Chuck's bouncy journey, part 16.

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HAHA right?! I figured he'd be spiking by now from picking up on my anxiety about switching to Lantus. But he's cool as a cucumber!
 
I'm totally jealous of you right now. I think I'd cry at anything under 200. Also, while Chuck is bouncing all over and I know it's driving you crazy, it helps me feel so much better about the high and fluctuating numbers I've gotten the last 3 days, esp since you've obviously been doing this much longer than me.
 
Those numbers don't look too bad for him still eating some dry! Once he gets off the dry you might see better numbers!
We don't see under 200 very often! We celebrate when we do!
I would do anything to see those numbers on 1 unit! Looks like you're doing all the right things so keep at it and soon you'll be celebrating blues too!
 
Couple pics! Chuck at the vet being a scaredy-cat and the other is him relaxing at home after the vet. LOL he sleeps in the strangest positions! That one makes him look normal weight, almost fat! The flash on the camera gives him more of a creme color...
 

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So I've been thinking about the switch to lantus. I have that almost full bottle of ProZinc that I thought was damaged from being warmed. I was thinking of trying another dose out of it to see if it really is compromised. If it's not then I'd like to donate it if there's anyone near me. I just would hate to see it thrown away if it's still good. If no one is near me I might just let it hang out in the fridge. Once I start lantus I can call the vet to see if they have anyone in need.
 
Oy,
+1 464
First picture is 9/17/2016 (10 days on insulin around 9.3 pounds I believe)
Second picture is 2/7/2017 (5 months on insulin around 10.4 pounds) I'll have to get an updated one for him at 11 pounds tomorrow! You can see how gray he's getting too. I look at his skinny picture when I feel like he's still too skinny and get anxious about it. He's getting there!
 

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Could post in the Supply Closet to see if anyone needs it.

Chuck! What are you doing?? Trying to make mom crazy??
 
Pictures are worth a thousand words, right? His little flat ears at the vet, all stretched out and relaxed at home...and oh my goodness he was skinny! his coat looks healthier now, too. You've done such a good job taking care of him!
 
Oy,
+1 464
First picture is 9/17/2016 (10 days on insulin around 9.3 pounds I believe)
Second picture is 2/7/2017 (5 months on insulin around 10.4 pounds) I'll have to get an updated one for him at 11 pounds tomorrow! You can see how gray he's getting too. I look at his skinny picture when I feel like he's still too skinny and get anxious about it. He's getting there!
Photos are a great way to prove there's progress even if you think you're getting nowhere day to day. :)
 
Still studying up on Lantus, Steph? You're a good candidate for TR because you test/monitor a lot. Complicated kitties will likely still be complicated on Lantus, as Teasel's SS shows, but you might see less BG volatility. It requires a very different mindset - that depot always has to be considered. Overall, things happen slowly and it can take days to see the effects of a dose. The scariest thing for me was shooting on low PSs. I'm getting a little more used to it.
 
Still studying up on Lantus, Steph? You're a good candidate for TR because you test/monitor a lot. Complicated kitties will likely still be complicated on Lantus, as Teasel's SS shows, but you might see less BG volatility. It requires a very different mindset - that depot always has to be considered. Overall, things happen slowly and it can take days to see the effects of a dose. The scariest thing for me was shooting on low PSs. I'm getting a little more used to it.
Yeah. I think we will try the TR. I gave him ProZinc this afternoon. I hope to start lantus Friday afternoon. I would start tomorrow afternoon but I don't be home all day Friday to test so I rather do it when I know I'm going to be home for a couple days.
 
+4 318
PMPS: 394
Fed usual with usual snacks
Gave 7.3 units out of vial I thought was damaged.
+2 352
+4 277 **vial is not damaged!*
7 units. I didn't know why someone told me 1 unit at starting was a great dose. Now I see why. Yuck. Poor Satan. (Have you seen the new Chuck Norris commercial?)
 
