10/6 - Bandit - PMPS 384, +3 354 - use R?

[Bandit's Mom]

Previous thread:
https://www.felinediabetes.com/FDMB/threads/10-3-bandit-ckd-sudden-high-numbers-tid-dosing.253791/

Bandit is bouncing from the green she saw a couple of nights back. Taking her time clearing it. Her eating HC past the nadir doesn't help!

@Wendy&Neko I have kept my paws off the R with great difficulty. She probably doesn't need it on this dose (and is diving in the AM cycles even without it), but I wonder whether I could use it in cycles like tonight? Say a drop of R at +3, when I know she is not going to dive and will be munching on the mix of Dr. Elsey's and HC kibble through the night?

I can get tests every hour for the first 4 hours if I do use it.

 

[Tina Marie (GA) and Jan]

I wish I could answer with confidence, but I cannot!
Bandit is on such a low dose to be adding R, but I get your thinking also.
I did like the idea Wendy had of simplicity/not adding R for a bit.

Unfortunately, Wendy may not be around before the time you would need to give a drop.

At least this gets a bump!

 

[tiffmaxee]

Wendy might be rowing. I too wish I could help but never used R. @Marje and Gracie Are you around?

 

[Bandit's Mom]

Thanks @Tina Marie and Jan and @tiffmaxee. I figured that Wendy would not see this in time. Was asking for future cycles.

I want to see if I can keep Bandit below the renal threshold. I know she's only going to head even higher because the second half of the PM cycle (1am to 5am) is when she does a big part of her eating and these days that's HC.

 

[Suzanne & Darcy]

Thanks @Tina Marie and Jan and @tiffmaxee. I figured that Wendy would not see this in time. Was asking for future cycles.

I want to see if I can keep Bandit below the renal threshold. I know she's only going to head even higher because the second half of the PM cycle (1am to 5am) is when she does a big part of her eating and these days that's HC.

I used a lot of R at times. Sometimes got my ears pinned back for it, too (not often). But Darcy wasn’t a diver like Bandit recently has been (so that’s a little scary.). I do understand the feeling of “I have to get my cat under the renal threshold! Now! Especially after his kidney disease diagnosis. ​

 

[Bandit's Mom]

224 @+6. Not too shabby.

She's going to graze for the rest of the cycle and give me a red AMPS (if I'm lucky! If not, another HI!).

 

[tiffmaxee]

 

[smorgasbord]

Lucky little brat, gets to graze on her HC like a princess.

 

[Suzanne & Darcy]

224 @+6. Not too shabby.

She's going to graze for the rest of the cycle and give me a red AMPS (if I'm lucky! If not, another HI!).

I know... Bandit eats when she wants to eat! Don't you feed Dr. Elsey's dry?

 

[Bandit's Mom]

I know... Bandit eats when she wants to eat! Don't you feed Dr. Elsey's dry?

She was eating Young Again & Dr. Elsey's. I was giving her YA in the second half of the cycle to graze on. A month or so back, she refused to touch YA and was eating only Elsey's. Since last week she is holding out for the HC kibble she loves. Won't eat the Dr. Elsey's unless I add a little HC kibble to it!

 

[Suzanne & Darcy]

She was eating Young Again & Dr. Elsey's. I was giving her YA in the second half of the cycle to graze on. A month or so back, she refused to touch YA and was eating only Elsey's. Since last week she is holding out for the HC kibble she loves. Won't eat the Dr. Elsey's unless I add a little HC kibble to it!

Oh, that's right. I now remember you mentioned this! You have to keep her eating, I understand! This makes your life even more difficult.

 

[Liz & Minnie]

You'll definitely want Wendy's guidance on this. The way our vet started using R was very different from what they do here, though we were in the middle of fighting a DKA so not exactly the same situation. I think the cautious way of starting this was doing it at shot-time when you know you can monitor closely, and test hourly - the idea is that you monitor how your cat responds to the R...but in my experience it isn't even consistent every time with the same cat! So I only give R when I know I can monitor hourly for the next 4 hours. There are other rules associated...

