4/18-19 Fred PMPS 350, +1 349, +6 412, AMPS 378 So discouraged

https://www.felinediabetes.com/FDMB/threads/4-15-fred-pmps-366-4-391-7-5-393-ketone-8.246200/

I corresponded with my vet about the possibility of doing some R, and she said that they only do that in emergency/DKA situations, so it wouldn't be a long-term solution. She then also said that she's never heard of a cat who had a Somogyi-like response when they hit normal numbers. (So I take that for what its worth)
She has again suggested an internal medicine specialist in NYC, but Fred absolutely cannot handle that drive. I just think, at this point, that they have reached their limit in what they can do for him.

To say I'm discouraged this morning is an understatement. I'm doing everything by the rules and all that I can. Out of each week, Fred has one day in decent numbers, and 6 in a bounce. (t least, I think it's bounce related) I can't get help with R/it doesn't seem to be the answer. So I increase and increase, only to have the same repeated.

We were making such progress starting in mid-March, and then the pancreatitis came along and erased that. Now, although he's acting very well, we can't get back on track. He's getting more demanding for food, which worries me. He's also starting to fight the testing, likely as I've just done too much, trying for answers and patterns. But he's just high and flat...high and flat.

I don't know what to do anymore.

 

I totally feel for you. Hang in there. It may just be a matter of needing to get to a breakthrough dose. Oberon had a similar pattern for a while where he would stay in the 300s and then every 6 cycles like clockwork he'd dive into the blues/greens for about a cycle. It was very frustrating. Once we got to about 10 U, it was like a switch flipped and he started staying nice and low with spikes into the 300s every 6 cycles. The whole pattern reversed. Some ups and downs (literally) since then, but at least I know when he gets stuck in high numbers it's just a matter of increasing until I hit an effective dose again. Hopefully you'll get to that dose soon!

 

Looks like Fred needs more basal insulin (Lantus). Getting to a better Lantus dose will also help with the bounces. I think you may have some glucose toxicity you are fighting too. The solution, again, more insulin. Back in the early days, there was a vet tech here who coined the phrase "be the tank, the tank gets where it's going". Keep increasing as per dosing method - you WILL get there. There is that breakthrough dose out there for Fred.

First of all, there is no such thing as Symogyi in cats, there has been research that studied cats on Lantus to show that. The original Symogyi research was done on fast acting insulin in a small number of humans and decades ago. What we call bounces is different. An interesting question would be how many spreadsheets has your vet seen?

 

Try not to get discouraged. It's only been a few months and you just haven't found the right dose yet for Fred...keep increasing the amount as Wendy mentioned - so that eventually you will find the dose that Fred will respond to.

If you have time, take a look around at other condos and their spreadsheets...there are several cats here that are on incredibly high doses of insulin and who are surfing along quite nicely on stabilized numbers day after day...healthy numbers for them.

It does take time and vets who are not informed of the long long road to regulation in diabetic kitties, well they're just uninformed! Try to focus on reading the materials here and looking/studying what folks here are dealing with daily...there is so much information here to learn from...and you will get there! I promise

Have a lovely evening Kathleen

 

Thank you all so much! Sometimes, it really helps to know others have been there.

Well, the Universe heard me today, and Fred has slid down to blue...barely blue, but we'll take it! Of course, when he gets "low", he acts like the life has been sucked out of him.

@Wendy&Neko You mention glucose toxicity...I strongly feel there must be a component of that. I'm certain he was diabetic but keeping it under the renal threshold for at least two months before he was diagnosed. I took him to the vet twice during that time, but as he always had a stress glucose response in the past and glucose wasn't showing up in urine, they didn't catch it. By the time he was diagnosed, he clocked in at 604. As a result, he's happy in the pinks, not greens, and his body won't have them.

She's seen mine. ;-) And I'd wager that's it. I don't mean to speak against her, because she really is very kind and a great overall vet. I think it's just as I said...she may feel unsure of what else to do for him, and thus wants me to head to an IM vet. I'd be all for that if it weren't for the fact that the nearest one is over 1 hour away, and Fred goes bonkers in the car. (you'd think living in the most densely populated state in the US, we'd have more IM vets. Not the case!)

I have to admit/acknowledge he needs more Lantus, but I am SO scared of those hypos! I just can't test him all night, and that's when it would happen, I am sure. How do we get to that breakthrough dose without them skirting that hypo line? It's so intimidating.

So as per SLGS protocol, I have 2 more days, after today, of his current dose of 6.5?

@Sue and Luci @Lisa & Oberon @Wendy&Neko You're so kind to prop me up...thank you.

 

One of the best things you can do if you think he's too low is feed him...if he's a pretty reliable eater, feed him a good dinner, and then get a test before going to bed - feed him again - if you have an auto feeder and you think that his numbers are in the lower ranges, set it up with food every hour or two. Perhaps you could set an alarm to get one test overnight - and once again, the cure for lower than expected numbers is food...food will get him up and over the lower number hump and keep him in safer numbers until you get up to test and start all over again.

Of course you'll need to take up any food 2 hours prior to your AM and PM tests - you don't want to get false high readings because he's having a nosh an hour before test time.

Try not to be so afraid of a possible lower than anticipated number...just increase gradually and test as often as you're comfortable with...to keep him safe.

 

A minor revision - this guidance is what we give to new people. Once you have enough +1 and +2 tests, and have an idea how much of a food bump Fred gets from food, then you can factor that bump in to decide his food uninfluenced BG would be safe to give insulin. And that's really only important if he's green at shot time. Who cares if he's above 100 at preshot and it's food influenced. He's still safe to shoot. It's unlikely he's getting 50 points BG jump from food.

 

I live in the NYC metro area and decided not to see an internist in Manhattan. You can use this website to see if there is one near you in NJ.

https://vetspecialists.com/

 

Hi Kathleen. I feel your pain. I have spent many days and nights wondering if I could ever find a dose for Darcy that would move him. I've said... over and over... this insulin is doing nothing (really, it was keeping him down a little, but it didn't seem like it did much because I never saw dramatic lowering of BG and sometimes not even gradual lowering of BG). I tried switching insulins thinking that might be the cause. Every time I would increase his dose I thought ... this will do the trick.... nope. Of course, in our case, I found out that Darcy has acromegaly. Lisa's Oberon has IAA and just look at her spreadsheet. She's fighting all the time to get to a good dose. It really takes time. I'm so sorry that you are going through this. I understand. Keep up the good work.

It's interesting that you mention Fred is lethargic when his numbers get "low." I've noticed this in Darcy as well. I don't get it. Maybe they aren't comfortable at those numbers? I don't know.

 

I wonder how many of us are up nights dreaming of spreadsheets...lol! Looking for a pattern...thinking it will break....

And you guys are doing such an amazing job managing those two issues! I've had Fred tested for both, and he is 'supposedly' negative. I put that in quotes because there is obviously something going on that is causing this resistance. I guess I shouldn't say he's completely resistant. He can GET there, but he can't STAY there. It's why I worry about hypos as I go higher. We are back flat in pink today-the price of a couple of fleeting hours in blue.

I've heard @Wendy&Neko refer to the punkiness some cats feel in lower numbers as taking caffeine away from a coffee addict. They've lost all their sugar juice. I think that's what happens with Fred. He's very cheerful in higher numbers.

 

I actually have had dreams about spreadsheets! Just last week, I think.