Chloe's not so good but not so bad news
- Thread starter srk4cats
- Start date
- Status
Tina and Gracie (GA)
Active Member
You need a ketone test SAP. I don't like all the blacks I see over the past few days on SS. She really needs stability.
Did you order from Marks? If you didn't then you delayed another day, if not weekend before starting. Did you ask about overnight shipping, or maybe 2-day shipping? Yes, it will cost more but ultimately cheaper than being from a retail pharmacy in the states.
If you don't want to wait until Friday for the Lantus from Marks then you can buy from your local Pharmacy. Walmart would probably be the cheapest place to get. It will cost more, but you wouldn't have to wait. The choice is yours.
Is your vet requiring you to bring Chloe in prior to starting Lantus? The vets over in Lantus-land could help you get started. This would save you time & money. I really think the sooner Chloe starts this depot insulin the sooner you will see some stability. Please keep in mind that it will not be overnight, as human insulin like Lantus needs to build up. @Chris & China would be a great person to help and answer all of your questions.
Did you order from Marks? If you didn't then you delayed another day, if not weekend before starting. Did you ask about overnight shipping, or maybe 2-day shipping? Yes, it will cost more but ultimately cheaper than being from a retail pharmacy in the states.
If you don't want to wait until Friday for the Lantus from Marks then you can buy from your local Pharmacy. Walmart would probably be the cheapest place to get. It will cost more, but you wouldn't have to wait. The choice is yours.
Is your vet requiring you to bring Chloe in prior to starting Lantus? The vets over in Lantus-land could help you get started. This would save you time & money. I really think the sooner Chloe starts this depot insulin the sooner you will see some stability. Please keep in mind that it will not be overnight, as human insulin like Lantus needs to build up. @Chris & China would be a great person to help and answer all of your questions.
Jill & Alex (GA)
Very Active Member
Are there any P users who are also experienced with the use of R who could provide some guidance here? What about any experience with shooting TID?
Are you available to monitor closely?
Thinking out loud. Given Chloe's history, just trying to figure out your options.
Definitely. When numbers are high, especially with Chloe's history, it's a good idea to get a ketone test twice a day if at all possible.
"IF" Chloe is actively throwing ketones it's not a good time to change insulin... especially changing to a depot insulin. Reason: it takes too much valuable time to build the depot and get to an effective dose.
"IF" Chloe is actively throwing ketones, your best bet is to either dose Prozinc TID or use Prozinc as a basal insulin and R as a bolus. However, it's important to find someone experienced with these methods to work closely with you.
Since an inadequate supply of insulin is one of the reasons for throwing ketones, you'll want to feed foods with a higher percentage of carbs... medium or high carb (depending on her carb sensitivity) in order to increase her dose without letting her bottom out... "IF" she's actively throwing ketones.
You'll also want to increase her food and water intake "IF" she's actively throwing ketones.
FWIW, just some thoughts... hope they help.
Rachel
Very Active Member
Unfortunately, no one here has any experience using R with Prozinc. That hasn't been done since I joined the board, and I think I'm the oldest member who frequents this forum.
You could shoot TID but it would ABSOLUTELY REQUIRE that you are able to test more frequently as you HAVE to test before each shot to be sure that she is rising each time. You'd have to be extremely vigilant in testing and shooting...you simply couldn't skip any of the testing that would be needed.
You could shoot TID but it would ABSOLUTELY REQUIRE that you are able to test more frequently as you HAVE to test before each shot to be sure that she is rising each time. You'd have to be extremely vigilant in testing and shooting...you simply couldn't skip any of the testing that would be needed.
srk4cats
Very Active Member
not sure what R and TID mean. have to work all this week, but then have spring break. She went down this morning and is eating well. I'm wondering if it might be how I inject her. I've been noticing how the syringe drips when you hold the tip downwards. I'm going to be more careful about that in future. I'm sure she got a full dose last night because I was very careful about that and her numbers went down. I don't understand why I should feed her high carb food.
Kris & Teasel
Very Active Member
R = fast acting insulin used in a tiny dose to get BG down fast - very tricky and you need an experienced FDMB helper to guide you, not for the faint of heart
TID = dosing every 8 hours instead of every 12 hours to get more active control of BG over the 24 hours in a day - very intensive testing and monitoring required.
