3/30 Doodles AMPS 315 +4 489 +7 387 PMPS 325 +2 348 +3 413 +4 399 +5 417

[Doodles & Karen]

Doodles 3/29 Doodles at pretty good this morning but he now has me trained to fish the kibble out of his water bowl once piece at a time that he drops in there. It's the least I can do. No poop yesterday so hope to see a deposit soon. By the end of the day his "pee bag" must weigh about 8lbs, no joke. There is a noticeable difference in his moving around after the Lasix shot. At least one of the injections he gets is helping

I truly appreciate all the vines and prayers. Honestly I'm still pretty angry about it all but will keep moving and figure out how to keep my boy comfortable and safe.

 

[Chrys & Stomper]

Hoping he continues to do well ( and does a poop!). We're all here with you sending more prayers and vines and huge hugs

 

[Bobbie And Bubba]

Looking good there Doodles! I know what you mean about pee bag weighing a lot. The same here!

 

[Judy and Boomer]

Doodles, how about you put your yellow swim shorts on today? I hear the girls really like yellow
Sending some poop vines your way !

 

[carfurby (GA)]

I'm glad the Lasix seems to be helping. I hope you get some poop today. Sending prayers.

 

[Doodles & Karen]

We did get poop

 

[Amy&TrixieCat]

Yay for poop!! And that the Lasix is helping!! You WILL get the insulin sorted out, and with some expert guidance here I am confident you will kick the IAA in the butt, too.

Funny how he drops his kibble in the water. My two Maine Coon mixes are both water fiends, too...the love it. But one of them is extra-funny. He also eats kibble. What he likes to do is run to the kitchen faucet, stick his head under the running water, then run back to his bowl and drip the water from his head onto the kibble, take a few bites, and repeat over and over. So funny to watch...crazy cat!

Have a great day, Karen!

 

[Doodles & Karen]

Funny how he drops his kibble in the water

EVO & YA sink so he gets mad trying to fish it out and eat it from his paw so I'm helping His hole life on kibble he would sit and play with his food. Funny how your kitty sticks his head under the faucet! He's not that daring but does enjoy watching the toilet flush

 

[Judy and Boomer]

Yay for poop!! And that the Lasix is helping!! You WILL get the insulin sorted out, and with some expert guidance here I am confident you will kick the IAA in the butt, too.

Funny how he drops his kibble in the water. My two Maine Coon mixes are both water fiends, too...the love it. But one of them is extra-funny. He also eats kibble. What he likes to do is run to the kitchen faucet, stick his head under the running water, then run back to his bowl and drip the water from his head onto the kibble, take a few bites, and repeat over and over. So funny to watch...crazy cat!

Have a great day, Karen!

Oh My Amy you should video that! I would love to see it

 

[Judy and Boomer]

Boomer doesn't do anything strange with his food....he doesn't want any delay whatsoever in eating it lol.
Happy you had some poop today!
So that increase at +2...is that from the Lasix?

 

[Lydia--(Rosie & Basil) GA]

HA ha ha ha ha! And I thought I was trained by my pets. I have this mental image of you spending the day on the floor by his water bowl just in case Doodles should want a kibble retrieved.

I hope Doodles has a good day today.

 

[Doodles & Karen]

I have this mental image of you spending the day on the floor by his water bowl just in case Doodles should want a kibble retrieved.

No joke, several times a day.

 

[Chrys & Stomper]

Too funny Karen! And a big woohoo for the poop!

 

[Doodles & Karen]

So that increase at +2...is that from the Lasix

Unfortunately no, that was before the Lasix shot.

 

[jayla-n-Drevon]

I am so happy to hear the lasix is helping--I had a kitty on it and we had HUGE pee clumps!!
I hear ye on the water /food drops--like a kid throwing a pacifier!!
Dre has been bellowing at the sink so I can watch him jump on the sink and drink.... apparently the clean cold fountains are not quite the same
I hope Doodles day continues to be a good one!

 

[Doodles & Karen]

Is Doodles bouncing? Do we need to increase Lantus to 6u at PMPS? It's a sad Doodle day.