Anyway, this is just me chatting a bit. Wendy will chime in and give you the official guidance! Good luck. (I just looked at Bandit's s/s...I bet Wendy will say you need to put on the patience pants since you've only just had some pretty major drops into blues and greens! I wouldn't feel comfortable giving Minnie R if her numbers were doing that)

 

[Suzanne & Darcy]

You'll definitely want Wendy's guidance on this. The way our vet started using R was very different from what they do here, though we were in the middle of fighting a DKA so not exactly the same situation. I think the cautious way of starting this was doing it at shot-time when you know you can monitor closely, and test hourly - the idea is that you monitor how your cat responds to the R...but in my experience it isn't even consistent every time with the same cat! So I only give R when I know I can monitor hourly for the next 4 hours. There are other rules associated...

Anyway, this is just me chatting a bit. Wendy will chime in and give you the official guidance! Good luck. (I just looked at Bandit's s/s...I bet Wendy will say you need to put on the patience pants since you've only just had some pretty major drops into blues and greens! I wouldn't feel comfortable giving Minnie R if her numbers were doing that)

Yep! We are all waiting for Wendy to weigh in!

 

[Wendy&Neko]

Sorry, rowing first, then retrieving a trailer from the blaster/painter, yada yada. Been a busy life day.

First, if you do R, please not at +3. Start with trying R at preshot. You don't want the Lev and R nadirs to coincide. Question for you, when is the Lev nadir for Bandit? When is the R nadir? Don't know that last one you say? Perhaps it's time to do an experiment and learn it. What we suggest for people new to R is to give R at preshot, and test hourly for at least 4 hours. Do that a couple times until you've figured out the R onset, then you can wait a couple hours after giving R before the next test and then work on figuring out the R nadir.

You don't want the R action to bring things down more than 100 points, or you can set off a cycle of dropping and bouncing. On her own, with just Lev, Bandit brought things down 130 points in three hours just on Lev in the PM cycle. Adding R would have almost guaranteed a drop/bounce. When figuring out how/when to give R, you layer the action of the basal insulin (Lev) down and put the the R insulin action on top. You want the sum of the two to not drop a lot over a short period of time. I found it handy to use some graphs for this the first couple times. R after Lev nadir when she is naturally on the rise is a possibility, to slow the rise.

If in doubt, leave R in the fridge.

 

[Katherine&Ruby]

I have a kooky idea about the HC kibble. Can you put it into a coffee/spice grinder and just sprinkle small amounts onto the Dr. Elsey's like you would with Fortiflora? Maybe she would eat less of it and she still gets the smell and taste? Grasping at straws here for ways to help you, dear Bhooma!

 

[Our Dolly Girl (GA)]

She was eating Young Again & Dr. Elsey's. I was giving her YA in the second half of the cycle to graze on. A month or so back, she refused to touch YA and was eating only Elsey's. Since last week she is holding out for the HC kibble she loves. Won't eat the Dr. Elsey's unless I add a little HC kibble to it!

Hi Bhooma, thinking of you and Bandit. Such a change to see you posting. I have to ask, what is “R”? Is it a secret type of insulin? Is it something I shouldn’t ask? Very curious. Wish I could offer some help. Prayers and hugs

 

[Suzanne & Darcy]

Hi Bhooma, thinking of you and Bandit. Such a change to see you posting. I have to ask, what is “R”? Is it a secret type of insulin? Is it something I shouldn’t ask? Very curious. Wish I could offer some help. Prayers and hugs

Novolin R is a short acting insulin. It lasts about 4 hours in a cat when injected under the skin. It can be used as a supplemental insulin along with long acting insulin in order to bring the numbers down, typically before onset, in order to give the long acting insulin a better number to grab onto at the time of onset. The goal is to drop the glucose no more than 100 points with the R.

 

[Our Dolly Girl (GA)]

Novolin R is a short acting insulin. It lasts about 4 hours in a cat when injected under the skin. It can be used as a supplemental insulin along with long acting insulin in order to bring the numbers down, typically before onset, in order to give the long acting insulin a better number to grab onto at the time of onset. The goal is to drop the glucose no more than 100 points with the R.

Thanks Suzanne. Now I know what you are talking about although I know nothing about it. Sounds tricky and scary.

 

[Bandit's Mom]

I have a kooky idea about the HC kibble. Can you put it into a coffee/spice grinder and just sprinkle small amounts onto the Dr. Elsey's like you would with Fortiflora? Maybe she would eat less of it and she still gets the smell and taste? Grasping at straws here for ways to help you, dear Bhooma!