Higher carb food allows you to give a bigger insulin dose. Enough insulin is key in preventing ketone development and Chloe has had three bouts of DKA already. She's a kitty that needs adequate insulin at 12 hour intervals with a good BG testing routine and frequent urine ketone testing. If any of those falls by the wayside she's vulnerable to another episode of DKA.
The hope is that Lantus will flatten out her BGs some but it won't mean you can relax more. The rules for dosing Lantus are stricter and every 12 hours is key because of the depot effect. I'll suggest again that you spend time studying the yellow stickies on the Lantus forum. The people on that forum are very knowledgeable and very helpful but there's an expectation that an experienced owner will have done their homework.
StephG
Very Active Member
I don't think R is a possibility for Roberta. Her schedule allows her to shoot in the morning then go to work. Gets home shortly before PMPS.
Although she's been testing more recently, the track record of mid cycle testing isn't ideal. I don't mean this in a negative way at all. Just pointing out that she isn't able to test enough for R or TID, in my opinion. I don't think she would be home to give TID shots.
Chloe reacts to prozinc really well when all the pieces fall together. I think she bounces from Green numbers and it ends up the same thing on repeat.
I think lantus would give her longer and better control of bounces. Spring break would be the best time to switch so you can monitor as much as necessary after the switch.
Please get a ketone test asap even though she's eating and acting better.
Although she's been testing more recently, the track record of mid cycle testing isn't ideal. I don't mean this in a negative way at all. Just pointing out that she isn't able to test enough for R or TID, in my opinion. I don't think she would be home to give TID shots.
Chloe reacts to prozinc really well when all the pieces fall together. I think she bounces from Green numbers and it ends up the same thing on repeat.
I think lantus would give her longer and better control of bounces. Spring break would be the best time to switch so you can monitor as much as necessary after the switch.
Please get a ketone test asap even though she's eating and acting better.
Kris & Teasel
Very Active Member
I agree.
Djamila
Very Active Member
Roberta, with spring break coming up, you really need that Lantus by Friday so you can get started. Check with Marks' about delivery date and if needed, get this first prescription from a local US pharmacy to ensure you have it in time to start either Friday evening or Saturday morning.
As mentioned, it will be very important to monitor at the beginning and you'll need to be home to do that which makes spring break an ideal time.
I agree with Steph, Kris, and Rachel, that TID dosing doesn't work with your schedule, and R requires more testing than you have been able to do consistently. However, with summer break coming up, it may be something to consider at that point if you are willing to commit to learning about how it works and following through on the advice given for its safe use.
For now though, get a ketone test today to confirm that she's okay (if you can't get one at home, take her to the vet and ask them to do a quick test there).
As mentioned, it will be very important to monitor at the beginning and you'll need to be home to do that which makes spring break an ideal time.
I agree with Steph, Kris, and Rachel, that TID dosing doesn't work with your schedule, and R requires more testing than you have been able to do consistently. However, with summer break coming up, it may be something to consider at that point if you are willing to commit to learning about how it works and following through on the advice given for its safe use.
For now though, get a ketone test today to confirm that she's okay (if you can't get one at home, take her to the vet and ask them to do a quick test there).
Jill & Alex (GA)
Very Active Member
Wow. In the past, even P users practicing TR would sometimes use R to help achieve tight regulation. R can also be a valuable tool in helping prevent as little as trace ketones from becoming larger... requiring expen$ive hospital stays... not to mention wear and tear on both the cat and the caregiver... physically and emotionally. I'm so sorry to see many of these advanced techniques disappear from any of our insulin support groups. Sounds like the only option available today is to try another insulin if kitty isn't following the PZI/Prozinc handbook.
Well, if using R isn't an option now, it won't be after switching to Lantus either. R (as a bolus) can be used to take a bite out of bounces and to prevent ketones from getting worse by getting more insulin into the cat... more than what one could possibly accomplish with a basal insulin alone. R can sometimes be the difference in the ability to treat ketones at home versus hospitalization.
Sigh... it's too bad R isn't an option. A touch of R at the beginning of a bounce can do wonders if administered properly and at the right time.
Hopefully, but Lantus isn't a magic bullet.
