No bouncing and same high numbers with increased doses

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Av & Luna

Av & Luna

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@Wendy&Neko
I am at a total loss to know what to do next. Luna is drinking endlessly and the numbers are not going down. She is NOT bouncing - I am awake most of the night every night and she sits at her water for most of it. To be certain and prove the point we got up at 4am (which is a +6 ) and the BG says what I expected. She is constantly in the 400s day and night.

Increased the dose this morning and yet again the numbers went up and she hadn't eaten anything at that point since the dose. Her eye's don't look right since the increase this morning and she is lethargic too. I am concerned we are overdosing her albeit that the BG numbers are consistently in the 400s. Apart from the excessive drinking I can also hear her stomach making very weird noises in the night too. From the SS she was clearly better on 2 units plus 1.

Whatever we do, nothing brings down the numbers. Food STILL hasn't arrived so still having to feed RC Diabetic plus Whiskas .

Do you think we should continue with 3 units tonight or just forget that and start reducing the dose right down to 2 units and 1 again when she had better numbers?

Very very confused
 
Av & Luna said:
@Wendy&Neko
I am at a total loss to know what to do next. Luna is drinking endlessly and the numbers are not going down. She is NOT bouncing - I am awake most of the night every night and she sits at her water for most of it. To be certain and prove the point we got up at 4am (which is a +6 ) and the BG says what I expected. She is constantly in the 400s day and night.

Increased the dose this morning and yet again the numbers went up and she hadn't eaten anything at that point since the dose. Her eye's don't look right since the increase this morning and she is lethargic too. I am concerned we are overdosing her albeit that the BG numbers are consistently in the 400s. Apart from the excessive drinking I can also hear her stomach making very weird noises in the night too. From the SS she was clearly better on 2 units plus 1.

Whatever we do, nothing brings down the numbers. Food STILL hasn't arrived so still having to feed RC Diabetic plus Whiskas .

Do you think we should continue with 3 units tonight or just forget that and start reducing the dose right down to 2 units and 1 again when she had better numbers?

Very very confused
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Hey,
I definitely understand the frustration, as I went through the same stage where were all red, black, and pink all the time. I think the answer is that your kitty needs more insulin. I wouldn’t decrease the dose because I’ve tried that thinking it might help, and it just made his ketones go up.

You said your kitty is lethargic. Are you checking her ketones?
Drinking more water is normal when the sugars are this high .

When was your kitty diagnosed? And what protocol are you following? Have you decided? The 2 protocols are posted on top of the Lantus message board with a tag next to them. Read through them and see which one works for you. Once you pick one, follow it to adjust the dose base on your kitty’s numbers at appropriate times, and with times the numbers should start improving.

If the kitty is really not acting like herself, I would advise taking her to the vet.

Hope this helps a little.
Ana
 
It's possible that there's a bit of glucose toxicity that's developed from some of the uneven dosing. I also think Ana's point about testing for ketones is important to consider. If there's any possibility of an infection or inflammation plus Luna being lethargic, I would urge you to pick up some ketone strips and make sure that you're not seeing anything more than trace levels. You should be able to find urine ketone test strips at any pharmacy.

The food you're using isn't helping. There's a good chance that you will need more insulin on board to offset the amount of carbohydrates in the food. It also means that once you get your shipment of food, you will need to monitor carefully since numbers could drop quickly.
 
Following SLGS protocol but seems dangerously slow with these numbers constantly.

I know drinking more water is because numbers are so high and this is constant since we increased dose from 2 plus 1, hence my worry about it.

Probably over reacting/ anxious as she's been playing with me in the garden for last half hour. So difficult when vet is saying reduce the dose when we think it needs to be increased. I reduced it the other morning because she pretty much forced me to and my head was not together in time to do the normal dose of 2.5. I don't want to keep changing the dose but this is doing nothing after 10 days at 2.5

No point taking her to vets and stressing her out even more as I don't believe they know what they're doing. The one who was treating her is now in Australia and new vet now wants me to starve her for 7 hours and to start more tests. Not happening as only just got her back eating again and after a full month of tests she looks like patchwork quilt as it is. .. and vet is getting really annoyed with me because I haven't reduced dose because I am sure she's wrong in her assumption of Somogy. She also thinks it is very weird that Luna is on Lantus and says it is for humans and she should be on ProZinc. That makes me question her knowledge at all about diabetic cats.