LOL. Already tried this and it worked for a little while but no more!

 

[Bandit's Mom]

First, if you do R, please not at +3. Start with trying R at preshot. You don't want the Lev and R nadirs to coincide. Question for you, when is the Lev nadir for Bandit? When is the R nadir? Don't know that last one you say? Perhaps it's time to do an experiment and learn it. What we suggest for people new to R is to give R at preshot, and test hourly for at least 4 hours. Do that a couple times until you've figured out the R onset, then you can wait a couple hours after giving R before the next test and then work on figuring out the R nadir.

You don't want the R action to bring things down more than 100 points, or you can set off a cycle of dropping and bouncing. On her own, with just Lev, Bandit brought things down 130 points in three hours just on Lev in the PM cycle. Adding R would have almost guaranteed a drop/bounce. When figuring out how/when to give R, you layer the action of the basal insulin (Lev) down and put the the R insulin action on top. You want the sum of the two to not drop a lot over a short period of time. I found it handy to use some graphs for this the first couple times. R after Lev nadir when she is naturally on the rise is a possibility, to slow the rise.

The reason I was using R at +3 in some cycles was that by then I had a clear idea that she was not going to dive - or in some cases, she was beginning a vicious bounce. The last 2 AM cycles she has dived a few hundred point without R. This morning she is flat and high at nearly +4.

Shall I try a drop of R if the PS is above 350?

 

[Wendy&Neko]

The beauty of Lev is that you have time after PS for the R to work, while the Lev is either worn off or waning. That takes the numbers down a bit, and gives the Lev a nicer number to work with when it onsets. The goal of R is not to take numbers down a lot, but rather to give the L a better number to work with.

You need to think of the R working with the L action and you don't want the two of them working hard at the same time. Giving R when L is fading, either PS, or after nadir, ensures you won't have a big drop to contend with. So you can try R after L nadir, or at PS. Most people start by using it at PS a while before adding mid cycle R. R at mid cycle when you see a bounce starting is a way to try to cap the height of the bounce. In that case you aren't looking to bring numbers down, but rather prevent them from going as high.

Other things to consider: sometimes the cycle after an R cycle can be more active. So when you are starting out, you don't want back to back to back R use.

To any other readers, the use of R is an advanced technique, used primarily for cats with recent DKA or high dose cats. It can be dangerous if used wrong, so we always suggest people start using it with the help of an experienced R user. There are all sorts of considerations with using R. For example, making sure you have a good process for separating injections of R from injections of L. You don't want to mix up those doses! Plus I've seen cases where people accidentally shot the L dose worth of R. The R dose is typically a lot smaller than the L dose, so this could be a serious overdose. Store L and R in different parts of the fridge. Always do one first, then the other. I always shot L first, put the L supplies back in the fridge, then did R. Thankfully for me, Lev was in a cartridge and R in a vial.

It lasts about 4 hours in a cat when injected under the skin.

Unless it doesn't. ECID. Neko onset and nadired late with R too. Using R means a lot of learning how R works in your cat. First time I gave R, Neko hardly moved at all the first 4 hours. I went to bed with her solidly in reds. And woke up to a green cat.

 

[Bandit's Mom]

Thanks, Wendy! Let me start with giving R at PS and see how she does on it. Will get tests every hour for the first few cycles and post here.
Maybe I can then graduate to dosing R after the L nadir.

Should I try some sort of sliding scale or stick to a drop to begin with? I can never predict what her cycle is going to be like any more. Sometimes she dives on her own, so I am not sure whether I can use the PS as a yardstick. Should I start with a drop to begin with? Irrespective of the PS and take it from there?

 

[Wendy&Neko]

Start with a drop and see how she does. You can them build an R scale, telling you how much to shoot, based on R preshot.

 

[Katherine&Ruby]

I was using the Charts feature of Google sheets for a little while to see how Ruby’s doses were working. I will make them visible on my SS so you can see. Maybe I inputting some data and creating a chart can help you figure out the nadir with Lev a bit more clearly.

 

[Our Dolly Girl (GA)]

 

[Kathy and tiger]

 

[Diane Tyler's Mom GA]