? Terry stays in high numbers

Could you please check my sheet?
Terry's numbers won't go down. Today his +6 is the same as amps. And the past few days he also did not get in to the better numbers.
It looks like he did better on less insulin.

Can you help me? It's so frustrating ....
@Sue and Oliver (GA) @Alexi @Rachel @Bobbie And Bubba @Kris & Teasel

 

Hi Fabienne ~It looks like to me that Terry is bouncing from that nice blue AMPS on the 9.21. It's possible that he even went lower the night before and was on his way up . The bounces can take up to 6 cycles to clear . See how the 86 you got on 9.18 took exactly 6 cycles to clear and give you the blue on 9.21.

Get those pretty pink patience pants out and keep on getting as many tests through the cycle that you can to help us understand what is happening. My guess is that he will come on down tonight or tomorrow AM cycle.

 

Hi Fabienne,
Try not to be discouraged. Some cats take longer to get into and stay in good numbers. You can see this is the case for Teasel if you look at his spreadsheet. What keeps me sane is to stay patient and remember that this is a marathon and not a sprint. For some cats that marathon is r-e-a-l-l-y long.

 

Hi Fabienne,

At times it seems as if we get nowhere. But actually we do. I agree with others Terry is still in a bounce. Like Terry, Smokey had pretty good numbers on lower dose and I couldn't understand why. But then he stops liking the dose and turns around and back up we go. Each time it happens, bounces clear faster, and dose we have to back to is less than the previous. Does that make sense, probably not. Okay maybe this. When I found FDMB we were at 5u Vetsulin. Eventually switched to Lantus. I think we were as high as 2.75u when finally he started down the scale. Then Smokey just puts on the breaks and back up in dose we go but not as high as 2.75u before he starts back down. At one time he was down to .75u. Now at this time it looks like we will be hitting 2u in the next day or two. Now Smokey is long term diabetic with other issues and he missed months of insulin mid dx.

One thing to keep in mind. The dose will fluctuate back and forth. I personally didn't realise that in the beginning. I thought you get the dose that works and it would stay at that dose. That was before FDMB. Just keep working at it. Terry needs what ever dose Terry needs.

 

One thing to keep in mind. The dose will fluctuate back and forth. I personally didn't realise that in the beginning. I thought you get the dose that works and it would stay at that dose.

This!!!

 

Bobbie you're right. You are all right!!! Just tested +10 218!!!
I need to be more patient... ( put on the pants) and do not panic....

 

Thank you! I will try not to panic if things like this happen

 

me too Kris, I thought that too..

 

Nice +4 Fabienne!

 

@Fabiënne
Hi Fabienne,
I just looked at Terry's SS to see how he's doing and it could almost be Teasel's SS. They are so much alike in how they respond! We'll get there eventually ...

 

Hi everyone, I was wondering what you all are thinking about Terry's numbers right now.
I was thinking he was doing better on a lower dose, showing us nice blue numbers and having a 'smile curve'.
Now is again really unstable when it comes to PS numbers and +6.. He doesn't drop that much, a little like he's surfing all the time and is having later nadirs or even 'extra' drops late around +10/+11.
What do you think about this?

Let me be clear, that I do find that Terry is progressing! Since Fabienne joined FDMB you are seeing that overall those numbers are mostely yellow.
But it's frustrating to not see them go lower into blues/greens...

Is there another method that you would recommend for Fabienne to try? Maybe up the dose more often or decrease the dose more often? I feel like we are hitting a wall here (I know @Kris & Teasel can reaaaallllyyyy relate to that don't you? )

@Sue and Oliver (GA) @Rachel @Alexi @Bobbie And Bubba

 

Here are my thoughts and I have no idea if they're correct. A lot of what I'll say pertains to Teasel as well:

1. In general, more blues and greens show up when the dose is nearer to 3 units;
2. Terry gets "jumpy" when the dose gets to a more effective level;
3. If he's like Teasel (also very jumpy) you have to sneak up on the more effective dose v-e-r-y carefully and be prepared to retreat;
4. The array of pinks and yellows and flat numbers since 09.19 probably mean the dose is a bit too low;
5. If he stays higher and flatter for several days, he might get stuck there - Teasel does this. I look at it as a bit of insulin resistance building;
6. A small boost in dose might shake him out of yellows and pinks but be prepared for more jumpiness.