Not tested ketones since vet did them but will get some strips.

Hope food arrives soon and does something positive to these numbers so save my sanity.

I'm a very logical person and this makes no sense to me at all but think will maybe stick to the 3 units now for 6 cycles and see what happens. If numbers don't fall /or increase there's just no logic in keep giving her more insulin when less (at 2 and 1 unit) provided better numbers for her
 
Some cats need more insulin that others, or it could be the food that is the issue, or both. FYI, Somogyi has been debunked in cats, unless they were started on really high doses or increased too fast or by too much. I would encourage you to get a mid cycle test each and every day during the AM cycle and PM cycles if you are awake.

And try to hold each dose for at least six cycles, to let the depot build. When you first increase, you can see a phenomenon we call New Dose Wonkiness or NDW, that shows as higher numbers right after you increase, as the depot rebuilds. Hold the course on dose, you will start seeing what the dose can really do as the depot builds.

Ketone strips are readily available at human pharmacies or chemists.

Prozinc is an acceptable insulin for cats. So is Lantus. Depending where the vet was trained, they may not have been taught about using Lantus, much less Levemir. My vet started us on Caninsulin, cause that is what she knew.
 
So when I tried decreasing the dose to 1 from 2.5 (same exact story as you), the ketones started trending up. When I took Frosty to the vet and she mentioned the possibility of Skmogyi effect, I told her that the ketones went up, and she agreed he needed a bigger dose. Boom! Convinced with evidence :). But most importantly it helped me convince myself.

Also, isn’t Somogyi the same thing as what we here call “bouncing.” Why was it “debunked?”

And as for the insulins, just like Wendy said, they can all work, but (again, like you) my vet told me to switch when he saw Frosty’s numbers go from 500 to 100 in the same cycle. I was still fostering him at the time so the insulin was given to me for free, so I said no, this is what I have and that’s what I’m using. Unfortunately, not all vets are experienced with diabetes. If you’re able to, you could consider going to an internal medicine vet - I was referred to because of the Cushing’s, but she just seems a lot more knowledgeable in general. Just a thought.
 
Yes we started on Caninsulin but only last a week as Luna had fever every time. We were supposed to swap to Prozinc but vet forgot to order it and gave her Lantus instead.

Overnight Luna was much better in herself, less drinking and more sleeping and this morning we are overjoyed to see a pink at last!!

The new 3 unit dose seems to have had some effect so we will test when we can and see what happens.

Re 'Also, isn’t Somogyi the same thing as what we here call “bouncing.” Why was it “debunked?”' - Like you Ana, I also thought it was same as 'bouncing' ?
 
Ana and Frosty said:
So when I tried decreasing the dose to 1 from 2.5 (same exact story as you), the ketones started trending up. When I took Frosty to the vet and she mentioned the possibility of Skmogyi effect, I told her that the ketones went up, and she agreed he needed a bigger dose. Boom! Convinced with evidence :). But most importantly it helped me convince myself.

Also, isn’t Somogyi the same thing as what we here call “bouncing.” Why was it “debunked?”

And as for the insulins, just like Wendy said, they can all work, but (again, like you) my vet told me to switch when he saw Frosty’s numbers go from 500 to 100 in the same cycle. I was still fostering him at the time so the insulin was given to me for free, so I said no, this is what I have and that’s what I’m using. Unfortunately, not all vets are experienced with diabetes. If you’re able to, you could consider going to an internal medicine vet - I was referred to because of the Cushing’s, but she just seems a lot more knowledgeable in general. Just a thought.
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Ana, your comments and experience with these same things really helped me make the choice to stick with 3 units last night so just wanted you to know that and thanks. There is apparently only one specialist vet on the island but he travels all over the world and access is via new vet who will not ask him for advice without more tests. We will wait and see what 3 units does plus the low carb food if it ever arrives!!
 
