1/7 Bronx AMPS 409, our first yellow today!

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The Lev will be onsetting at around +4, so maybe the yellow is a combo of the both. I would get a test at +5 see what Bronx does with the juice.

@Doodles & Karen am I right in thinking that with R the drop in BG is much more immediate but has a relatively short duration??
 
Gill & George said:
The Lev will be onsetting at around +4, so maybe the yellow is a combo of the both. I would get a test at +5 see what Bronx does with the juice.

@Doodles & Karen am I right in thinking that with R the drop in BG is much more immediate but has a relatively short duration??
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I read that some have actually used R twice in one cycle. Hopefully I am not setting Bronx up for a bounce.
 
Bronx's dad said:
A bounce will be new to us if it happens, when will it most likely occur?
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I think the 1 unit did pretty good but we don't know when the drop occurred meaning was it gradual or a big drop at once. I wouldn't worry about the "bounce" at this point. It's good to see movement.

Gill & George said:
R the drop in BG is much more immediate but has a relatively short duration
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Typically it lasts about 4 hours...onset usually around R+2 and nadir @ R+4. Now hopefully the Levemir will do it's thing.

I'm certainly not an R expert and really again ECID. R sometimes seems to effect the following cycle. It's tricky. Regardless, good to see some movement today.
 
Doodles & Karen said:
I think the 1 unit did pretty good but we don't know when the drop occurred meaning was it gradual or a big drop at once. I wouldn't worry about the "bounce" at this point. It's good to see movement.


Typically it lasts about 4 hours...onset usually around R+2 and nadir @ R+4. Now hopefully the Levemir will do it's thing.

I'm certainly not an R expert and really again ECID. R sometimes seems to effect the following cycle. It's tricky. Regardless, good to see some movement today.
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Wondering if I should shoot R again at PMPS if I don't see a bad bounce today. Maybe .75R since he does go a little lower in the overnight hours? But I have heard an R shoot at AMPS can even cause a 2nd cycle drop in some cats? Will not be up all night to monitor.
 
Bronx's dad said:
Wondering if I should shoot R again at PMPS if I don't see a bad bounce today. Maybe .75R since he does go a little lower in the pm hours?
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I think others like @julie & punkin (ga) or @Wendy&Neko or @Jill & Alex (GA) are best to advise you. I'm not comfortable doing so. My gut says as long as you're monitoring it should be fine but PMPS is pretty far from now and will have to see where the rest of the cycle goes. Onset just likely started so it will be interesting to see if he stays yellow, goes down a bit or trends up.
 
Doodles & Karen said:
I think the 1 unit did pretty good but we don't know when the drop occurred meaning was it gradual or a big drop at once. I wouldn't worry about the "bounce" at this point. It's good to see movement.


Typically it lasts about 4 hours...onset usually around R+2 and nadir @ R+4. Now hopefully the Levemir will do it's thing.

I'm certainly not an R expert and really again ECID. R sometimes seems to effect the following cycle. It's tricky. Regardless, good to see some movement today.
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Thanks Karen, having never used it I wasn't sure at all, but being the lurker that I am I have followed you and Bobbie when you've used it and that's what I remembered, of course ECID that goes without saying.
 
Bronx's dad said:
But I have heard an R shoot at AMPS can even cause a 2nd cycle drop fin some cats?
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It's not that R will cause a second cycle drop in some cats. The effects of R are in and out in a matter of hours. What happens is the use of R interrupts the normal course of events. When you are able to lower numbers with R, the next cycle may run lower than if you hadn't used R in the previous cycle. I hope that makes sense.
Bronx's dad said:
Wondering if I should shoot R again at PMPS if I don't see a bad bounce today. Maybe .75R since he does go a little lower in the overnight hours? But I have heard an R shoot at AMPS can even cause a 2nd cycle drop fin some cats? Will not be up all night to monitor.
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My personal opinion...
If I didn't see a bad bounce and I wasn't planning on staying up to monitor, I'd simply skip using R. You can always resume the use of R in the morning if necessary. That's one of the beauties of using R... you don't "have to" use it. If you want to go somewhere, do something else, sleep... forget using R that cycle!
Doodles & Karen said:
My gut says as long as you're monitoring it should be fine but PMPS is pretty far from now and will have to see where the rest of the cycle goes. Onset just likely started so it will be interesting to see if he stays yellow, goes down a bit or trends up.
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I agree. My gut says it should be fine, BUT you're nowhere near making that decision yet. Like Karen said, you have to see how the rest of the cycle goes.

Just my thoughts...
 
Woohoo! :woot: Awesome seeing another colour in there. I wonder what he'll do the rest of the cycle now that the Lev has a lower number to work with.

