? MARKIES HELP NEEDED. PMPS (443) 1.25 uLev 0.5 u R +9 (452)

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To all, I started a new thread on the Levemir section. I will copy the link down this one. I m still hoping to be able to have the Rapid scale.
 
@Sienne and Gabby (GA) Im bringing this paragraph from your´s from the other thread so we can continue here. Let me read it again so I can understand it.

Others will be more proficient in guiding you but we don't typically used a sliding scale with R. You want to maximize your basal insulin (Lev) so the idea is to steadily and systematically increase the Lev and likewise systematically increase your dose of R. When starting to use R, you "curve" the first 4 hours of the cycle to see how the dose of R is affecting Markies' numbers. The general idea is that the R will pull the numbers down a little. You don't want the dose of R to yank the numbers down so hard that you complicate matters with bouncing.
 
@Sienne and Gabby (GA) I think I understand. I may have some questions. I assume that I will not have to give R all the time, only at high numbers. And if Levemir increases R also increases but it will not change according to the BG nuber at that time, it will stay steady the same as the levemir dose during those cycles.

I simply can´t believe this pink and red numbers.

I will now read about the protocols, may be its time to start all over again. May be we need to stop and start from scartch. May be he is bouncing very very quickly and Im not catching him??
 
Silvina, I saw the 327 at +2, did you get another test? You don't want him going down so fast that he bounces up real high again. That's the key.
 
Dyana said:
Silvina, I saw the 327 at +2, did you get another test? You don't want him going down so fast that he bounces up real high again. That's the key.
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Dyana I just tested at +3.5 and he was 273. What this means? I remember one of the girls posting it was expected a drop of 100 points. Obvioustly this is the double. In what time is that 100 points drop expected? Within what time after shooting?

Is there a sticky notw on the use of Rapid?
 
No, there's no sticky note on it. We usually recommend that someone experienced with R help you in the beginning. I only received a little bit of help way back when, and I messed up a lot and sometimes made J.D. go down way too fast and then just set up another bounce.
I have to run to the store before it closes at 7:00pm. Hopefully, Sandy will be here soon.
 
@Sandy and Black Kitty here we are Im copy pasting here your message

Hello Silvina,

I see you gave Markies a small dose of R at PM+1 which is good for now.
  • How is Markies behaving today? Is he eating well?
Yes, he is. If it was for him, he would be eating the whole day. But today they are all more quiet. Starving usually starts at night when he usually begs for food. He looks ok. He cuddles and purrs when I get close to him.
  • Please let us know what method (special blood meter or urine ketostix) are you using to monitor for the presence of ketones. The result of these tests are very important knowledge you need so that we can best help you to help Markies.
Blood meter today Im using Accu check Performa. Keto sticks are KETO DIABUR TEST 5000 FROM ACCU CHECK.
  • please also let us know if your daily schedule permits you to closely monitor his BG.
Yes. I can clos monitor. I work and live at same place.
  • Share with us please the details of the hypo in May - what happened?
In may Markies was hospitalized. He stopped eating. He had hemobartonellam and hematocrit reached 6. He had blood transfussiondad. During hospitalization he was on DKA. Those times where very difficult. Mush stress and sadness. Also dad recently diagnosed. Markies was under treatment for hiw haemobartonella for 28 days after hospital. Also Markies vomits frequently, and doxicicline is very stomach upsetting. Si I don´t really know if this is the reason. But he didn´t show symptoms of hypo, he had that low numbers but no symptoms.

I'm happy to try to help, however for your information please know that I am a very slow typist due to the effects of Parkinsons. I'll be looking for your answers to the questions above.

Hang in there, and hang in here. :cool:

You are so sweet!!! and you are a fighter!!!!
 
Silvina, I know you see how confusing it becomes when there are two threads going for the same person. We ask that there only be one thread per day for each person/cat. This one is getting very long, but since you already directed people to this one from your other post and you already have so much information on this one, why not finish using this one only for the rest of the day, and then tomorrow start a new one with Markies numbers in the Subject Line and a link back to this post for reference.

I'm glad Sandy is here to help answer some of your questions.
 