Wendy&Neko said:
A day of pinks - progress!

Here is a post about Symogyi vs bounces and the attached article describing the research debunking Symogyi in cats started at a reasonable dose and increased safely. And a link to a Facebook page on pet diabetes at UC Davis talking about it.
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Ok, got it. Somogyi means rebound hyperglycemia after a LOW numbers which calls for a reduction in insulin to prevent the low. “Bouncing” means rebound hyperglycemia due to a number the CAT thinks is low due to being used to high glucose (but the number is not low and so no need to decrease insulin). Correct treatment is keep the dose the same until the cat becomes accustomed to it and doesn’t bounce.

I am glad I was able to help and to see the pinks! Hoping for continued progress. :)
 
Ana and Frosty said:
Also, isn’t Somogyi the same thing as what we here call “bouncing.” Why was it “debunked?”
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Yes and no. Here's my take - I was taught that given too much insulin, pets will go too low, then counter-regulate with high numbers. I was taught this is called Somogyi, which is it not. It is, as you said, what we call bouncing. So, to me, it's a matter of semantics.

Coming from a perspective of most vets, where you are doing some guesswork with limited home testing from most clients, there is a worry when you see high numbers that somehow you've missed the "magic" dose, there are untested hypos and you're only seeing the highs from it. So, it's scary to tell a client to keep increasing the dose, when increasing the dose appears to be causing high/higher numbers. With adequate home-testing, this is less of an issue.

The other thing not being considered (by most vets) is the idea of "too much" insulin. It's not really an absolute of too much insulin, it's just more insulin, thus lower numbers, than kitty is used to. I was never taught this concept in this way. It's not too much, kitty's liver just "thinks" it's too much. Keep going up 0.25u at a time, unless you have documented hypo - as listed in the protocol.
 
Janine & Floyd said:
Yes and no. Here's my take - I was taught that given too much insulin, pets will go too low, then counter-regulate with high numbers. I was taught this is called Somogyi, which is it not. It is, as you said, what we call bouncing. So, to me, it's a matter of semantics.

Coming from a perspective of most vets, where you are doing some guesswork with limited home testing from most clients, there is a worry when you see high numbers that somehow you've missed the "magic" dose, there are untested hypos and you're only seeing the highs from it. So, it's scary to tell a client to keep increasing the dose, when increasing the dose appears to be causing high/higher numbers. With adequate home-testing, this is less of an issue.

The other thing not being considered (by most vets) is the idea of "too much" insulin. It's not really an absolute of too much insulin, it's just more insulin, thus lower numbers, than kitty is used to. I was never taught this concept in this way. It's not too much, kitty's liver just "thinks" it's too much. Keep going up 0.25u at a time, unless you have documented hypo - as listed in the protocol.
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Thanks for your input,@Janine & Floyd , it’s greatly appreciated to have a vet’s opinion! I was surprised when my IM vet mentioned Somogyi, given how much testing I do. I gave her my entire spreadsheet for the last 3 months, but she didn’t look at it lol. (I guess I could have a similar reaction when my patients bring me a stack of papers from other doctors, and all I just want them to do is to sum up the story for me, haha) but as I said before, once I reduced the insulin dose and the ketones started trending up, that convinced both of us that this was NOT Somogiy.

In human medicine, although we do not see bouncing when the body isn’t used to being in the lower sugar range, humans can get hypoglycemic SYMPTOMS - the shakiness, etc when they are used to high sugars and suddenly are brought down into the normal range! But once a human is diabetic, unfortunately their counter-regulatory hormones are not functioning as well either (glucagon), so they are not protected from a hypoglycemic episode. I remember thinking that was interesting when i was learning it in PA school. This is why cats have 9 lives and humans don’t!! :)
 
Back to the same old numbers yet again! Seems to me her body is resisting the insulin for whatever reason.

Just found out despite taking blood every day for nearly a month, sometimes 5 times a day, the vet did not do the thyroid test or FV tests which I requested numerous times. Poor cat looks like a patchwork quilt and legs are still bald and sore from endless testing/blood taking. Looks like she will have to be subjected to more of it to discount thyroid problem which I believe could be causing insulin resistance - plus new vet wants me to starve her for 7 hours now prior to these tests - which is impossible when she is having insulin within that time and i do not want to do this anyway. Last time the vet starved Luna's sister for tests she never ate properly again and ended up dead.
 
