Xuxu 1/17/13 750.

I'm still trying to get my head around the discussion on my post yesterday. The discussion was that Xuxu is still going 750 at the ends of a 12 cycle because he's rebounding which means the dose is too high??? But if the nadir isn't low enough to get near a normal range then what good does the insulin do? Isn't the nadir what determines what the dose should be? I understand about the reaction to prevent hypo, but his curve on Sunday was only down to 197, so why would his physiology respond in a protective action to go clear up to 750 again. I get the idea that the body is adjusting over time, but as a biologist, I see it as a physiological process. The discussion I've seen with talk about the body being afraid of good levels, that almost seems like assigning athropormorphic emotional features to a cell. I respect all the experience on this board, but it just doesn't make sense to me.

There was a question about how I'm injecting. He does have tough thick skin, it's a Birman trait. I'm using a regular diabetic needle (relion). My vet showed me how to make sure the injection is going below the skin and when he kept having 750 readings all day, she had me show her what I was doing to double check and she says it's correct. She also got me in the habit of doing a U from one mid-side around the hips to the other mid-side so there is at least a week before getting back to the same area. That leaves the neck/scruff for putting in the subq fluids. I'm pretty confident that the insulin is getting to the right place and depth.

I have him scheduled for a thyroid test next Monday.

 

Re: Xuxu 1/15/13,

Deb, a lot of the terms used, liked "scared liver", or whatever it was, are coined to try and explain concepts to people with no medical background. I have to confess to never questioning those terms even though they are not exact. I can understand that with your background you want facts and clear explanations.

You are right to question the explanations if they don't make sense to you.

When Xuxu dropped to 25 from a 690 and then ended up back at 750+ is sure looks like rebound to me. Chronic rebound can leave the numbers high and flat or with movement but not down to "normal" nadirs because the body is constantly "fighting" the exogenous insulin to prevent a hypo. Another thing that seems happens is that their body can get used to a certain BG level over time and a drop below that, even though it isn't to a dangerous low, can trigger a rebound response. Reducing the dose can allow the numbers to drop more because it allows the rebound response to stop.

When I switched Beau to lev he dropped to 35 on the 3rd shot and I reduced his dose. Then he was up in higher numbers with no decent nadir for a few cycles, had one good cycle, followed by being back in the 200s and 300s so I raised his dose - got no real change, raised him again and began to get a few decent nadirs, but also a few sudden drops to lows followed by flat numbers again. I bounced back and forth between doses where one seemed like too much and the other not enough. It turned out they were both too much and when I finally dropped him below the lower one his numbers suddenly got a lot better. I continued to lower his dose and his numbers continued to get better. 6 weeks later he was off insulin.

One thing that I think is really throwing most of us are these 500 to 750 numbers. I have seen a lot of 500s and a few 600s but never a 700. And in most of those cases those were numbers from either rebound and/or high carb food. The insulin is clearly working because it is bringing him from 690 to 25. A dose that has that much action is astounding to me. We are usually looking at doses that move the numbers by 100-200 points or something - not 660. It is drops like that that "scare" up the rebound response since the body detects a rapidly falling BG and can't know where it will stop without intervention. Our experience tells us that reducing the dose takes the force out of both the drop and the response (rebound) to the drop. All the other things that have been suggested are not to question you or your abilities, but to try and eliminate any possible factors that can influence the blood sugar levels - particularly to prevent them from going so high.

There is another good website with tons of great information about feline diabetes and the various complications to regulation, like rebound, called petdiabeteswiki. You might find some explanations there that make more sense. Here is a link: http://petdiabetes.wikia.com/wiki/Main_Page

 

Re: Xuxu 1/15/13,

Thanks Sheila for sticking with me as I try to understand it. I can relate what you are saying to my own condition. I have myofascial pain, with tight muscle knots (trigger points) that have to be worked out by massage. My PT explained to me that muscles have memory, and you have to slowly consistently keep releasing the knots until the muscle stops trying to go back into the knot. Then you can start strengthening the muscle as it "remembers" how to stay relaxed. It took 6 months of massage the first time I was dx'd before I felt normal. I still have to maintain the massage on a consistent basis, or my skeletal structure causes the muscle to return to a knot. I'm never cured, just periodically can get to a better state.

Anyway, if he is rebounding, and we want a slow smooth curve, so the question is if I should reduce the Levemir dose form 1.5. It seems to me it would keep him high again, but i'm willing to try it for a couple of days. I already have another old cat that goes into seizures from lack of oxygen to the brain (respiratory problem), and Xuxu has had one as well when he went DKA in Nov. So I don't want to let him stay really high for very many days.

