Meatball 2/27 Curve

Did most of a curve today, check out my SS, let me know what you're thinking! It looks like I need to up the dose? or maybe this insulin is not lasting long enough?

 

I hope others chime in here.

You're sure getting some wonky numbers there. Making me very suspicious that something else is going on here.

I'm maybe nominating a panicky liver situation perhaps but I don't know. 280 from 447 is only a 37% drop right? Not that big of a drop and it's hard to say what happened at +5.

I'm sorry, I probably asked this before, but which flavors of Friskies are you feeding? And Meatball is an indoor kitty right? You might add these to your profile.

If when they were added to J&B's was a while ago and if I remember I may call Purina on Monday to see if I can't wrest the current info on those flavors from them.

 

I'm not sure that I would raise the dose personally. It will be interesting to see what tonight's +9 shot does.

The choices I see are:

1) Try going back to a lower dose (2? 2.5? 3?) and work back up more gradually from there. I know I pushed to go fast and I would stand by that as far as dropping the dose any further than that or if there is any renewed sign of ketones. But on the other hand, since Meatball is a big mystery in terms of what dose is needed, there could be merit in reducing somewhat and holding at a dose for at least 2 or 3 days and getting a curve or partial curve in before making each increase. Not knowing much about how the mid-cycles looked on some of those intermediate doses, I think it's hard to say for sure whether you are now at too much or too little insulin. Sorry that my earlier advice probably contributed to putting you in that situation but really I am so happy to see the ketones being negative I would say the same thing again I think in the same situation. :mrgreen:

2) Raise the dose and shoot through the rebound. I think it's a little risky personally to do this, as it's unclear to me whether or not you are seeing some Somogyi action or not. Those drops on the nights of 2/24 and 2/25 look pretty steep to me - even though the % drop is ideal, the PSs were so high that it's really a lot in terms of #s, and by +4 means it happened pretty quickly, possibly all within a couple hours. Today's drop doesn't seem that steep, but his liver could be primed already if it has been seeing some drops it thinks are too steep, and overreacting (?).

If it were me, I would probably try easing off to 3.0 (sorry if I am getting repetitive, and honestly I don't know if that is the best solution, just what I think I would do if those were Bix's #s) and see if you get a smoother U-curve, with less dramatic PSs.

 

So... if it is a panicky liver, how do you regulate it? I was just reading about this, and it seems very possible that his numbers have been so high for so long that his liver is uncomfortable with a drop like that, though it never really gets all that low.

Meatball is and indoor cat, and he is actually eating Fancy Feast now. Friskies seemed not to sit well with either of my cats.

Can you explain this a bit further? I'm not sure what it means.

I did lower the dose today to 3.0u. Let's see what happens!

 

Pretty much what Joanna said "raise the dose and shoot though the rebound." Now, I've never had to deal with a panicky liver [thank goodness] but if I were going to approach it I would raise the dose in very small increments to see if I could eventually get a "break though" dose where the numbers would eventually get low enough that the live would give in. Terri sometimes also advocates a "bam" dose and you would have to get her guidance on such a thing. But basically the not so gentle way it's put it to shoot that darned liver into submission. But again, this is just one possibility of what is going on and I'm not say to to go out and shoot your kitty into submission. It's probably safe to do what you are doing first, which is to back track and see if you can get some results before taking the aggressive approach. Hopefully Joanna can add some clarification.

Good to hear he's an indoor only cat - that eliminates one possibility on the wonky. Can you add that and those FF flavors to your profile? Donna was asking about some Fancy Feast flavors and I or whomever called might make a group effort on getting the info from Purina. You can read a little about what it takes here and if you think you can handle it I'd be glad to help you along the way or if you think you are not able to do it [in your spare time of course ;-) ] then I might do it here.
http://felinediabetes.com/FDMB/viewtopi ... 760#p76760

 

As I understand it (non-expert!)..... rebound means their liver is throwing out stuff that gives them higher #s (glucagon & hormones? there's more in the Wiki stuff on that). So the two choices are to let that stuff clear itself out in it's own sweet time (if it's acute Somogyi rebound, my understanding is that it will sort itself out within 3 days, often faster than that), or you can raise the insulin dose to counteract the liver goop, and force the #s down, aka shooting through the rebound.