 

[jayla-n-Drevon]

Is Doodles bouncing? Do we need to increase Lantus to 6u at PMPS? It's a sad Doodle day.

 

[Doodles & Karen]

My thought is to go without R tonight and tomorrow which is the 6th cycle to see what he dose and likely increase tomorrow at PMPS...7th cycle to 6units.

 

[Wendy&Neko]

I wanted to comment on a few of the wise words Sandy left last night:

• IAA can retard the initial rise of available insulin after an injection.
• IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation.
• The increase in half-life can lead to prolongation of action.
• The release of insulin from the antibodies can happen at inopportune times

What you can see (of course ECID is even more true with IAA kitties), is that onsets can be delayed and nadirs can be delayed. You do have to be fairly aggressive with increases, though that will be a balancing act with Doodles eating dry food. The standard "look" of an IAA spreadsheet is that soon after an increase you might see some action (lower numbers), then the antibodies will take over and you'll lose those lower numbers. I called it the dose going stale. Going in the other direction when there are reductions earned, be conservative in dosing. That last statement of antibodies being released at inopportune times can bite you.

A few other IAA kitties around here if you want to take a look at IAA spreadsheets are Neko (her IAA broke after SRT in fall of 2012), Hyde who is doing some funky "needs less insulin" lately, and Ozy (IAA only, not acro) - Donaleen switched to Levemir in December 2013 because of the sting of Lantus at higher doses was bothering Ozy.

 

[Doodles & Karen]

You do have to be fairly aggressive with increases, though that will be a balancing act with Doodles eating dry food.

I understand so think 6 cycles is conservative enough at this point. Not sure if you agree or not but that's my gut. Miss Hyde also eats wet/dry combo so I'll look at her SS even more closely.

onsets can be delayed and nadirs can be delayed

Been seeing that on and off for a while now. It's also my understanding that they change frequently.

switched to Levemir

Right now my vet won't prescribe Levemir. I have 1.5 viles of Lantus left and then we'll see where he is and if needed will press the issue with her.

Thanks Wendy.

 

[Jill & Alex (GA)]

Karen, I'm sorry to hear about the IAA diagnosis, but it sure explains a lot.

My thought is to go without R tonight and tomorrow which is the 6th cycle to see what he dose and likely increase tomorrow at PMPS...7th cycle to 6units.

I don't know if Sandy and Wendy have thoughts on or have a particular plan when it comes to dosing now that we know Doodles is also an IAA kitty. I hope they weigh in before shot time.

My thoughts:

Tonight is the 5th cycle at 5.5 units Lantus. My gut feeling is to

• increase the R dose to 0.5u tonight if preshot numbers are 300 or greater (because 0.25u doesn't appear to be enough to combat the effects of the lasix)
• hold the 5.5u Lantus dose through tomorrow morning (that'll give you 6 cycles Lantus @ 5.5u)
• shoot 0.5u R @ AMPS if preshot number is greater than 300
• increase the Lantus dose to 6u tomorrow night
• shoot 0.5u R if PMPS is greater than 300 tomorrow night

My reasoning: Increasing the R dose is simply an attempt to find a dose which will help combat the lasix. I really don't think Lantus alone has the strength to pull the elevated BG numbers (due to the lasix). My thoughts (for now, subject to change depending on how Doodles responds) are that increasing the Lantus after 6 cycles is being aggressive enough due to the dry food in the picture.

Just my thoughts.
I hope others will jump in with their ideas or suggestions.

 

[Judy and Boomer]

I have nothing to add to the R vs Lantus issue. Sending lots of vines to Doodles and lots of hugs to you!

 

[Tara & Ivana (GA)]

We did get poop

Nice work Doodles! (Only fellow FDMBers understand the exciting of seeing a poop haha)

 

[Wendy&Neko]

I agree with Jill. I had been about to add that .25uR is like p!$$ing the wind. The antibodies can also work against R. As long as you can monitor tonight, I think you are OK with shooting .5uR tonight. I don't know if @Jill & Alex (GA) agrees, but I think you are close to not needing the +1 test. I am trying to be aware of number of pokes vs. data we need at this point on R. If you are up, a +5 might be a good replacement, unless you see he is trending up at +4 in which case it may not be necessary. Neko does a late onset and nadir with R as well as L and surprised me with late R action so it's something I am on the lookout for.