Av & Luna said:
Back to the same old numbers yet again! Seems to me her body is resisting the insulin for whatever reason.

Just found out despite taking blood every day for nearly a month, sometimes 5 times a day, the vet did not do the thyroid test or FV tests which I requested numerous times. Poor cat looks like a patchwork quilt and legs are still bald and sore from endless testing/blood taking. Looks like she will have to be subjected to more of it to discount thyroid problem which I believe could be causing insulin resistance - plus new vet wants me to starve her for 7 hours now prior to these tests - which is impossible when she is having insulin within that time and i do not want to do this anyway. Last time the vet starved Luna's sister for tests she never ate properly again and ended up dead.
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I know it’s frustrsting because the results are slow and there’s set backs, but keep going with the protocol. He’s throwing you pinks and yellows! That’s improvement. :)
 
Thanks and yes, the yellow is a first and was a total surprise, nearly fell off my chair lol! Pinks I can live with, it's the high reds that have been driving me nuts!
 
Av & Luna said:
Thanks and yes, the yellow is a first and was a total surprise, nearly fell off my chair lol! Pinks I can live with, it's the high reds that have been driving me nuts!
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I hear you! I saw some blues last night for the first time and I wanted to cry, I was so happy. This whole journey is just one big emotional roller coaster! Then he bounced this morning back up to 400, I guess he’s not used to the blues. :rolleyes:
I think over-all, the yellow and pinks over the last 2 days tell us this dose of insulin is better than the previous one. Keep following the protocol! You’ll get there :D
 
Ana and Frosty said:
I hear you! I saw some blues last night for the first time and I wanted to cry, I was so happy. This whole journey is just one big emotional roller coaster! Then he bounced this morning back up to 400, I guess he’s not used to the blues. :rolleyes:
I think over-all, the yellow and pinks over the last 2 days tell us this dose of insulin is better than the previous one. Keep following the protocol! You’ll get there :D
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Yes I can just imagine how happy you were. It's all a complete nightmare but could have been a much worse diagnosis so I am thankful for that. Yes I think this is the dose that I will be sticking with.

I read this article too which chilled me out no end and I thought it was very interesting https://www.petmd.com/blogs/fullyvetted/2012/nov/less_is_more_with_feline_diabetes-29293
 
Av & Luna said:
Yes I can just imagine how happy you were. It's all a complete nightmare but could have been a much worse diagnosis so I am thankful for that. Yes I think this is the dose that I will be sticking with.

I read this article too which chilled me out no end and I thought it was very interesting https://www.petmd.com/blogs/fullyvetted/2012/nov/less_is_more_with_feline_diabetes-29293
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Very interesting! Thanks for sharing. I bet that many long-time forum members might strongly disagree with this approach. I’m a physician assistant and work with humans, so my approach is even more different than those here vs. what vets usually recommend.

I personally think every care taker is different, and everyone should do what is in their ability. Some people would never be able to check their cat’s sugar. Their level of anxiety or discomfort may just not let them. This doesn’t mean that they love their pets any less than we do. Some cats are also more resistant to testing than others. I’m a believer of tailoring treatment to the patient (or in this case, the caretaker). Making someone do this who is just not ready mentally is not a good idea. And I think a lot of vets are coming from this angle (correct me if I’m wrong, @Janine & Floyd ). It’s scary and overwhelming as it is to have a sick cat, never mind the bills, but now they have to draw blood and give injections multiplentimes per day? It just may be too much for some people, so if they can just give injections twice a day and bring a cat in for an occasional curve, that might be all they can do, and that’s ok. It’s better than putting the cat down or turning it into a shelter.

On the other hand of the spectrum, there’s people like us. Personally, when my vets tried talking me OUT of doing the home testing, it made me feel frustrated and as if they weren’t taking what I was doing seriously.

