Smiffy's progress end September

http://www.felinediabetes.com/FDMB/threads/smiffys-numbers-lower-august-september.163681/page-3#post-1783884

Smiffy and I are in the UK. She is on Caninsulin and was diagnosed in April 2016.

As you will see from her spreadsheet she has very recently enjoyed some very nice blue numbers and for four or five days required now insulin:

This is what her Vet Roberta had to say about her spreadsheet and dosing at that point:

"Hi Mrs Smith,
That's all really positive isn't it! Fantastic work, you've both done brilliantly. I would agree with you that I would be nervous of giving insulin below 8, especially in the morning. My view would be that Smiffy is in remission if she manages to keep her BG below 12 (so below the renal threshold) without insulin. I would also prefer her blood glucose to remain above 4 ideally, I have seen cats hypo on 2.5-3. I think also that we have to take into account a little degree of sampling related hyperglycaemia (stress related) and differences between glucometers. I think the 'tight regulation' numbers are a little too tight for practical use if that makes sense? I would only give her insulin if her numbers are above 12, and keep a very close eye on her.
Absolutely brilliant news"

However for the last few days Smiffy's numbers have risen again (coinciding with a thunderstorm breaking the hot weather to damp weather and DH - her Daddy - going abroad for a couple of weeks).

The sliding scale that I have devised for her from experience and looking back at her spreadsheet is still in place but for the past couple of days her numbers have still stayed high which is out of character.

So it feels a bit as if I am starting all over again.

Thank you to Smiffy's regular friends for popping in to see her.

I will be posting a new thread for her more often now.

@Marje and Gracie @Marlena @MrWorfMen's Mom @Alexi @JanetNJ @Louise1989 @HWright @Woodsywife @Squalliesmom @manxcat419

Thanks for your continued advice, support and encouragement

 

From @Squalliesmom :

"Honestly, where you have not given a shot, I probably would have gone ahead and given it, even if it was a reduced dose. However, I am NOT recommending you do this, that's just what I would have done.

If you look at Squallie's spreadsheet from a year ago, around this same time (late Sept), you'll see similarities in his and Smiffy's. I use a human meter so my numbers are lower but the pattern is similar. This to me is just a typical Caninsulin (Vetsulin, here) pattern. When we used it, we had lots of ups and downs, some brief and some frustratingly drawn-out. Small fluctuations will occur in cycles, no matter what insulin you use, and are normal.

You can also look at Squallie's ss just from this week: on a couple of occasions he has had numbers that are more than twice what he his numbers were the week, or even the day, before at the same time. I have given up worrying about the "Why?" of it and just reconciled myself to the fact that sometimes, it just happens. You'll go nuts if you always try to dfind a reason for it, believe me, I've been there, lol!
Bottom line: you are doing a good job with Smiffy, keeping her numbers in a good range and keeping her safe!"

 

From @Marlena and @Marje and Gracie :

Advice on dosing tonight - they concur:

"For tonight, if she stays in yellow numbers, I think shooting the 1u, as Marlena has suggested, is appropriate but please be sure and monitor her"

And @Squalliesmom this is interesting:

She is PMPS 11.2 (202) so she has come DOWN from her +7 number 12.8 (230) which is promising and shows signs of her pancreas working a bit I would say?

Am going to give her one unit provided she eats and do her +3 Nadir reading and possibly her +4.

So Smiffy's +3 tonight is 13.4 (241)! So she has gone up again from her PMPS!

First she shows signs that her pancreas is working by going down before her PMPS and then she goes up by her Nadir at +3? I could have given her 1.5 units .... unless of course she bounced before +3? Going to check the pen again ...... It works. This kind of result/trend is what I mean - so unlike her completley!

I have never had such confusing data from her before as I have done the past few days.

I am going to take a +4 reading now to see if she is still rising ...... no about the same at 13.5 (243).

Just took a urine sample and Smiffy is negative for keytones but she is showing a bit of glucose whereas 6 days ago there was no trace of glucose whatsoever so I suppose that confirms that she has been over the renal threshold in the last few days?

 

I try to follow Smiffy whenever I can. Smiffy and Calley are so much alike. Smiffy has been so good.

 

That's so lovely to know I hope following her is helpful? I will have to look at Calllie's spreadsheet tomorrow too

 

Your posts have been a big help.

 

I have just looked at Callie's spreadsheet and you are right Smiffy and Callie are quite similar

They seem to be at a similar stage now don't they except for Smiffy's most recent trend which is not to respond to her Caninsulin as much as she was for those four or five days when I deemed her too low to give a shot (nor as much as she has ever responded to it actually!).