FYI: I've seen cats taken off of Lantus and switched to vetsulin to get better control of numbers when throwing ketones. There's one on Health right now and sadly, another one who recently lost their kitty.
FWIW: Switching insulins is a time when a ketone prone cat is extremely vulnerable to developing ketones. That's why it's usually recommended the cat be ketone free for a reasonable amount of time prior to making the switch.
I agree. With Chloe's history, monitoring for ketones frequently is a must. You want to be the first to know if she's throwing as little as trace ketones if you want to have any chance of getting rid of them before Chloe's in crisis. Not sure if you've looking into blood and ketone meters? The Nova Max Plus or Precision Xtra Blood & Ketone are two of the more popular choices. Given your schedule, you may find a blood ketone meter very helpful.
Anyway, like I said last night... just some thoughts. Alex was a ketone prone cat. I'm familiar with all that goes with it. If I can help at all let me know.
StephG
Very Active Member
A touch of R at the beginning of a bounce can also cause another bounce on top of the current one.
I'm aware of the benefits and drawbacks of using R. I use it on Chuck with lantus.
I agree. But with Chloe and her history of ketones and DKA-- if she can get better control and stop the insane level bounces, she will be better off. If Roberta can switch this Friday, she can start at the 2.25 or 2.5 units with lantus and hopefully build her Depot up quicker than she would starting with a lower dose.
This is only if she will commit to testing Chloe as often as necessary. And that is the biggest issue. With R you need to test the first 3 or 4 hours after giving the micro dose, each time you give it. Once you get a good amount of data to show how R works you can reduce the testing to +1 and +3 or something similar.
She isn't home to give or test R.
The bounces are awful. I suggested increasing by a tiny bit last week. But she reached green before on 2 units. So, it is possible the blacks are from the increase causing lower numbers and then bouncing.
I remember when you feeding hills and giving 2.5 units (or was it 2 units?) And she was doing great for a while. This is what they mean by feeding higher level of carbs. It allows you to increase to insulin without bottoming out her BG.
As for the shots, you could clip a bit of her fur so you can see the needle going in. Take your time with them and make sure she's getting the full dose.
My needles don't drip if held upside-down. I don't ever remember the u40s doing that either. Could it be the "wasted" drop getting left on the needle after evening out the dose or expelling air?
The last week it looks like she gets a good PS then bounced for 2 cycles and then showed another good PS, this morning being one of the "good" PS. If this really is a pattern for Chloe, you might see two more ugly PS then a good one on Wednesday evening. My best guess looking at her SS. If it's been an issue with shot technique, it could be a false pattern.
Try getting some before bed tests to see if she's coming down at all over night. Get some in the door tests after work too. It will help show how fast she's going up at the end of the cycle.
Keep testing for KETONES. At these numbers, Chloe is very likely to start showing them at any time.
StephG
Very Active Member
FWIW: I would have LOVED to use R when Chuck was on prozinc! If you look at the 2016/2017 SS, I was micro-dosing him with prozinc mid cycle. Sometimes twice. Which is ABSOLUTELY against the protocols. ***WARNING*** DO NOT DO THIS. DO NOT COPY MY DOSING.
Chuck ended up being a high dose cat so he would use up half a unit in 2 hours. But I was a test-aholic! I did curves EVERY cycle. If I had R, I wouldn't have gone against the dosing protocol in a desperate attempt to get him out of black and red numbers.
I can NOT stress enough, do not do what I did with ProZinc. It can be very dangerous. I was simply lucky that it worked out.
Chuck ended up being a high dose cat so he would use up half a unit in 2 hours. But I was a test-aholic! I did curves EVERY cycle. If I had R, I wouldn't have gone against the dosing protocol in a desperate attempt to get him out of black and red numbers.
I can NOT stress enough, do not do what I did with ProZinc. It can be very dangerous. I was simply lucky that it worked out.
Jill & Alex (GA)
Very Active Member
Not when it's "administered properly and at the right time" as I stated.
No, I strongly disagree. It's not the biggest issue. The biggest issue is if Chloe is actively throwing ketones or recently throwing ketones when Roberta wants to start Lantus. If Chloe is actively or recently throwing ketones starting Lantus is as good as pulling the door wide open and laying out a welcome mat for DKA to come waltzing in... once again. If not, she's good to go!
