? mr b's rollercoaster

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Sue and Oliver (GA) said:
Hope the dose increase gives you some more movement like your lovely pmps. A curve someday soon might be helpful.
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Things are not going great. Although prior dosing at lower amounts wasnt ideal, these higher doses arent producing results as good as what we got on lower doses. Our ss reflects this.

I'm extremely confused AGAIN.
 
I saw Larry and Kitties suggestion to go back to 4 u to see what happens. It certainly won't hurt to try. Basically there are two possibilities, regardless of type of insulin: 1. his dose is too low for what's going on physiologically at this point in time or 2. his dose is too high and he's bounced up to higher numbers and has gotten stuck there (insulin resistance). Test option 1 by lowering the dose for several cycles to see what happens. Later, if necessary, test option 2 by continuing to raise the dose until you break through the resistance. Very frustrating situation ...
 
I'm glad you're trying the dose lowering experiment. It can't hurt because his numbers have been high.
 
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Misterbeesmom said:
Thanks kris

I will continue to try to find what is best for mr b but tonight i really have lost hope of ever getting him regulated.
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I know how you feel. I gave up hope of getting Teasel regulated quite a while ago. It would be great if it happened but I'm not holding my breath. My goal right now is to keep him in as decent a range of BG as I can.
 
I like the result of last night 5 u dose, Jen! If he's like Teasel, dropping the dose as you did and then going back up has "jumpstarted" his response. I view it as them getting complacent at a dose rather than full on resistant and they need a tweak to budge them out of it. Mr. B.'s SS suggests to me that he's like that. Also - he's at 5 u now so you can probably go for 0.5 u increases because that's only 10% but you'd want to monitor. He might be at a stage where he needs a little stronger push, always with safety in mind of course.

BTW - I went back to look at your Lantus SS. You were getting up into 5 u dose territory then too so that tells me that this is the range you'll have to be in with ProZinc as well. A unit of insulin is a unit of insulin, no matter the type. It's the Lantus depot that can help kitty - or not. That can depend on a lot of things like owner's need for flexibility or tendency for kitty to get stuck at a dose. My theory is that the depot/duration of Lantus worked against us for Teasel because he so easily becomes dose complacent/resistant. I need an insulin that can be steered like a car rather than a heavy truck. I might have been able to make Lantus work for him but that's history ...
 
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Kris & Teasel said:
I like the result of last night 5 u dose, Jen! If he's like Teasel, dropping the dose as you did and then going back up has "jumpstarted" his response. I view it as them getting complacent at a dose rather than full on resistant and they need a tweak to budge them out of it. Mr. B.'s SS suggests to me that he's like that. Also - he's at 5 u now so you can probably go for 0.5 u increases because that's only 10% but you'd want to monitor. He might be at a stage where he needs a little stronger push, always with safety in mind of course.

BTW - I went back to look at your Lantus SS. You were getting up into 5 u dose territory then too so that tells me that this is the range you'll have to be in with ProZinc as well. A unit of insulin is a unit of insulin, no matter the type. It's the Lantus depot that can help kitty - or not. That can depend on a lot of things like owner's need for flexibility or tendency for kitty to get stuck at a dose. My theory is that the depot/duration of Lantus worked against us for Teasel because he so easily becomes dose complacent/resistant. I need an insulin that can be steered like a car rather than a heavy truck. I might have been able to make Lantus work for him but that's history ...
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thanks kris.

yeah he really didnt like lantus. i think the depot action just confused him, and overall he didnt feel well on it.
 
Sue and Oliver (GA) said:
I agree - I think I'd give small increases every 6 cycles and see if you get a breakthrough. That blue was nice.
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Thanks
Got a red this am. I dont understand how.
I am in a permanent state of confusion and anxiety over his numbers and dosing. It seems no matter what i do i cannot keep him out of the pinks, and now with this red-? My brain is burnt.
 