Usually people will build an R scale, meaning shoot a certain amount of R based on the BG test at the time they are shooting it, and the time in the cycle. For example, Neko got .5R when her dose was over 5 units and her BG was over 300 and while the Lev action was tailing off. Which would be at preshot or even a couple of hours before.

One option to R at PMPS is R after you start seeing Bronx's numbers start to head back up towards the end of the cycle. But I would use a lighter touch on the amount as you are still learning whether he shows the second cycle after affect. The beauty of shooting R later in the AM cycles instead of PMPS is that you might get to sleep earlier. But like Jill said, you could also skip it and see what happens. Whatever you do at this point is all about gathering data on Bronx.
 
I would encourage you to make a practice of testing hourly after an R test, until you can say with confidence how many points a particular dose will drop Bronx's blood sugar.

Right now, you don't know how fast he's dropping with this dose and that is a critical bit of information that is missing.
 
julie & punkin (ga) said:
I would encourage you to make a practice of testing hourly after an R test, until you can say with confidence how many points a particular dose will drop Bronx's blood sugar.

Right now, you don't know how fast he's dropping with this dose and that is a critical bit of information that is missing.
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I have been since +4, should've started earlier but did not expect to see a yellow, was a nice surprise. So far +4,+5,+6 all steady high yellows. Will keep testing every hour. Also started Zobaline for the 1st time last night, do you think that has anything to do with it?
 
Finally a ray of sunshine on the SS !

I would proceed with caution at this point. Being that you just switched to lev and also that you just have two 8.5u cycles under your belt. Personally, being that it's the first yellow for Bronx, I would want to see what the third lev cycle looks like sans R.

The power of R can be very seductive ... however it is double edge sword. Easy does it. :cool:
 
Bobbie And Bubba said:
Beautiful! Congrats on your first yellow! Bubba did some R also last year in Dec and Jan if you'd like to look at his SS.
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Thanks, I did. How do you measure .1u?? I see you also use a ketone meter, what meter are you using? How do you get Bubba down from a 5 to no ketones in a day? I have a PrecisionXtra and only used it once and got a 2.2. Been using dipstrips since those meter strips are insanely expensive and get a "trace"every time so far.
 
Funny story: Had an order of Relion strips coming from Walmart.com, delivery due date Tuesday. But using so much today and most likely tomorrow to monitor the R and only had 32 left. Decided I better get some today in the snowstorm since all Walmarts are closed in my county on Sunday. As I'm shoveling the snow to get my truck out, Fedex pulls up and has a box from Walmart.com....my strips!!!
 
Bronx's dad said:
Thanks, I did. How do you measure .1u?? I see you also use a ketone meter, what meter are you using? How do you get Bubba down from a 5 to no ketones in a day? I have a PrecisionXtra and only used it once and got a 2.2. Been using dipstrips since those meter strips are insanely expensive and get a "trace"every time so far.
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Here is a pictorial guide to show how to dose .1 unit

I use the Abbott Precision Xtra meter also and I pushed the water like crazy in his food every time I fed him to flush the ketones. I found the Universal Pharmacy in Canada was the cheapest place to get those strips let me know if you want their number .

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Bobbie And Bubba said:
Here is a pictorial guide to show how to dose .1 unit

I use the Abbott Precision Xtra meter also and I pushed the water like crazy in his food every time I fed him to flush the ketones. I found the Universal Pharmacy in Canada was the cheapest place to get those strips let me know if you want their number .

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Sure, thx! I bought 20 on ebay for $70, did I get ripped off?. Just got a 258 at +7, a 150 drop from AMPS. Hopefully a bad bounce is not coming?
 
Bronx's dad said:
Sure, thx! I bought 20 on ebay for $70, did I get ripped off?. Just got a 258 at +7, a 150 drop from AMPS. Hopefully a bad bounce is not coming?
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You can do better at Universal the number is 1.866.456.2456 last I ordered I paid $90 /40

Lets hope he doesn't bounce, You only want to get about a 50 point drop with the R other wise they can bounce .
 
Bronx's dad said:
I guess once I become an R expert & learn Bronx's pattern, I can control the bounce with more R. But at this point I will skip the R until tomorrow morn and maybe cut it back to .75u.
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You def want to get guidance with the R use. I had the T team of Jill and Libby helping me. Couldn't have done it without them.
 
Bronx's dad said:
I guess once I become an R expert & learn Bronx's pattern, I can control the bounce with more R. But at this point I will skip the R until tomorrow morn and maybe cut it back to .75u.
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It took him down just about 100 points which is what you want. Not all kitties bounce from R but since it's the first time he's seen yellow it's possible. It'll also be hard to tell if he's bouncing or if the Lev. dose isn't enough. That's why it's good to go without R here and there to see what the Lev dose is doing. If you do go with 1u R tomorrow, or any R tomorrow it's best to test hourly again to see what it's doing.