7 units. I didn't know why someone told me 1 unit at starting was a great dose. Now I see why. Yuck. Poor Satan. (Have you seen the new Chuck Norris commercial?)
The commercial with the salt or pepper shaker? LOL yeah! Man he's gotta be like 500 years old now! Yep he was originally started on 7 units twice a day "whether he eats or not". It almost killed him. I started over at 1 unit and saw some success as we increased his dose. I think he might have a high dose condition. He hasn't been tested yet.

I FINALLY got a urine sample... I have been impatiently waiting since 6pm! (4 hours). I tested it twice with my 10 panel urine dip sticks. He's got a UTI. Poor baby. He shows no symptoms of it!
Glucose: 250+ (last test was 318)
Bilirubin: Neg
Ketone: Neg
Specific Gravity: 1.025
Blood: Neg
PH 6.0-6.5 was hard to distinguish
Protein: Trace
Uro Bilinogen: Normal
Nitrite: Neg
Leukocytes: small(70)- medium(125)

The first strip was "normal" but then I did another and actually used a timer and sure enough the leukocytes popped up positive. I'll be calling the vet in the morning and hopefully getting him started on antibiotics. I rather not wait for it to get worse.
 
Poor Satan! (It's just fun to say that). But seriously, I'm sorry to hear he has an infection! My strips only test BG and ketones. I'll have to look for those next time. Were you just checking for ketones? Or were you suspicious of something?
 
I actually bought these strips from Amazon. They're "URS-10 Urine reagent strips for urinalysis" I got 100 strips for ten bucks I think. I can't really remember. I bought them in the peak of my Prednisone induced anxiety attack because I was certain my dog was dying from kidney failure. Kinda funny now but at the time I was devastated. She was completely fine and healthy but my mind would not have it.
Anyway, the vet told me to test his urine with it to rule out UTI for the reason he has increased his need for insulin. I thought she was probably going to be wrong because he has no symptoms. Yeah it's not an awful infection but it's there. She said they use the human strips there too then run the urinalysis through a machine or whatever it is after it's a high positive. I REALLY like that she's so into letting me do things at home. Saves money and stress on Chuck. They would have to squeeze a sample out or they could do a needle aspiration. She didn't want to do either and I agreed.
 
It's amazing how our minds do that to us, isn't it?

So what now? Does staring antibiotics tomorrow alter your timeline for switching insulin?
 
I don't think so. I still plan on switching to Lantus on Friday afternoon. I will probably start lower around 7 units. I think tomorrow afternoon I'm going to try 7.4 units ProZinc depending on his PS. I could do another week of ProZinc to sort out dose size just in case. I don't want to load him up with lantus then have his needs drop lower and cause a hypo. I realize this can happen with ProZinc too but I'm much more comfortable steering or aborting the cycle on ProZinc. He's kinda predictable on it. I'll ask the vet when I pick up the antibiotic tomorrow.
Maybe Kris will have some insight on what I should do...
 
Poor thing! Yeah, I'd be tempted to wait out the week on ProZinc so he gets on the meds and starts feeling better before starting a new insulin...especially with the depot since you have no data on how he reacts to that yet. But that's just coming from me with no experience with the depot either! Kris will probably have good insight for us on this one.

I hope the antibiotics make him feel better! Does he seem to be in any pain?
 
I don't think so. I still plan on switching to Lantus on Friday afternoon. I will probably start lower around 7 units. I think tomorrow afternoon I'm going to try 7.4 units ProZinc depending on his PS. I could do another week of ProZinc to sort out dose size just in case. I don't want to load him up with lantus then have his needs drop lower and cause a hypo. I realize this can happen with ProZinc too but I'm much more comfortable steering or aborting the cycle on ProZinc. He's kinda predictable on it. I'll ask the vet when I pick up the antibiotic tomorrow.
Maybe Kris will have some insight on what I should do...
Hi Steph,
The UTI puts a different light on it I think. We know it can raise numbers so it might be wise to wait a week to start Lantus. The good thing with ProZinc is that it's gone after 12 hours but the Lantus depot can confound things. Some people do a dose for dose switch but I wouldn't be comfortable with that myself. I'd given Teasel 3 u of ProZinc just before the switch and dropped him to 2.5 u of Lantus. I fast tracked him (3 days at starting dose instead of the protocol's 5 to 7 days) to 2.75 u because he wasn't new to insulin. Since then I've been playing around in the 2.5 u to 3 u range.

