5/30 Tiggy prelim vet report

Previous condo

Initial bloodwork was normal with fructosamine in the normal range - showing excellent control. Vet was surprised by that. I wasnt because all the dose increases have been controlling him best I can. Said Tiggy needed to drink more water though.

No evidence of a UTI although the culture isnt back yet- he thinks it will be clear.

Vet asked again if Tiggy was eating or drinking excessively.. any idea what his thoughts are here?

Also Tiggy was acting super weird last night but I wonder if it was the vet visit that did it. He literally sat in the lower hall and howled for a few hours almost non stop. I went down and checked on him a few times and he stopped when he saw me just looked back as if to say "what". I tested his BG to be sure nothing unusual was going on. He went back to yowling as soon as my head hit the pillow. Didnt eat much either overnight which is odd. This morning he also didnt greet me when I got out of bed - was lying on the living room floor instead.also odd. Anyway I am in the office today so I will call my DH later to see if he is still acting odd.

Wendy

PS I got a sneaky feeling this is going to be a $700+ "inconclusive" suite of tests again....

 

Ouch on the big expenditure with no answers. I'm with you...
we both know (yours and mine) that something is off but just can't figure it out... yet.

 

I am very surprised that a fruc test would show he was in excellent control. I'm surprised, too, that you would have one done...you have much better data.

Did he check his thyroid levels....minimum fT4 and tT4. Tiggys BGs aren't high enough that he should be PU/PD from that but if the vet is asking that question, I wonder if he is thinking thyroid? Yowling is a symptom of hyperT but you said Tiggy isn't PU/PD?

Did he do the acro/IAA tests?

 

well maybe with his blues and greens every second day it averages out as good? The test was part of a package deal thing or i wouldnt have bothered.

I dont know. I sent him an email

he drinks a bit more when his BG is high but then goes back to normal when its normal. He doesnt normally yowl except when he is carrying around his toy lion but with his lack of energy the last month or so, he hasnt been doing that. Plus he put on 0.8lb.. didnt lose it.

 

vet just emailed me with an odd question "Are you just basing the dose increases solely on his blood glucose levels?"

wonder where he is going with this..

 

Huh? :shock:

 

I should have said "no I am basing it on lunar cycles" lol

 

He may be thinking pre-shot vs nadir and not understand the TR protocol.

Another possibilirt is cognitive dysfunction syndrome.

 

OMG...I burst out laughing at the office here....that was funny. :lol: :lol: :lol:

 

Of course you base it on nadirs not simply blood glucose levels. Important distinction.

What was the actual fructosamine reading?

 

I got a response from the vet - see below. Any idea how I answer this???

The issue here is that these clinical signs can be a sign of low blood sugar. Giving more insulin when you see a spike can cause the insulin to drop very low and then spike high as the liver releases sugar to maintain a minimum sugar level,. You wold see this spike and think not enough insulin so increase.. This simply causing more dips and spikes.. It's called symogi effect. We usually base an insulin increase on clinical signs: increase drinking, thirst, polyphagia weight loss. Lets wait on all test before making any more insulin changes..

 

Show the testing logs and the protocol. If he's not going too low and he's not up into the blacks ever, then I don't think he's in Somogyi. And you aren't knee-jerk upping the dose in response to spikes.

 

I don't think he is either but I need to find a way to explain that to him. I emailed him the protocol and even handed him a printed copy yesterday.

 

Take out some graph paper. Use a week or two of data. With AM & PM time along the X axis, you might plot several days using different colors, or just put the data points on showing that it isn't going too high, ever. (because you know what you are doing!!!!)

 

I told him Tiggy wasn't going too high or too low but he still thinks tiggys "pattern" of lows followed by highs and being independent of shot time (no normal lantus curve ever) are indicative of somogyi. I don't think he can distinguish between somogyi and a very bouncy boy. To him bounce = somogyi.

Do we have any reports or anything that spell it out and ezplain why a bounce isn't somogyi?

 

About the only thing that is likely to prove it is to back off the dose long enough to show the numbers go higher. If you decrease the dose by 0.25, it should show up pretty quickly as higher average numbers if he's wrong. Just be on alert for ketones, and document water and food consumption.

 

First, you are the one holding the syringe. You can politely nod and say, "Thank you." to the vet and do what you know is right for Tiggy and what you're comfortable with.

Second, (climbing on to soapbox) ask your vet if he can provide you with the citations for the empirical research on Somogyi. Not opion pieces and not a paragraph out of a text book. Ask for research papers that have been published in reputable vet journals. Thee is not any convincing research. I posted this in Gracie/Marje's condo about 2.5 years ago:

Your vet is doing what a lot of people do -- not distinguishing between a bounce and chronic Somogyi rebound. (Stepping down off of soapbox)

 

Got a response from the vet... Looks like he is moving away from the somogyi theory?

I know I hold the syringe. I am going to ignore this and keep Tiggy going at least until the bloodwork is back. If he isnt IAA or acro then maybe all bets are off and I will give his theory a go.

All the same though I would love your thoughts on what he just said.. so I can reply sensibly! This is a great opportunity for "educate a vet"!

Wendy

 

I know this may be picky, but "generally accepted" by who? Where's his research evidence? How does this relate to cats that go into remission? I don't think what he's saying necessarily makes sense. I suspect he's thinking in terms of a cat where remission isn't a goal. Even with tight regulation on Lantus, numbers in the greens are safe IF you are home testing. I suspect your vet is more familiar with insulin other than Lantus and that most of the caregivers seen in his practice don't home test.

 

wow - then what do I do about Maui - she has been green the past four years and sits around 70 most of that time..... - does this mean she's in danger and I don't know it! nailbite_smile


sorry, just had to say it.....

 

And what about Oliver who tested positive for acro and IAA but he's off insulin and gets lots of greens?

If you are dosing and getting the majority of the time in 50-150 all the time, just like a cat getting no insulin, the fructosamine test would give a nice low number meaning the cat is well regulated..... I don't think your vet knows anything specific, so I hope you have the IGF-1 and IAA tests getting done now.
If the vet has the link to your ss, let the vet watch how well you manage the BG with insulin... the vet may learn alot from your actions and decisions. Your test numbers should help him to get other clients to test and get good results like you.

I am not really accustomed to any of the vets that saw Shadoe and Oliver telling me what to do in the way of dosing, but I never asked them. Instead, I informed them what I was doing and why.... kept them in the loop so they were OK.

Gayle

 

Glad he's backing off Somogyi.

Somogyi, whether one believes it exists or not (and I agree with Sienne), is indicative of a chronic overdose which causes very low numbers followed by high spikes. When faced with that Somogyi response, I ask how they explain a cat that bounces off blue numbers or a quick drop which does not result in a low number.