I see though that Callie can run a bit higher at night as Smiffy is doing at the moment. You seem to have give Callie bigger doses than me. Smiffy has in the past been more sensitive to Caninsulin. It's interesting. Do you work to a sliding scale that you find works for Callie?

xxx

 

@Squalliesmom I have just had a look at Squallies's spreadsheet and I can see the odd higher yellow number recently in his otherwise blue and green numbers.

I tried to scroll back to September last year but the spreadsheet wouldn't allow me to go back that far? Or am I missing something?

By the way I also use a human meter The Accuchek Aviva.

 

@Looby & Smiffy

The older numbers from 2015 are HERE but remember, she's on Lantus now so it's hard to compare numbers

 

Thanks Chris ..... how did you do that?!

Anyway @Squalliesmom I can see what you mean about those numbers from September 2015 when Squallie was on Caninsulin - thanks

 

The 2015 numbers are located on the tab titled "Relion readings" at the bottom

 

Ah ha!!!!

 

Thanks, Chris!

 

For the sake of clarity, Squallie started Lantus in early March 2016.

When suggesting you take a look at his current ss I was not suggesting you compare the numbers, rather just see that the same types of unexpected rises and falls can interject themselves into your cats' "usual" pattern, regardless of what insulin you are using.

 

No I realise that thanks

I am concerned and more importantly bemused by her patterns just lately ie she is showing signs of her pancreas working and then she goes high and barely responds to the Caninsulin at night OR she has bounced before +3 in the evening .... would you have a look at her data I recorded in the post above and pop in to see us from time to time please if you have time?

What is your name - is it Lucy?

I have been called that lots of times and is one of my pet names

Thanks for your input so far

Smiffy was a not so encouraging but safe 14.6 (263) this morning. I have kept to the one unit which is her usual and highest morning dose I have ever given her.

On a AMPS of 14.9 (268) Smiffy has given me a +3 of 7.8 (140) before now so as I am not usually around for her morning Nadir I am reluctant to give her more than that.

@Marlena do you think I should still be keeping to the one unit at night or do you think I could start giving her 1.5 units again? What did you think about the data I recorded her in her post last night and my comments?

Thanks ..... I really want to get her back to these lower numbers again ....

She is completely off the Hill's m/d now but still has a dry breakfast and evening meal of a Porta21 Sensible but mostly Thrive Premium Chicken.

Tried to tempt her this morning on some Sheba but she wasn't having it! She will have a bit later when she eats with Pasha as she likes to show that she is Top Cat - it's a territorial thing and a jealous thing with Smiffy ..... she has to eat what Pasha eats! Pasha was not here this morning.

 

For the benefit of all Vetsulin/Caninsulin users who may be reading this thread, for safety reasons I feel obliged to post that Caninsulin/Vetsulin is not - repeat NOT - a suitable insulin for use with Tight Regulation Protocol. The appropriate insulins for use with the Roomp-Rand published TR protocol are Lantus, Levemir and ProZinc.


Mogs
.

 

Hello Mogs,

I am so pleased to hear from you at this difficult time for you.

Please don't be concerned that I am going to dose Smiffy aggressively to get her numbers down but I appreciate your warning to others using Caninsulin/Vetsulin.

I know it has been a long time since we spoke, but as you are so experienced with Caninsulin/Vetsulin, I would really be grateful if you could advise me with Smiffy. She would love you to pop in and see how she is doing from time to time. If you have time to look at her spreadsheet, she had a period of really good numbers consistently below the renal threshold about a week ago and now they are elevated again.

The Caninsulin/Vetsulin appears to be lasting pretty much the full 12 hours in Smiffy so her Vet and I have seen no real reason to change her insulin.

Smiffy has been doing so well for quite some time now and those few days when she was too low in BG for me to give her her shot (as I would not risk aggressive shooting as you have referred to) and now she seems to be back at square one ... well not quite - still in the yellow numbers but I don't know shy her numbers have gone up again. I even wondered if she has become less sensitive to Caninsulin. I am puzzled and would welcome you input.

Smiffy adores her Daddy and he has been away since the Thunderstorm and the change in weather so I am wondering if both these things have raised her BG?

@Marlena is giving me dosing advice where she can but she is very busy with her new job and with Rocky.

Hope Smiffy and I hear from you soon.

In the meantime, I am still sending you love and hugs for your loss.

xxxxLooby and Smiffy

 

I thank you for your condolences for Saoirse.

As I have advised in the past, Looby, I don't have anything more to contribute to your threads. My post today was solely one of safety peer review.


Mogs
.

 

Ok Mogs thank you and be kind to yourself

 

Smiffy is 15.3 (275) at +8 today - what is going on?!!!