Misterbeesmom said:
Thanks
Got a red this am. I dont understand how.
I am in a permanent state of confusion and anxiety over his numbers and dosing. It seems no matter what i do i cannot keep him out of the pinks, and now with this red-? My brain is burnt.
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That red number is only a couple of points off from being within the allowed 20% meter variance, Jen. It's merely part of the same trend of pinks you've had after that blue. I suggest going to 5.2 u or even 5.5 u if you can monitor him today. Look at the significant effect going from 3.8 u to 5 u had the other day. My opinion is that he needs to be carefully pushed.

You'll feel calmer if you look only at trends on your SS and not individual numbers - unless it's a nice surprise of course! :cat:
 
Kris & Teasel said:
That red number is only a couple of points off from being within the allowed 20% meter variance, Jen. It's merely part of the same trend of pinks you've had after that blue. I suggest going to 5.2 u or even 5.5 u if you can monitor him today. Look at the significant effect going from 3.8 u to 5 u had the other day. My opinion is that he needs to be carefully pushed.

You'll feel calmer if you look only at trends on your SS and not individual numbers - unless it's a nice surprise of course! :cat:
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Thanks. I have looked at ss overall and still get confused. He had reds and pinks when dose was much lower too, so for me i just dont see the trend. He had blues on lower dose as well as the recent overnight curve i did on the much higher dose. Its all greek to me, basically! Which makes it hard. I cant monitor today.
 
Misterbeesmom said:
Thanks. I have looked at ss overall and still get confused. He had reds and pinks when dose was much lower too, so for me i just dont see the trend. He had blues on lower dose as well as the recent overnight curve i did on the much higher dose. Its all greek to me, basically! Which makes it hard. I cant monitor today.
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If you can't monitor, give him 5 u again to be safer.

Yes, Jen, it is hard with a tricky cat like Mr. B. or Teasel. Reading a SS like theirs takes practice, judgment, willingness to focus on groupings of colours and - maybe most important of all - acceptance that you're on shifting sand and it's a fluid, not static, situation. Teasel has had nice numbers on lower doses as well but we're now on our way up to where I began in August. I attribute this to fluctuations in insulin sensitivity over time. He's gone through periods of being stuck in pink and red with some yellow (first half of September) and then periods of some nice blues and a few greens, usually after a dose increase or in reaction to a fairly low number. These fluctuations in sensitivity are what I watch for in testing but I can't really explain most of them. Complex physiology at work ...

I've come to see these things on his chaotic SS and even understand them a little. I form my own theories about what's going on and as numbers accumulate I see evidence that I'm on the right track. I've learned that:
  1. I can't let him sit too long at an ineffective dose or he'll get stuck and it'll be tricky to shift him;
  2. I can only increase his dose in small amounts;
  3. usually a dose increase will show more in the next cycle rather than the one begun with the increase;
  4. his "good" dose is a moving target.
Mr. B.'s requirements will be different but the basic approach is the same. Set aside all expectations as best you can and be willing to experiment with doses (safely!) over time. At this point in time he's telling you he's stuck and needs a dose boost.

Like many situations in life we cope better while treating FD if we can learn to live with ambiguity.
 
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I gave him a little boost this afternoon and at the same time it was an early dose, at +8. I dont mean to sound cavalier, but i figured what the hell. I,m soooooooooooooo sick of these high numbers and him feeling like crap. And now its +6 and he's still the same. Drinking and peeing tons.

Recording on the ss is going to be confusing for a bit.
 
Thanks for your good advice, kris and taking the time to share what you've experienced with teasel. I'm so tired i've just lost nearly all my manners. I'm having a hard time coping, even with good advice. He has gone downhill over this past year and my brain is fried.
 
Misterbeesmom said:
Thanks for your good advice, kris and taking the time to share what you've experienced with teasel. I'm so tired i've just lost nearly all my manners. I'm having a hard time coping, even with good advice. He has gone downhill over this past year and my brain is fried.
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No problem, Jen. If my "calm voice from a distance" can help that's all that matters.

I LOVE that beautiful yellow 230 this AM! Two doses closer together created what was in effect a higher dose and look what happened! This tells me that he WILL respond to insulin but the dose needs to be high enough. Some people would suggest that every 8 hours dosing might be what he needs to get him moving but that's really hard to fit into a schedule if you work away from home etc.

