pancreatitis). I googled IPL and cant really find information about whether the vet could have misinterpreted that result. Cuz Faya does not have ANY symptom of pancreatitis. If anything he has too much appetite (no appetite loss), lots of energy (not lethargic), no increase in thirst etc... So what could the vet be thinking about when he talked about that pancreatitis??

    Otherwise, the thing he saw (which is the only thing that makes sens to me), is gingivitis and tartar on Faya's teeth. Faya will soon start to take some antibiotic for the procedure, but honestly, I dont know if I trust that vet anymore!

    Oh and Tuxedo, to answer your question, Faya is eating a low carb high quality canned food available in France. It is also relatively low in phosphorus (even though I would like it to be slightly lower). She is using a Bayer Contour meter and has never changed anything about the meter since the beginning of Faya's diabetes, so I dont think the meter is suspicious.
     
  13. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    One of my kitties has chronic pancreatitis because of other health issues. He has only had a few flare up where he actually needed treatment (pain meds/anti-nausea) and the rest of the time he is fine and has no symptoms. The usual test for pancreatitis is called the fPLI..this may be what your vet meant. What there an actual number for that test or just a "yes" reading? With chronic pancreatitis the pancreas is inflammed and over-worked which will affect the glucose levels. Sometimes vets want to treat chronic pancreatitis with steroids, to reduce the inflammation. That can of course increase the glucose levels. Using this approach with a diabetic kitty is suggested in some literature and nixed in other literature.

    It is possible that Faya needs a dental. Sometimes there are things going on below the gums that are not obvious from a normal examination. What antibiotic are they using pre-dental?...antirobe (clindamycin hydrochloride) is a good A/B for gum issues. One of mine had quite bad gingivitis and was on antirobe for a week before the dental. The inflammation was greatly reduced with the round of A/B by the time the denatl was done.
     
  14. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    They want to give him Histacetyl before his dental... Should we argue with his choice?

    The IPL test (which I guess is called fPLI in the USA), simply said "Abnormal", with no actual number.

    The vet said he saw tartar and gingivitis, but I dont know if he's planning to do x-rays before the procedure to actually see if Faya needs any extraction. I told Faya's owner to make sure that was the case!

    If Faya doesnt feel better after the dental, I guess we'll need to look more into the pancreatitis diagnosis...
     
  15. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    The IPL test would have been the Snap test, done at the regular vets office, which only gives a positive or negative and does not measure how severe the pancreatitis is. She would have to have a specific fPLI test to fond out how severe it is....this would have to be sent to an outside lab such as IDEXX for the results to be obtained.

    I am not familiar with Histacetyl, It appears that this is a drug more specific to France. I am going to tag @Capoo and see if she is familiar with this medication.

    Xrays are always advised with a dental. There could be problems that are not obvious to the naked eye and all dental issues should be dealt with at one time.
     
  16. Capoo

    Capoo Member

    Joined:
    Jan 15, 2016
    Hi,

    I have never used this medication for my cat nor for my dog.
    I just have a look at the characteristics of it : it is made with spiramycin and dimetridazole, and is prescribed in case of oral disease. It is an antibacterial for systemic use.
    The laboratory that manufactures it is a well-known one, with a good reputation.

    By the way, @kimouette , you were saying that Faya is eating a low carb high quality canned food available in France. Could you please tell me what it is?
     
  17. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Yes it is called GranataPet Symphonie pure chicken. She buys it from Zooplus. We tried to give him Terra Faelis which is the best she could offer, but the cat wont eat it even after insisting for many weeks! Granatapet Symphonie is the best "compromise" we can offer him!

    Oh and thanks for the infos about the antibio!!
     
  18. Capoo

    Capoo Member

    Joined:
    Jan 15, 2016
    I know GranataPet very well: it's a really good brand, a German one.
    When I see your sentence first, I was hoping that your friend had discovered a good French brand, available directly in shops.
    But GranataPet, Terra Faelis, and all the other good brands are only available trough Internet, and that's a pity.

    My cat is a big fan of Terra Faelis, the rabbit flavor, and he only wants to eat this brand.
     
  19. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Guys I need to be reassured on this one... would you still keep on increasing the dosage at this point? (I mean every 3 days), even though the numbers keep getting higher after each increase?
    Of course Faya's dental issues are gonna be taken care of, but in the meantime, his BG values are ugly, and getting uglier!