Silvina said:
I just tested at +3.5 and he was 273. What this means?
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It is the 5th consecutive cycle of the 1.5u Lev 1.25u lev dose and the Lev is showing you what it can do. As you can see, that small dose of R added momentum.
Silvina said:
I remember one of the girls posting it was expected a drop of 100 points.
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What we advise is that the ideal result desired when giving R is to bring down BG around 100 points.
Silvina said:
In what time is that 100 points drop expected? Within what time after shooting?
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These are unknowns. You must discover this step by step, taking great care along the way. This is how you develop your kittys R scale. It is different for every kitty and can and will change over time with your kitty.
 
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Sandy and Black Kitty said:
It is the 5th consecutive cycle of the 1.5u Lev dose and the Lev is showing you what it can do. As you can see, that small dose of R added momentum.

What we advise is that the ideal result desired when giving R is to bring down BG around 100 points.
These are unknowns. You must discover this step by step, taking great care along the way. This is how you develop your kittys R scale. It is different for every kitty and can and will change over time with your kitty.
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great, what I have been noticing lately, is that I cant find any nadir... nadir desapear... there is not nadir..

look my spread sheet

I feel that this drop from R can help me find a base from which I feel the nadir good and safe, I remember in a previous thread we had (we already had a thread about R) someone told me that I have to be careful with both nadirs, that I remember not to overlap both nadirs.

@Sandy and Black Kitty do you know which one is the Humulin R nadir in cats? aprox?
 
Sandy I don´t want to bother you any more. Things are smooth right now. You´ve been a lot here. I appreciate a lot your help and your efforts. But don´t want to bother you
 
I'm not Sandy, but R usually nadirs around +2.5 to +3, I think, and is done and out of the system around +5 to +6. Sandy correct me if I am wrong.
So, for a simple example if your shot times were at 12:00pm and at 12:00am, and if your kitty's nadir on Levemir is at +8 or at 8:00am in this example, then you do not want your R to nadir at that same time at 8:00am, so you wouldn't want to shoot the R at +5.5 (5:30am) as they would both have their nadirs at the same time. It's hard to explain and it varies with each cat, and sometime with each day. Sorry, if I just confused you more.
 
Dyana said:
I'm not Sandy, but R usually nadirs around +2.5 to +3, I think, and is done and out of the system around +5 to +6. Sandy correct me if I am wrong.
So, for a simple example if your shot times were at 12:00pm and at 12:00am, and if your kitty's nadir on Levemir is at +8 or at 8:00am in this example, then you do not want your R to nadir at that same time at 8:00am, so you wouldn't want to shoot the R at +5.5 (5:30am) as they would both have their nadirs at the same time. It's hard to explain and it varies with each cat, and sometime with each day. Sorry, if I just confused you more.
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Thank you Dyana!!

I usually shoot R at the same time of Levemir. so nadir never touches.
 
I just noticed (and corrected) an error in my previous post - you are on the 5th consecutive cycle of 1.25u lev.
Silvina said:
what I have been noticing lately, is that I cant find any nadir... nadir desapear... there is not nadir..
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nadirs can and do move around from time to time. Some cycles will appear flat. As Markie approaches a better lev dose nadir will become easier to see.
Silvina said:
do you know which one is the Humulin R nadir in cats? aprox?
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R onset is rapid however duration is short, ~4 hours for some, ~5 hours for others and sometimes a bit longer for kitties with IAA (antibodies that grab insulin as soon as it is injected, releasing it back into circulation after a variable and unpredictable length of time). The R nadir will fall somewhere in between. Since it varies from cat to cat close observation and documentation of your kittys reactions to R is a must.
Silvina said:
I usually shoot R at the same time of Levemir. so nadir never touches.
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This is a best practice for starting and becoming familiar with R.

Please remember that using R to battle ketones while a diabetic kitty recovers from DKA is a temporary measure and differs greatly from the strategies (generally long term) used for kitties with high dose conditions

I'm happy to hear Markie has a good appetite. Im also happy to hear you are checking for ketones. with Markies history of multiple DKA episodes you should check daily for the presence of ketones and note the results on the ss.

Its great that you work from home and can monitor closely. Battling the formation of ketones is labor intensive.
I worked from home as well, allowing me to closely monitor BK. Thank goodness because he needed a lot of close monitoring.