@Marlena @Marje and Gracie @Alexi @Squalliesmom @MrWorfMen's Mom @JanetNJ @Capoo @KarenRamboConan



I think I have to go back to her 1.5 dose tonight don't you think?

I have tested the meter on myself and it read 4 so there is nothing wrong there.

I really need your help here.

Do you think it is possible that Caninsulin is not working for Smiffy anymore for some reason?

The the cartridge that I am using for Smiffy was changed during her good number and is only two weeks old so that is not the problem.

So tonight's dilemna is shoot 0.5 on the basis that she is bouncing or 1.5 her full dose to make an impact?

 

First, I agree with @Critter Mom that tight regulation as we use it on the Lantus and Levemir board is not designed for Caninsulin.

I actually don't think her pancreas is sputtering. Her BG the last two days has been relatively flat. Remember that every meter can have a variance of up to 20%.

Since I haven't used Caninsulin before, I'm not qualified to give dosing advice on it. I haven't studied the action of the insulin to know what a reasonable "no shoot" number is and how lowmyou can safely shoot.

If it were me, I'd give some thought to one of the longer duration insulins. You could choose between Prozinc, lantus, or levemir.

 

Lucille,

I really think it's time for you to get accustomed with the use of syringes, and to change of insulin.

 

In addition, I saw this evening on FB that Smiffy is peeing outside her litter box . That's another sign of a non optimum regulation of diabetes, and another reason to change something:
- you can transition to all wet food, but it seems impossible, as you have mentioned in all of your previous posts,
- or to change of insulin. But in that case, you need to use syringe.

 

Yes I agree that the TR Protocal should not apply to Caninsulin so I have reassured @Critter Mom that I absolutely don't condone that.

A week ago I am sure there was evidence of her pancreas working - how else would Smiffy have stayed in lovely blue numbers for those five days? And also there are numerous days where Smiffy goes down after a shot and then up of course and then she has gone down again before her evening shot - doesn't that indicate a splutter?

She has often 'surfed' on her lower numbers for the duration of her daytime cycle which to me would indicate that the Caninsulin lasts the full 12 hours for Smiffy?

However, when she has had low numbers in the evening with or without a shot, she seems to 'bounce' by the time it is her preshot time? But that was reduced for that short period of tie and she was holding her low numbers.

I was educated in the early days by @Elizabeth and Bertie not to let Smiffy's Nadir on Caninsulin fall below 5.6 and I am fairly sure that she gave me a guideline of no shot below a preshot reading of 10 (my computer will ALL my notes on Diabetes etc was lost when it crashed a week or so ago - gutted!). I HAVE given Smiffy a shot when she has been 10 or a bit lower (only in the morning) but only 0.5 unit and it has proved to be OK. @Louise1989 suggested one night that I do a test an hour before her shot (when she was getting her nice blue numbers) to see if when I tested her for her PMPS she was rising or falling and that helped me determine whether to give her a shot or not so that was useful.

I just don't understand why her numbers have gone up so much since the Thunderstorm (you can see that spike on her SS and I made a note of the storm) and now the only common denominator seems to be that her BG has gone up since DH has been away and she misses him. She is really well in herself - just as well as she was when she had the low numbers and all the clinical signs are still good.

I understand that you can't give dosing advice on Caninsulin so of course that is fine

I will see how things go and discuss whether a change of insulin is in Smiffy's best interests when I see Smiffy's Vet Roberta in the middle of October. There is the option of changing to Glargine (Lantus) or ProZinc but I think the more likely is Glargine. We have not considered it or rather ruled it out because Smiffy has made such great progress on Caninsulin - it really is just the last few days since DH has been away and I am very bemused by it .... wondering if that is really enough to upset her BG.

I think if she is still in the higher yellow numbers tonight I will (unless otherwise advised) give her a 1.5 unit dose and test her at +2 (to see if she drops quickly before a bounce) and then at +3 and +4. Or maybe I will stick to one unit for one more night but test her at +2 to see if she drops.

Thanks for your comments and I take them all on board

 

One other thing to add: to use a tight regulation protocol with Lantus, Levemir, or Prozinc, she must be eating a low carb canned or raw diet.

I would also be using a form of the insulin where syringes can be used. Pen needles are not for cats and do not allow the micro dosing we often do.

 

Looby, it is difficult to say why Smiffy's numbers are not going lower.
Just few days ago she was on a smaller dose of 0.5 and she had lots of blue numbers.
As I said to you earlier on when Rocky was like that I couldn't figure out what was going on with him and therefore decided to change his insulin, Caninsulin did not seem to work.
You could try to give Smiffy a lower dose of 0.5 as what we see could be bouncing, give it for 3 days and see what happens. Don't increase the dose to 1.5 at this stage
This is the best I can come up with at the moment.
I'm very upset and stressed myself as Rocky seems to be having cystitis again so back to worry and lots of drugs to keep him comfortable.
My brain is not working properly.