I'm sorry the technique was never offered as an option. With guidance from an experienced R user, it would have been a safer course of action.
StephG
Very Active Member
Not when it's "administered properly and at the right time" as I stated.
No, I strongly disagree. It's not the biggest issue. The biggest issue is if Chloe is actively throwing ketones or recently throwing ketones when Roberta wants to start Lantus. If Chloe is actively or recently throwing ketones starting Lantus is as good as pulling the door wide open and laying out a welcome mat for DKA to come waltzing in... once again. If not, she's good to go!
I'm sorry the technique was never offered as an option. With guidance from an experienced R user, it would have been a safer course of action.
It has been a month since Chloe's last DKA. At this rate, she's going to get ketones on prozinc if she can't get the numbers down. IF she has ketones, I agree that she needs to clear them ASAP but even if they clear, going back on prozinc at the same dose is not much different than going to Lantus.
I think it's in Chloe's best interest to get the blood ketone meter and test daily.
Add water to her food to help keep her hydrated.
If you can get some tests tonight, before bed and maybe +5 or +6, you could try giving 2.5 units tonight if she's in the blacks to help bring down those numbers. But this brings the risk of her going too low so you should test before bed and +5 or +6 to make sure. If she's still high at +3 (or whatever your before bed test is) you could probably skip the midnight test. I would still want to get it to see what she's doing with the increased dose.
I don't think it's a good idea to continue with the 2.5 on the lower numbers. Just on the blacks. Maybe on reds if you can test.
Tina and Gracie (GA)
Active Member
The meter is great and it is a 1-step process. I get Gracie's BG and a Ketone test in 1-step.
Administrating TID would be ideal for someone who is retired, works from home and able to be home most of the time to test frequently. This is just my opinion Most of us have busy working and personal lives. We want to so everything we can for our felines, but we can't do it all.
Roberta, have you called Marks to ask about the shipping?
Administrating TID would be ideal for someone who is retired, works from home and able to be home most of the time to test frequently. This is just my opinion Most of us have busy working and personal lives. We want to so everything we can for our felines, but we can't do it all.
Roberta, have you called Marks to ask about the shipping?
Djamila
Very Active Member
I've been curious how R would work with Prozinc, so it will be great to learn from you @Jill & Alex (GA) (or someone else with R experience) as you coach Roberta through this next phase. Since none of us have first hand experience with the two together we really haven't been able to suggest that. We've all been very concerned about her safety and wanting the best for her and I'm glad you'll be here to guide her through this!
Jill & Alex (GA)
Very Active Member
I'm not around enough, but if I may suggest...
watch what is done in L & L (especially when a caregiver talks about wanting to use R) and then apply it to Prozinc. I"m rather busy at the moment, but I'll see if I can find some appropriate threads as soon as I can. It's a great tool to have!
Jill & Alex (GA)
Very Active Member
Actually, this is what I said:
Edited to add:
Happy to hear you're familiar with using R, Djamila. That knowledge should be a big help to those that need it in this forum.
Last edited:
StephG
Very Active Member
I've been trying to help Roberta for months now. Maybe that's why I feel so strongly against R at this point. It could possibly be an option in the summer when she has more time to test.
At this time, I really think a switch to Lantus could help her. Spring break is a good time to try, she can test more often so maybe with enough guidance on L&L and commitment from Roberta she could try R too but I don't think it's recommended to switch and start R at the same time.
Roberta, hopefully this hasn't made your head spin! I wish we lived closer so I could help you with Chloe.
Let us know what you're thinking about all this.
At this time, I really think a switch to Lantus could help her. Spring break is a good time to try, she can test more often so maybe with enough guidance on L&L and commitment from Roberta she could try R too but I don't think it's recommended to switch and start R at the same time.
Roberta, hopefully this hasn't made your head spin! I wish we lived closer so I could help you with Chloe.
Let us know what you're thinking about all this.
Jill & Alex (GA)
Very Active Member
Spring break is a great time to switch to Lantus if Chloe's not throwing ketones! <----- That last part is just common sense.
Maybe I missed it, but I'm not aware of any suggestion/recommendation made by me or anyone else to switch insulins AND try R at the same time. Not even different times. LOL!