It is not a bother to be here and help Sylvina. Many good people here spent many hours, day and night, for 21 months helping us get through our crazy journey. A journey from deaths door, through the previously uncharted territory of IAA, to a remission that lasted the rest of BKs life. :cool:

 
Sandy and Black Kitty said:
I just noticed (and corrected) an error in my previous post - you are on the 5th consecutive cycle of 1.25u lev.
nadirs can and do move around from time to time. Some cycles will appear flat. As Markie approaches a better lev dose nadir will become easier to see.

R onset is rapid however duration is short, ~4 hours for some, ~5 hours for others and sometimes a bit longer for kitties with IAA (antibodies that grab insulin as soon as it is injected, releasing it back into circulation after a variable and unpredictable length of time). The R nadir will fall somewhere in between. Since it varies from cat to cat close observation and documentation of your kittys reactions to R is a must.
This is a best practice for starting and becoming familiar with R.

Please remember that using R to battle ketones while a diabetic kitty recovers from DKA is a temporary measure and differs greatly from the strategies (generally long term) used for kitties with high dose conditions

I'm happy to hear Markie has a good appetite. Im also happy to hear you are checking for ketones. with Markies history of multiple DKA episodes you should check daily for the presence of ketones and note the results on the ss.

Its great that you work from home and can monitor closely. Battling the formation of ketones is labor intensive.
I worked from home as well, allowing me to closely monitor BK. Thank goodness because he needed a lot of close monitoring.

It is not a bother to be here and help Sylvina. Many good people here spent many hours, day and night, for 21 months helping us get through our crazy journey. A journey from deaths door, through the previously uncharted territory of IAA, to a remission that lasted the rest of BKs life. :cool:
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thank you so much @Sandy and Black Kitty

One last question. What R dose would you reccomend. Today he had a 170 drop in 3.5 hours. (from 443 to 273).

I still dream with remission, although I know Markies is a difficult cat with all his underlying problems, specially those that will not heal, for example his heart restrictive cardi0miopathy.
 
If AMPS is 400 or above, no more than 0.25u R with the morning lev shot of 1.25u (which will be cycle 6 of that lev dose) If below 400 do not shoot any R.
I will look for your new thread , dated 3/13, tomorrow. :cool:
 
Please, I need help. He is 452 at +9. Should I use Rapid again? He is begging for food and still have a long night. Many hours till we go to bed. I will try to give him subq fluids but I know he will battle me.

I catched him breathing with this mouth opened (usually when he has high BG he does that). Nothing terrible but I know him. I don´t like that too much.
 
Hi

Let me copy and paste my comment from the Facebook page here: That looks like it might be a bounce. He dropped really fast into +3 - almost 200 points in 3 hours. Then I don't see any numbers between +3 and +6, so he could very well have gone lower again during those 3 hours before coming back up.

Please bear in mind that I have not used R for any of the cats I've treated...I'm just looking at the fast drop and then him finishing up high again a few hours later.
 
manxcat419 said:
Hi

Let me copy and paste my comment from the Facebook page here: That looks like it might be a bounce. He dropped really fast into +3 - almost 200 points in 3 hours. Then I don't see any numbers between +3 and +6, so he could very well have gone lower again during those 3 hours before coming back up.

Please bear in mind that I have not used R for any of the cats I've treated...I'm just looking at the fast drop and then him finishing up high again a few hours later.
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I honestly don´t think it went down again. That big drop is due to the big dose of Rapid. It was too much. Ive been told to give half the dose I gave today. Rapid in Markies wares off very soon no longer than 4 to 6 hours as much, usually 4. And lately levemir dose seemed not enough. But imagining Im right, can that 443 to 273 drop in 3.5 hours be enough to cause a bounce? May be thats a bounce anyway.

Anyway whatever it is his numbers are in the sky and he is behaving weird. Now he is meowing in the doorway. This is what he used to do when his diabetes started. Im starting to panick. Shut. Im thinking he might have hemobartonella back. That´s usually how his hospitalizations starts.