Six cycles on a dose sounds good for now. With an IAA kitty on all wet food we would increase after four cycles if kitty remains essentially above 300. Given Doodles tastes and your ability to monitor, I think six cycles is a good compromise. To any lurkers, this is a Doodles only recommendation.

As Jill said, we are using R to help see what a dose can do, and with the Lasix pushing up the numbers, it makes it too hard for the Lantus to show it's potential.

 

[Jill & Alex (GA)]

I had been about to add that .25uR is like p!$$ing the wind. The antibodies can also work against R. As long as you can monitor tonight, I think you are OK with shooting .5uR tonight. I don't know if @Jill & Alex (GA) agrees, but I think you are close to not needing the +1 test. I am trying to be aware of number of pokes vs. data we need at this point on R. If you are up, a +5 might be a good replacement, unless you see he is trending up at +4 in which case it may not be necessary. Neko does a late onset and nadir with R as well as L and surprised me with late R action so it's something I am on the lookout for.

Good points! I agree with each of them.

As Jill said, we are using R to help see what a dose can do, and with the Lasix pushing up the numbers, it makes it too hard for the Lantus to show it's potential.

Yes. At this point, the way I see it is giving the R dose at shot times is simply an effort to level the playing field for Lantus to do it's thing.



So, those are our thoughts. What do you think, Karen?

 

[Doodles & Karen]

Tonight is the 5th cycle at 5.5 units Lantus. My gut feeling is to

• increase the R dose to 0.5u tonight if preshot numbers are 300 or greater (because 0.25u doesn't appear to be enough to combat the effects of the lasix)
• hold the 5.5u Lantus dose through tomorrow morning (that'll give you 6 cycles Lantus @ 5.5u)
• shoot 0.5u R @ AMPS if preshot number is greater than 300
• increase the Lantus dose to 6u tomorrow night
• shoot 0.5u R if PMPS is greater than 300 tomorrow night

I almost did .5R this morning but held my plunger and agree with the plan above.

With an IAA kitty on all wet food we would increase after four cycles if kitty remains essentially above 300. Given Doodles tastes and your ability to monitor, I think six cycles is a good compromise

If we see any movement I'll hold it longer than 6 cycles but at the moment he's not really going anywhere.

Thank you both for the help.

 

[Paula]

Yeah for poop! Michael was about ready to do the poop dance for Doodles when you posted that Doodles had pooped! Sending more vines & hugs.

 

[Shoeskitty-GA]

Prayers for Doodles and Karen.

 

[Ella & Rusty & Stu(GA)]

Hang in there, Karen. I hope that the new dosing plan will help Doodles. Hooray for poop!



Ella & Rusty

 

[Doodles & Karen]

Shots were 10 min late because the vet called. She's still not sure of the significance of the IAA result and indicated that "if we tested every diabetic" they would have elevated IAA results. I did however finally get her to admit that 72 is not "a little high". Other than that she prefers me to be more aggressive with R than Lantus and still thinks Levemir is too strong and that we couldn't measure a dose small enough for Doodles.

Anyway, I'll be getting a +2.

 

[jayla-n-Drevon]

Shots were 10 min late because the vet called. She's still not sure of the significance of the IAA result and indicated that "if we tested every diabetic" they would have elevated IAA results. I did however finally get her to admit that 72 is not "a little high". Other than that she prefers me to be more aggressive with R than Lantus and still thinks Levemir is too strong and that we couldn't measure a dose small enough for Doodles.

Anyway, I'll be getting a +2.

I am not sure what that means about Lev being "too strong" isn't it just different?
I have read the differences in the way it works but never read it was "stronger" ??
Doodles is so lucky to have such a dedicated bean

 

[Doodles & Karen]

I have read the differences in the way it works but never read it was "stronger" ??

It's just her opinion.....

 

[Marje and Gracie]

I had been about to add that .25uR is like p!$$ing the wind

Ive actually thought this for some time now.....even without knowing about the IAA but you need to have a comfort level with shooting R. I also think leaving out then+1 is fine and, depending on what he's doing at +4, you could decide on what tests you want to get later but I think the +2, +3, and +4 tests are important for now. I also agree the Lantus increases should be approached conservatively (every six cycles) since it might take longer to see some effect with the IAA.