 

Well Smiffy has done so well on Caninsulin so far, Smiffy's Vet and I saw no need to change her insulin but it is definitely something that I will discuss with Roberta the next time I see her. As I have just told @Marje and Gracie, our options would be for Glargine (Lantus) and less likely ProZinc.

I won't repeat what I have just written to @Marje and Gracie naturally but in short I am really wondering if the fact that DH is away is responsible for this sudden change to higher numbers since her lovely progression to the period where she required no insulin at all. As @Critter Mom suggested in her post and I agree, I will not dose aggressively with Caninsulin to push Smiffy's numbers into the green 'normal' range. Roberta (her Vet) and I were rather hoping that her little pancreas would do that for herself as it was clearly keeping her in the 'blues' for those five days.

As I say, if things don't change in the next few days nor when DH is back, then there may have to be that discussion with Roberta

Thanks for popping in @Capoo

 

Looby,

Please show a little respect and stop tagging me. As I have repeatedly advised I do not wish to participate on your threads.


Mogs
.

 

I really do have a fear of using a syringe with Smiffy ...... I am so scared of not getting her dose right for several reasons - my own human error, the dull lighting in our house and my not so good eyesight and just the way we are set up here but I would be willing to give it a go of course if it was the only solution.

Wet diet is a sticking point for Smiffy - tried again this morning .... have been trying for months ..... she is just one of those cats that is not going to have it! She has a little as a snack but nothing like enough for a main meal ... I have read the documents as to how to make the transition .... I am limited too by my illness to a certain extent and am really doing my best. But I will have the conversation with Smiffy's Vet if things don't improve.

 

Oh sorry Mogs .... really I am ..... I just wanted to make sure that others knew that I had taken in your advice and you too ... my appologies again ....

 

I'm afraid that the "blue numbers" you're targeting are still in the range of beta-cells damage, and not in the healing range.

 

But, with Caninsulin, you cannot target the healing range safely.

 

Oh poor Rocky - that must be terrible for him and very painful and horrible for you to watch too ....

OK I will just give her a half and test her again at +2 tonight to see if she goes down before she bounces up again - does that sound like a plan?

Hugs to Rocky and you

 

She has been peeing outside her litterbox for over a year! Long before she had Diabetes! She is really fussy about her litter!

 

Please, allow me to interject... for the benefit of those reading this thread, for safety reasons it should be noted the appropriate insulins for use with the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats are Lantus or Levemir.

This particular protocol is not for use with ProZinc or PZI. My understanding is some experienced members are currently working on an advanced guide for Prozinc/PZI users which will hopefully include help for those wishing to tightly regulate their kitty when using ProZinc/PZI as well as other advanced methods for regulation. Watch for when it's posted in the Prozinc / PZI Forum!

 

@Jill & Alex (GA) - I know that in some of the Roomp-Rand publications they mention Prozinc hence my referencing their work above. Thank you very much, Jill, for catching the inaccuracy in my post and also for sharing news with us about about developments for Prozinc users.

Mogs
.

 

I think you can PROVIDED the cat owner is available to test often. I was fairly aggressive with my dosing on vetsulin, but only because in the summer I was home to test 5-6 times a day and could predict with fairly good accuracy exactly what her result would be at each dose with very few surprises. Any time I COULDN'T be there to test I dosed conservatively. I was able to get my cat into those healing ranges and eventually into remission. This would not have been possible though had I not obsessively tested her every day.

 

Right so @Marlena @MrWorfMen's Mom @Alexi @JanetNJ @Louise1989

this is Smiffy's recordings tonight:

So she PMPS is 13.5 (243) which has come down from her 15.3 (275) that she was at +8 so surely that indicates some pancreas activity?

Now I am going to give her a 0.5 unit shot and test her again at +2 to see if she comes down before she bounces up again ....

+2 Smiffy is 14.7 (265)!

If that is a food spike it is on very little food.

I will test her at +3 too .... so she is 16.2 (292) at +3 so that shows me that I will definitely give her her full dose tomorrow night and that her numbers are not bounces on a big drop after her evening shot.

 

My kitty, Gracie, spent weeks on end in healing numbers but that didn't mean her pancreas was working. It meant the dose I was giving her at that time was working to get her and keep her in healing numbers.

Never say never but I'd be surprised if the change in her numbers is due to your DH being gone. Things change. I try not to over analyze it if the cat is healthy. Sometimes, they need more insulin on a dose that recently worked well. And, again, I am not that familiar with Caninsulin.