 

So you are saying, that you would increase the dose again but slowely to avoid of course bouncing? I do think Terry looks a lot like Teasel's case indeed! But Teasel is now showing some more nice numbers lately. We hope the same will do for Terry but i'm (like you already mentioned) a little concerned that he's a bit of insulin resistance at this point because a 'normal case' would show a PS, then drop to around 50% and then go back up slowely. But Terry is not doing that lately... So my guess would be to increase the dose to 'shock' his body a little bit so it can work with a little bit more insulin.. I think he is a little bit too comfortable with this dose don't you think?

 

But then I do find it odd for him to do 'better' on less insulin.. When he was on a 2U dose he was showing more progress then he is doing now so there needs to be made a change I think but is it increasing or decreasing....

 

I think you both have hit it on the head. They do seem to get "comfortable" with a dose and just a bit more can get them started again. Great job analyzing ladies!

 

Thanks Sue

So are you agreeing for now we can advise Fabienne to shoot the following dose?:

Pinks (16.7 -22.1mmol) 2.75
Yellows (11.2 - 16.6mmol) 2.50

 

Yes, that's what I'm saying, Ruby. That's what I have to do with Teasel and for now it seems to be helping him but you can see the back and forth dance I've been going through with him for weeks now. I do think Terry is very similar to Teasel in his responses. They're not "normal" in the way they respond - they're jittery and unpredictable. The trick is to accept that your cat is like that and be willing to do the dance the way he wants to do it. And FYI - Teasel spent his first 2 months as a diabetic on Lantus and it was no better. He started spiking and then dropping too low and then he really got stuck in insulin resistance, I think because of the residual effects of the insulin in the depot.

I'll be interested to read what others think.

 

Jittery - that is a great way to describe Teasel, Kris.

 

They indeed are not normal, but hey every cat is different and has there ways... I mean I've got Baco OTJ but this little diva is still not loosing weight and is a little bit 'food resistant aka, not losing weight' hahahaha so you know, everyone deals with there kitty in a different way.
It's just there way of doing every kind of 'dance'

 

Teasel also shows this Ruby. Have a look at his SS since I started here. I think it's all related to the way they respond to insulin. There's no smooth, predictable progression of response in relation to dose. You have to test and take it cycle by cycle, at least until they (hopefully) settle more. There are stories on FDMB of bouncy cats who eventually settle. You know ... they bounce until they stop. This is Teasel and Terry's version of "bouncing", along with the more typical BG spike after a low number. Maybe we need a new category - cats who are jittery/jumpy until they calm down.

 

I think you are right. Terry is very comfy at this dose so something got to change. Maybe increasing step by step very gently is a good idea, but I was thinking... maybe it's just a crazy feeling but I would like te hear what you think of it.

Could it be that mr P likes this ( and higher) dose, so he won't have to work for him self. My feeling is that if we decrease the dose again we will wake him and he will come and help out again.
What do you think? Makes sense or totally crazy?

 

Hi Ladies! I like the dose schedule that Ruby proposed because there is still room for him to come down. Even the 2.50 dose for yellows is not giving enough action and he is staying rather flat.

 

I think anything is possible, but I don't think I have seen it work this way. We think the renal threshold is -250 and at those numbers and below, the pancreas can heal. Eventually it starts to work - usually intermittently.