    Faya's spreadsheet : https://docs.google.com/spreadsheets/d/1jPkBkDbcNvbrAX148vjvcbhqzTBJczjnh7MZSDM2sfU/edit#gid=0

    Oh and is there anything we could do for his pancreatitis in terms of food or supplements?
     
  20. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    anyone??
     
  21. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    I don't see any evidence of bouncing so my thought is that whatever is happening on the side...maybe dental issues is causing the higher numbers. Until the dental can be dealt with there isn't any other obvious health issues that show up, so my thought is to continue with the dose increases to keep the numbers down as mucvh as possible. Once the dental is booked the vet may suggest a skip or lower dose insulin for the day of the procedure.
     
  22. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    Can't offer any advice re pancreatitis, tho my GA cat had a bout years ago and they prescribed digestive enzymes, do bumping you up for help with that!
     
  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
  24. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    I cant believe i am back here to post about the exact same situation (not to say an even worse situation), but here i am!

    Faya got his teeth cleaned and one tooth removed on November 11th (exactly one week ago). He no longer needs any medicine, he has perfect blood test results (with a steady result for his creatinine which has been showing a stage 2 CKD for a while), and the Spec Fpl test showed NO PANCREATITIS! In other words, Faya's owner and I are super happy with all the results he has, but unfortunately, we are still struggling with his insulin dosage! His BG values keep getting higher and higher or, at best, remain the same no matter how much we increase the dose. It's starting to freak me out!
    She told me there's never any insulin left in the syringe, the cartridge is new, the cat's health is perfect (including urine and feces), but his BG values are purple and red, getting closer to black!

    We are still following the procedure (increasing the dose 0.25u every 3 days until the nadirs are normal), but normal nadirs seem to get further the more we increase the dose! How can his pancreas not respond to such a difference and never get any better? What could we be missing?

    Here's his spreadsheet : https://docs.google.com/spreadsheets/d/1jPkBkDbcNvbrAX148vjvcbhqzTBJczjnh7MZSDM2sfU/edit?usp=sharing

    Thanks a lot AGAIN for your help and patience!
    Kim
    :/
     
  25. Lincolns Mom

    Lincolns Mom Well-Known Member

    Joined:
    Oct 23, 2016
  26. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    It's not a medical emergency, you don't need to put up a 911. A simple ? will do.

    I notice that Faya is on antibiotic after the dental. Do you know which one? Some have sugar in them if they are syrup based. Also, when Neko has had dentals before, it's taken about 10 days for her numbers to start coming back down again. There is usually inflammation associated with extractions, and that can inflate the BGs. And is he on any pain relief meds any more? He did get a couple shots of bupe after the operation, but I don't see anything after that. Has he been rechecked after the dental to see if there is any infection as a result of the extraction? I usually had follow on visits a week after a dental.
     
  27. kimouette

    kimouette Member

    Joined:
    Feb 25, 2012
    Did I put a 911 in the title? I didn't know I did and I dont know how to take it off!
    I already spoke about the antibios in this thread (Histacetyl), and someone confirmed that they were ok. Faya did receive some Temgesic (sub lingual Bupre), but nomatter what's in it, it doesn't make any difference since we have seen Faya on and off Temgesic since the procedure.
    I will speak to Faya's owner about bringing him back to the vet to check if he is healing properly though! Thanks a lot for pointing that out.

    What scares me if that, even prior to the dental procedure, Faya was not responding well to his insulin anymore. The number were slightly lower (not that much though!), but still, nomatter what we did (or even if Faya's owner missed the injection), it's just as if nothing happened! Its ugly or uglier! Considering how sensible he was with 0.60u couple of months ago, it's very frightening to be increasing like this without seeing any results...

    We'll be patient (even though I consider we have already been patient for months!), and give this dental healing process some times, but after that, I might ask her to do something as radical s going back to Caninsulin ... even though I have always hated that insulin (roller coaster effet between PS and nadirs), but atleast it might make him react and give him couple of hours of normal values throughout his day!

    Kim
     
  28. Lincolns Mom

    Lincolns Mom Well-Known Member

    Joined:
    Oct 23, 2016
    Maybe if you get her to go back to the vet... have the vet check how she is injecting the insulin to make sure she didnt change how she is doing it?
     
Thread Status:
Not open for further replies.

Share This Page