So I agree with the article from the perspective of maintaining good life quality for both humans and the cats. I think the level of how aggressive we treat the cats should be based on what the cat parent is willing to do, given that there IS data that tight regulation can lead to diabetes remission. Having said that, I also find it really amazing how cat diabetes is different from that of humans. They are so much more resilient! Their renal threshold is higher, they can handle hypoglycemia better and even bounce to protect themselves! Would be nice to have those safety features in humans. I’m really starting to believe this whole 9 lives thing ...:cat:
 
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Yeah for yellow! Progress. :) This may not be the dose you stick with as Luna is still spending most if not all of her time above renal threshold. But you are definitely closer. I would hold the dose a few more days and keep gathering data.

That article is pretty terrifying. I can't imagine adjusting the dose based on the cats expected peak numbers. :eek: Guess they aren't familiar with the concept of bouncing. Or elevated numbers at the vet. At least in early days before I started testing :oops:, my vet got us in during nadir time for testing. In addition to Neko who had no problem with testing, I've tested my civvies and those of friends, all with no fuss.
 
I agree with everything you said @Ana and Frosty. I disagree with the article because if you set the bar that low right off the bat, you'll probably achieve even less than that.

In a species that can go into remission, that should be our goal. Of course as a vet you have to be flexible and work with clients where they are, but telling someone that the less is more approach outlined in the article is adequate is doing a disservice to many cats. If a client decides that is all they can do, I'll try to work with them, but let them know it's not ideal. (With the exception of spot checks at PS time)
 
Personally I would find it difficult, if not impossible, not to test before shooting for the safety of my cat.

However, my general perception of the article is different in that I understand they ARE working towards remission
eg quote.... Dr. Norsworthy reports the following results with his approach:
  • Approximately 30% of cats go into remission
.....I read that the idea is to work in a less intense manner for the purpose of the cat's quality of life

On a different matter, I do wonder what Luna's 'normal' BG levels were like prior to this diagnosis as she has always drank excessively in the 9 years I have had her. The day she was diagnosed the numbers were in the 400s and nothing's changed despite twice daily lantus at various increasing levels.

It is only the fact that she lost weight since steroids that I took her to the vet at all and she was diagnosed as diabetic.

But if cats can tolerate numbers in 300/400s I am thinking that maybe because she is a constant grazer that she might always have been in this range - maybe this is normal for her and maybe this is why whatever dose we give her, (whether it be 3 units per day or 6 units per day) her body resists and returns back to those same numbers again.

Any thoughts on this?
 
300/400 is not normal. That is above renal threshold which is the point where the kidneys can't keep up with the sugar in the blood stream. If you have any other cats, try testing them. My civvie who was on steroids went from the 50's before steroids to 70/80's on prednisolone.
 
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Wendy&Neko said:
300/400 is not normal. That is above renal threshold which is the point where the kidneys can't keep up with the sugar in the blood stream. If you have any other cats, try testing them. My civvie who was on steroids went from the 50's befor steroids to 70/80's on prednisolone.
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I’m sorry Wendy, but every time you mention testing your non-diabetic kitties and how easy it was, I laugh because all I can think of is how badly my Bella will hurt me if i try to test her. She’s been overweight all of her life and even now that everyone is on fancy feast she is still a big girl, so I’ve always worried about diabetes with her. If she ever becomes diabetic, I am screwed. :eek:I will never be able to test her. I’ll pay any volunteers willing to try, but I will NOT pay your medical bills, lol.
 
Av & Luna said:
But if cats can tolerate numbers in 300/400s I am thinking that maybe because she is a constant grazer that she might always have been in this range - maybe this is normal for her and maybe this is why whatever dose we give her, (whether it be 3 units per day or 6 units per day) her body resists and returns back to those same numbers again.

Any thoughts on this?
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I don’t think that she has ALWAYS ran that high, but probably recently she has, for some time.

It may appear as though she is resisting the insulin, but remember, diabetes in itself by definition means insulin resistance. So we just need to find the dose at which we are able to overcome her resistance and get her to start utiliing some of the insulin we are giving. Keep following the SLGS protocol and increasing the dose by 0.25 once a week once you determine how she is reacting to the current dose. you will get there.
 
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