Also, know that insulin absorption can vary up to 50% from shot to shot. There is a lot at play that can affect numbers.

More likely, the change in her numbers is due to the pen needles. Pen needles aren't accurate for small doses or doses in between 0.5u increments. Usually for long-term remission, it's better to take the dose down into smaller increments than 0.5u before stopping insulin. In fact, syringes aren't that accurate and that's why I developed the post on Dosing with Calipers. I would imagine lighted magnifying glasses or headlamps are available to you as is the lighting table I used so that should help with lighting and eyesight. It can make a difference in some cats to dose this way with syringes especially for microdosing.

It's up to you whether you leave her on dry food but it does limit your approach if you switch to Lantus or Levemir. In over six years on this board, I've seen a rare cat that couldn't be transitioned if you do it correctly and slowly. I've also seen cats almost immediately go off insulin once they were switched off a dry diet to a LC canned diet. That would certainly be worth it to me to attempt it again slowly. Some members even crumble the dry on the canned as a topper or mix it in and slowly decrease the dry while increasing wet. There are a lot of freeze dried whole meat treats (LC) that can be used as snacks or crunchies.

 

Thank you Marje for your time and comments

Well I can't do very much whilst husband is away as I can't get to the Vets on my own so the best I can do for the time being is to follow my instincts with the Caninsulin and see how things go over the next few days ... husband is back at the end of the month. And give Smiffy as low a carb diet as I can and keep plugging away at the wet food. I tried the opposite way of doing it this morning and put some wet on top of her dry in attempt to try something different to putting the biscuits on top of the wet But she turned her nose up at it.

I will have to speak to Roberta (Smiffy's Vet) about her most recent trends. It's great that I can send her Smiffy's spreadsheet and discuss it with her on line

I am really tired now so I am going to leave Smiffy for tonight and not stress her with any more testing and start again tomorrow with a smile on my face.

Thanks again

 

And remember that cats are very attuned to their owners stress... Try not to stress or be tense over minor fluctuations. Be positive and upbeat around her so she feels at ease as well.

 

Yes I am feeling really down trodden and inadequate but in fact I have done a great job with Smiffy when I think about it .... she was a very sick baby when she was first diagnosed - I thought she was dying and she spent all day under the chair in the bedroom and hissed at me for several weeks after she was diagnosed and now she is a happy beautiful coat and loving puss cat back to her old self now .... even this afternoon she was in the sun with me rolling around and having a ball in the grass so I should not be so hard on myself!

There are lots of good indications in her spreadsheet that I have to remember.

So dust myself down and go back to dosing her according to my instincts and not to bash myself up about her diet that is actually much better than it was a few weeks ago when it was just Hill's m/d.

I will give her full doses tomorrow to see if I can't get those numbers back down again. I am still convinced that Caninsulin (Vetsulin) works for her and lasts the full 12 hours.

So onwards with positivity.

Thanks Janet

 

Just a though @Marje and Gracie - did you realise that I got those really good blue numbers without insulin for five days? Just a thought

 

I did see that. But she should have been on insulin then....she wasn't even in healing numbers.

 

I agree that over 150 I would have given a small dose, esp since it's a human meter. A reading of 180 could easily be like a 220 on my alpha track. She isn't using needles though which is limiting what she can dose.

 

But I thought that TR Protocol was dangerous with Caninsulin/Vetuslin as Critter Mom said .... that is why I didn't give her insulin to push her dangerously low .... Elizabeth Campbell said not to let her Nadir go below 5.6 on Caninsulin ..

Smiffy was 16.2 (290) last night at +3 and she is the same this morning at her AMPS so she has held that number for 9 hours even though it is a high one. Surely that would indicate that there is some pancreas activity and/or the Caninsulin/Vetsulin lasts the full 12 hours for Smiffy.

There are a lot of cats that are held in numbers between 8 (144) and lower than the renal threshold on insulin that are not suffering any further damage to their bodies. Elizabeth's Bertie must be the most renowned example of this and I know of others.

I will discuss everthing at length with Smiffy's Vet Roberta and in the meantime I will dose Smiffy to her sliding scale to try to get her back to those nice blue numbers.

Thanks for your help and time ..... I promise I am taking it all on board - just playing my own Devil's advocat if you like

I will no matter what keep Smiffy well now that she is back to her old self from being limp and thinking that she was dying back in April!

 

I will give her the lower dose next time she is in lower numbers as you suggest Janet .. in the evenings only when I can test her .... I can't risk it in the mornings as I am not around for her Nadir as I have explained lots of times ..... that is my illness and there is little I can do about that in the short term.

 

So Smiffy has held her +3 number of 16.1 (190) from last night as she is the same this morning at AMPS time. More later ....

