1/4...Elmo update

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Beth 73

Beth 73

Member Since 2016
Hello to all..miss our daily posts and wanted to update u all on Mr Elmo( aka Buddah Kitthe) ...Still waiting on Lantus. It is now in the hands of US customs:nailbiting: but is scheduled for arrival Friday. My buddies at our post office are watching for it and will put in frig and call me immediately. Love my small town Post Office . I purchased a FS freedom lite ( cos of AT familiarity) and have been practicing with it, taking backup BGs to get at ease with the lower numbers. I know you all told me there is greater difference at high numbers and get closer as BGs go lower...today his AT BG at +3 was 112 and FS was 72. Am getting ready to call vet to see if they carry ulticare 100 with half unit markings and have them show me where the .25 mark is. My old eyes need all the help they can get( thats from too much reading and cross stitching, so says my sage 94 year old momma, Millie:)).
Wanted to ask you all if there is anything you believe important?relevant ab Elmo to date that I would need to point out to folks on LL forum. You have been with us thru these last few months and know him very well so I would love to hear if there is anything I need to be passing along . I have poured over the LL Stickies, taken notes and am getting ready to post my questions there later today. Can feel your support and love all the way down here in the Ozarks hills and hollers(Kris;)) ...means more than i could ever express. You are in this with Elmo and I and no kitty could ask for better godmommas:bighug:. Praying you and yours are fit and well . ANd a btw, if Canada would quit hogging the snow we might get more than a forecast of flurries( flurrieS??!!! Flurries!?!:woot::woot::woot:). Also am so blessed to know Chris and China are there for us on LL ...this could all not be any better.
Again, please keep an eye on Elmo's SS and let me know of any insight ab him u might have to pass along. :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
@Critter Mom
@Kris & Teasel
@MrWorfMen's Mom
 
Was that 66 on the Alphatrak, Beth? If yes, that signals a dose reduction is needed.

Sorry I can't write more; I'm really unwell.

:bighug:


Mogs
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Sorry about the run on paragraph...did indentions and felt so techy....will do better next time...
Critter Mom said:
Was that 66 on the Alphatrak, Beth? If yes, that signals a dose reduction is needed.

Sorry I can't write more; I'm really unwell.

:bighug:


Mogs
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oh , Mogs....please take care of yourself ! And no , it was AT. 112 and FS 72.....Elmo is doing well and we r praying for u to be well and restored ASAP:bighug::bighug:
 
Also, what syringes do you all use...got some Relion u 100 but not liking the movement after using the ulticare vet Rx so ordered some from ADW and waiting on them as well. Even my new good vet doesn't carry them ,even after agreeing that Elmo needed to start Lantus with same .25 as Vetsulin. Ah well, it will all come together as planned. So please tell me which syringes u prefer and where to get them . Thanks and hugs :bighug::bighug::bighug:
 
Beth 73 said:
Am getting ready to call vet to see if they carry ulticare 100 with half unit markings and have them show me where the .25 mark is.
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There isn't any .25U mark.....the best we can do is half unit....after that we either have to eyeball it or use calipers to get those "in between" doses
 
Beth 73 said:
Also, what syringes do you all use...got some Relion u 100 but not liking the movement after using the ulticare vet Rx so ordered some from ADW and waiting on them as well. Even my new good vet doesn't carry them ,even after agreeing that Elmo needed to start Lantus with same .25 as Vetsulin. Ah well, it will all come together as planned. So please tell me which syringes u prefer and where to get them . Thanks and hugs :bighug::bighug::bighug:
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Re syringes: I doubt whether most vets even think of dosing between the lines on the U100 syringes and that's what you'll have to do to get 0.25 u. I have had 3 different kinds of syringes - Monoject (from vet), Ulticare (from human pharmacy) and now am using Elimedical brand from my vet. I have no strong opinions on syringes. All three of these cost me the same - $25 CAD for a box of 100. I was fine using all of them.

