The Ultramarathon Part 14

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Kris & Teasel

Kris & Teasel

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AMPS was 16.4. I'm giving 2.8 u again. If he was less volatile I'd have increased a bit but Teasel walks a tightrope that acts like a trampoline sometimes. This might be a low bounce and the only way to know is to get data. Stability is the order of the day ... for now. o_O
 
AMPS was 21.8. I'm starting a new vial of ProZinc this AM so I kept his dose at 2.8 u. Another of my "rules" - no dose increase when a new vial is first opened. I'll monitor.
 
Still keeping everything crossed for you! :D Come on Teasel!
 
AMPS was 9.7 with AT strip (periodic spot check). :) I gave him what turned out to be a skinny-ish 2.8 u because I expelled a teeny bit too much from the syringe. I don't like poking the needle a second time into the vial and have it lose more sharpness so I left the dose as it was. Close enough.
 
PMPS was 23.9 - no surprise there. I gave him 3.0 u. Will test before bed, give snack and set my alarm clock if needed.
 
At least you'll be able to sleep all night tonight. Tomorrow is a new day, hopefully with better numbers!
 
So much for thinking he'd stay up there! AMPS was 6.5! :blackeye: I'm stalling to see if I can get him up to token dose range. I know you understand this craziness, Kimi.
 
BG after 80 minute stall was 6.3. I'm reluctant to go with no shot after yesterday's AM fur shot so I'll give a chicken !$*@! dose of 1.0 u. I've given him time after his breakfast for his food to kick in. I'll be here to steer/monitor as needed. This is envelope pushing territory but it's necessary I think. I can see him dragging out his trampoline as I type ... o_O

Just gave his dose: used the scruff in case absorption rate there can be an added margin of safety.
 
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He never has a dull moment. How do you analyze the latest craziness? Delayed bounce/delayed reaction to new vial? I bet it is discouraging/surprising/upsetting/frustrating (take your pick) when you think you have covered all the possibilities and he throws a new reaction!
 
Sue and Oliver (GA) said:
He never has a dull moment. How do you analyze the latest craziness? Delayed bounce/delayed reaction to new vial? I bet it is discouraging/surprising/upsetting/frustrating (take your pick) when you think you have covered all the possibilities and he throws a new reaction!
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I expected a reaction to the 3 u dose of last night after him having a fur shot in the AM. However, I expected it to be a bit delayed and it wasn't! The new vial was started 7 cycles ago so I'm not sure it's the culprit. He is known for his delayed bouncing.

His SS data of early September shows me that doses in the area of 2.2 u - 2.6 u weren't doing the job. He was in yellow and pink a lot but was less volatile by Teasel standards. Then I moved him up into the 3 u + region and he started giving better numbers but was jumpy during this transition. Down went his doses and more reds, pinks etc. appeared.

We had a decent patch of more stable blue and yellow numbers around mid-November when his doses were in the 3 u+ range for the second go around so I have that in the back of my mind as his "breakthrough" zone, although it's all shades of grey with Teasel. I've had him at 2.8 u for quite a while and some PSs have been good but the mid cycles not so much. I could be full of it but the theory I work with is that if he's close to but not quite at his effective dose zone, the insulin can't keep a lid on his BG as effectively as at a higher dose. He also seems jumpier than usual - and that's saying something - when we're in a dose range transition of some sort.

That's the best I can come up with. Thoughts? I'm planning to finish this vial of ProZinc but have entertained thoughts of either going back to Lantus with the knowledge I have now or trying Levemir. I'm very conflicted about this because of my past Lantus experience and Teasel's bounciness and propensity to get stuck up high. His curve data from his third week on Lantus way back in January showed him going from around 20 to 3's mid cycle and back to 20-ish on 1 u. Six weeks later all the time he'd spent stuck high (20 +) resulted in DKA.