 

My experience when Bubba got stuck in the yellows was that it was a bit of glucose toxicity. Another words, they get use to higher numbers and resistant to the exogenous insulin being given. I think if it were my kitty, I would keep doing small increases to break though the numbers and also please check for ketones . Usually they show jup when a cat is stuck in higher numbers but Bubba developed them in the 200 range when he was stuck there.

 

Hi Bobbie, nice to see you again Hope you are well!

Bobbie, (and everyone who is engaged in this conversation) what time period has to be between those increases? Do we still stick to 3 days (6 cycles)? Or some what longer/shorter then that?

 

I think it's that ECID thing. Some cats do okay with switches every 6 cycles; some seem to need longer. Teasel is a great example of this - he definitely hears his own personal music in this dance. So try one way and see how that works?

 

Thanks Sue!

@Kris & Teasel how long do you keep between dose increases normally?

 

Okay I will increase the dose this evening. We will wait and see what happens.
In 2 weeks I will go on holiday for a week. I have to sitters who will test and shoot him in AM and PM. So there is no one to monitor him in between. We have to have a safe schedule by than

 

If he were real high (300-400) with little movement, I'd try 0.5 increases every 6 cycles. But since he is lower overall, maybe 0.25 increases - every 6 cycles if you can monitor on the cycle you change, or give him a little longer if you are seeing some "action"

 

Hi ladies,
I've been out so haven't added to the conversation earlier. If you look at Teasel's SS, I've held doses longer when I thought they were in more effective territory (eg. 3.0 u, 3.2 u) but changed more often if I was responding to some surprise lows. I certainly don't have a formula for him and I might never get to one. Right now I'm following my gut and what I see on the SS and hope to get better at this over time. Sometimes I feel like I'm trying to conduct an orchestra where very few of the musicians are in tune.

 

Terry is behaving a bit like my kitty, I have recently increased her dose and she is now seeming to cycle through her numbers with a bit of Mr P activity every few cycles, rinse and repeat with dosing adjustments for the lows according to her protocol (of course I have the specialist who monitors her spreadsheet and replies to e mails within a few hours - benefits of being in the trial) she was stuck in higher numbers for a few days and the dose increase seems to have benefited her numbers but I am expecting her to stay on the roller coaster for a while longer. It is a bit scary seeing some of those lower numbers but she doesn't seem to be bouncing. It would be useful to see a curve after some cycles on the higher dose to see how Terry is using the insulin.

 

I think Fabienne has time on the weekends to do a curve so that would be nice indeed to see.!

 

Haha great comparison

 

Cappuccino's sheet is colourful... he jumps around a lot! I can imagine that it is scary, such low numbers. Hope she will stabilize soon!
I will make a curve tomorrow

 

Hi everyone,, question!
Fabienne is going on holiday next friday for a week and the cat sitter can't grab midcycles.. Only PS numbers.
So is the way Fabienne is giving shots/dosis now ok? or should there be a saver dosis list to hold on to better for Terry that week?

 

The dose for the Petsitter looks okay to me. When Fabienne returns, I'd encourage her to tweak the dose up. 250s are nice, but he has room to drop.

 

Thank you, we will keep the dose this way till after vacation.
I did lower the boundery for 2.75 sonce yesterday. 16 (288) and higher 2,75 amd 11( 198) -16 2,5iu.
Is that okay?

The sitters don't have time to stall when he is under 11 so I will instruct them not to shoot under 11.

And there is an other problem, which I hope will not be an issue, but I like to be prepared.
Terry is a bit rebellious lately. Sometimes he really don't want to be tested and uses his nails to scare me off.
I am not so impressed by him and know how to act and how te be smarter than him to avoid scratches. But he could trick the sitters.
He also does this sometimes while shooting but that can be solves by giving him something to eat.
What if he doesn't let them test him??? The sitters are used to cats and have practiced on Terry so they are well instructed but they haven't done this on regular basis. So If they really cannot test him don't shoot? Or shoot less?

 

By the way , this is a good sign, this is the old dominant Terry. If he really doesn't want something it is not going to happen