Dear, I need to know WHAT i SHOULD DO KNOW TO PUT DOWN THIS GLUCOSE. I BELIEVE I WILL HAVE TO USE RAPID AGAIN RIGHT.? @Sandy and Black Kitty @Dyana @Sienne and Gabby (GA)
 
A fast drop, even if it isn't into low (or even normal) numbers can cause a bounce. If Markies' body feels itself dropping fast, then that defense mechanism can kick in before he ever reaches normal numbers and send him right back up. I can't say for certain that that's what happened...it's just the way the numbers look to me. I don't know enough about R to help you with whether or not to give a second dose as late as +9 or +10.
 
manxcat419 said:
A fast drop, even if it isn't into low (or even normal) numbers can cause a bounce. If Markies' body feels itself dropping fast, then that defense mechanism can kick in before he ever reaches normal numbers and send him right back up. I can't say for certain that that's what happened...it's just the way the numbers look to me. I don't know enough about R to help you with whether or not to give a second dose as late as +9 or +10.
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Thank you dear. Mostly sure it was a bounce. It kept going up so I had to give another R dose. this time less.
 
Hopefully the smaller dose won't drop him quite so far or so fast. If it still drops him too quickly, you may want to stop the R completely for a few days and just let his numbers settle...if a lot of these higher numbers are from bouncing, then he may do just fine on just the Levemir once you can break the cycle of bouncing.
 
manxcat419 said:
Hopefully the smaller dose won't drop him quite so far or so fast. If it still drops him too quickly, you may want to stop the R completely for a few days and just let his numbers settle...if a lot of these higher numbers are from bouncing, then he may do just fine on just the Levemir once you can break the cycle of bouncing.
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good that you are there!!!!! I need you!! can you stay a little longer? I have a very basic question about how to charge the syringe.
 
Oh I'm going to be about for a while tonight. Roxi gave me a pre-shot of 78 and she's at 61 at +1. She'd been high for a couple of days after a fur shot, but she means business tonight so I could easily be here for another 4 or 5 hours yet.
 
This is what happens. When Markies was hospitalized I was told how to charge the syringe U100 (the syringe that charges 100 units) loading 10 units of Humulin R and 9 units of physiologic solution and leaving the syringe like that in the fridge already loaded and using it as needed. They gave me at that time their scale (a sliding scale).

But now that I have to use very little dose, 0.25 units and that it will be impossible to use this already charged syringe and take only 0.25 units from a 100 units charged syringe (hope you follow me) and be able to stop my hand at the right spot.

So tonight what I did. Was:

1. Charge the 100 units syringe the the 10 units of HR and 9 of physiological solution
2. Took the BD orange 30 units syringe and load 5 units of this mix of insulin + the solution
3. Took off some drops in order to find the right dose 0.25 units
4. shoot.

How do you handle this. Im mostly sure you don´t do all this stupidity.
 

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manxcat419 said:
Oh I'm going to be about for a while tonight. Roxi gave me a pre-shot of 78 and she's at 61 at +1. She'd been high for a couple of days after a fur shot, but she means business tonight so I could easily be here for another 4 or 5 hours yet.
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GOOD FOR ME!!! :cat:
 
here are two more pictures, one that shows how I load the 30 units syringe that allows me to find the smaller dose and the one that shows how the doctors show me how to "store" the insulin at home. This is RIDICULOUS!!!!
 

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I have a vial of Humulin R in the fridge. I would just insert the BD syringe into it and withdraw 0.25 units. Much simpler. I kmow the vets will dilute R for even smaller amounts, but you should be able to eyeball the 0.25 units.
 
Wendy&Neko said:
We don't dilute the R insulin. We just measure the R dose (0.25 units in this case) using the BD orange cap 30 unit yringe.
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Then that´s why may be the 1 unit that I was using was not that huge finally, I mean, that´s why most people was surprised at such a high dose.

Well, anyway. I need to be completely sure then which one be a safe dose for Markies and I will be so happy not to have to make all this circus my Lord!!! Just using my favorite BD Ultrafine with half marks 30 unit syringes!!!
 