My concerns with the L's:
  • I worry that the depot could be a drawback in his case but I don't have FDMB style data to rely on to make a judgment.
  • I worry that SLGS holds doses for long enough for him to get stuck.
  • I worry that even TR requires time spent at a dose.
  • I worry about the amount of time a hypo can last on the L insulins.
  • I worry about the lack of dosing time flexibilty.
  • I worry about the issue of micro-fraction dosing a U100 insulin.
  • I have evidence that he can drop like a stone on Lantus too. How much of the depot is still there to influence his "active" dose versus what I drew up in the syringe?
I like that ProZinc is more amenable to "real time" intervention. I love the ability to micro-fraction. I like that I don't have to worry if I'm late dosing. Of course, I'm also more accustomed to it as well ...

What a conundrum! Feedback appreciated ... @Sue and Oliver (GA) @MrWorfMen's Mom @Critter Mom @Carol & Murphy
 
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@Sue and Oliver (GA) @Carol & Murphy @Critter Mom @MrWorfMen's Mom
Your take?
Brief summary of Teasel's Lantus history from weekly BG curves done for vet:
  • Week 1 - 1 u BID: BG dropped through the day from AM 17.9 to a PM low of 6.3 (AM/PM tests right after meal at this time)
  • Week 2 - 1.5 u BID: BG was 3.9 around +8 and 10.3 at +12 on Day 3
  • Week 2.5 - 1.5 u BID: BG was 4.0 at +11 on Day 4 so dose was reduced back to 1.0 u
  • Week 3 - 1.0 u BID: BG went from AM 20.3 to 3.8 and 4.6 mid day to PM 19.3
  • Week 4 - 0.5 u BID: BG hovered between 22.6 and 21.1 all day
  • Week 5 - 1.0 u AM/ 0.5 u PM: BG went from 24.2 AM slowly down to 10.9 PM
  • Week 6 - 1.0 u BID: BG stayed around 21 all day. I thought the Lantus had deteriorated so bought a new vial.
  • Dose kept at 1.0 u BID for 2.5 weeks with no curve done.
  • Week 9 - 1.0 u BID: BG hovered between 19 and 21 all day.
  • Week 10 onward - began feeling ill and went into DKA.

I was frustrated that I couldn't fraction the dose better when Teasel seemed to need something "in between". I also learned of his tendency to get stuck if a dose is not working and he's left there. 1.0 u BID wouldn't work by Week 9 even though he almost hypoed on it in Week 3. I think you can see why I wanted to switch. Yes, I have much more knowledge now but I'm still gun shy.

My other notes about how he was feeling on Lantus don't reveal any major differences from ProZinc. He had his ups and downs then and he still does.
 
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Hey Kris, I so understand your reluctance to switch as I know that I wasn't getting where I needed to be with ProZinc and deciding to switch caused me to cry a whole day the day before. How long were you using lantus before and do you have any data while he was on it just to review ?

Here is what I will tell you about lantus that I love, the protocol takes the guess work out of dosing Do cats still bounce, yes, but those guide lines help me to hold a dose because of the depot and not to jump around. As far as the 12 hour shooting schedule there will be times you will be late and sometimes you'll need to shoot a little earlier ,there is some flexibility there. And ways to get bac on your schedule if you have to deviate.

Also you can shoot lower numbers with Lantus after enough data because you shoot low to stay low as the curve is much flatter with lantus unlike ProZinc

Here is what I would suggest to you until you decide for certain if you want to move to lantus Could you get some other times of day for test, for instance, let's see what Tease is doing at +3 & 4 on each cycle and would it be possible for your to get some +10 & 11? maybe those missing numbers could shed some more light on things.

If you decide to switch post over in that forum ahead and get some starting dose advice and the peeps there are just as nice as the ones here and will help you along the way. sorry about typos trouble with my keyboard.
 
Bobbie And Bubba said:
Hey Kris, I so understand your reluctance to switch as I know that I wasn't getting where I needed to be with ProZinc and deciding to switch caused me to cry a whole day the day before. How long were you using lantus before and do you have any data while he was on it just to review ?

