8/3 Boomer AMPS 335 +3 248 +6 142 +9 151 PMPS 229 +3 169 +6 77 yahoo green!!!!

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Judy and Boomer

Judy and Boomer

Member Since 2014
Yesterday
Good morning!
t/f/s due in an hour.

So very annoyed right now. On July 24 I asked Dr Larry to contact the two surgeons and get time lines and estimates on Boomer's dental procedure. He confirmed he would. This past Tuesday I sent him a message asking whether he had heard from either surgeon. He responded by asking about Boomer's levels and dosage. In the middle of the night when I guess he realized he hadn't answered my question, he sent me a message "I didn't think you were interested in pursuing that at this time". Seriously?
 
AMPS 335 shooting 1.5u
Well he did hit blue on this dose but that was 5 cycles ago. Holding dose for today and tomorrow he will go to 1.75u.
 
More from Dr Larry "
I misunderstood. My recommendation is to confirm that we have insulin resistance before we look for a cause of insulin resistance. The way we do that is by trying to normalize blood glucose levels with insulin; we usually think insulin resistance only when we fail to achieve appropriate glucose levels at an insulin dose we'd expect to work. 1.25 units twice daily isn't a large enough dose to consider insulin resistance."
 
Judy and Boomer said:
More from Dr Larry "
I misunderstood. My recommendation is to confirm that we have insulin resistance before we look for a cause of insulin resistance. The way we do that is by trying to normalize blood glucose levels with insulin; we usually think insulin resistance only when we fail to achieve appropriate glucose levels at an insulin dose we'd expect to work. 1.25 units twice daily isn't a large enough dose to consider insulin resistance."
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:confused::blackeye:o_O???
 
I believe I know what caused the confusion between Dr Larry and myself. On July 24 he clarified what needed to be done in the next dental and indicated he would contact two surgeons here. The following day I contacted Dr Larry, Boomer's levels were even higher, and I suggested blood work and/or antibiotic. We got into a long conversation about what could possibly be causing these high levels and I did ask Larry whether he thought it was the dental problem. He indicated no, that he thought Boomer was just not getting enough insulin. I told him of my plan to increase by .25u every 6 cycles. And we left it at that; I assumed he was still getting the dental info for me and I guess he assumed I didn't need it. I did at one point send him a message that we had a breakthrough will Boomer's levels (when he finally had a blue cycle) but I didn't update him that the better levels had only lasted one cycle.
 
Judy and Boomer said:
I believe I know what caused the confusion between Dr Larry and myself. On July 24 he clarified what needed to be done in the next dental and indicated he would contact two surgeons here. The following day I contacted Dr Larry, Boomer's levels were even higher, and I suggested blood work and/or antibiotic. We got into a long conversation about what could possibly be causing these high levels and I did ask Larry whether he thought it was the dental problem. He indicated no, that he thought Boomer was just not getting enough insulin. I told him of my plan to increase by .25u every 6 cycles. And we left it at that; I assumed he was still getting the dental info for me and I guess he assumed I didn't need it. I did at one point send him a message that we had a breakthrough will Boomer's levels (when he finally had a blue cycle) but I didn't update him that the better levels had only lasted one cycle.
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Take away: you know more about Boomer's dosing, reactions to doses, etc. because you live it 24/7. Until you get more info on the dental issue, just keep increasing as needed. It's like people who have to dose around other meds.
 
Infection/inflammation, such as from a bad tooth, can cause some insulin resistance. :banghead: I would be more aggressive with the increases. The protocol says you can increase every 6-10 cycles if you are seeing blue. All he has seen is high blue so I wouldn't wait the full 10 cycles. You need to be more aggressive to fight glucose toxicity.
 
Wendy&Neko said:
Infection/inflammation, such as from a bad tooth, can cause some insulin resistance. :banghead: I would be more aggressive with the increases. The protocol says you can increase every 6-10 cycles if you are seeing blue. All he has seen is high blue so I wouldn't wait the full 10 cycles. You need to be more aggressive to fight glucose toxicity.
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Judy and I discussed this in a condo a couple days ago and I also felt she could raise every six cycles even if she saw a little blue because she's experienced, he's been in and out of remission, and I was worried about insulin resistance.

She was a little concerned that she might not be giving him quite enough time so she decided to let him go a little longer on a dose where he is seeing blue. I told her I wouldn't go more than a total of ten cycles on the dose if he sees blue...and that's ten total cycles...not ten from when she sees blue. I had explained to her previously that the longer he sits at high numbers, the higher the dose will have to go to get to a breakthrough dose.

Judy....I think that Dr. Larry is thinking about the insulin resistance that comes with IAA and/or acro. For those conditions, we generally don't test until the dose gets to six units. Perhaps it's time to explain it in a different manner and tell him that what you are concerned about is glucose toxicity:

Glucose toxicity refers to the oxidizing and hypertonic (dehydrating) properties of hyperglycemia, both of which continually stress and damage tissues in the body. But the term is also specifically used to refer to the phenomenon of temporary insulin resistance brought on by this tissue stress.
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I copied this from Julie's post on Glucose Toxicity. You might want to read through it again and share some of the info with him. You can see that insulin resistance can occur at a lower dose but I don't understand his comment about it occurring "at a dose we would normally expect to work". With Boomer, we would,normally expect 1.25u to work. However, it probably won't do to argue that point with him. I'd just try it from the Glucose Toxicity info.

I'd also press to get the surgeon scheduled if that is what you want to do. If the teeth are causing the resistance, which I totally agree with Wendy that it is a real possibility, then it's going to be a circuitous argument that won't get resolved if you don't insist (if that is the path you want to take) because the dose will likely have to keep going up and Dr. Larry might want the BG to normalize first. :banghead::banghead:

Can we know 100% it's the teeth causing the issue? No but it sounds like there is definitely some dental work that needs to be done that "might" help. It could be that he did just build up some temporary insulin resistance from being at high numbers a bit too long. In that event, he will reach a breakthrough dose at some time but, as Wendy said, you'll have to be more aggressive to get to it.