I agree with Wendy. Insulin isn't meant to be diluted anyway. And, that I'm aware of, pre-filled syringes aren't really meant to be kept for later use either. If you want to give 0.25 u, then you would just draw 0.25 u direct from the vial. But if the R that you're using is diluted pretty close to 50/50, then your 0.5 u was actually closer to 0.25 u. And the 0.25 u you've given is closer to 0.125 u. So if you are going to continue using R, you will need to reduce the dosing accordingly if you're changing to drawing it direct from the vial.
 
manxcat419 said:
I agree with Wendy. Insulin isn't meant to be diluted anyway. And, that I'm aware of, pre-filled syringes aren't really meant to be kept for later use either. If you want to give 0.25 u, then you would just draw 0.25 u direct from the vial. But if the R that you're using is diluted pretty close to 50/50, then your 0.5 u was actually closer to 0.25 u. And the 0.25 u you've given is closer to 0.125 u. So if you are going to continue using R, you will need to reduce the dosing accordingly if you're changing to drawing it direct from the vial.
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I have no clue what is the ratio of dilution, I mean my brain is not intelligent enough to know that about 50/50 but I can tell you that what I just did drop Markies glucose from 490 to 402 in 1 hour 40 minutes.

Im kind of not feeling happy that I had to use again Rapid but he was going high again, even higher than today, and I felt I had to put down this bounce. He was even behavingn weird, meowing at the doorway, begging desperate for food and he still is, etc. which is way much better than not eating. Im happy for that. Crossing fingers.

So, lets see. I gave him 0.25 of a diluted insulin, remember (10 units insulin / 9 physiological solution in a 100 syringe). Obviously this 0.25 DIRECTLY FROM THE VIAL insuline will be a lot (CANT TELL WHO MUCH MORE).

Anyone have that hability to make that mathematics? to tell me which could be a safe direct from the vial dose for Markies?
 
If it's 9/19ths physiological solution and 10/19ths then it's pretty close to 50/50. So 0.25u direct from the vial is almost double what you would get if you gave 0.25u of the mixed solution. You will need to give somewhere around 0.1u or 0.15u to get the same amount of insulin straight from the vial. I don't know about deliberately pulling down bounces - that, to me, feels like a recipe for setting up continued bounces and having to keep using the R to pull them down which becomes self-defeating after a while - it would be better to level him out and stop the bouncing altogether. Can I ask why the decision to use R when he was only on a low dose of Lev that could easily have been increased? Was it advice from your vet? It looks as though his numbers were better before you introduced the R at all last year.
 
manxcat419 said:
If it's 9/19ths physiological solution and 10/19ths then it's pretty close to 50/50. So 0.25u direct from the vial is almost double what you would get if you gave 0.25u of the mixed solution. You will need to give somewhere around 0.1u or 0.15u to get the same amount of insulin straight from the vial. I don't know about deliberately pulling down bounces - that, to me, feels like a recipe for setting up continued bounces and having to keep using the R to pull them down which becomes self-defeating after a while - it would be better to level him out and stop the bouncing altogether. Can I ask why the decision to use R when he was only on a low dose of Lev that could easily have been increased? Was it advice from your vet? It looks as though his numbers were better before you introduced the R at all last year.
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Well, I don´t have a coherent answer for that my dear. I was dealing with many issues at the time. If you see. I was intending to start from scratch. Actually, I posted that same thing some time ago, but it wasnt so successfull and I also lose energy very easily. Im really not at a good moment and its hard for me to sustain changes, I keep doing things for others, and last year was the whole year for dad.. then this year is for mom... and Markies poor little guy suffers because I cant be as much as I used to and stress, mood, depression, mistakes in dosing, my own mess, and this all together makes a very bad combination so I can´t tell.

I did increase the dose. He was lower and I increased but I didn´t do it as I should. I didn´t follow any pattern, I didn´t follow any protocol, I just cut on muy own.. sometimes stopping, logging, requesting new passowrd, logging again, posting, waigint, reading, etc... when energy is low.. is hard. I simply get lost.

But this time as you might have seen, I whas the whole day online, I dont want to lose this energy, Markies is my child, he deserves the best of me before mom starst to get bad.
 