There's a clue here though:
In the 24 hours between yesterday AM and today AM he had 5.0 u + 5.2 u + 4.8 u = 15 u of insulin. That would be 7.5 u per dose if it was given BID. I certainly wouldn't suggest jumping up to that dose but I think this tells you that he might need 6+ u to get him going. He has a fair bit of resistance built up.

The other thing I was going to ask is how old is your bottle of ProZinc? Sometimes we can overlook a simple thing like that. :)
 
Nice numbers yesterday - 2 yellows and 2 blues! Don't fret about this AM's red. It's a bounce. I see you've gone up to 5.5 u which is a good choice I think. Can you monitor today?
 
Kris & Teasel said:
Nice numbers yesterday - 2 yellows and 2 blues! Don't fret about this AM's red. It's a bounce. I see you've gone up to 5.5 u which is a good choice I think. Can you monitor today?
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Thanks kris for hanging in there with us.
Just updated his ss, monitored today, and dosed early again.
 
Kris & Teasel said:
No problem, Jen. If my "calm voice from a distance" can help that's all that matters.

I LOVE that beautiful yellow 230 this AM! Two doses closer together created what was in effect a higher dose and look what happened! This tells me that he WILL respond to insulin but the dose needs to be high enough. Some people would suggest that every 8 hours dosing might be what he needs to get him moving but that's really hard to fit into a schedule if you work away from home etc.

There's a clue here though:
In the 24 hours between yesterday AM and today AM he had 5.0 u + 5.2 u + 4.8 u = 15 u of insulin. That would be 7.5 u per dose if it was given BID. I certainly wouldn't suggest jumping up to that dose but I think this tells you that he might need 6+ u to get him going. He has a fair bit of resistance built up.

The other thing I was going to ask is how old is your bottle of ProZinc? Sometimes we can overlook a simple thing like that. :)
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The pzi is very fresh. Its bcp bovine so i have to buy new bottle every 4 wks. perhaps it lasts longer but the mfctr says 4 wks after puncture. Pooey. Well if we keep going up in dosing we might actually get through a whole vial by then!
 
Bounce numbers. Are you planning to try every 8 hours dosing for a bit? Might be worth a try if you can monitor frequently. I've read on here of others who've gone that route for a while to get the cat responding better and then they were able to resume BID dosing. I don't know enough about bovine PZI to know whether it's identical to ProZinc in its effect.
 
Kris & Teasel said:
Bounce numbers. Are you planning to try every 8 hours dosing for a bit? Might be worth a try if you can monitor frequently. I've read on here of others who've gone that route for a while to get the cat responding better and then they were able to resume BID dosing. I don't know enough about bovine PZI to know whether it's identical to ProZinc in its effect.
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I'll do the 8hr dose when i can yes. I dont know how long I can pull that off but I'm trying. As long as i can monitor.

Yeah I figured he'd bounce today. Silly pooper loves pinks!
 
Hard to know what's happening. He'll have had three 5.5 u doses in 24 hours. That's a lot of insulin but he's stuck in pink. Could well be too much insulin looking like too little. If I was in that situation, I'd try to simplify it by going back to two doses a day of, say, 6 u AM and 6 u PM (or even the 5.5 u you've been giving) and I'd do a full (at least) every-two-hour-testing curve. That might reveal something that's being missed right now.

A lot of things gave been changed in the last few days:
  • 5 u BID on 11/22
  • TID dosing on 11/23
  • two doses 10 hours apart on 11/24
  • 5.5 u TID today.
I'd reduce some of this complexity for a few cycles but give a high enough dose and do a full on curve, even every 1 hour testing if you're ambitious. That's the only way to fill in the picture - onset, nadir, duration, Somogyi, etc.
 
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I don't have any advice, but I sure do sympathize. Our bouncy kitties are such a challenge, we just have to keep our patience pants on and keep plugging away!