Let hope the increase to 1.75u will work.
 
Judy and Boomer said:
quoting Dr. Larry: 1.25 units twice daily isn't a large enough dose to consider insulin resistance."
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FWIW, the Royal Veterinary College study that found one in four diabetic cats has acromegaly (which is a form of insulin resistance), found some acros with doses as low as 1.0 units. I'm not suggesting Boomer has acromegaly, but rather than Dr. Larry's knowledge on insulin resistance might be not current on the latest. Most vets aren't.

In 2015, Neko was a mostly regulated cat. Starting in August, her numbers started going off the rails (pink and worse. :mad:). I had to be aggressive with dosing to keep on top of the resistance and try to prevent glucose toxicity. I found that as few as 5 days in higher numbers meant I had to go even higher to get back to good numbers. So yes, I know how scary and confusing it is to have to chase the numbers. But the TR protocol lets you be aggressive yet safe. :bighug: I always felt better when I found the green again.
 
Thanks @Wendy&Neko and @Marje and Gracie ! Yes I was being aggressive and increasing every 6 cycles but did decide to let it go a bit longer at this dose because I thought that possibly I was not giving Boomer enough time to clear the bounce before increasing the dose and setting off some NDW. 10 cycles was my limit and I plan to increase again tomorrow.
But just to clarify.....I have never used the term insulin resistance.....that term was used by Dr Larry from the beginning. I have always assumed that there is something, whether it is the teeth or an infection, causing Boomer to not respond to what was for him normal doses of insulin. I don't consider that as insulin resistance.
Since Dr Larry apparently believes that Boomer's high levels are only due to not enough insulin (earlier today he had the nerve to question whether I was giving it two times a day and he has previously said to me that it's important that Boomer consistently gets insulin) I'm not even sure he will contact the surgeons now. The dental surgeon that he had consulted with a couple of weeks ago (not one of the surgeons that we are hoping will do the dental) did indicate to Dr Larry that these issues could cause "insulin resistance" and Larry obviously doesn't believe her.
I will try to get Larry to look into the surgery but I really feel like I'm caught between a rock and a hard place now.
 
Alicia & Maggie said:
Yeah, can't you just contact the surgeon directly since she's already been consulted? I hope so, because even if the dental issues aren't affecting the BG they are causing Boomer discomfort.
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The surgeon that was consulted is actually a dental surgeon; she's in another city which would be a 2 hour highway drive with a cat that goes low with stress. So there are a couple of surgeons (not specific to dental) that he recommends that are within our city....he was going to contact both of them to ask for timelines and cost.
I don't think he's in any discomfort! And I know that cats can be very good at hiding pain....but I've watched him eat. He's not hesitating at all. He's not tilting his head to one side. He's not refusing to eat. He chows down. And he's not only eating pate, he loves fowl ball (which is shredded chicken) and his +9 each cycle has been shredded cooked chicken.
 
Wendy&Neko said:
Any chance you could get Dr. Larry to give you a referral to the dental surgeon, so that he stops being the go between?
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The dental surgeon that he first consulted is not the one that will be doing the surgery; she is in another city and the idea of having to drive 2 hours with a cat that goes low with stress didn't appeal to me. There are 2 surgeons (not dental specifically) here in London that Larry was going to contact.
 
@Marje and Gracie @Wendy&Neko when Boomer was on antibiotics before and after his dental, his numbers did come down (blood work/urine came back clean). Since I believe that Dr Larry is resisting contacting the surgeons because he doesn't believe it's a teeth issue, if we put Boomer on another round of antibiotics and his numbers came down, would that help persuade Dr Larry that this is indeed a dental issue?
 
Judy and Boomer said:
@Marje and Gracie @Wendy&Neko when Boomer was on antibiotics before and after his dental, his numbers did come down (blood work/urine came back clean). Since I believe that Dr Larry is resisting contacting the surgeons because he doesn't believe it's a teeth issue, if we put Boomer on another round of antibiotics and his numbers came down, would that help persuade Dr Larry that this is indeed a dental issue?
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I only saw a small drop in his numbers with antibiotics. I think this is a discussion you need to have with Dr, Larry as to whether he thinks a/bs will help and if there is infection.

To be truthful, and we've discussed this before but I post it for others, I'm not a fan of giving antibiotics unless we know there is infection. It does more harm than good in the long run. So it's up to the vet to help you chart the appropriate course in that respect.
 
More from Dr Larry who tells me that he will contact his colleagues about the dental surgery and he tells me "don't adjust the dose too frequently".
My response......that Boomer actually came down to 7.4 today so I'm waiting to see what he does tonight to decide whether to increase tomorrow morning. And I told him that there is something called glucose toxicity and it occurs when kitty is getting too low a dose for too long a time and it makes it even more difficult to get them to respond to insulin.
:smuggrin::smuggrin::smuggrin::rolleyes:
 
I am just catching up on everything since I haven't been on the board for a few days - how frustrating!!! :banghead::mad: I sure hope that Dr. Larry will talk to the two local surgeons asap and get more information for you.

And fingers crossed for some better numbers! Boomer, remember how much fun the lagoon used to be.
 
Ugh, Judy........ those root tips have to come out. It is not a healthy situation to have them sit trapped under healed tissue. They are like petri dishes growing bacteria. Please insist to him that is the path you want to take to remove any possibility of infection glucose toxicity or not. One thing plays on the other. Infection left untreated =higher numbers and left in those higher numbers = glucose toxicity.

Hugs and more hugs :bighug:
 
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