8/14 Michael AMPS 464 +10 294 PMPS 263 +2 250

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Re: 8/14 Michael AMPS 464

Ah, he's being a fickle FD kitty, isn't he? Wanna nudge it down to the blues for MamaBea, Michael? Have a great day, Paula!
 
Re: 8/14 Michael AMPS 464

Hi Paula!

Don't worry about trying to absorb it all right now.

In response to your post yesterday, your goal isn't to try to get Michael used to a dose, it's to get him used to healthy numbers. Does that make sense? So you adjust the dose to try to keep him in healthy numbers.

I'm watching for you every day and will help you - others will too. We can tell you when we'd suggest you change the dose. For right now, I would keep giving the 1.0u. When I see the red this morning, I think he might have gotten lower last night. It really helps if you don't skip testing and get at least one test in each cycle.

Look back to August 9th. See how he went from am+6/311 to pmps 169 to pm+4/333? I think he's dropping down very quickly and then zooming right back up. If you had skipped his pmps, we'd have assumed he was likely solid pink the entire day.

Just keep with the 1.0 for now and continue getting a sprinkling of tests at different times in between shots. You're doing fine - it takes everyone a while to get the hang of this. :-D
 
Re: 8/14 Michael AMPS 464

HI there :cool:

That red AMPS makes me wonder where Michael went last night - he may very well have visited lower numbers, numbers that his system is not accustomed to and interprets as potentially dangerous. So counter-regulatory hormones are released into the bloodstream in a heroic effort to bring BGs back up.

Like Julie said, the goal is to get Michael used to healthy numbers. The more time he spends in healthy numbers the better - you will be lowering the ceiling, creating a new normal and his cycles will gradually start to smooth out along the way.

Lik Michael, my boy BK has hyper thyroid too - The pill pockets didn't work but fortunately I can grind his 1/2 tablet into a powder and add it into about 1/4 can of food. No problem :-D

Hang in there - and hang in here !
 
Re: 8/14 Michael AMPS 464

Paula

You are doing great with Michael. As Julie suggested, a few more tests at certain times would be very helpful if you are able to do them.

Also....on the pill pockets. I understand Michael doesn't like the FD friendly duck and pea. They used to make one for cats and Gracie liked them. But they stopped and the only ones now are for dogs and they have a really smoky smell that Gracie doesn't like. So I use the feline chicken pill pockets. The way I keep it from impacting her BG too much is I use the tiniest piece to wrap her pills in. The pockets are big; I never use a whole or even a half pill pocket. I'd be surprised if I use even 1/8. It's the smallest amount I can tear off a whole pill pocket and surround the pill.

Somogyi has not been documented as occurring in cats. In theory, Somogyi, as Julie explained, results from chronic overdose. Julie did a good job of explaining the difference between Somogyi (chronic rebound) and bouncing. Most vets look at bouncing and think it is Somogyi. But if they really studied the SSs, they would see that a cat will bounce from any lower number that it is not used to or from fast drops. Also, the way we increase/decrease doses in very small increments under the TR protocol, it is difficult to get a cat overdose.

Here is some additional information Sienne posted on Gracie's condo when we were new and had a vet tell us Gracie was experiencing Somogyi. She wasn't; she was just bouncing.
For a theory that has so many people convinced that it is a factor in human as well as in feline diabetes, there is an amazingly small amount of research on the topic. The earliest paper by Michael Somogyi, is from the 1930s and was not published in a widely recognized medical journal (i.e., it was in the Weekly Bulletin of the St. Louis Medical Society). Note that this was a report based on 5 human subjects and urine glucose, not blood glucose was measured. More recent reports note that Somogyi's observations have not been reliably reproduced under controlled conditions.

Gale, EA., et al., Lancet, 1980, pp 279-282, In search of the Somogyi effect wrote:
Although some patients had a very rapid fluctuation from hypoglycaemia to hyperglycaemia, we found no evidence that changes in counterregulatory hormone levels were responsible.The preceding interval of hypoglycemia was often prolonged, which implied defective homeostasis, and the difference between the patients with apparent rebound and those without could not be explained in terms of circulating levels of cortisol, growth hormone, or glucagon. Other workers have noted very variable changes in growth-hormone and cortisol levels after acute hypoglycsemia in unstable diabetics. We did not measure catecholamines and cannot rule out the possibility that they were partly responsible for the difference between our groups. However, the evidence presented here suggests that free insulin is the major factor involved.

In addition to the dearth of empirical research, there is even less that pertains to cats and none that addresses Somogyi phenomenon in the use of Lantus. Given that the presence of Somogyi is believed to be associated with doses that are raised in too large of an increment, it is surprising that this IM vet would not be an enthusiastic supporter of the Queensland/Rand tight regulation protocol. (FYI - there is another TR protocol and the vet may have assumed this was the one you were referring to.)

This is a link to info on Chronic Somogyi Rebound on Wiki. I would draw your attention to the section on Controversy:
Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night fail to wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.

This information pertains to humans, not cats. However, the phenomenon was based on humans and extrapolated to felines so I'm going to presume the issues with the paucity as well as quality of the research are the same.
 
Re: 8/14 Michael AMPS 464 +10 294

Thanks All for the replies and info.
Julie, again thanks for watching everyday, and I will try & test more when I can.
If the goal is to adjust the dose to keep him in healthy #'s Then it doesn't matter how long he stays on the dose? (still confused). How do I get the Vet to understand this without her thinking I don't trust her judgement? She really is a good vet.
 
Re: 8/14 Michael AMPS 464 +10 294 PMPS 263

Honestly, what I would do is stop talking to the vet about dose. She isn't in your kitchen watching you shoot. You have lots of company in this, probably 75% of new people ask this question. I just now posted in Booger's condo about it. Nod at her dose advice and come here for help.

I sympathize - went through it myself. The people here discovered my vet had me using the wrong syringes , an error that coudve killed punkin if he hadn't had acromegaly. By the time he had made several mistakes that people here caught, he stopped trying to advise me on dose. Loved my vet, but I realized I needed people who had far more experience in feline diabetes than my vet had. I put punkin's needs above my loyalty to the vet I'd been with for 25 years and a dozen pets. I felt like I had to for his sake.
 
Re: 8/14 Michael AMPS 464 +10 294 PMPS 263

Thanks Julie. I'll try nodding my head.
I tried the Terumo syringes 31g 3/8 in. they slide easily, but the barrel is a little narrow and the markings are hard to see. So I'm back to Monoject 29g 1/2 in U-100. Which work.
I want what is best for Michael. he is my #1 priority. I'm worried. he is losing weight. His hips are starting to indent. I don't know what will help him gain some weight. Having to diseases at once (hyper-T and Diabetes)
seems to interfere with his gaining weight. I'm worried he is losing muscle mass. He seems fine, he just looks a little thin. He needs to gain some weight.(he is a big kitty). That's why I wish he could get regulated.
Paula
 
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