Like I say, maybe I missed it. Sorry for tying to help, ladies!
Djamila
Very Active Member
Roberta, I absolutely agree with Steph on this. She has walked with you throughout this journey and there is no one who knows you and Chloe better. Please let us know how Chloe is doing, how you are doing, and what questions or concerns you have after reading all of this.
StephG
Very Active Member
Spring break is a great time to switch to Lantus if Chloe's not throwing ketones! <----- That last part is just common sense.
Maybe I missed it, but I'm not aware of any suggestion/recommendation made by me or anyone else to switch insulins AND try R at the same time. Not even different times. LOL!
Like I say, maybe I missed it. Sorry for tying to help, ladies!
So, again,. If she has ketones they need to be dealt with immediately. Once clear of ketones, I think she would be ok switching to Lantus when compared to her recent history on prozinc.
My cat was SUPER bouncy when we switched and he surfed in the pinks when we switched to Lantus on almost the same dose. (Only 0.4u difference)
I get what you're saying. But comparing the options
1. Staying on prozinc and adding R on spring break, then stopping it when she goes back to work. Then going back to the same dance she's doing now. Her history of DKA all while on prozinc and with minimal changes in treatment plan.
2. Switch to Lantus while on spring break and hope for anything but black numbers for a few days and when the depot fills maybe she will see flatter numbers. Continuing to check for ketones daily and encouraging eating and drinking.
In my opinion, option 1 doesn't have a long term goal of improving numbers.
I understand you're trying to help. We have been helping for months. Take a look at some of her older threads and you'll see we are trying to keep Chloe safe while working within Roberta's life schedule.
Rachel
Very Active Member
When I joined the board the first thing I learned was first do no harm. Therefore I'm unwilling to ever suggest something I find myself unwilling to coach someone through...since I am not able to coach Roberta through using R I can't recommend it. It would be great if that knowledge had been preserved. By the time I arrived no one used R with prozinc anymore. It would be great if those who had been here before had hung around this forum as well as the others to pass that knowledge on but they didn't... I'm sure they had their reasons. But I refuse to try to blunder my way through something I don't know enough about so I can have it in my toolbelr for later. It seems dangerous and against that first principle I learned.
Jill & Alex (GA)
Very Active Member
Agreed. It's what I've been saying all along.
Thank you. I was beginning to think we were posting in different languages.
I have read quite a few of Roberta's older threads... I've been following for quite awhile. It's why I posted in the first place.
Goodnight ladies!
Djamila
Very Active Member
This tone is not necessary or helpful in any way.
PussCatPrince - GA
Very Active Member
Well. I don't know about all the fancy stuff above.
Hope there is something in it all that you feel you can safely use.
I saw your condo title and just thought I would pop on in and offer you a
.It's rotten when one is unsure which way to jump with our lovely pusscats.
srk4cats
Very Active Member
Very nice of you. Her numbers have come down slightly and tomorrow, I will get a ketone test. How's your moggie?Well. I don't know about all the fancy stuff above.
Hope there is something in it all that you feel you can safely use.
I saw your condo title and just thought I would pop on in and offer you a
It's rotten when one is unsure which way to jump with our lovely pusscats.
srk4cats
Very Active Member
Sometimes words come across the wrong way. I'm sure there's no malicious intent. Yes, I've been on this roller coaster for quite awhile and I've learned many things along the way. I try not to panic, but she never got 2 HI's in the same day before. I give Chloe lots of love. She sleeps next to my pillow at night. I feel atuned to her feelings.
PussCatPrince - GA
Very Active Member
Do not mention the Poop Monster. You might swing him into rear end action
Ty used to sleep right by my head at night and dribble on me chops with his love.
Rotten to see such high numbers for your girl. Do hope something will work for you guys.
Rachel
Very Active Member
I 100% agree with this.
srk4cats
Very Active Member
What are you referring to?
Thank you both. I sent an email to the vet yesterday asking about R. Chloe is HI again this morning and maybe the vet can do something for her.
StephG
Very Active Member
You need to test every hour for the first 4 hours after giving R.
PLEASE get a ketone test today!!!
If she's still hi or black tonight and can get a +3 or +4 again, I think you can give her 2.75 units ProZinc to try to pull her numbers down. But don't give it the next morning if you can't monitor. If she starts clearing a bounce on that dose it could be dangerous.