:bighug:
 
Kris & Teasel said:
Hard to know what's happening. He'll have had three 5.5 u doses in 24 hours. That's a lot of insulin but he's stuck in pink. Could well be too much insulin looking like too little. If I was in that situation, I'd try to simplify it by going back to two doses a day of, say, 6 u AM and 6 u PM (or even the 5.5 u you've been giving) and I'd do a full (at least) every-two-hour-testing curve. That might reveal something that's being missed right now.

A lot of things gave been changed in the last few days:
  • 5 u BID on 11/22
  • TID dosing on 11/23
  • two doses 10 hours apart on 11/24
  • 5.5 u TID today.
I'd reduce some of this complexity for a few cycles but give a high enough dose and do a full on curve, even every 1 hour testing if you're ambitious. That's the only way to fill in the picture - onset, nadir, duration, Somogyi, etc.
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He drank a ton of water overnight and peed an ocean. He's in the red And i am going insane once again. I dosed him at +9 and then saw your reply.

I'll do a curve today.

All of this really makes no sense to me in terms of dosing quantity. It seems no matter what i dose, its either too little or possibly too much ?(not sure aabout the latter.) and how much he might need and how he might respond depends on his mood, physiology, and the angle of the moon and what house venus is in. Its insane. I might as well give him no insulin at all at this rate and save us the aggravation. We had gone 24 hrs without insulin when we switched brands and guess where he was after 24 hrs wihtout - yup in the pinks.

I could call my vet but fat lot of good any of them have been. Diabetes and my unpredicatble boy are beyond them.
 
Misterbeesmom said:
He drank a ton of water overnight and peed an ocean. He's in the red And i am going insane once again. I dosed him at +9 and then saw your reply.

I'll do a curve today.

All of this really makes no sense to me in terms of dosing quantity. It seems no matter what i dose, its either too little or possibly too much ?(not sure aabout the latter.) and how much he might need and how he might respond depends on his mood, physiology, and the angle of the moon and what house venus is in. Its insane. I might as well give him no insulin at all at this rate and save us the aggravation. We had gone 24 hrs without insulin when we switched brands and guess where he was after 24 hrs wihtout - yup in the pinks.

I could call my vet but fat lot of good any of them have been. Diabetes and my unpredicatble boy are beyond them.
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I'm sorry you're having such a hard time with this, Jen. Has Mr. B. been tested for anti insulin antibodies or other conditions that raise his insulin requirement like acromegaly, etc. There's a forum on here for that and maybe those people would have better advice. From what I've read, they don't necessarily treat some of those conditions but just dose around them.

Meanwhile, it won't hurt to try BID dosing and a curve. Sometimes back to basics can help. Some kitties have been knocked back in dose and restarted. And then there's the other depot insulin, Levemir. You might get input from people on that forum who've used both Lantus and Levemir to see what their thoughts are.

I understand what you mean about having a cat that's beyond the vet's ability to comprehend. My vet is great but Teasel was beyond her ability to handle. I think she was relieved when I decided to come here to FDMB and figure it out for myself. She's still there in the background if I need her but at this point I could probably teach all the vets at that clinic more about diabetes than they could possibly know.
 
Just putting this out there, Jen: I see that BCP PZI is a compounded insulin and I've read here that occasionally people have wondered about batch to batch differences in effectiveness. Seeing as you're at your wits' end to know what to do, would you consider putting out the cash for a vial of ProZinc to try for as long as it lasts (I get 2+ months out of a vial) to see if it's any better? You've just written that you feel as though you might as well be not giving any insulin to Mr. B. right now. Yes, ProZinc is more expensive but probably cheaper than more diagnostic testing by your vet. Worthwhile experiment I think.
 
I like the idea of the curve. Sometimes changing things around (doses and times etc.) can make things muddier, not clearer.

As Kris says, you might look at the High dose forum and read the stickies, just to see if any of the symptoms sound familiar. But the forum itself is not at all active - most people with high dose kitties use Levemir (because it is reported to stick less at high doses) and post on the L insulin forums.

I am guessing he is just going to take longer, with a slow increase to higher doses to break through his resistance. He has been on several insulins and for a long time and I think resistance is a real possibility. There is a thread on insulin resistance on this forum somewhere - use the search function for ProZinc forum and insulin resistance.
 