@Louise1989 @Marlena

 

@Marlena @Louise1989 @JanetNJ @MrWorfMen's Mom

Smiffy is a very nice 10.1 (180) at +4 today so Caninsulin kicking in again and maybe pancreas if she holds this number until tonight first blue number in a few days and a good one

 

Sounds like a plan.

 

She's sitting in the garden in the grass in the sun as happy as a bunny right now - full of confidence and happy just being ... sooo lovely to see

Did you see her lower +4 today - just 10.1 (180) so nicely back in the blues today

And I bit of pancreas activity overnight holding that +4 number last night until this morning

My faith in Caninsulin and Smiffy's pancreas restored

 

Smiffy is looking good! GO SMIFFY! A whole lot of patience is required with our sweet furry kids! Like us they have their ups and downs but they can't tell us about them so we're left guessing about what's going on. Sometimes it's better not to focus so much on the individual numbers and pay more attention to other signs of how they are feeling. Sometimes Menace is more playful when her numbers are higher than I'd like so I've learned to just take one day at a time and not get in a tizzy over a day of yucky numbers.

 

Eh hem "she" has a name! Only kidding

You are so encouraging and positive and helpful - like a breath of fresh air .... so pleased Smiffy has you as her friend

 

I don't understand your conclusion when you say that there is some pancreas activity when Smiffy keeps a BG at 290.

 

To hold the same number for 9 hours .... either that or the Caninsulin held her number for the full 12 hour duration.

I said and/or not definitely pancreas activity ... it must be one or the other or a combination of the two so I am optimistic

 

I cannot agree with that sentence.
If there was some pancreas activity, or an effect of Caninsulin for the full 12 hours, you would see a drop in BG between AMPS and PMPS.
Here, when BG keeps constant with Caninsulin, you can :
- have done a fur shot (or something else that ends in your cat not receiving any insulin, or not enough of it),
- meet a Somogy effect (or a rebund, whatever you name it).

 

That's OK Sophie - we can agree to disagree

I definitely didn't give Smiffy a fur shot and if I had done then I think her BG would have been even higher by the morning preshot number.

I don't know what the 'Somogi' or 'Somogy' effect is but I don't think it is the same thing as a 'bounce' from the liver?

The reason I say it could be her pancreas working a bit is beacuse she has demonstrted more than a few times that her pancreas is working sometimes for example of course when hse had the run of low numbers for five days.

Also she has had more than a few days when she goes down after her AMPS, then goes up a bit as you would expect but then by her PMPS she has gone down again. In this instance I don't think there is any other explaination for it even taking monitor variance into consideration.

 

Lucille,

The Somogy effect, still subject of controversy, is well explained on the website of Vetsulin:

http://www.vetsulin.com/vet/Monitoring_Somogyi.aspx

It can be assimilated to the bounce effect.

What is interesting in that article is:
- what can suggest a Somogy effect is when you have persistently high blood glucose values (I would say that your reading of 290 with a human meter is a high value) with no discernible nadir (rebound hyperglycemia can persist for a few days following the hypoglycemic event),
- Hyperglycemia due to a Somogyi effect can persist for as long as 3 days after a single hypoglycemic episode. As a result, blood glucose concentrations do not always stabilize within a few days after lowering the insulin dose.

They say that the Somogy effect is seen when BG approache hypoglycemia, but also when the blood glucose concentration falls too rapidly. With your case, I would more suspect a too rapid fall than an approach of the hypoglycemia range.

I'm also a little bit concerned by your story about Smiffy peeing outside the litter box.

 

Sophie,

That is really interesting and I am going to study it more later so thank you for that

Don't worry about Smiffy peeing outside the litter box - she has been doing if for well over a year if not more! She has brought up the laminate where she has peed on the floor when we are not around .... she is so fussy about her litter tray and she is quite a big cat so if she has done a poo as well she pees towards the front of the litter tray house and it goes on the floor.

 

@Capoo
Sophie,

Are you saying that Smiffy's higher yellow numbers recently have been a Somogyi reaction to the lower blue numbers that she had for five days when I didn't feel the need to dose her?

Are you also saying that I should be careful how I dose Smiffy and not be 'fooled' by the high numbers in case I overdose her and run the risk of causing a hypo?

I was thinking that if Smiffy is back down in the 10 (180) range tonight (and she eats) that I would give her 0.5 units and if she is around 12 (216) to give her one unit. I think you might be warning me not to give her 1.5 units even if she gets up to 16 (290) again?

 

I'm just saying that:
- For the time being, I don't see any evidence of Smiffy 's pancreas working well again,
- I don't see any evidence of a 12h duration of Vetsulin in Smiffy's organism.