I'm sure I've told you that I use Freestyle Lite strips in my AT meter. They give a reading much closer (generally only 3 - 7% difference) to what the AT strips give using them that way as opposed to putting the FS strips in the FS Lite meter.

Yes, we're hogging the snow here, Beth.
 
Chris & China said:
There isn't any .25U mark.....the best we can do is half unit....after that we either have to eyeball it or use calipers to get those "in between" doses
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Thanks Chris....soooooo looking forward to you walking me thru this. Went to Bradford Park Vet in Spgfld last week and they don't carry half marking syringes. Prescribe .25, yep....have syringes with half marking, nope. Got some Relion but am so use to ulticare I feel awkward with any other but will hang onto them for now. Have been eyeballing .25 on u40 for weeks now so it's no biggie but it would be if not for half marking. Btw, how is your momma? Gotta go up to St Louis and take mine for doc appointment later this month . She still drives(not much) but is very hard of hearing ....she is a hot mess !!! Thanks for checking in on us....I have a million questions from reading the Lantus Stickies that I will post, few at a time, on LL forum. So glad you are a Lantus Lady !!! Makes me feel so much more at peace at this switch :)
 
Chris & China said:
Are you "priming" the syringe first? There's lubricant inside the syringe so you should pull the plunger in/out a few times before you use it to spread it around and help with the "stickiness"
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Yep, I primed...just bit stiffer movement than ulticare which at times can be too sensitive to movement...I'll experiment with both ....have old bottle of vetsulin I'm messing around with...such is my exciting life here in Big Buffalo :rolleyes:
 
Kris & Teasel said:
Re syringes: I doubt whether most vets even think of dosing between the lines on the U100 syringes and that's what you'll have to do to get 0.25 u. I have had 3 different kinds of syringes - Monoject (from vet), Ulticare (from human pharmacy) and now am using Elimedical brand from my vet. I have no strong opinions on syringes. All three of these cost me the same - $25 CAD for a box of 100. I was fine using all of them.

I'm sure I've told you that I use Freestyle Lite strips in my AT meter. They give a reading much closer (generally only 3 - 7% difference) to what the AT strips give using them that way as opposed to putting the FS strips in the FS Lite meter.

Yes, we're hogging the snow here, Beth.
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Thanks,Kris....as usual my overthinking MO concerning syringes is in full play as I wait for Lantus...I am pondering the attributes of syringes WAY too much as I run out my back door periodically screaming at a sparrow hawk trying to get my songbirds ! What must the neighbors think ???? Ha, they are sadly use to it;)
 
Beth 73 said:
Thanks,Kris....as usual my overthinking MO concerning syringes is in full play as I wait for Lantus...I am pondering the attributes of syringes WAY too much as I run out my back door periodically screaming at a sparrow hawk trying to get my songbirds ! What must the neighbors think ???? Ha, they are sadly use to it;)
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My personal approach is always what I call the "middle way". There are SO many variables in the FD dance - insulin absorption location to location and day to day, minor variations in injection technique, invisible fluctuations in kitty's physiology moment by moment, etc., etc., etc. Against that backdrop I try not to get fussed by slight variations in syringes, syringe mechanics and so on. I do my best to be as consistent as I can in measuring out doses but beyond that I don't worry too much. I can't possibly control every variable so I don't try. :rolleyes:
 
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Vet tech just called, seeing if I had started my two week OTJ trial yet ... I said no but would get back with them soon:rolleyes:.... they restated they would much rather have me remove Elmo from insulin for two weeks then do a curve and go from there....not supportive of what I'm getting ready to do but didn't discuss it with them. Are they afraid of people letting their cats hypo ??? Elmo is very sensitive to meds ....still planning on going with .25 ( maybe minus a drop like vetsulin??) ....thots ????
 
Kris & Teasel said:
My personal approach is always what I call the "middle way". There are SO many variables in the FD dance - insulin absorption location to location and day to day, minor variations in injection technique, invisible fluctuations in kitty's physiology moment moment, etc., etc., etc. Against that backdrop I try not to get fussed by slight variations in syringes, syringe mechanics and so on. I do my best to be as consistent as I can in measuring out doses but beyond that I don't worry too much. I can't possibly control every variable so I don't try. :rolleyes:
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Amen...gotta shoot ur best and go ...
 