If the dose is actually too high that is like playing with fire IMO, but if it's liver training you don't get much choice. With liver training, I don't think the stuff the liver is throwing out will clear up in time, because every time you get good #s the liver tosses out more stuff. So with liver training you pretty much have to shoot higher doses to counteract their liver's action, until they can stay in good #s for long enough that their liver adjusts and stops acting up, and then chances are you'll have to start lowering the dose.

I don't know that my understanding of it is 100% right, but that's my take on it.

The toughest part for me is deciphering which kind of rebound you are seeing. The only solution I know of if you aren't clear on it is to lower the dose and see if you get better #s within 2 or 3 days. If lowering the dose just results in higher #s, then you know you will need to raise the dose. The other catch is how long to wait to make that determination - you want to wait long enough to be sure that it isn't Somogyi, but you don't want to keep your cat in high #s for days.

Looks like you are seeing quite a drop at +2 tonight, so I hope that is a good sign and will land you with an improved PS by morning. Paws crossed! Keep in mind though that it is a steep drop it looks like (almost 200 pts in under 2 hrs, right?), which could in itself trigger rebound. But hopefully not. Nice to see the action though - the high flat #s are the worst IMO!!! If you can get another spot test in this cycle (you don't need to sleep or anything, right? :lol: ) that would be good data, since at this point it's kind of up in the air whether the dose is too high or too low.

WIth that kind of drop by +2 I'm suspecting this dose may actually be too high, but there are other factors, and if there is rebound that is clearing some of the drop could be from that rather than from the insulin (?), so I'm not sure. Depending on what you see from here, I'd consider backing off the dose a little more perhaps...? I really didn't expect to see that much drop by +2, it's starting to make me wonder.

 

Hey Gator - if that eliminated one possibility, does that mean you have some sort of a mental list of other things that might make his numbers crazy? And if you do, can I know what's on that list? :mrgreen:

Also, are there any signs that a cat's gums or teeth are infected or irritated? All three of the vets he has seen since Christmas have check out his mouth, and none of them have given me any indication that I should worry about anything with regards to that, but maybe there's a specific test or something?

I just sent a detailed email to Purina via their website, was thinking maybe they would just email the info? Maybe the don't send things like that out in writing for liability reasons though. We'll see. Anyhow, I'll also call them this week to see what information they're willing to part with over the phone.

I like your solution, b/c i can use mon-friday to make a determination about if the lower dose seems to have any effect. I agrees that i really sped through 2u-3u, and may have missed the appropriate dose. If I get higher #'s or no change by the weekend, I can test a higher dose on Sat, when I can stay home all day.

Thank you both so much! I really don't know what I'd be doing right now have I not found this place when I did!

 

mental list of things to cover for wonky numbers

Well, it sounds like you know what is on the list Molly.

mental list for wonky numbers - not necessarily in order:
a) Indoor cat eliminates getting junk food [even dog food] from neighbors
b) Is kitty sneaking civies food? Dog food? Scraps? Trash?
c) Food - Wet only and it is REALLY low carb? Are any treats low carb too?
d) Infection/inflammation/pain - UTI, teeth, constipation, arthritis, other infection or pain -- I've even seen pancreatitis and thyroid alluded to [but H has P-titis and we've never been too wonky] or other???
e) Sources of potential stress [other cats taunting yours, litter box sharing stress, food sharing stress or other]?
f) Chronic rebound, panicky liver etc.?
g) If high doses needed, then testing for insulin resistance or acromegaly
h) Feeding schedule to a lesser extent. Free-feeding or closest approximate hopefully?
i) ???? probably forgetting something

If you weren't a hypochondriac about your kitty then that list is probably enough to make you one ;-)

Having your vet look at is good. Having board certified dentist $$ look at is probably best. The "dental" thing can get expensive and in order for it to be done completely [taking x-rays at least] it needs to be done with anesthesia. So nothing to take lightly. Maybe the last thing on the list to investigate [other than insulin change] but probably one of the more common issues. But your regular vet should be able to take a quick look and see if follow up is needed. The vets generally like H's teeth because I knock off the plaque on H's teeth once a year myself. H does have some teeth missing that have been "resorbed" though at this point - even with my attention to them. So just because one cleans them does not mean that the teeth cannot be an issue. But cleaning is just part of the full "dental" most people speak of. Do you ever get Meatball's teeth cleaned at least [not full dental?] - how old is Meatball? From my experience, if their teeth don't get cleaned after a couple years their gums DO get inflamed and this would put a question mark on the vets that looked and said nothing was up.

