Wackiness #'s-Copper

Copper's amps is 323. Last night his pmps was 214. So what is going on. He didn't get that much to eat last night and it was all no carb food. What is up with his wacky numbers? Not sure what to shoot this am, .8 or 1u? I will not be here for late afternoon readings (+6 and on).

lori

 

There must be something the cats know about this weekend as many have been getting odd numbers. And Copper sure seems to want to keep you guessing! :mrgreen:

If I couldn't be home, I'd sure hate to up Poopy's dose with those numbers and would stick with the .8u. Seems Copper likes to float between the .8u and 1u.

 

I will have to agree about something's up with all the kitties this weekend. Must be something in the air.

Yea, i agree about the .8u. I had decided to stick with the .8 for today and get what numbers i can. I would go up to 1u, but just not sure which direction he will go. He keeps me hopping for sure. ope the air clears soon. WACKY!!!

lori

 

What is going on? He is going up after his ps and then going down as the insulin wears off? What does that mean? Too much????? I was thinking i needed to give him more insulin. Now i'm questioning everything. I hate this guessing over and over everyday. Wish he would be more consistent. I'm really thrown for a loop at all this wacky numbers? :dizcat

HELP! Need other brains to help figure this out.

Lori

 

Not counting last night's weird PMPS and the decreased dose I gave this morning because of it, Poopy usually fluctuates between 1.2u and 1.4u. Looks like Copper does the same between .8u and 1u. If his PMPS tonight is closer to 300, I'd be tempted to do the 1u. Closer to 200 and I'd stick with the .8u. That's just me, though. :smile:

 

Hi Lori,
Curious to know if you are feeding him with his AMPS? If so, can it be that he was trending upwards already and the food caused an additional spike? If ProZinc can take up to 2 hrs to 'kick in' then that could be a possible cause of giving the shot and getting a higher BG # at +2, +3?

 

Assuming his numbers are rising before every shot....

A curve "should" look like this.

AMPS
+1 to +2 BG should rise due to food at shot time
+3 to +6 BG should drop due to insulin taking effect and peaking
+7 t0 PMPS BG should gradually rise, first slowly, then more rapidly as the insulin tapers off. There may be some surf in the +6 to +9 range.

The nadir can happen between +5 and +7. The duration can be anywhere between 10 and 14 hours depending on the cat (according to the Prozinc website)

Any time food is fed during the cycle, you would see a "food spike" within the first two hours after eating. It may not show as a rising number. It may just not allow the BG to go as low as it might have if food had not been eaten.

Copper seems to have long duration some days, while on other days he might have "normal" duration. No idea why that happens, but it obviously does.

Excessive duration can indicate a dose that is too high. Super low numbers can indicate a dose that is too high. Conversely a dose that is too small can cause a shallow curve, or it might show a shorter duration. Nothing about this is logical or simple it seems. It just "is".

So you have:
Long duration
Short duration
Deep curve
Shallow curve.
Here's the kicker. All 4 of these things can happen on the same dose! Four different patterns all on one dose. We have all seen it happen, and not just with Copper. With every kitty.

Here's where I'm going with this....

Given that all these different things can happen without making any adjustments to dosage, now throw changing doses into the mix. The simple reality is that you don't know if the different results are happening "just because", or because of the changes to dose. No way to tell for sure.

Something that Dr. Lisa said several weeks ago keeps tugging at my brain.

Now, remember, that was when Copper was getting 2.6 or 2.8, so the difference was only 7% in the amount of insulin. Today, Copper is fluctuating between .8 and 1.0, which is a 20% difference. So with that much more of a difference, we would expect to see some sort of "real" difference in the BG numbers. But I don't think we do, not consistently anyway. So that just leaves me (and others) even more confused.

I think that perhaps the big factor in how his BGs act is that some days it looks like his pancreas decides to help, and some days it doesn't. I think I have seen that referred to a "sputtering pancreas". What is scary is that you never know when the pancreas is going to decide to work well, or when it isn't, if that is actually what is causing the confusion with his numbers.