Beth 73 said:
Vet tech just called, seeing if I had started my two week OTJ trial yet ... I said no but would get back with them soon:rolleyes:.... they restated they would much rather have me remove Elmo from insulin for two weeks then do a curve and go from there....not supportive of what I'm getting ready to do but didn't discuss it with them. Are they afraid of people letting their cats hypo ??? Elmo is very sensitive to meds ....still planning on going with .25 ( maybe minus a drop like vetsulin??) ....thots ????
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Hmmmm .... I don't think I'd want my kitty off insulin for 2 weeks especially since there's been a DKA episode. Having said that, Elmo's numbers have been good. Maybe you could experiment with taking him off for a few cycles to see what happens and if there's the slightest trend upwards in his numbers put him right back on.
 
Hmmmm....just read over my notes from vet visit and what he advised was :
1. Stop insulin for two weeks
2. Do an every 2 hour curve
3. If ( after two week trial) BG above 350,restart insulin with 1/2 u 2x a day Lantus ..if below 350, 1/4 u 2x a day
Not so sure about this dude now
 
Beth 73 said:
Hmmmm....just read over my notes from vet visit and what he advised was :
1. Stop insulin for two weeks
2. Do an every 2 hour curve
3. If ( after two week trial) BG above 350,restart insulin with 1/2 u 2x a day Lantus ..if below 350, 1/4 u 2x a day
Not so sure about this dude now
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Actually, this is a decent methodical plan: 2 weeks off to see if Elmo holds his good numbers then two different restart doses depending on the BG drift. You could still try leaving him without insulin for 2 or 3 cycles to assess step 1 of the plan.
 
Beth 73 said:
Yep, that was a shocker...came back up very easily...may have given full .25 without minus a small drop...
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The dose needs to be reduced, Beth. 66 is under the limit on an Alphatrak.

Be extra cautious; Elmo's BGs are improving very quickly now. Double digit BGs on Vetsulin - especially when measured on an Alphatrak - are uncomfortably low.

Can't type the positive thoughts I have - don't want to jinx anything ... :nailbiting:

(((Beth and the Buddha Kitteh)))


Mogs
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Beth 73 said:
Hmmmm....just read over my notes from vet visit and what he advised was :
1. Stop insulin for two weeks
2. Do an every 2 hour curve
3. If ( after two week trial) BG above 350,restart insulin with 1/2 u 2x a day Lantus ..if below 350, 1/4 u 2x a day
Not so sure about this dude now
Click to expand...

If starting on Lantus I wouldn't give any more than 0.25IU as a starting dose; you need to take into account the Vetsulin history.


Mogs
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I see where I got vet endorsement of .25 unit...it was from what would need to be done after trial OTJ and referring to possible BGs at that time
 
Critter Mom said:
Also, if numbers started to drift up during the OTJ trial I would not wait for 2 weeks to restart insulin treatment.


Mogs
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I'm not a fan of that 2 week idea of his....Mogs, ur thots on trying him off insulin for a few days? Or go straight to Lantus at .25 when it arrives ???
 
Critter Mom said:
The dose needs to be reduced, Beth. 66 is under the limit on an Alphatrak.

Be extra cautious; Elmo's BGs are improving very quickly now. Double digit BGs on Vetsulin - especially when measured on an Alphatrak are uncomfortably low.

Can't type the positive thoughts I have - don't want to jinx anything ... :nailbiting:

(((Beth and the Buddha Kitteh)))


Mogs
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What about the yellows ???
 
Bless his heart, he doesn't stay low for long...careens right back up...just got a +7...179 after a + 3 of 110.... feel ya'll what, Ole Buddha Kitteh is aging me quick and it ain't pretty o_O
 
Beth 73 said:
I see where I got vet endorsement of .25 unit...it was from what would need to be done after trial OTJ and referring to possible BGs at that time
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Whatever the BGs were, I still would not start Lantus any higher than 0.25IU (based on Elmo's spreadsheet data and response to Vetsulin).