BTW, as a biologist, I do understand that sometimes "sh_t happens" and you get one outlier for which there is no explanation that we can see. Maybe Xuxu is that outlier. Certainly several specialists from vet schools have looked at his numbers and said just to put him down primarily (IMHO) because they could figure out what was going on.

 

Re: Xuxu 1/15/13,

Well, "I am confused by these numbers" is NO reason to put down a diabetic cat!!!! So many of us here have had well meaning family members (my mother) and friends, and vets, suggest that as the first (and only) response to the diagnosis. I can not imagine giving up on Beau nearly 6 years ago - and he is still here, off insulin, and slowly becoming an old man cat - something I never dared to hope for.

I fully support you doing whatever you need to to get Xuxu healthy again - whether that is as a regulated diabetic on insulin or as a diet controlled one in "remission".

Right now you could try staying with 1.5u for up to a week and see if his curve evens out and comes down. One of the first steps is flattening the curve and then slowing raising the dose to bring it down. If the BG swings continue then you need to decide to either raise the dose or decrease the dose to stop them. Because I have not seen how a cat going to 750 regularly responds to dose changes, I can't really say "this is what I would do..." Also, because he has been DKA you need to be more cautious. The conservative thing would be to slowly raise the dose and see if you can being things down, but if he is rebounding even on 1.5u that could make it worse - with a repeat if his first shot of lev, which you don't want.

Do you test for ketones at home with ketostiks? If you do and you feel confident that he is well hydrated and getting enough food you could try going to 1u and see if his numbers get better. Given that he because diabetic so fast and after a surgery, maybe it was some sort of transient diabetes.

Unfortunately, I don't think any of what I posted really helps you. It is still a decision you need to make, but maybe you have some more ideas of what to look for in his number patterns and what to watch for in his behavior that will give you more data. More data, makes for a clearer decision - usually!

I had some PT for a shoulder issue - with muscle knots that would not give to regular therapies so the PT did deep muscle message. Man, was that painful! But it did the trick and the muscle "let go" and I could finally get my shoulder back into proper alignment and then work to keep it there. Does your muscle pain center in the bigger muscles or in all muscles? Is there anything you can do to keep them unknotted longer - like swimming or a hot tub? It just seems like heat and movement would help. How about yoga? I am so sorry you are facing this, Deb.

 

Re: Xuxu 1/15/13,

Well now I'm totally flummoxed. I'm working at home to day and wanted to do nadir, which has seemed to be 6-7 hours. @6 hrs, he was 155, I though that's great. But I did it at 7.5 hrs and he's 35! Does this make any sense? He should be going up by then. I even did both ears to make sure, the other was 37. I''ve given him some Karo and will check in 30 min.

 

Re: Xuxu 1/15/13,

Well he just earned himself a reduction in dose that is for sure. Anything under 50 on a newly dxed diabetic is a dose reduction. He just told you loud and clear that his dose is too high.

For what it is worth I wouldn't have given karo at 37 I would have given a small amount of regular low carb food and keep testing, unless he was clearly showing signs of hypo. Some nondiabetics routinely run in the 40s so while a 37 is a number to watch and test often, it isn't really one to pull out the High carb or Karo for unless they are clearly in hypo.

Mel, Maxwell, Autumn & The Fur Gang

 

Re: Xuxu 1/15/13,

he wasn't breathing heavy, but he was very lethargic. He was under the bed which is a sure sign that he's not feeling well. I don't know, my vet said do the Karo under 50, it would have been another 10 minutes before I could have gotten some food in a syringe to feed, and I've seen him go nearly comatose in that time. He's acting better now that it's up to 123. I have to leave for an hour, but hubby will watch him for me.

 

Re: Xuxu 1/15/13,

Is he not eating on his own? If you mentioned that you were having to force feed him I must have missed it, I thought he was eating on his own.

Mel, Maxwell, Autumn & The Fur Gang

 

Re: Xuxu 1/15/13,

He is eating on his own, but when he gets that low for very long he's nearly comatose, he would not chew on his own. He would still swallow a liquid. We've nearly lost him several times and minutes count with him. He'd already been out of my sight for 30 minutes under the bed, I didn't know how long he'd been that low or acting lethargic. I guess I'll drop back to 1 U and see how he does on that.