I've just had a look at your curve data, Jen, and if it was for some anonymous kitty I knew nothing about I'd say that kitty is responding but not enough because the dose needs to go up. He fluctuates up and down between yellow - I like those! - and pink and it's easy to see why your less frequent testing previously lead you to think he was stuck in pink. This curve exercise is a good one to carry out.
 
Still following your SS. What can look like short duration of insulin can be too low a dose just as overly long duration can be caused by too high a dose. I see others on the main health forum have made some good suggestions along the lines of what I mentioned earlier.
 
Speechless. I'm just speechless. What dropped mr b into high yellows yesterday isnt even budging him today. Drinking and peeing tons, even making griping sounds a bit. I'm just about done with this ride. I dont know what to say. Low doses dont work, high doses dont work. Do i need to to even higher?? Do i need to go lower? Restart the whole process?? I'm so sick of this. Why cant i break through this?? I'm dosing 3x a day recently. If it was too much insulin, his numbers would be hypo by now. If i dropped his dose by half i would probably be getting the same results. I am just smh.

I can bring him to my vet, for the bazillionth time, for help, but though they are great with other ailments, they havent been able to figure out deciphering mr b's diabetic issues.
 
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Hi Jen,
  • You need a plan going forward because you've tried using dose changes and you're not getting anywhere. No point continuing with the TID dosing. I copied the info below from the Vetsulin website but it applies to all insulins. Teasel's curves on Lantus looked like this for well over a month. I kept saying to his vet that it was chronic rebound that had led to resistance. Leaving him at an (ineffective) dose for a week as per Lantus protocol only made it worse. She suggested a 48 hour halt to insulin with a plan to restart. He went into DKA in less than 24 hours. She was surprised by it happening so quickly. Restarting is a known technique but it has to be done cautiously while testing for ketones repeatedly. This method was mentioned the other day on the main forum in response to your post there. It's something you might want to try - or have your vet try in hospital.
  • If I was in your shoes, I'd really consider trying ProZinc. I've read that the compounded bovine PZI is closer in structure to feline insulin but what if your most recent vial is from a less effective batch (for whatever reason)? You started PZI on 09/26 and you said you change vial every 4 weeks. Where are you now - finishing your second, just starting your third? If you try this you're out the cost of one vial of ProZinc if it doesn't help. Much cheaper than rounds of vet testing if it does help.
  • Where on Mr. B.'s body are you injecting? The scruff is handy but absorption might not be optimal there.
  • Failing all the above, you could have Mr. B. tested for anti insulin antibodies or acromegaly. Sometimes vets will say that they never see issues like that and it's when an owner insists that the problem is revealed.
Mr. B. needs you to be calm and willing to explore other options. If you keep doing the same thing over and over and it doesn't get results, something has to change. Food for thought ...
_______________________________________________________________________________________

From the Vetsulin website - section for vets: http://www.vetsulin.com/vet/Cats_Monitoring_Insulin.aspx

Blood glucose curve
Blood glucose measured in mg/dL
Click on thumbnail for full image:



Solution
  • Investigate cause, eg, Cushing’s disease, hyperprogesteronism, owner issues, injection issues, or use of the wrong type of syringe
  • Consider Somogyi overswing, which can present as persistent hyperglycemia for a few days following the hypoglycemic event
 
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More reading for when you feel like it:

http://veterinarymedicine.dvm360.com/discovering-reasons-underlying-difficult-control-diabetes-cats
Note paragraphs on “Insulin-related Problems” and “Insulin Options”

http://veterinarymedicine.dvm360.com/discovering-reasons-underlying-difficult-control-diabetes-cats
Go down half way to section on insulin resistance.

http://www.vetfolio.com/internal-me...ce-in-diabetic-patients-causes-and-management
Note doses that mark insulin resistance in “Abstract” and relation of hyperthyroidism to insulin resistance. Mr. B. is hyperthyroid, isn’t he?
Check out algorithm under “Management”.

http://www.vcaspecialtyvets.com/ckfinder/userfiles/files/Linda Jantzen/Insulin Resistance WVC.pdf
Quite technical, covers dogs and cats.

http://todaysveterinarypractice.navc.com/consider-case-uncontrolled-diabetic-cat/
Focuses on acromegaly.
 