Look back at the period of 1/5 thru 1/10. There were cycles, like the AM cycle on 1/7 that show a perfectly shaped curve on a dose of 1.8. But on the 6th and the 8th, exact same dose, but the curves are not good. On the 6th, he was flat. On the 8th, there is no curve. It just drops from AMPS to PMPS. All on the same dose. On the PM cycles, each day, he got a fat 1.6 (now I will agree with Dr. Lisa here....the difference between 1.8 and a fat 1.6? I don't think there really is a difference, not one that matters anyway.) But for some unexplained reason, the shot on the PMPS on the 10th caused a "no shoot" AMPS on the 11th. Why? Pancreas? I have no idea. The same thing had happened just two days earlier. 1.6 at night caused a "no shoot" AMPS the morning of the 9th.
On the 11th, Lori had to wait until +19 to shoot a small dose of .8, and then it looks like his pancreas decided to take a vacation. The next day, AMPS he got 1.0. Nothing happened all day on the 12th. Flatness. That night, he got .8.

OK. Look at the total insulin given on the 10th. It was 2.6u. Two days later, on the 12th, he got a total of 1.8 units. Why? Because on the night of the 10th, it looks like his pancreas woke up again. Then it went back to sleep. The morning of the 13th, he had the highest AMPS he'd had in a while, got only 1u, and lo and behold, Mr. Pancreas woke up again! But late in the cycle it looks like, because once again, Lori was forced to withhold shooting due to the low PMPS. The morning of the 14th, he had an expected high AMPS due to no insulin for 23 hours. That day, his cycle was not all that great. Small curve, higher PMPS.
Yesterday, on .8, the curve looks inverse? No clue why. Today, flat or slightly inverse on .8? What? Why? No clue.

OK, my logical mind says "Copper is not getting enough insulin". Because his dose has gone all the way down to .8, and it was 2.8 a month ago, and 1.8 two weeks ago. But looking at his curves, that logic is shot all to hell.

I have no clue at all what is going on inside Copper's body. As frustrating as that is to me, I can't imagine how frustrating it is to Lori (or to Copper for that matter!).

I can't sit here and say "up the dose", and the major reason for that is because I keep seeing these cycles where is AMPS is higher than his PMPS, and there's no "dip" in between. Just a slanted line downward all day long. The exact pattern he was showing prior to his first "hypo" on Dec. 18th. I don't know if it is too much insulin, but it is showing what looks like "long duration". I don't want to tell you to reduce the dose either, because I don't want to see high numbers.

I am totally confused and at a loss here.

 

Carl, Wow that was thorough! I'm glad to see a GREAT mind see's it the way i do, confusing as....... :dizcat !!!!!!!!

So, that leaves me right where i started from, lost at what to do. Just when i though he was recovering and getting better. UGH!

The next two days are very busy for us and can't be here in the afternoon's for nadir or even after +4. I hate to see him with high numbers and feel guilty he is damaging his organs everyday that he is in these numbers. So my instincts are to give more and deal with the lows and try to catch it and keep him even? Maybe some TR? Who knows. But, i just can't have the risk of hypo when i'm not around. So, guess that answers the questions for the next two days anyway. Two days is a long way away. Pray Mr. P decides to quit sleeping and get with the program here!!!!!!!!!!

THANKS for brainstorming with me!! At least i don't feel so alone in this confusion and frustration. I can only do the best that i can do with what i know.

Lori

 

I have been so busy lately and have not been following Copper's saga but I want to reiterate the above because I often see folks on this board getting so caught up in the insulin dosage (down to overdone minutia....driving themselves crazy....) as if that is the only issue...and as if 0.1 (not even measurable...) or 0.2 units (highly doubtful that this level is accurately measured...) is the end all...be all...'deal breaker' for the cat's situation when it simply is only one TINY (at that level of change) piece of a very complicated puzzle.

Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.

(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)

Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:

*Exogenous insulin absorption

*Endogenous insulin production

*Intracellular uptake of exogenous and endogenous insulin

*Insulin degradation and elimination - different for exogenous vs endogenous

*Intestinal glucose absorption

*Endogenous glucose production

*Tissue glucose uptake and utilization

and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....

....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)

When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.

Carl - it is great that you take the time to really think these cases through and I know that Lori deeply appreciates the time you, and everyone else here, have spent on Copper's case. He is not an easy one, that is for sure.

 

As usual, THANKS Dr. P for the encouragement and the amazing info on all the factors involved in FD. After reading about all the factors involved in BG levels, it's a miracle that FD can be regulated at all.

I'll try not to stress over it all, but as you know it's hard for me because i want to figure it all out and just get him better. I'm learning, very slowly though to just go with the flow of what copper's body is saying for the day.

Thanks for the info on the miralax. Started him on it today (1/8tsp 2xday) and he is already doing better tonight with his poop. I will work my way up to 1/4tsp 2xday in the next couple of days. Copper thanks you too! I know he has to feel better for not having to struggle so hard to poop.