Beth 73 said:
What about the yellows ???
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Slight rebound from the quick drops early in the cycle on the Vetsulin. Look at how easily the current dose will pull down a yellow preshot as well as a blue one.

BTW - if your vet starts saying that Lantus should be dosed on the preshot BG that is categorically incorrect; Lantus dose adjustments are based on the nadir BG.


Mogs
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God bless vets for the knowledge they have and I am proud of his prescribing Lantus but he sure is not a fan of micro doses...thinks at that point let an OTJ trial rip and see what happens:confused:
 
With Lantus the curve should get much, much smoother.

Re skipping a day or two you might lose momentum - or Elmo may coast down into lower numbers without insulin assistance. Ask for input on this from the experienced members on L&L.

ETA - spending a little longer on insulin may promote further healing of the beta cells.

Empirical evidence here shows a slow taper off insulin makes for a more solid remission. (Some OTJ trials fail if the dose is dropped from 0.25 straight to zero. With Vetsulin the taper's nigh on impossible but it's fairly straightforward on Lantus. Technically after that 66 yesterday the dose of Vetsulin should have been reduced to zero.)

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Beth 73 said:
Yep, I think Mogs had gone thru similar with Saoirse...and I believe in ECID but Elmo and Saoirse's journeys are similar in so many ways ....
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Saoirse's first OTJ trial didn't hold because I didn't do the taper on that occasion.

I tapered the dose down to 1 drop and then did the second OTJ trial (successful).

.
 
Critter Mom said:
Whatever the BGs were, I still would not start Lantus any higher than 0.25IU (based on Elmo's spreadsheet data and response to Caninsulin).
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With adequate monitoring Lantus doses can be ramped up fairly quickly under TRP if the starting dose is insufficient for a cat's needs.

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Chris & China said:
I don't think Elmo is ready for an OTJ trial just yet

We like to see at least a week in mostly normal numbers (50-120 or 68-about 150 on AT) before starting an OTJ trial

Our goal is a strong remission.....not a fast one, so we want to keep them on insulin as long as possible to give their pancreas the extra support time
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Chris, you have seen Elmo's sensitivity to slight insulin variations ( like last night I possibly gave a .25 without minusing a small drop and he dropped like a rock at Lake of the Ozarks...in a quiet cove , of course;))...with that in mind and ur extensive experience with Lantus, what would u think his starting L dose would be ??? I'm gathering all info now so ready for when it gets here .
 
AND he is now on a full 2.5 mg methimazole for thyroid 2x daily, up from 3/4 of a pill twice daily last week.....may be kicking in and starting to affect BG values ....
 
Beth 73 said:
AND he is now on a full 2.5 mg methimazole for thyroid 2x daily, up from 3/4 of a pill twice daily last week.....may be kicking in and starting to affect BG values ....
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I'm wary of the dips you're seeing in BG now, Beth - especially with another hormonal treatment in the mix. Safety is everything. If it becomes unsafe to give any Vetsulin (and I think it is very much getting that way) if it were my cat I would stop it and wait for the Lantus to arrive before giving any more insulin.

Other members may have a different view.


Mogs
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Maybe go with .25 minus large drop tonight and see where we go ??? And you know me, monitoring is my life as well as middle name:)
 
Critter Mom said:
I'm wary of the dips you're seeing in BG now, Beth - especially with another hormonal treatment in the mix. Safety is everything. If it becomes unsafe to give any Vetsulin (and I think it is very much getting that way) if it were my cat I would stop it and wait for the Lantus to arrive before giving any more insulin.

Other members may have a different view.


Mogs
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Mogs, right now that would be for at least two days...Lantus has gotten hung up cos, like a doofus, I ordered during the holidays...tracking says is in US customs and here on Friday the 6th....if it doesn't come I may have to bite the bullet and go buy one pen to get me by til it arrives...
 
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