Hey Jen, I know this is tough. Kris has given some great suggestions. Have you taken a look at the high dose conditions? Any of the symptoms sound like Mr. B?
 
Kris & Teasel said:
One last reference that's relevant:

http://endocrinevet.blogspot.com/2011/09/q-diabetic-cat-on-compounded-insulin.html
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I appreciate all the info links you sent me. Thnx..i read them all.

I dont want to throw in the towel just yet on bcp pzi. Lantus is human recombinant and although on paper we had better control, he was a very unhappy cat. Granted, pzi is not lantus, but its human recombinant as well, so we might have that same problem. If bcp doesnt work out for us, i will consider trying pzi.

I dropped his dose way down, not knowing what the heck to do and the higher dose seemingly getting him panicking into the reds, though by no means do i feel confident with this. This morning i screwed up his shot.

He was very gripey yesterday and overnight. Wish i knew what that was about. Was going to call vet for appt but he has quieted down. Maybe the reds was liver panic and that made his liver hurt? Who knows? Gosh i wish he could tell me.

He's got the hyperactive thyroid and pancreatitis (mild, no symptoms like pain, nausea, etc.), so maybe its simply those reasons why we'll never get good control. I'm not going to put him through the tests and pay more money to see if he's acro, iaaa, etc, when the treatment will be the same either way. Understand over the past year we have seen specialists, several vets, and had tons of tests done. I've spent thousands. So unless there's a damn good reason to bring him to the vet, we're not going. He doesnt appear to fit the profile of any of the conditions mentioned with insulin resistance.

Sorry i'm rambling. I slept 3 hours last night.
 
Kris & Teasel said:
Hi Jen,
  • You need a plan going forward because you've tried using dose changes and you're not getting anywhere. No point continuing with the TID dosing. I copied the info below from the Vetsulin website but it applies to all insulins. Teasel's curves on Lantus looked like this for well over a month. I kept saying to his vet that it was chronic rebound that had led to resistance. Leaving him at an (ineffective) dose for a week as per Lantus protocol only made it worse. She suggested a 48 hour halt to insulin with a plan to restart. He went into DKA in less than 24 hours. She was surprised by it happening so quickly. Restarting is a known technique but it has to be done cautiously while testing for ketones repeatedly. This method was mentioned the other day on the main forum in response to your post there. It's something you might want to try - or have your vet try in hospital.
  • If I was in your shoes, I'd really consider trying ProZinc. I've read that the compounded bovine PZI is closer in structure to feline insulin but what if your most recent vial is from a less effective batch (for whatever reason)? You started PZI on 09/26 and you said you change vial every 4 weeks. Where are you now - finishing your second, just starting your third? If you try this you're out the cost of one vial of ProZinc if it doesn't help. Much cheaper than rounds of vet testing if it does help.
  • Where on Mr. B.'s body are you injecting? The scruff is handy but absorption might not be optimal there.
  • Failing all the above, you could have Mr. B. tested for anti insulin antibodies or acromegaly. Sometimes vets will say that they never see issues like that and it's when an owner insists that the problem is revealed.
Mr. B. needs you to be calm and willing to explore other options. If you keep doing the same thing over and over and it doesn't get results, something has to change. Food for thought ...
_______________________________________________________________________________________

From the Vetsulin website - section for vets: http://www.vetsulin.com/vet/Cats_Monitoring_Insulin.aspx

Blood glucose curve
Blood glucose measured in mg/dL
Click on thumbnail for full image:



Solution
  • Investigate cause, eg, Cushing’s disease, hyperprogesteronism, owner issues, injection issues, or use of the wrong type of syringe
  • Consider Somogyi overswing, which can present as persistent hyperglycemia for a few days following the hypoglycemic event
Click to expand...