I know you've been through a lot recently and I know how difficult it can be to keep on top of things like dosing when other parts of your life are falling apart. :bighug: I do think that it would likely benefit Markies for you to get back onto one of the dosing protocols for the L insulins if you possibly can. And, in the long-term, I feel as though that would benefit you too...if Markies is doing better, I'm sure it will be easier for you to cope with everything else that's going on. It does occur to me that R insulin may be rather demanding of you as a caregiver right now too as it does require fairly intensive testing for safety. How would you feel about maybe going back to just the Levemir and working the protocol with help from all of us here? :bighug:
 
Wendy&Neko said:
I have a vial of Humulin R in the fridge. I would just insert the BD syringe into it and withdraw 0.25 units. Much simpler. I kmow the vets will dilute R for even smaller amounts, but you should be able to eyeball the 0.25 units.
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Wendy you will realize after reading that 0.25 is the dose that I gave Markies that was diluted and already made an important drop in less than two hours. So The equivalent to that 0.25 diluted would be arround 1 or 1.15. But its ok, I may load a little more and take away some drops.
 
manxcat419 said:
I know you've been through a lot recently and I know how difficult it can be to keep on top of things like dosing when other parts of your life are falling apart. :bighug: I do think that it would likely benefit Markies for you to get back onto one of the dosing protocols for the L insulins if you possibly can. And, in the long-term, I feel as though that would benefit you too...if Markies is doing better, I'm sure it will be easier for you to cope with everything else that's going on. It does occur to me that R insulin may be rather demanding of you as a caregiver right now too as it does require fairly intensive testing for safety. How would you feel about maybe going back to just the Levemir and working the protocol with help from all of us here? :bighug:
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GOOD!!!
 
That's great news. I know we can get Markies, and you, feeling so much better about all of this. It will take a little patience to get his dose to where it needs to be, but I know all of us here will help you to figure out the best way to go about adjusting his dose. :bighug:
 
If inreasing levemir can better things good... I hope! Now I realize its hard for me to go back up in Levemir, I am always so anxious to get into remission.. but I have to forget about it... Makries is a difficult cat.. he has too many issues and he has a caotic mother! lol
 
manxcat419 said:
That's great news. I know we can get Markies, and you, feeling so much better about all of this. It will take a little patience to get his dose to where it needs to be, but I know all of us here will help you to figure out the best way to go about adjusting his dose. :bighug:
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:p:cat::bighug:
 
Remission is always possible, but I prefer to work on getting a cat well-regulated as the primary aim. Once you do that, if remission is possible for Markies, it will happen given time. But we need to get him out of this cycle of bouncing to give him a chance to really show you what he can do. @Wendy&Neko - any ideas about dosing if Markies goes back to just the Lev? It looks as though, bouncing after lower numbers aside, he was doing pretty well on around 2u of Lev in the middle of last year. But I don't know whether the dosing would start over at base level after he's not had a particularly fixed dose in a few months now.
 
manxcat419 said:
Remission is always possible, but I prefer to work on getting a cat well-regulated as the primary aim. Once you do that, if remission is possible for Markies, it will happen given time. But we need to get him out of this cycle of bouncing to give him a chance to really show you what he can do. @Wendy&Neko - any ideas about dosing if Markies goes back to just the Lev? It looks as though, bouncing after lower numbers aside, he was doing pretty well on around 2u of Lev in the middle of last year. But I don't know whether the dosing would start over at base level after he's not had a particularly fixed dose in a few months now.
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Dear you are getting confused with the time column. The dose is at the right. From thiw ss I see that his best dosing was 1.25. Look february 2016.
Mid 2016 was a mess since I was totally collapsed. Once I realized I was doing a mess with dosing, giving one dose and writing int he ss another different so I never know finally what dose I gave at that time (it is written somewhere).

But before that I was neat, and you can see things were more smooth.
 
manxcat419 said:
Remission is always possible, but I prefer to work on getting a cat well-regulated as the primary aim. Once you do that, if remission is possible for Markies, it will happen given time. But we need to get him out of this cycle of bouncing to give him a chance to really show you what he can do. @Wendy&Neko - any ideas about dosing if Markies goes back to just the Lev? It looks as though, bouncing after lower numbers aside, he was doing pretty well on around 2u of Lev in the middle of last year. But I don't know whether the dosing would start over at base level after he's not had a particularly fixed dose in a few months now.
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plus at that time I was using R plus lev not following any coherent protocol so that part of the ss should be bombed.
 
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