Good for you! I have high hopes but they can be incredibly frustrating. You read J&B's FAQ right? Very important to get the right info and get everything J&B specifies because it then allows one to double check and make sure everything adds up. I'm hoping they get you the right info straight off. And when/if they do then you will need to convert using the Spreadsheet J&B have linked on the FAQ. The first step is always to take the numbers they give you and compare against the "guaranteed analysis" on their website or on the can. If they are the same you got punked and you should ask for their staff nutritionist or veterinarian and tell them you want the DM or AF NOT GA!!! Grrr. The craziness I've been though over something so seemingly simple. If you need help along the way or want me to verify anything you can PM me for my email and you can send over to me. I'm glad you took the first step.

 

You're right, much of that list is no surprise.. But this ^ is the kind of stuff I was wondering about. Oddities/ailments that might effect the BG levels. For instance, his thyroid and urinalysis have been tested and both came back negative.

I'm thinking about this now b/c I'm supposed to talk with the vet tomorrow about the curve I did yesterday. I want to mention the 'panicky liver' to her, and I like being somewhat prepared for these conversations. I'm trying to be prepared for what she's going to want me to do next. Probably raise the dose, when my plan is to lower it. She's cool in that - so far - she's been willing to listen to why i'm doing what I'm doing. But she generally thinks he should be on a higher dose of insulin. I think she'll recommend that i take him to see the internal specialist. Has anyone taken their cat to a specialist? I'm nervous to do that, I don't think a specialist will be willing to listen and work with me. He'll just KNOW that he knows best.

He is just a year and a half, so his teeth are still looking pretty, though I've never had them cleaned.

 

Yes. I've taken H to see supposedly the "best" at a certain University that will go unnamed. I even took H to see a certain endocrinologist at that certain University. All I can say is that I was VERY disappointed in their approach to DM. Did I post to you about them telling me to test the urine ONLY???!!! Man! I don't mean to disparage all vets but my experience with them has been so disappointing and even tragic [for one of H's brothers - yet another University & specialists] especially at the highest level. Which makes me so very scared about the lower levels. The best vet we've found so far is a cat specialist [no dogs or other] for H's only living brother at this point in another state if that give you any help. On the other hand the other partner in that same cat only practice we've not been as impressed with, so go figure.

Good vets, special or not are so hard to come by.

I'd ask why they want you to see an internal specialist. For insulin dosing? Or for getting down to the bottom of potentially other issues? By far the best DM help I've found here - light years ahead of the vets. H's current local vet I use just because he is fairly easy to deal with, other than that I've found him to be frequently uninformed and maybe even dangerous... But if they are easy to deal with that is a lot right there. I just order what I want and they are happy to do it [other than grilling me and asking me if I was going to do the the buprenorphine I requested for H ohmygod_smile ]. And I have my favorite vet tech there and she is an angel and just gets anything I needed done on the spot.

Wow so young? There was just a poll here done and most cat are older that have DM. I don't want to scare you but Type I DM comes to mind - not saying that is what is going on but just come to mind.

If you have a very patient cat and a helper and a human descaling tool one can actually knock the "rocks" off the teeth that accumulate the most plaque [generally the ones in the back and on the outside]. Some cats require being immobilized/wrapped in a towel for the deal. It's best to approach this with a lot of patience, good lighting and even complete it in multiple days especially if you have never done it before. Some "cleaners" will even come to your home, and if you have seen it does once I bet you could do it yourself [with a helper] in the future.

 

Is there any way to know for sure if it is type 1 or type 2? and do you know if that has any implications regarding his treatment?