Tina and Gracie (GA)
Active Member
I agree with Rachel. I think you would be adding fuel to the fire. I think you would be putting Chloe at more risk. I know you want to do what is right for Chloe, and it can be hard with so many conflicting advices. Sometimes even testing twice a day can be difficult for those of us who work a lot and have other commitments.
I think you should try Lantus while on Spring Break , and take one step and a time. I think trying to try all of these different things at once could be confusing and perhaps overwhelming. You won't know what works best if you are using too many things. Just my opinion. You of course can make your own best judgement.
I think you should try Lantus while on Spring Break , and take one step and a time. I think trying to try all of these different things at once could be confusing and perhaps overwhelming. You won't know what works best if you are using too many things. Just my opinion. You of course can make your own best judgement.
Kris & Teasel
Very Active Member
I'd wait on trying R too.
Tina and Gracie (GA)
Active Member
I think your vet made a good call. I know others think R insulin might work better for you, but the fact that you are not able to monitor like they could in a hospital it simply isn't safe. Also, the fact the there isn't one here experienced enough and available to be readily available.
Did you call Marks? Almost Friday. If you chose to get from a human retail pharmacy you will want to ask your vet for a new Rx and drop off--to allow enough time for them to fill.
Did you call Marks? Almost Friday. If you chose to get from a human retail pharmacy you will want to ask your vet for a new Rx and drop off--to allow enough time for them to fill.
srk4cats
Very Active Member
I'm getting upset with Mark's. I paid them with my Visa card first thing Monday morning and haven't heard from them since. I posted in the Lantus thread and I may post in the general thread, too. I'd like to know if anyone gets insulin from Mexico. I live only an hour away. btw, I stepped in a puddle in the corner of the kitchen and figured it must be Chloe's pee. I had her locked up in the bedroom while I was at work and she didn't pee in the empty litter box like she used to. Anyway, no ketones.
srk4cats
Very Active Member
Djamila
Very Active Member
I posted on your Lantus thread, but just in case: I think getting it from Mexico is a great idea. However, it sounded like Mark's told you Friday or Monday, right? Mine arrived a day or two before the day they told me - it just depends on how long it gets held up in customs. Fingers crossed you see it by Friday!
I suppose if it doesn't arrive by then, there are worse things than a trip to Mexico for spring break.
I suppose if it doesn't arrive by then, there are worse things than a trip to Mexico for spring break.
srk4cats
Very Active Member
I don't know if I can get a written scrip from my vet. Usually, they just call it in to the pharmacy these days. There's been some negative publicity about the quality of Mexican drugs. I'll call her today.
Meanwhile, my Relion hasn't been acting right so I went to change the battery, but now I can't find the battery cover. It doesn't work without it. I'll swing by Walmart today and get a new one. It lasted 15 months, so I think I got my $10 worth.
On the bright side, my boss from the Exceptional Ed department is back from maternity leave and wants to meet with me on Friday. I hope she can assign me to a different school for next year. I have 2 more workdays before Spring break and so much to do. It would be such a relief to know the Lantus is on its way.
srk4cats
Very Active Member
I'm about 95% sure it's Chloe's. I've never seen any of the other cats pee outside the box. She's acting normally and eating well.
Djamila
Very Active Member
In Canada Lantus is OTC. Is there any way you can check if that might be true in Mexico as well? You may not need a prescription. You might also call Mark's and see if there is a way to track the package. I'm guessing maybe not since you can't predict what will happen through customs, but maybe you could at least see when it leaves customs and starts to travel your direction again.
A lot of negative publicity about drugs in other countries is US pharmaceutical just trying to scare people into buying the more expensive drugs in the US market. They say drugs from Canada are bad too. That's just BS though. As long as you're buying in a real pharmacy and not out of the trunk of someone's car, it should be fine.
A lot of negative publicity about drugs in other countries is US pharmaceutical just trying to scare people into buying the more expensive drugs in the US market. They say drugs from Canada are bad too. That's just BS though. As long as you're buying in a real pharmacy and not out of the trunk of someone's car, it should be fine.
srk4cats
Very Active Member
Found order confirmation dated March 8, but that's before I paid for it.
- Status