But what I can see is that you still have a lot of levers to pull in order to improve Smiffy 's regulation:
- her diet,
- her insulin dose,
- her type of insulin.

 

@Marlena @JanetNJ @MrWorfMen's Mom

So Smiffy's AMPS was 16.1 (290) but at +4 it went down to a lovely blue 10.1 (180) then it went up a bit at +6 to 12 (216).

She is at PMPS 10.6 (190) so she has come down again in her cycle

I am just giving her 0.5 units and at +2 she is 11.8 (212) and +3 she is 11.6 (209)

 

I still don't understand how you meant the symogyi (bouncing) affect was relevant to Smiffy over the last few days? I know she has bounced for her AMPS plenty of times in the past.

I didn't say that Smiffy's pancreas was working well again, I said there have been signs that it is spluttering and working a bit for her again at times.
I believe (and others do too) that there is plenty of evidence that Caninsulin/Vetsulin lasts the full 12 hours for Smiffy most of the time and so I have no real reason to change it at the moment (although as I have already said in this thread, that is up for discussion when I next see Roberta, Smiffy's Vet)

I agree her diet is not the 'ideal' but I am still working on it and it is a lot lower than it used to be even though Smiffy is very stubborn about it.

I am careful with Smiffy's dosing after her AMPS reading as I am not around for her morning Nadir and I don't believe in dosing aggressively with Caninsuiln to push her numbers down into the greens and I have been warned against doing that by one of our mutual colleagues earlier in this thread.

Smiffy's numbers are going down again now so I am very optimistic that her recent higher numbers were a blip or because she was getting used to a few changes recently like her Daddy being away, the thunderstorm and the change of weather and the fact that perhaps her bit of arthritis is giving her a little more trouble than it does in the warmer weather (she is on Seraquin). I am optimistic now that I can hold her under the renal threshold again - fingers crossed

She has made a steady improvement since she has been on Caninsuiln/Vetsulin which is apparent in all her clinical signs and her behaviour. Today I was delighted to see her rolling around in the sun in the grass in our bottom garden unescorted (she had lost her confidence a bit because of changing neighbours and because she felt unwell when she was first diagnosed) and she is purring, playing and wanting to be out and climbing on furniture again just like our old Smiffy.

That is not to say that I don't still need advice and support for her as I do and a lot of time I just need reassurance so thank you for taking the time to read her post and contributing

 

INFORMATION FOR NEW CANINSULIN/VETSULIN USERS READING THIS THREAD:

The general advice often given here for newcomers to Caninsulin/Vetsulin is not to aim for a nadir (lowest blood glucose level) lower than 5 - 5.6 (90 - 100). This allows some buffer of safety if the blood glucose actually drops lower than that.
This is because Caninsulin/Vetsulin can drop the blood glucose 'hard and fast' in many cats. A caregiver needs time to learn how their cat will respond.

When the caregiver is comfortable with hometesting and has gathered sufficient data about how their cat responds to insulin, then they should be guided by what their own experience tells them may be appropriate for their cat.


See also:
Vetsulin/Caninsulin user guide
.

 

Dear Looby, dear all!
I'm really sorry but I can not participate in this discussion any more.
I'm struggling with my own issues and am very stressed, my brain is so affected that I can not trust myself to provide the right advise to Looby.
I will come back when I'm feeling better and strong enough to give support.
I hope that you understand.
Lots of love to everybody, sending healing vines.
Marlena

 

Take care of yourself, that's the most important.

 

Thank you so much.

 

Thank you Elizabeth

 

I am so sorry to hear that things are so stressed for you at the moment .. well I knew that you had a lot on your plate my lovely.

Hope that Simon and Rocky get better soon and that you can have some peace of mind.

Thanks for your help for so very long and hope that things get better for you soon and that we will see you again soon.

Love and hugs,

Looby and Smiffy xxxxxx

PS Will stay in touch otherwise every now and then

 

@MrWorfMen's Mom @Alexi @Louise1989 @Woodsywife

Smiffy's AMPS is 10.6 so as I am not around to test her at her Nadir I am not going to give her her shot until I know a bit more about what is going on with her numbers now that they are falling lower again .....

I am really pleased for her but I am not going to risk her going into dangerous numbers during the day ......

She is 9.7 (175) at +4 so she is still holding that number from her PMPS last night

 

Lucille, I'm sure that my following post is going to be reported, but anyway, I just have to get this off my chest:

- Comment removed by Moderator. -

Now, it's time for you to pull your finger out!!!!

I can easily admit that you have some problems:
- your DH is often abroad,
- you live in a small house,
- you have some anxiety problems,
- you have an aversion for syringe,
- Smiffy doesn't like wet food,
- you have server problem (you gave me this excuse last night when you "were unable to open the link I gave you, and thus, you felt obligated to directly go to FB to pray for a paraphrase about Somogy effect)....
- and a lot of other excuses....