Here is what I will tell you about lantus that I love, the protocol takes the guess work out of dosing Do cats still bounce, yes, but those guide lines help me to hold a dose because of the depot and not to jump around. As far as the 12 hour shooting schedule there will be times you will be late and sometimes you'll need to shoot a little earlier ,there is some flexibility there. And ways to get bac on your schedule if you have to deviate.

Also you can shoot lower numbers with Lantus after enough data because you shoot low to stay low as the curve is much flatter with lantus unlike ProZinc

Here is what I would suggest to you until you decide for certain if you want to move to lantus Could you get some other times of day for test, for instance, let's see what Tease is doing at +3 & 4 on each cycle and would it be possible for your to get some +10 & 11? maybe those missing numbers could shed some more light on things.

If you decide to switch post over in that forum ahead and get some starting dose advice and the peeps there are just as nice as the ones here and will help you along the way. sorry about typos trouble with my keyboard.
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Hi Bobbie,

Thanks for responding. If you go up a little in this thread to my post at 11:23 a.m. there's a summary of my Lantus experience. Let me know your thoughts.
 
Bobbie And Bubba said:
How long were you using lantus before and do you have any data while he was on it just to review ?
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I used it about 10 weeks . See above for data from vet requested weekly BG curves.

Bobbie And Bubba said:
the depot
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The depot worries me because he's extremely dose sensitive. I also wonder about fluctuating absorption rates although I inject over a broad area along his side.

Bobbie And Bubba said:
cats still bounce
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Check out Teasel's bounce numbers while on Lantus - limited data but hard evidence.

Bobbie And Bubba said:
let's see what Tease is doing at +3 & 4
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That I can do. I generally forego those tests because I don't see much action before +5 with him. By +10 or +11 I'd usually think, why not wait until PMPS.

Will put my thinking hat on ...
 
I am definitely thinking of making the switch away from Lantus to ProZinc. I think that 10 months on it has given me enough data to know that something else would work better for Shoes. Have done the Novolin N and will not ever ever ever go back to that. Everything I have read about ProZinc leads me to feel that it would be better for me because I do work M-F and it's becoming a work issue for me to go home and check on him daily and/or have to be late because he is dropping like a rock even with higher carb food fed to stop it. From the things I have read about Pro Zinc, it lasts longer than the Novolin N and is more gentle as far as dropping the glucose levels., etc. I realize that ECID but Lantus has just not been wonderful for me.
 
Kris & Teasel said:
used it about 10 weeks . See above for data from vet requested weekly BG curves.
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thx, I missed that Here is what I think, while on Lantus , your dosing was raised in increments of .50 and we recommend increments of .25. That alone played havoc with his numbers taking him too low at times . For instance the 2 nd week when he was 7o .2 @ +8 then bounced to 185 by +10 was a normal response after going that low, And the dose reduction should have been by .25 and not by .5o as he just shot up again He was just bouncing around with the depot being disrupted.

I think you weren't' with Lantus long enough, usually takes 6 months for a kitty to get really acclimated with an insulin. If you switch, the L forum will help you with dosing and all you would need to do is decide what method you want to follow and everyone will help.
 
Shoeskitty said:
I am definitely thinking of making the switch away from Lantus to ProZinc. I think that 10 months on it has given me enough data to know that something else would work better for Shoes. Have done the Novolin N and will not ever ever ever go back to that. Everything I have read about ProZinc leads me to feel that it would be better for me because I do work M-F and it's becoming a work issue for me to go home and check on him daily and/or have to be late because he is dropping like a rock even with higher carb food fed to stop it. From the things I have read about Pro Zinc, it lasts longer than the Novolin N and is more gentle as far as dropping the glucose levels., etc. I realize that ECID but Lantus has just not been wonderful for me.
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Sue has always said, the best insulin for a cat is the one that works It could be the insulin to do it for Shoes You won't now unless you try:cat: And you will be in good hands here.
 