Thanks again for all you do!

God Bless!

lori

 

Wacky tonight again. Stayed up to do the +4 pmps reading and now he has dropped to 152. Cra... Now i have to stay up all night checking him so he wont hypo. Wish he would be consistent. I didn't change his dosage at all and his last two day readings have all been flat and high. Don't know what happened? Guess his Pancreas started to kick in tonight. I guess i will have to go down tomorrow because i will not be around in the afternoons after +4. This is driving me bonkers!

Will check back in an hour.....

lori

 

Mr. P decided to wake up last night. +4 @152. Got through the night ok. I guess he ate too much after +4 and his +6 was high. So set alarm and got up 2hrs later and checked him and was doing ok. Decided not to test him because of sore ears. Fed him a little and went to bed for couple of hours. This morning he was doing great, just hungry. His amps was a surprising 254. So went with the .8u again today, although i will not be home after +3 today. My girls and babysitter will keep an eye on him and feed him for me. I think he will be ok.

WIll get +3 before i leave and see where he is at. He went outside this am and wanted to play with the birdies at bird feeder. First time he has done this in days. He is hanging out with the family more this am. He just looks better in general, although his neuro still bad.

Will check in later.

lori

 

Good to hear that he is doing well and wants to play with the birdies. Nice AMPS!

 

glad the miralax worked for copper this dance always keeps us on our toes I think you are doing wonderful cat_pet_icon dancing_cat

 

Thanks all! I was gone all day for dr's appt's and came home right at pmps time and DH, bless his heart, had just given him some food to eat 15-20min before i got home. So i tested right away and got pmps@314. Not sure if that was beginning of food spike or not. So gave the .8u anyway and will test him in +4hrs. Hopefully Mr. P will ZZZZZZ tonight. I'm tired. I did test @+3.5 before i left this morning and he was dropping. So maybe he went down to a nice nadir today. The girls said he was doing well all day and they kept feeding him.

We shall see.....

Lori

 

pm +3.5 @292.

Going to catch some zzzzzzzzzz

lori

 

good night Lori and copper

 

You are doing great Lori!
is he taking anything for the neuropathy?
Sorry cant remember

 

You are doing great Lori!
is he taking anything for the neuropathy?
Sorry cant remember

 

It's nice that DH helps out.

You are doing great.

 

Thanks for the encouragement everyone!

Copper's amps@292. Going to be gone most of day again from +2 to +9. So gave the .8u again today. Will test the +2, but sure it will be a food spike #. Will test when i get home this afternoon. My family will be around today to watch him and feed at needed times.

Robin,

So good to see you on the boards, even in your grief. I'm amazed at your strength and admire it! Hope you are doing ok. Yes, DH helps when he can. He works a lot of hours, so not home much. So funny, last night he said, "Copper made me give him some food. He was bitting his feet for food." Don't blame him, i would of givin in too!

Have a good day everyone!

lori

 

Don't be too impressed. If Sue wasn't on vacation I wouldn't be here right now, I'd still be curled up under a blanket. While logging on is a comforting ritual, seeing his avatar brings tears to my eyes with every post.

 

Robin,

I'm still proud of you. I know how hard it is to loose such a good friend and how painful greif is. It just shows your unselfish nature. I've been praying for you everyday!

Lori

 

Looking good Lori,

Looks like Copper's levels are more balanced each day without any huge swings.

 

Yes. The funny thing is that i haven't changed a thing because i've been busy the last couple of days so was forced to keep dosage the same. He came down on his own without going up. Now i know why they suggest to stay on the same dosage for several days.

My girls today said he was doing great. Haven't been able to test him, so we shall see tonight's pmps.

GOOD NEWS: His neuropathy is finally getting better. He walked normal up stairs and down stairs tonight. YEA! Progress!

lori

 

His pmps is @ 279. Pretty good. Not sure what his nadir was today, wasn't home. He layed on my lap this evening for a little and prrrrr. Getting my kitty back again. YEA! I like seeing him feeling a little better.

Lori

 

Really good news!! The neuro is so heartbreaking. Very happy to see some progress made.

 

so good to hear copper is doing better :YMHUG: before you know it he will be running around like the tazmaenen devil is chasing him :lol:

 

I sure hope he stays getting better! The neuropathy is the worst thing i've ever seen in a cat. Just one day he was fine, the next, could hardley walk.

Thanks for the support and encouragement all! Your the best!!!!

lori