The depot is a silent player in this game. It shrinks and expands in response to dose and the change in its size happens slowly over several cycles. That's why when you shoot a dose you always have to keep in mind where kitty is in the dose change process - new dose, same dose for several cycles, dose increase, dose decrease, etc. I've said it before - it's like steering a tank instead of a sports car.
 
Hi Steph,
The UTI puts a different light on it I think. We know it can raise numbers so it might be wise to wait a week to start Lantus. The good thing with ProZinc is that it's gone after 12 hours but the Lantus depot can confound things. Some people do a dose for dose switch but I wouldn't be comfortable with that myself. I'd given Teasel 3 u of ProZinc just before the switch and dropped him to 2.5 u of Lantus. I fast tracked him (3 days at starting dose instead of the protocol's 5 to 7 days) to 2.75 u because he wasn't new to insulin. Since then I've been playing around in the 2.5 u to 3 u range.

The depot is a silent player in this game. It shrinks and expands in response to dose and the change in its size happens slowly over several cycles. That's why when you shoot a dose you always have to keep in mind where kitty is in the dose change process - new dose, same dose for several cycles, dose increase, dose decrease, etc. I've said it before - it's like steering a tank instead of a sports car.
Yes that Depot is what terrifies me. I think I will keep him on ProZinc until he's done with the antibiotic. I'm still waiting to hear back from the vet. I'm going there at 430 either way. I want to get him started on it. He doesn't act any different. I did notice while cleaning the box that there was smaller spots. Even his sample last night wasn't that big. Guess I missed that sign. I figured he was slowing down from better numbers or from the insulin. But hindsight is 20/20. Adding the 3 tablespoons water I think should have increased it a bit... Funny how my brain rationalizes things so easily sometimes but then becomes an anxiety attack prone blob of cells at other times.
 
It's easy to miss those signs, Steph unless they are constantly in and out or there is blood or crying from pain. With Elektra, every time she has a cystitis flare up, I only notice because of the in and out of the box...the smaller spots of urine never seem to tip me off.
 
PMPS: 491!! Race to the top I guess!
Fed the usual with usual snacks.
Gave 7.4 units.
I'll be home at +3.5 or +4 to monitor.
 
+3.25 316
Started 17mg Enrofloxacin beef flavored tabs once a day for 16 days. I looked it up and it's generic baytril. I figured I'd try to just give it to him as a treat and I was shocked that he ate it! Nothing on the pill. Gobbled it right up! :eek::D Hopefully he continues to do that every day. If not I'll just crush it into his food.
 
+9 284
AMPS: 269
Fed usual meal and snacks
Gave 7.2 units
+2 456
+4 269
+5 251
That +4 snack still seems to stop him in his tracks... Thinking about trying a zero carb food for his snacks.
Kris & Teasel, someone said on my lantus post that with TR there's no dry food allowed... Does this include Young Again? I have a ton of it left and will not waste it. My civvie loves it so I can feed it to him. At this point Chuck only gets 1 teaspoon. I was giving a tablespoon but he was going up from that much so I use a regular spoon and give him one spoonful. And he gets the extra 3 tablespoons water each cycle.
 