 

[Marje and Gracie]

It's just her opinion.....

@jayla-n-Drevon ...Karen is right and the sad part is that not many vets are familiar with levemir. It would probably take showing her some of the acro and IAA SSs where lev is used to get her to back off that statement. I also think she does not have a grasp of IAA. While the occurrence of it might be higher than was thought in previous years, I doubt seriously that every cat has elevated results. We know this isn't true.

 

[Shelly and Spaceman]

It's just her opinion.....

Opinions are like....uh, Never mind. What is her opinion based off of? Wih my recent experience of both I wouldn't say one is stronger than the other...just different. I have gotten some pretty good drops from it but now that the Lantus has worked it's way out the lev has leveled out....a little too high, but we are working our way down.

 

[Peg and Toby]

Sending vines that you will find a good dose for Doodles and he will start coming down.

 

[Doodles & Karen]

It would probably take showing her some of the acro and IAA SSs where lev is used to get her to back off that statement.

That is my thought when the time is right.

 

[Wendy&Neko]

FWIW, I didn't switch Neko to Lev until we were back down to smaller doses the first time. I switched to the standard 70% dose, and ended up with about .125U less (taking off the fat) of Lev than Lantus. But when we went back up to 7 units last fall, I was really glad to be on Levemir. Neko used to occasionally walk away from the shot when it was Lantus, but she never does that with Lev. With Lev sometimes she purrs through the shot, or like tonight, grooms her paws. I didn't think Lantus bugged her until I saw the difference.

Paws crossed for that +3.

 

[Jill & Alex (GA)]

Other than that she prefers me to be more aggressive with R than Lantus and still thinks Levemir is too strong...

At times, there's something to be said for ramping up the R dose quickly because of not having to worry about a depot with R. One can see the R dose progression on Black Kitty's spreadsheet. Sometimes BK received sizeable R doses 3 or 4 times in a 24 hour period. Take a look at his R scales (click on the R scale tab at the top of his ss). I remember jojo and I agreeing it would be much easier to steer the cycle, if necessary, because of the nature of R being in and out versus having to deal with a humongous Lantus depot. Obviously one wants to eventually get to a good basal dose safely, but R is a great tool to use until one gets there!

I have read the differences in the way it works but never read it was "stronger" ??

This always makes for an interesting discussion. jojo (vet tech who used to post here a lot) had her cat, Settle Down, on Lantus, switched him to Lev, and then talked about putting him back on Lantus because she felt Lantus was better able to pull down higher numbers (stronger) than Lev. We've seen several switch from Lantus to Lev and then back to Lantus because they felt Lantus was stronger. I've never heard anyone ever say they felt Lev was stronger than Lantus. On a side note, Settle Down flinched when she shot him with Lev and didn't when given Lantus (Lev sting?). LOL! Just another one of those ECID things!

I also agree the Lantus increases should be approached conservatively (every six cycles) since it might take longer to see some effect with the IAA.

Ha! I see increasing the basal dose every 6 cycles an aggressive approach considering Doodles' current diet.

 

[Doodles & Karen]

Paws crossed for that +3

413

 

[Marje and Gracie]

Ha! I see increasing the basal dose every 6 cycles an aggressive approach considering Doodles' current diet.

Yes, I know, and I would agree entirely if there weren't so many other things affecting his numbers (e.g. Lasix) and if Karen wasn't at home with him testing him. If he just had IAA in the mix and the lasix wasn't a factor, I'd be all for taking it slower in case the IAA broke....and it still might and numbers till might come down but he's not budging much yet. But...that's JM perception or how I know I'd feel if it were me in Karen's shoes. This just really seems like one of those cases where, as you said, we need to set aside guidelines and protocols and try to get the numbers looking better without causing them to tank suddenly.

