Oscar's random numbers

Oscar's pancreas sure likes to keep us thinking, and I'll be darned if I can figure out what it is doing! Back around 4/10 we started to hit low greens at +6 with 3.5u, so I slowly backed down the dose to 2.8u then started seeing a flat line curve wise. Slowly bumped it back up to 3u and got a +11 nadir in the mid greens, so slowly dropped it, and while dropping the dose we started seeing 17-20 hour durations even at 2u. So still need to drop it. Dropped to 1u and then to 0.8u and we didn't get past the mid 100s on nadir, ketones came back, and drinking/peeing increased. Ok, need to raise it a bit. Went to 1.2u - flat line. Raised to 1.4u today with an amps of 254 and we are at an inverse curve with a +6 of 319! What?!?!? I am absolutely sure he didn't get into anything high carb because he has been monitored all morning around anything he would try to sneak (usually while the dogs are eating at meal time he tries to butt in so we have to be uber diligent about monitoring). I need opinions as to what going on here. Is Oscar's liver protecting itself even though it really needs more insulin? He isn't wanting to eat the 6-7 cans of FF he was eating before all the greens happened, but he is still eating around 4 FF cans a day. I add water to his food each time. The ketones have to mean he isn't getting enough insulin. But his numbers are being very ambiguous.

 

took a look at your ss kelly, wish i could help but i have a cat who's not responding normally to the insulin also. it's maddening is'nt it?

 

I have my own feelings about flat line "curves."

The lower H's insulin needs get it seems the delta is also smaller. One reason for this is that his PSs are also lower during these periods.

Now, I know what the common knowledge here is about flat curves, and in some regards I agree with it [flat = needs more insulin]. On the other hand if the cat is happy and healthy at that dose and you are able to keep the PSs even, then my reactions is like "who cares if the curve is flat?" Isn't the ultimate goal to keep the PSs in a range you want them in with a nadir in a range you want it in? And if the fat line [or any other shape] is all within that range, then it really should not matter?

I think maybe too I'm more comfortable with it since I do variable dosing. I think if the curve is flat and one is doing consistent dosing then it might be more relevant.

Just my thinking.

 

I agree with that thinking to some extent. The problem with Oscar is that his peeing symptoms and ketones have come back along with the flat curves. Also, his ps numbers haven't changed at all from what he was without insulin. He seemed to be doing the best actually when we were hitting those 40 nadirs, which I didn't like him going that low - no room for error there. My biggest concern right now is the blatant inverse curve we are getting today. We haven't gotten anything quite this drastic as of yet and there was no recent hypo that would cause this.

 

I'm pretty much out of the loop and rushed as well, so if this doesn't help just pretend I never posted but wanted to say that with Bix I have found that an inverse curve for him = dose was too high. Sometimes if I shoot 0.2 or 0.3 it will be flat for a while, but then definitely goes higher & higher soon enough - those kind of doses seem to always be too low for him. He seems to be at times very sensitive to small changes, so can give me an inverse curve on a dose, and then if I lower even by 0.1u sometimes I will get a good curve. When the dose is too high for him and the #s are flat, he often will have a late drop in the cycle, and the next PS will be lower than the mid-cycle #s, that's generally my cue to lower a bit. Hope that helps some - sorry I am not able to study his SS right now and give you any specific feedback, just sharing Bix's patterns in case that helps....

 

We are getting another inverse curve today. We dropped a little bit for a shallow nadir last night, but we are back up over 300 today at +6. We've never had an inverse curve even when the dose was too high and we bottomed out with 3.5u. Should I hold out and see if his liver will stop fighting us since he still has a trace amount of ketones? He is still peeing a fair amount, but not as much as when we were at 1u, and more than when we were at 2u. Maybe its time to go TID and give smaller doses more often?

 

A benefit to TID (if it IS that the dose is too high) is that you'd start with a smaller dose (significantly since it's 3x day) but if it turns out not to be enough, you only have to wait the 8 hours instead of 12 to raise the dose (or an early 7 shot if it's really going through the roof)

ETA - but I would let your vet know what you're doing just so they have it in the record. You did say he was going in soon for a checkup, right?

 

Yup - he's going in tomorrow morning. I somehow don't think that they will be gung-ho for TID though. It is too unconventional and I doubt they have encountered it before. If I choose to go that route, I might do it for a week or two and say "look what we did!" lol

 

That works too

We have several vets at our office and I think someone flagged Ari's chart for "concerns about owner" as the vet that owns the practice came in the discuss with me Ari's treatment and my adjusting doses and refusing fructosamine tests and shooting TID. I tend to be a very fast talker and I think I might have overwhelmed him with my sheer deluge of info on Ari's tests/schedule and my observations, the use of U100 needles, etc, etc. He asked somewhat obscure questions (Symogyi rebound and liver action, pancreas healing - things that a regular owner might not know) and when I was able to intelligently discuss with him and show him data regarding each in Ari's bg charts, he left saying that he was perfectly comfortable leaving dosing decisions in my hands. Then he told me I should write a book for his other owners. LOL! All the time I'm thinking "you're the vet... shouldn't you have some sort of class or something titled 'Your cat has diabetes - now what?'"

Point being - especially if you're sticking with this vet - if you can show them that you have a good understanding of the principles and make them understand that you see your cat every single day and are much more familiar to his patterns, they will sometimes become more comfortable with you taking more of a hands on role in his treatment.

 

Either that or they'll get pissed and refuse to treat your animal as in some degree what happened to me. After at least a 6 month blackout one of our vets has finally communicated with me again, so I guess the damage was not permanent. It sounds like Kelly is perhaps lucky to have the vet she has, my recommendation is to go easy on him/her