+9 284
AMPS: 269
Fed usual meal and snacks
Gave 7.2 units
+2 456
+4 269
+5 251
That +4 snack still seems to stop him in his tracks... Thinking about trying a zero carb food for his snacks.
Kris & Teasel, someone said on my lantus post that with TR there's no dry food allowed... Does this include Young Again? I have a ton of it left and will not waste it. My civvie loves it so I can feed it to him. At this point Chuck only gets 1 teaspoon. I was giving a tablespoon but he was going up from that much so I use a regular spoon and give him one spoonful. And he gets the extra 3 tablespoons water each cycle.
Hi Steph,

Yes, the TR protocol is strict on the no dry food point. People who feed some dry follow the SLGS protocol. The dose reduction cut off points and how long you hold the dose are different as well. Having said that, ECID and I'm making up my own protocol with Teasel. I'm officially following TR, as in no dry , testing frequently, using 68 on my AT meter as the dose reduction point BUT I'm not increasing his dose after 3 days if he hasn't shown me good numbers. He's such a bouncer that I have to let that run a lot longer. Case in point - on his recent dose of 2.5 u he's been in bounce numbers almost the whole time until the 10th cycle yesterday when he threw me a green 79 (AT) for PS for PMPS. If I had increased his dose after 6 cycles of "too high" he might have bottomed out badly.

What I did was:
  • start the Lantus at a slightly lowered dose
  • fast tracked so I increased after 6 cycles instead of the TR rule of 5 to 7 days (for newbies - you aren't one either),
  • followed the TR rules as I made my way up to 2.75 u then 3.0 u
  • moved up and down between 2.75 u and 3 u as he showed me some lime greens
  • learned to bite the bullet and dose on a green PS
  • got a few no shots within a couple of days
  • decided that I had to go back to 2.5 u - with resultant disappearance of blues and dark greens
  • tried a fat 2.5 u for a couple of doses and got more lime green
  • said to myself, "To hell with this! I need to follow Teasel Rules!" and am now doing it my way with a nod to TR. I'll let him run on a dose (maybe for 5 or so days - not sure yet, need more data) and let the lowest he gets to somewhere in there be my dose guide. That dark green PS last night tells me to stay at 2.5 u for now. All the while I'll watch for signs of him getting stuck.
In my opinion Chuck will need his own version of Lantus protocol. I suggest trying the TR as written for a bit and as time goes on you'll get a feel for what works and what doesn't. Teasel has been on it 6 and a half weeks now so I'm getting a good idea of what I have to modify. No doubt there'll be new lessons along the way.

I hope this helps! I understand the anguish around making the decision to switch. It wasn't easy for me either. :)
 
I'm lucky to have you here to help!! I probably wouldn't want to switch without seeing your results and knowing you've done it!
I'm not understand why he can't have ya zero... Even in the small amount he gets... But if I can find a zero carb that works as a snack with higher calories to help him keep gaining I'll cut out the YA. I really think that's what's helping him gain. I'll look at the new food chart tonight.
 
I'm lucky to have you here to help!! I probably wouldn't want to switch without seeing your results and knowing you've done it!
I'm not understand why he can't have ya zero... Even in the small amount he gets... But if I can find a zero carb that works as a snack with higher calories to help him keep gaining I'll cut out the YA. I really think that's what's helping him gain. I'll look at the new food chart tonight.

It really comes down to doing what's best for Chuck, Steph. If he needs that YA to keep him happy and put on weight, stick to it. That's more important I think. The Lantus protocols are a guide for people to use when they need to know what to do in the beginning. They're good for people who are more comfortable with a defined structure guiding their dosing decisions. They work very well with kitties that are more predictable and neither Chuck nor Teasel are in that category, although they might get that way eventually. There are a few bounce-crazy Lantus cats that have settled down.

The way I look at it is that you can't always balance our ECID mantra with the notion of a set protocol that MUST be followed. We learn to make independent dosing decisions with ProZinc and that gives us confidence to know when something works and when it doesn't. The Lantus protocols are a really good general guide to follow, especially as you start. There are very experienced people there who have/had kitties with many complex issues who can advise you. They, too, learn over time how much your kitty is with the program - or not. We're very far down the FD road with very hard to figure out kittties and that experience is our bedrock.
 