 

Your getting into territory that I'm not completely informed in. I believe the tests for insulin resistance and acromegaly. I'm not sure that is the complete list. Nancy & Cody are the ones to ask about that or even the entire High Dose forum. And I have my specific instructions for sending samples off to University labs that you absolutely should ask me for if that is something you do. This is something you should ask your vet about though definitely. I cannot tell you about the implications except that acrocats generally need more insulin. So you would have a good excuse for giving more insulin in essence. Also if Type I then remission I don't believe is something to look to. But all this is territory I don't know much about. I'm just rattling off the top of my head. Hopefully giving you more things to ask about tomorrow than answers at this point.

If you guys do go the specialist route which I generally encourage [not just in your case], just don't let them bully you around and remember you are the one paying the bills.

Here's the Internal Medicine specialists website:
http://www.acvim.org

Yea, and the young age makes me think less about the dental being an issue.

 

Hmmm, those other mid-cycle #s last night are NOT what I wanted to see, darn it!!! Not sure what to make of it.

If you mention panicky liver to your vet, be prepared to get a weird look!!!! My experience is they don't think about things the same way we do - we tend to finesse it a lot more, whereas I think they see high #s and think "more insulin". My personal opinion is that your vet previously pushed the dose WAY too high without investigating whether that is warranted. Those doses were shocking, and if I were a vet, I would want to do some accompanying blood tests - Acro, insulin resistance - to confirm that there was a reason for the doses.

I would take the curve from the days that looks Somogyi-like to me if you want to show your vet #s (1/30 & 2/27 are the two I see that look possible, as well as any steep drop in a short timeframe), and ask them specifically to explain to you why they think that is NOT Somogyi rebound. Because if it is, they should be recommending a lowered dose at that point. Given the results you saw previously on astronomical doses, I can't see how they can just keep telling you to up the dose. If you were seeing improvement and getting closer, yeah, but when the PSs are in the 5 & 600s, to me that's either 1) rebound, 2) undiagnosed acro (or other mystery cause), or 3) you need to try a different insulin. So you have been testing for rebound and at least some of the time getting a decent response from the insulin, just not better #s overall . So that seems to me like rebound is pretty likely from before, but so far you haven't hit on the right dose (personally I'm feeling confused at the moment as to what last night's #s mean).

I'd also try starting a new thread here with a catchy title "Meatball 3/1 - HELP!" or whatever. Often I think on the longer threads you won't get new eyes, and new questions tend to get buried (you may have already started one, sorry, I'm a bit behind in checking posts!!!). There are some people around with more expertise than I at least have who have not chimed in lately (no offense to anyone posting/reading along!), and I for one would really like to see their take on Meatball's #s!

 

p.s. My experience is that vets recommend a specialist when they realize they don't have the answers. I have found specialists for the most part pretty awesome to work with - they know a lot, and I only worked with one who was bossy. The others have been very understanding, very open to alternatives, etc. And often they seem to enjoy discussing the stuff more than regular vets (maybe I've caught them on days with a light schedule?), so you can learn a lot if you keep asking questions. The $$$ are insane though, so I don't go to the specialist unless it's something I feel is needed.

All that said, the only one I have discussed diabetes with had 100% the same generic approach as a regular vet (I was seeing her for something else, but brought it up to get her take on it). I would think a vet who specializes in diabetes (e.g.. someone the board here might recommend) would be a better bet than an internal medicine specialist. I would guess your vet thinks there is "something else going on" with Meatball and that is why you don't get better #s. I'm not convinced, but I wouldn't rule it out either.

 

My cat Ziggy just got diagnosed 2 weeks ago. He went in initially to have a cyst looked on his leg. He was not eating and losing weight so I feared it was cancer. The Vet said he had a lesion on one of his smaller front teeth and needed it to be extracted when he gets his dental and cyst removed. She said the good news is that i don't have to do it right now. Bad news is he is diabetic. So now I am learning to give prozinc 2x a day 4units. Is the bad tooth (which I can hardly see) part of the diabetes symtoms?

 

Hi Ziggy's Mom,

Your post may get lost down at the end of Molly's. We start a new topic when we have new information. I started a new topic for you - It's called "Ziggy's Mom - Here's your new post" Just click on it and add to the thread.