Wer'e dosing in the scruff. For months we were dosing around shoulders for better absorption (the rear is a no-go. He is very sensitive/sore in that area). I have seen no pattern that the shoulders were any better than the scruff.

The new bottle of bcp is our 3rd one and we had some yellows and blues on this bottle. We're about halfway through it. Just for the heck of it i wrote to bcp for their take on batch accuracy. Hearing that batches can vary is one thing, but is it really true is my concern. Mr b's bg numbers have been all over the place on lantus and bcp, so i'm not so sure the insulin bad batch theory can be used.

That insulin resistance graph is interesting. Some days mr b has looked like that, when other days he has a decent response. That goes for lower doses and higher ones.

I guess i got too aggressive with the dosing which has gotten him cranky and sore and into the reds. I can only guess. If this was any other condition, we'd be at the vet now getting answers, but his bg not making sense is not a new thing and they're not going to be able to help.
 
Rachel said:
Hey Jen, I know this is tough. Kris has given some great suggestions. Have you taken a look at the high dose conditions? Any of the symptoms sound like Mr. B?
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Thanks rachel. Kris is great finding all that info..i dont think it sounds like mr b, and if i put him through the tests, it wouldnt change treatment. Its good to have that info though, to be aware.
 
....and to add to confusion, he just had small stool with diarrhea. This is not typical for him. I had been giving him miralax recently and i think i threw him off. Maybe that is related to his gripeyness last night. I cant imagine it would increase his bg. Is that possible?

I have stopped the miralax!
 
I can hear your pain and sorrow, all the way over the miles and Internet, Jen. You are doing the most possible - you have changed insulins, you have raised carefully, you have tried different approaches.

I do think the experimenting with different times and doses could have muddied things up. I think dosing early can help when done in a systematic way - dividing the dose you are giving into 3 doses, every eight hours, as long as the numbers are rising. But I do think it is helpful to do it systematically. Just like some cats react negatively to sliding scale or tiny increases in doses or bouncing when the dose is raised, switching around the shot time can cause more frustration.

If he were mine, I would either raise the dose by 0.25 every six cycles, starting with 5.5 where you go some decent numbers. (IMHO, raising by 0.5 is too much with the occasional yellows/blues he throws) or try the TID - every eight hours if rising, maybe 1.5 units every eight hours to start.

One interesting thing on the spreadsheet: changes made really fast may made have made things wonky: 11/24 dosed 4.8 at +8 230. Then he went down to 143, setting up a bounce. 5.2 at +10. Next cycle to 5.5. That's a lot of changes in a short time.
 
Sue and Oliver (GA) said:
I can hear your pain and sorrow, all the way over the miles and Internet, Jen. You are doing the most possible - you have changed insulins, you have raised carefully, you have tried different approaches.

I do think the experimenting with different times and doses could have muddied things up. I think dosing early can help when done in a systematic way - dividing the dose you are giving into 3 doses, every eight hours, as long as the numbers are rising. But I do think it is helpful to do it systematically. Just like some cats react negatively to sliding scale or tiny increases in doses or bouncing when the dose is raised, switching around the shot time can cause more frustration.

If he were mine, I would either raise the dose by 0.25 every six cycles, starting with 5.5 where you go some decent numbers. (IMHO, raising by 0.5 is too much with the occasional yellows/blues he throws) or try the TID - every eight hours if rising, maybe 1.5 units every eight hours to start.

One interesting thing on the spreadsheet: changes made really fast may made have made things wonky: 11/24 dosed 4.8 at +8 230. Then he went down to 143, setting up a bounce. 5.2 at +10. Next cycle to 5.5. That's a lot of changes in a short time.
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Thanks sue. Just had myself a good cry. I would rather have lost mr b to something sudden, than to see him decline all these months, despite my best efforts to help him. He's such a good boy and deserves better. Its very hard.

I think you're right. In reflection i believe too i became a bit too aggressive. But hindsight is 20/20. At the time i thought a strong push was what he needed to get unstick. I was wrong.

My plans are similar to what you stated. If i go with frequent dosing, it,ll be 2u or lower. Slower increases, etc. I'm actuallh thinking of giving him 2u for a bit, sort of starting over, even if dose at 12/12.