 

[suki & crystal (GA)]

Sorry Karen that you got the IAA confirmed, but all the experts here will provide a much better dosing strategy than anything your vet will suggest. Paws crossed that Doodles responds well, hugs to you both

 

[Doodles & Karen]

Sorry Karen that you got the IAA confirmed, but all the experts here will provide a much better dosing strategy than anything your vet will suggest. Paws crossed that Doodles responds well, hugs to you both

Thank you Suki. Hope to check more condo's tomorrow...this boy keeps me busy! Extra to Crystal for us and for you.

 

[Jill & Alex (GA)]

This just really seems like one of those cases where, as you said, we need to set aside guidelines and protocols and try to get the numbers looking better without causing them to tank suddenly.

That's my intention. My suggestion is to totally set aside SLGS guidelines while incorporating some dosing guidelines from TR... for all the reasons you've mentioned. As much as we would like to get those high numbers down lickety-split... we can't throw out everything we know to blindly proceed full steam ahead. This basically comes down to using a bolus while reaching a basal dose that will overcome the insulin resistance safely... and at the same time, doing what we can to keep him from bouncing all over the place. Looking at BK's ss, you'll see for the most part Sandy held doses for 6 cycles, but for various reasons, oftentimes longer. It worked out pretty well.



ETA: I simply posted a suggestion. As always, Karen (or for that matter, anyone receiving suggestions) can agree, disagree, or do whatever they want.

 

[Tricia Cinco(GA) & Harvey]

{{{Karen}}}

I don't know anything about IAA or R, so I have nothing technical to contribute to this discussion, but I just wanted to add my good wishes. You and Doodles are in my thought and prayers.

@Amy&TrixieCat, I, too, want to see video of that civvie putting his head under the water faucet, then running to his kibble and dripping on it!

 

[julie & punkin (ga)]

just getting home tonight but wanted to look in on you and send a little support your way, Karen.

 

[Gill & George]

Just grabbing 5min while guests still sleeping, wanted to catch up on Doodles, nothing to add Karen just lots of hugs and prayers for you and Doodles

 

[Sandy and Black Kitty]

My suggestion is to totally set aside SLGS guidelines while incorporating some dosing guidelines from TR...

I agree.

As much as we would like to get those high numbers down lickety-split... we can't throw out everything we know to blindly proceed full steam ahead. This basically comes down to using a bolus while reaching a basal dose that will overcome the insulin resistance safely..

I agree.

At times, there's something to be said for ramping up the R dose quickly because of not having to worry about a depot with R.

I remember jojo and I agreeing it would be much easier to steer the cycle, if necessary, because of the nature of R being in and out versus having to deal with a humongous Lantus depot.

A very important point.

The graph below is average daily insulin units, both Lantus and R combined, each month over the entire 21 months BK was on insulin.

The IAA broke in October 2009, with BK getting some 45u per day at the time (26uL and 19R)
One month later his insulin needs had reduced the dose to 13.5u (27u daily)
Thats a reduction in dose of 9u (18u daily)
Because I used R, I was able to accomplish it all at once, with no pj parties and no HC.

I can't imagine what that would have been like had I been using only Lantus

 

[elizabeth and gus]

Karen I am hoping that you find dose that finally gets Doodle in better numbers. Sending lots of vines and prayers.

 

[Marje and Gracie]

That's my intention. My suggestion is to totally set aside SLGS guidelines while incorporating some dosing guidelines from TR... for all the reasons you've mentioned. As much as we would like to get those high numbers down lickety-split... we can't throw out everything we know to blindly proceed full steam ahead. This basically comes down to using a bolus while reaching a basal dose that will overcome the insulin resistance safely... and at the same time, doing what we can to keep him from bouncing all over the place. Looking at BK's ss, you'll see for the most part Sandy held doses for 6 cycles, but for various reasons, oftentimes longer. It worked out pretty well.



ETA: I simply posted a suggestion. As always, Karen (or for that matter, anyone receiving suggestions) can agree, disagree, or do whatever they want.

Actually, I do agree 100%. There has to be a happy medium in there somewhere that doesn't take the dose up too fast but also doesn't leave him sitting in high numbers for a week. Perhaps six cycles works great this time but next time he needs 10 or 12 cycles. Or maybe he responds enough to the Lantus increase that he only needs R tweaking.