- Comment removed by Moderator. -

In your SS, we cannot see that Smiffy is hitting the healing range, at any time. You have now in hand enough data to predict Smiffy's reactions.
And please, avoid the excuse "I'm not here to watch on Smiffy during the morning", in that case, please find another schedule time for shots that allow you to watch carefully your cat.
You have the advantage, compared to other caregivers, who work all day long, to be able to monitor during the day. At least, take benefit of it!!!!

- Comment removed by Moderator. -

Sorry, I had to tell that. I can of course understand that my post will be reported, but anyway, that's what I think....

 

Wow!!!!!

That is really really unkind and uncalled for Sophie - I am really surprised at you! If you really understood my circumstances you would know that I have done very well with Smiffy.

I am really disappointed and terribly hurt by your comments!

Actually I could do very little on my new laptop yesterday - even 'chat' on Facebook was going in and out so I was having a really rough time of it - especially as I am on my own.

I am speechless

@Marje and Gracie help me out here ... I don't want to report Capoo but this is really horrible treatment ..... I am shaking I am so upset .... I don't know what to say!

 

Lucille,

You need a kick ass in order to improve Smiffy's regulation!

You are on this board for nearly 6 months, you have already received a lot of information, a terrible amount of good advises,...
Now, everything is in your hands : you apply what has been given to you, or you continue as usual....

Once again, I'm totally sure that if Smiffy was transitioned to a 100% wet food diet, she would be in remission. That's not a big deal, isn't it, compared to shoots, tests....

Please note - Switching to a 100% wet diet and a short stint on insulin has often been all it takes for kitty to go into remission, but there are no guarantees.

 

I didn't realise you had such a cold heart ....

If you could see the difference in Smiffy and understood my circumstances you would not be so unkind.

There are a lot of people who think I have done really well with Smiffy and it is because I have learned here and followed advice ....

I CANNOT FORCE Smiffy to eat wet food .... some cats just don't eat it .... she has a wet lunch snack and that is the best I have been able to achieve thus far and even then she mostly just licks the jelly and doesn't actaully eat the meat ...

I am beyond speechless - I don't know why I am trying to defend myself .... please don't try to sabotage this thread for Smiffy any further please Sophie!

@Marje and Gracie

 

To sabotage this thread for Smiffy????
Are you kidding????

I'm telling that's Smiffy isn't the problem here, but that you are the problem here.

You are no more a new-by, you need a kick-ass....

 

Until I can get Smiffy to Roberta her Vet my aim is to keep Smiffy in numbers under the renal threshold and at the same time not in risk of a hypo by me over dosing her.

Please try to understand my circumstances and all that I have achieved for Smiffy and respect what I am trying to do for her ... I have been following advice here on the Board regarding her sliding scale and dosing and this advice has come from some of your peers.

 

THIS THREAD IS NOW CLOSED!
Comments to follow after I've had a chance to review this thread.

@Looby & Smiffy -- Start a new thread if you want to... or don't. It's up to you. However, if you bring up anything posted in this thread I will close that one, too.

​

 

This is a purr-fect opportunity for everyone to review the following documents:

Feline Diabetes Message Board (FDMB) Guide to Posting Etiquette
Summary of Community Rules:
The purpose of this community is to help people give their diabetic cats the best care possible. We also recognize that dealing with the illness of a beloved animal companion is often very stressful. Therefore, we follow these basic rules of behavior:

• Be kind.
• Be polite.
• Inform yourself.
• Never personally attack anyone.
• Recognize that reasonable people can differ on many aspects of treatment.
• Check your ego at the door.

Terms of Use/Rules

Suggestions for Advice Givers



Removing my moderator hat, a personal comment...

I've been a member of the FDMB for a long time. I understand and remember all too well the frustration felt as a caregiver. I can also feel the aggravation sometimes felt when being the one offering advice.

That said, the best advice I can offer today...

For those offering suggestions/advice: Sometimes it's best for someone offering advice or suggestions to simply walk away from a given situation. One of my favorite lines from the Suggestions for Advice Givers: "You can offer help and advice, but it's up to the other person to decide what advice to take for their cat. They won't always agree with you -- that's life. If it makes you crazy, move on to someone who is interested in what you have to say."

For caregivers: Sometimes it's in your kitty's best interest to listen and rethink/reconsider advice and suggestions made even when the comments may seem brutal... especially when the same suggestions and advice appears to follow a recurring theme. When the same advice is offered over and over again from multiple members, it may be the best damn advice you're going to get!