Anyhoo i want to share what the folks at BCP PZI told me today. I emailed them about my concern regarding batch variance. They explained while yes there could be slight variances, they have strong quality control, and its always the same pharmacist makes the insulin. I told them about our recent run of 400's, and although i emphasized that mr b has been unregulated for a long time and this run of reds could be my fault, they are sending me a free vial to see if there might be a factor with our current vial. Again, i dont think i have a 'bad' vial, and even if i did, and i tapped this new one after i get it tomorrow, he's so all over the place anyways I dont know if we could even establish that yes it was a weaker solution or whatever. Anywaaaaaays what i'm getting as that was a nice thing of them to do, and they got back to me right away about my question.

Also, in case this comes up, it has been suggested that their u100 formula has better performance in terms of longevity, later nadir, etc. i've seen this claim on some diabetes websites. For the record, they said they have seen no evidence of that. Both formulas work equally well, they said, and a unit is a unit.
 
A good cry can purge a lot of mental toxins, Jen. I feel bad that you're having such a hard time trying to help your beloved Mr. B. Good idea to contact the people who make BCP PZI and that was very nice of them to send you a new vial. I agree that it could be hard to determine whether it's an insulin issue with Mr. B.'s unpredictability. Sue gave you some good ideas to try. If you do a type of 'start over' it's a good idea to do more urine ketone testing just in case.

We're still here if you need to vent or want input. :)
 
Kris & Teasel said:
A good cry can purge a lot of mental toxins, Jen. I feel bad that you're having such a hard time trying to help your beloved Mr. B. Good idea to contact the people who make BCP PZI and that was very nice of them to send you a new vial. I agree that it could be hard to determine whether it's an insulin issue with Mr. B.'s unpredictability. Sue gave you some good ideas to try. If you do a type of 'start over' it's a good idea to do more urine ketone testing just in case.

We're still here if you need to vent or want input. :)
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You've all been a big help. I appreciate it.
I ordered more urine sticks yesterday! I got ones that show even more stuff than glucose and ketones.
 
Well its 2am and i'm starting to think something else is in play.

Its been +7 and he is 449. Awful. I had dropped to a very low 2u with plans to restart slowly. But i just gave him 4u now. Praying i'm not making it worse somehow by going off schedule but this is intolerable. He drank soooooo much water, has been peeing every couple hours or less, and when he's this high its really obvious he feels dreadful.

However when i went to clean his litter box there was a small dollop of diarrhea, like what he had yesterday. At this point i question the chance of impaction, so we'll be calling the vet in 6 hrs when they open. Cross fingers for us please.
 
I feel your frustration. I'm in a similar situation with Chuck and just yesterday got beyond frustrated! I even got to the point where I thought about taking him to the vet and telling them to get him into a good level and I'll pick him up once he's there. Of course I'd never really do that but man it was a tempting idea. Instead I took a nap. I hope he's not impacted and I do hope you get better control and some peace of mind. :bighug:
 
StephG said:
I feel your frustration. I'm in a similar situation with Chuck and just yesterday got beyond frustrated! I even got to the point where I thought about taking him to the vet and telling them to get him into a good level and I'll pick him up once he's there. Of course I'd never really do that but man it was a tempting idea. Instead I took a nap. I hope he's not impacted and I do hope you get better control and some peace of mind. :bighug:
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Omg i have had that same notion about dropping off kitty at vet and 'call me when you've got him regulated' but of course we know it doesnt work that way lol. I wish it did, i wish it did.

I cant get back to sleep. But mr b is napping, right in the middle of the bed the little bedhog.

Thanks steph
 
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TG we have a yellow at +5 holy crap pardon my russian but jeeeeeeeez!!! So thankful., confused as always but thankful.
 
TG no constipation-obstruction. They ran some bloodwork, results in couple days.

So relieved. And look at the little bugger in yellow. I wanted to dose him now to get back on a more normal schedule but i'm afraid of freaking out his liver or whatever mess i created the other day by being too aggressive. I'll work it out somehow.
 
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