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Remember, also, Steph that YOU are very experienced. A lot of people who start on Lantus are not. They don't have the data that you have so they can't make the decisions about what is best for their cat based on data...they have to start with a defined protocol that has worked for others and tweak it from there if needed. Remember that Bobbie had to change the Lantus protocol around to include R when Bubba was throwing ketones...and now he is OTJ!

I think with your experience and data, and the fact that Chuck is Chuck...well you gotta do what you gotta do. :)
 
AMPS: 529 (Bounce?)
Fed 4.5oz +2T water. .8oz pate + 1T water @+4. 1 teaspoon YA @+7.
Gave 7.4 units.
DH will monitor.
 
Ugh. I was expecting better numbers this afternoon but I guess he could still be bouncing...
AMPS: 579
+2 "HI"
+4 378
+6 411
PMPS: 319 (possibly a low reading)
Fed the usual with usual snacks.
+2 537 :blackeye:
 
I'm not sure. DH is home with him so I'll have him keep an eye out to see if he notices any different behavior.
 
Ok so DH didn't see any symptoms of not feeling well. He is eating like his new normal. Eating most of his meal then laying close to it and finishing it about half hour later.
+4 416 0.2u given *DO NOT COPY MY DOSING*
+6.5 329
+9 292
PMPS (+12): 254
Fed 4.5oz +2T water. .8oz pate +1T water. 1 teaspoon YA @+7.
Gave 7.2 units.
DH will monitor.
+1 364 A bit nervous about this number but he should be fine. I think it's only a 100 point increase because of the late micro dose. Might see some blues again today.
 
So we are going on vacation in May... to Cape Cod, MA. I will be using lantus by then and have my friend, who has experience giving insulin to a dog, set up to give chuck his insulin. I'm thinking by then I'll know what dose will keep him in acceptable "higher" numbers and away from potential hypo range. It's only 8 shots (pm, 3 whole days then AM) that I'll be gone for. But then we are going on vacation again (never vacation this much!) in August to Wells Beach, ME for a week! I'll be gone for 14 shots! My stomach turns to think about it. I hope to really be able to know a dose to keep him in safe range with no risk of hypo. The first 3 of those days I'm stuck looking for someone to give him his shots. I don't know if our housemate will do it. He seemed reluctant to even test him for our May vacay. I'm thinking way ahead of myself here but I need to know I have it covered before I put money up for a vacation that long! I think I might ask my Aunt who is a nurse. She's comfortable with lantus because my Uncle is on it and has given shots to her dog before.
 
Sounds like wonderful vacations! Try not to worry. You have plenty time before you leave to get someone trained and learn about how Chuck responds to Lantus. The peeps in the L&LL forum will help you with a vaca dose too.
 
So we are going on vacation in May... to Cape Cod, MA. I will be using lantus by then and have my friend, who has experience giving insulin to a dog, set up to give chuck his insulin. I'm thinking by then I'll know what dose will keep him in acceptable "higher" numbers and away from potential hypo range. It's only 8 shots (pm, 3 whole days then AM) that I'll be gone for. But then we are going on vacation again (never vacation this much!) in August to Wells Beach, ME for a week! I'll be gone for 14 shots! My stomach turns to think about it. I hope to really be able to know a dose to keep him in safe range with no risk of hypo. The first 3 of those days I'm stuck looking for someone to give him his shots. I don't know if our housemate will do it. He seemed reluctant to even test him for our May vacay. I'm thinking way ahead of myself here but I need to know I have it covered before I put money up for a vacation that long! I think I might ask my Aunt who is a nurse. She's comfortable with lantus because my Uncle is on it and has given shots to her dog before.
You'll have enough Lantus experience by then Steph, to know what dose is high enough to keep his numbers in an "OK" range - ie.,under dosing slightly. The L&L pros can also help when you get closer to departure.
 
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