The last time I used R (.5u) on 12/17 it dropped Doodles 200 points :nailbiting: and he did not bounce but rather his numbers just want back to being crappy. The recent time before that on 12/11 I gave him 1u R and he went down about 150 pts and he did not bounce.
 
Doodles & Karen said:
It took him down just about 100 points which is what you want. Not all kitties bounce from R but since it's the first time he's seen yellow it's possible. It'll also be hard to tell if he's bouncing or if the Lev. dose isn't enough. That's why it's good to go without R here and there to see what the Lev dose is doing. If you do go with 1u R tomorrow, or any R tomorrow it's best to test hourly again to see what it's doing.

The last time I used R (.5u) on 12/17 it dropped Doodles 200 points :nailbiting: and he did not bounce but rather his numbers just want back to being crappy. The recent time before that on 12/11 I gave him 1u R and he went down about 150 pts and he did not bounce.
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Wow, his numbers are all over the place, that 32 must've been scary! Is he so unpredictable because of the IAA?
 
Bronx's dad said:
that 32 must've been scary! Is he so unpredictable because of the IAA?
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Yes, it's the IAA. Waking up to a 26 isn't fun either..he is very difficult for me to bring up and never was before the IAA developed. He's had a tough road like many others. He also has HCM and recurrent heart failure (more insulin resistance) so we're just trying to keep him ticking with a decent QOL...out of the "shark" territory since he's now prone to some scary hypo symptoms. ECID and Doodles is well....just say different and should not be used as any example ;)
 
BTW @Sandy and Black Kitty had IAA, they beat it and BK was in remission for 6 years :) Sandy mastered using R. We're just out of time because of Doodles heart failure and are now taking a palliative approach.

I look forward to seeing Bronx's continued progress. You're both in great hands here in L&LL.
 
Bronx's dad said:
I have been since +4, should've started earlier but did not expect to see a yellow, was a nice surprise. So far +4,+5,+6 all steady high yellows. Will keep testing every hour. Also started Zobaline for the 1st time last night, do you think that has anything to do with it?
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R typically onsets about 1-2 hours after the shot and is typically out of the system about +4. In cats with iaa the action can last longer. However, ECID - Every Cat is Different in their response to insulin(s). I would test hourly for the first 4 hours after the R shot until you can identify when the R onsets and how far a given dose drops him, and how quickly that happens.

I don't think the Zobaline has anything to do with today, however, I'd encourage you to write any/all meds in the comments section of the spreadsheet. That is often very important information.
 
julie & punkin (ga) said:
R typically onsets about 1-2 hours after the shot and is typically out of the system about +4. In cats with iaa the action can last longer. However, ECID - Every Cat is Different in their response to insulin(s). I would test hourly for the first 4 hours after the R shot until you can identify when the R onsets and how far a given dose drops him, and how quickly that happens.

I don't think the Zobaline has anything to do with today, however, I'd encourage you to write any/all meds in the comments section of the spreadsheet. That is often very important information.
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Based on the #s today, what do you think I should do with R at AMPS? I skipped R at PMPS 30min ago and will do a +3 test and prob once more around +6 to +8 to see if he ever bounces from the yellows in the 1st cycle. I am thinking .75 or 1u again at AMPS.
 
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Today's 1u looks like it dropped him just about 100 points.

I'll look back later tonight and see what test results you get in the pm cycle. One of the things you'll discover is that it can be hard for us to predict what you ought to do in advance. In order to make a sound suggestion, it's good to see what's happening in the time right before the shot. I promise I will look at his spreadsheet later this evening.

As far as the potential bounce goes, without us having seen his personal bounce style yet, lol, we can't know. Like all of this, different cats have different bounce styles. Punkin with acro-only usually bounced directly after the "lower numbers event." It was straightforward, up relatively quickly to the peak. I've seen some cats with iaa bounce in a way that I thought of as "climbing the mountain." It was like they took a couple of days to get to the peak of the bounce. I'm not sure that those styles are particularly representative of acro bouncing versus iaa bouncing, but those are 2 examples that I've seen.

Remission? An acro tumor is considered pulsative, which means that it pulses. It can ramp up and it can decrease. Yes, there have been acro cats that have gone into remission without treatment - I know of a couple that did. One was early on after diagnosis and after a time (don't recall how long) the tumor ramped back up and the cat was back on insulin again. A second one went off of insulin when it was very ill and the person thought he was going to die. I don't recall what the illness was, but whatever it was it caused him to go off.

Other than that, the only remissions I know of are when the tumor is treated. Punkin's dose went down, but he didn't go off of insulin. Same with Neko.
 
I'm counting from preshot to +4. Yes, he continued to go down after that point, but hopefully that was Lev action onsetting, rather than the R. I can't be sure of that, of course, but I would have expected the R to not linger much past the first 4 hours after the shot.