Bobbie And Bubba said:
thx, I missed that Here is what I think, while on Lantus , your dosing was raised in increments of .50 and we recommend increments of .25. That alone played havoc with his numbers taking him too low at times . For instance the 2 nd week when he was 7o .2 @ +8 then bounced to 185 by +10 was a normal response after going that low, And the dose reduction should have been by .25 and not by .5o as he just shot up again He was just bouncing around with the depot being disrupted.

I think you weren't' with Lantus long enough, usually takes 6 months for a kitty to get really acclimated with an insulin. If you switch, the L forum will help you with dosing and all you would need to do is decide what method you want to follow and everyone will help.
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Thanks for this, Bobbie. I'll think about this some more. I was quite sure that the non-FDMB way of doing things was a big part of the problem but I was only working with my vet at that time. At the end, the scary and $$$$ DKA episode frightened me off the Lantus.
 
PMPS was 21.6. I'm giving him 2.6 u because that 3 u dose seemed a bit high for that moment in time. I dropped back to 2.6 u instead of 2.8 u because he'll be more sensitive after the low number this AM.
 
Kris & Teasel said:
By +10 or +11 I'd usually think, why not wait until PMPS
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These two reading will be great info for you to see if the AM or PM pre shot is a falling number or one that is rising.


As far as me using R with Bubba, it was during the ketones and only because he became insulin resistant for being stuck in higher numbers for quite some time .His numbers would not budge out of the high yellow range which isn't where DA usually shows up but it did for Bubba.
 
Bobbie And Bubba said:
That is what I think happened as well and when Teasel got DKA was it during a pancreatitis fare or IBD attack?
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No, I think he was just stuck at high numbers too long. No evidence of pancreatitis - the expensive IDEXX test was done at that time. So far, no history of IBD with him.

The end of first week on Lantus (1 u BID)BG curve showed a gradual lowering of BG over the day. Lowest number at PM dose time.

The end of second week (still 1 u BID) BG curve showed wild bounces from 20 to 3 and back up to 20.

By end of week 6 after a few dose tweaks and return to 1 u BID, that dose was ineffective. Later BG curves at the same dose showed high and flat. I think my vet was stymied and so was I. It's all a bad dream now ...
 
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I know you'll make the right decision for Teasel, Kris! You're so methodical and careful, maybe all the experience you've gained is what you need to make Lantus work for him this time.
 
ShipsCat said:
I know you'll make the right decision for Teasel, Kris! You're so methodical and careful, maybe all the experience you've gained is what you need to make Lantus work for him this time.
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Thanks, Kimi! Just gathering info at this point and then it has to "percolate" for a bit. I still really like the flexibility of ProZinc.
 
Hi Sue,
I tagged you yesterday to ask you to read my long posts (back to back higher up in this thread, around 10 - 11 AM) about Teasel's craziness. I needed some sounding boards for my venting. Not ready to change anything at this moment in time but I value your input.
 
I defer to Bobbi on Lantus. I just have no experience with it. I know we have had some difficult cats switch and sometimes the longer flatter cycles are very helpful for them and sometimes if they are bouncy, they continue to bounce. I would say that the experience you have gotten with ProZinc is invaluable to helping Teasel and in general, he is doing pretty well. But he is definitely a challenge and incredibly bouncy.

And Bobbi is exactly right - the best insulin is the one that works for your cat. ProZinc is more difficult to dose because you have to interpret the data. With Lantus, if he is at this number, you shoot this. For some people, the advantage of ProZinc is the flexibility. Especially with difficult cats, you have lots of options.

Selfishly, you have been an amazing asset to this forum and I would hate to have you go. But your job is to do the best for Teasel. You might look into Levemir. It is supposed to have even longer flatter cycles than Lantus.
 
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