 

Re: Xuxu 1/15/13,

I had missed the fact that you are using the Alphatrak as a meter so yes a 37 is a reason for pulling out the Karo. I just have gotten so use to folks around here using a human meter that I didn't think to check to see which one you were using. as that would basically equate to a 7 on a human meter..yikes!

Mel, Maxwell, Autumn & The Fur Gang

 

Re: Xuxu 1/15/13,

Definitely reduce the dose after the low today. Can't remember what you answered to my testing for ketones question, but you should do that regularly while you are working with the reduced dose just to be on the safe side with him.

I had no idea an AlphaTrak meter was that far "off" from a human one. Mel where did you get your info on that? Are the top end numbers also really "exaggerated" compared to what we would see on a Contour meter? Maybe if the 750s equaled a Contour's 500 it would make more sense to me.

Deb, I am actually wondering if he still needs insulin - that's why I commented on his diabetes possibly being transient. However, you just need to follow his numbers down and reduce as he hits these low (and, hopefully, not THIS low!)

Yikes is right.

PS - he cam up nicely from that, what was his PS tonight?

 

Re: Xuxu 1/15/13,

Sheila,

I just know that the Alphatrak reads about 30 points higher than a human meter. So whereas normal for cats on a human meter is between 40-120 on the Alphatrak it is between 70-150.

Mel, Maxwell, Autumn & The Fur Gang

 

Re: Xuxu 1/15/13,

What I am wondering is if it that is a constant (always 30 pts higher) or some geometric relationship that makes those high so, well, d*mn high?

 

Re: Xuxu 1/15/13,

I have wondered that too, wish there was a way to test it without 1) Having a wildly unregulated kitty & 2) Having to put out the $$$$$ for the Alphatrak. I would think that the two meters would be closer together at the low end because I can't imagine a cat even still breathing at 7 on a human meter which is what that 37 would have equated to if the Alphatrak was always 30 points higher..so if they are closer together on the low end, I would think they would be farther apart on the high end.

Something else to add to my "If I win the Lottery I want to do" list..

Mel, Maxwell, Autumn & The Fur Gang

 

Re: Xuxu 1/15/13,

Our router went out and we just got the new one running. I've just reposted his sheet.
Look at the last 2 days. He went down at the 2nd 10th hr yesterday, it was just a spot check, then back up to 750 an hour later. Today, he hasn't really gone down much at all. He hasn't eaten much either. I just gave his mirtazapine half a day early to get him to eat. and I'm finally convinced, I'll give a 2 wk trial to canned food only. It will mean confining him to the bedroom completely which he will hate. I hope he doesn't get depressed. But that's where I telework from so I'm there all day a couple of days a week.

I'm giving him 100 cc of subq fluids every night. That's the only thing he gets grumpy about. The blood for his tests flows easily, his gums and eyes are moist. So I think he is well hydrated. I felt I was giving the shots correctly before, but I've been very careful and attentive to how I'm giving him them the last 3 days. It sure seems like they are going clear through the skin, there is no lump like you get when it's in the epidermis. I'm using the standard 100 insulin needle.

We hoped his diabetes was transient, but if his BG is still 750, doesn't that mean he still needs insulin? I let him go 18 hrs before starting the Levimir and he stayed high.

I do have a human meter that I got a while ago. I'll do both at next test, he usually gives me way more blood than I need.

I do have ketone strips, but haven't checked him lately. I'll do that the next time I see him pee. I've even checked his temp and it's been around 100F every time.

On my problems, I do have a small hot tub, and have an Arthritis Foundation Aquatherapy class in a heated pool twice a week. That all certainly helps. But it's the regular massage that makes the most difference. I seem to have triggerpoints everywhere. Myofascial Pain Syndrome is one of those things that seems to come up with medical stress. Mine went big time after a hip replacement and lower back fusion. I've since had 3 more surgeries and there will be more, all for arthritis based problems. It's the reason I had to stop breeding and showing. I just couldn't do it anymore because I went to shows and took care of the cats by myself. Hubby helps with the cats now but he never had any interest in cat shows. And I always figured I needed to stop having kittens 20 yrs before I wanted to be completely free of pets so I could travel. Everyone I have left is over 10 yrs now, but they could all live to 18. Having 4 of them with health problems now is a handful, I can't imagine having a dozen more with problems in a few years.

 

I know Lu (and Grayson) is doing a testing run of three meters- Relion, Accucheck, and Alpha (I think those are it or it could just be three human meters) and the lower the numbers go the closer they are together. the higher the numbers go the more variance there is between them.