If I'm remembering right, you did get him tested for iaa and it was something under 10%, right? That is negative. If I've got that right, would you edit your signature block and add "iaa negative" or "iaa 7%" to it? It's just helpful to have it present in a high dose kitty's info.

You must be thrilled to see that yellow in there! He's making progress.
 
julie & punkin (ga) said:
R typically onsets about 1-2 hours after the shot and is typically out of the system about +4. In cats with iaa the action can last longer. However, ECID - Every Cat is Different in their response to insulin(s). I would test hourly for the first 4 hours after the R shot until you can identify when the R onsets and how far a given dose drops him, and how quickly that happens.
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When kitty's BG numbers remain high and flat, it's difficult, if not impossible to get a handle on kitty's response to the exogenous insulin given. However, once movement is seen, learning how Bronx responds to not only the basal dose (Lev), but also the bolus (R) becomes very important. You'll want to test enough/collect data to learn how Bronx is responding to both Lev and R.

Essentially what you'll want to do is find Bronx's onset, nadir, and duration for Lev and R. Once you get to doses that do more for him, you have to be very careful to not give R at a time in the cycle when the nadirs of R and Levemir might overlap, or when both insulins are working hard at the same time. If you have R pulling him down at the same time, the Levemir joins in and starts pulling down even harder, then you can get into a situation where it is hard to control the drop.

To put R use into perspective, the goal isn't to give enough R to bring BG numbers down to a better range. Making him drop too fast or too far would just set up a round of bouncing. If one isn't careful, this can become a vicious cycle. That's why ideally, we like to see a maximum drop of only 100 points.

This is what you want to try to learn at this point for each insulin:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
In addition, a full understanding of the following concepts will go a long way in helping you regulate Bronx's blood glucose when using both Levemir and R:
  • Carryover - insulin effects lasting past the insulin's official duration
  • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
  • Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
  • LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Bronx's dad said:
Based on the #s today, what do you think I should do with R at AMPS? I skipped R at PMPS 30min ago and will do a +3 test and prob once more around +6 to +8 to see if he ever bounces from the yellows in the 1st cycle. I am thinking .75 or 1u again at AMPS.
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Without knowing what will happen tonight and what AMPS will be, all I'm comfortable saying is I think you could give 1u R at AMPS like you did today if the AMPS is greater than 400 and you're available to monitor. That 100 point drop this morning was nice without being too much. :)


Just some thoughts for your consideration...
 
julie & punkin (ga) said:
If I'm remembering right, you did get him tested for iaa and it was something under 10%, right? That is negative. If I've got that right, would you edit your signature block and add "iaa negative" or "iaa 7%" to it? It's just helpful to have it present in a high dose kitty's info.

You must be thrilled to see that yellow in there! He's making progress.
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IAA was 8% and added that in my block. Yes, I was thrilled to see a string of yellows, a good day for us!
 
Jill & Alex (GA) said:
Without knowing what will happen tonight and what AMPS will be, all I'm comfortable saying is I think you could give 1u R at AMPS like you did today if the AMPS is greater than 400 and you're available to monitor. That 100 point drop this morning was nice without being too much. :)
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I will be avail to monitor all day tomorrow. So maybe 1u of R if AMPS >400 and .75u if >300?
 
I will be avail to monitor all day tomorrow. So maybe 1u if AMPS >400 and .75u if >300?
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If numbers are greater than 400 @ AMPS, one would assume they're either flat or on the rise. Shooting 1u R as you did today should be fine as long as you're monitoring because you'll be able to intervene if necessary.

Again, without seeing what happens tonight and where Bronx will end up at AMPS... you could probably give 0.75u of R @ AMPS as long as the BG numbers are on the rise and you're monitoring. However, there's no way I could commit to a reply at this time if his BG numbers are over 300, but flat OR falling.

Make sense?
 
Jill & Alex (GA) said:
If numbers are greater than 400 @ AMPS, one would assume they're either flat or on the rise. Shooting 1u R as you did today should be fine as long as you're monitoring because you'll be able to intervene if necessary.

Again, without seeing what happens tonight and where Bronx will end up at AMPS... you could probably give 0.75u of R @ AMPS as long as the BG numbers are on the rise and you're monitoring. However, there's no way I could commit to a reply at this time if his BG numbers are over 300, but flat OR falling.

Make sense?
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yes, it does. thx so much!
 
Bronx's dad said:
yes, it does. thx so much!
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You're welcome!

Something I should have added to my comments above...
It's difficult to "plan ahead" when it comes to using R. To use R effectively and safely, it helps to know how Bronx responds to the insulins used (review post #40) plus in the moment you have to see where the BG numbers are at, understand how kitty got there, and have some idea of what will happen. This kind of information can't be planned. You get the info, analyze it, and then make the decision to give R... or not.
 
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