1/19 Buzz AMPS 495/Don't know what to do

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Sarah and Buzz

Sarah and Buzz

Very Active Member
I am rapidly approaching the point where I can't do this anymore. Her numbers get worse every day. I don't understand why, if the dose weren't high enough, there wouldn't be at least SOME improvement. I also don't understand why 1u was enough to get her great action on two days, and then give us numbers that are nearly 5 times that high for 8 days.
 
(((Sarah)))

Hang in there Sarah!!!! We all get frustrated at times & the board is a great place to vent with friends. :YMHUG: :YMHUG:

I'm sure someone with more experience will be along soon to give you some knowledgeable help.
We're all here for you. Stay strong!!
 
Hi Sarah

can't get into ur SS. Have a look at ur link, maybe something is off on it or ur "share" options in google docs?
 
I thought I'd been following Buzz since you came over here, but I can't remember why you've stayed on a dose for so long when it isn't working. Per Tilly: "Generally the starting dose is kept for 3 days." And "Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU." http://www.tillydiabetes.net/en_6_protocol2.htm
 
Ronnie: Ok, just fixed SS, try now. Please let me know if it's not working. I have had problems with it since last night. Thanks!
Terri: I just raised the dose yesterday (from 1.0 to 1.25).
 
Sorry, I can't see your ss for Buzz, but just seeing your amps, I can TOTALLY relate!
It totally sucks but we do what we can. And you are not alone in the least with all the frustration.
I started out with mostly numbers in the 400 and 500s, then slowly we moved down a bit, very slowly.
It takes time to convince those organs to play nice and give us some good BG numbers.

I don't get it either; Shadoe does the same thing. She gives me some good numbers and then goes all 'fraidy cat and climbs back into her pink numbers. And she lies around like whew! now I feel better! :shock:
I say OK missie what ARE you doing now? Get back down with those numbers.

I don't know near as much as many of the others around here, but I am muddling through it all, for Shadoe.
We are sitting at 5.25u for dose and she is hugging those pinks like she can't let them go. Slowly but surely, she is getting there, and so will Buzz. When? Well, that's up to Buzz.

All we can do is to be sure we are feeding good low carb food, watching for ketones, testing to see how kitty's numbers are, and following the protocol with dose changes according to what fit kitty's needs. If you have the info from any tests your vet has done, I am positive that those details will be helpful to the guys around here. Shadoe was just dx with pancreatitis, and that would pretty much have been causing some of her high numbers. Now with her meds and fluids, we are seeing lots of yellows, and she even saw her very first GREEN the other day, so just don't give up because we are ALL here for you to help. Sometimes, it's like one step forward and 3 giant leaps backwards, but that's ok. We can find ways to make it work.

You and me both, we want Shadoe and Buzz better now, right now. And action helps.

First thing is to make your ss changed to pub so all others can see the numbers and all of your notes. That way, everyone here can offer you help and suggestions. There are plenty of things that could be the cause of those high numbers, so let's see what all the others have to say. Watch for their questions, and I am sure we will have Buzz feeling better soon.

There are some very knowledgeable people on this site who will know what questions to ask and based on your numbers, they will be able to help you determine what's up with Buzz.

Stay strong, stay positive. Believe.
 
If I'm understanding correctly, you're wondering why Buzz's numbers are worse after about 10 days vs. the first 2 days? If this is correct, the issue is shed. The numbers got less good as insulin was being directed to the shed. Sometimes, there's a day or two of good numbers and then the Lantus begins to settle in and the work starts once the shed is built. During this time that the shed is building, not all of the Lantus you're injecting is available to lower BG. It also means that after that initial burst, it's likely that the dose isn't high enough. In addition, you had that string of blue numbers on 1/13. When you have numbers in this range, the dose is held for a few more days to see whether the dose is effective.

You raised the dose on 1/18. Because there's always the potential for NDW (new dose wonkiness), you let the dose settle for 6 cycles. Tonight will be the 4th cycle. The dog kibble incident probably didn't help, either. It takes surprisingly long for that stuff to clear out of a cat's system.

I know it's frustrating. One of the hardest aspects of this process is patience.
 
oh Sarah, I hear ya... The pink and red numbers are sooooo frustrating, and especially when you are used to seeing better numbers on another insulin. It is TOTALLY normal to have higher numbers the second day of a dose increase. Either they will come back down tonight or tomorrow, or if they don't then you can raise the dose again.

One thing that is different about Lantus/Lev is that you might see absolutely no response at all until you get to the right dose, and then BAM! All of a sudden the green is there. It's not usually a gradual change, where you might see a little bit of improvement on 1.25 and then a little more on 1.5, instead it might be a lot of nothing on 1.25 then a lot of everything on 1.5 (or whatever dose is the magic dose for Buzz). It makes the trip up the ladder frustrating, I remember getting Lucy up to 4.0 and still seeing nothing and being upset that there was no improvement, but all of a sudden on 4.25 she started hitting green over and over again (and then we got to DECREASE the dose!). You'll get there. ((((Sarah))))
 
See? I told ya! The smart guys come along and tell you how come.
:thumbup
Your ss says you went to the vets to check for infection, what were the results and what was tested?
Also, how is Buzz acting now compared to before?
Sometimes that kibble really has a bad effect on some kitties' numbers. It sounds like the dog's biscuits will need to be watched so Buzz does not get all rascaly and nibble the kibble.

Let's hope that Buzz gets his shed filled and his numbers come down nicely.
 
Aww Sarah, sorry this is so frustrating and we know you just want Buzz to be healthy. Like Libby said, sometimes it just takes time to get to that dose that 'snaps' and Buzz starts getting the response you want. Once you get today's and tomorrow's information, then it will be time for another increase if needed.

That helpless feeling is hard on a loving mamabean... we know, but have faith. (((Sarah)))
 
(((((Sarah)))))

I know how hard this is for you. Just don't forget we are with you every step of the way. This is a completely normal response. Buzz will reach her breakthrough dose - you just need to systematically continue increasing until she does. The trip up the dosing ladder is frustrating, but she will get there. This is by far the most difficult part of Lantus - the wait. Just love on her lots right now and come here to vent whenever you need to.
 
:YMHUG: Sarah and Buzz :YMHUG:

I agree with the others, we just need to work up to the correct dose for Buzz and then everything will snap into place.

Is there any chance that Buzz still might have a secret stash of kibble around? How are his teeth? Does he need a dental?
 
Awww, thanks you guys. :) I knew I could count on you to make me feel better. I guess what's scary to me (besides her increased numbers, of course) is just not knowing how long she's going to have to be in them. I mean, if her correct dose is 3u, just to pick a number out of a hat, then it's going to be an awfully long time until she reaches that dose.

To answer Gayle's question, the vet did a urinalysis (done by cystocentesis) to check for any UTI-type infections, and I also had her do bloodwork on Buzz to rule out anything else that might be going on. The u/a was negative for everything (except glucose, of course ;) ) and the BW showed no infection either. Buzz's BUN and creatinine were elevated. I've gotten advice here (and from the vet) regarding that and I am going to recheck again when her BG has been stabilized for a month or so.

I understand from the board that tooth problems may not show up in BW, but I was told that it's hard to get a good look at the teeth without sedation. I really, really can't afford another vet bill right now, therefore that is going to have to wait. If her #s don't come down with increased insulin, I will have to look into it further.

Libby, that's good to know about the "not usually a gradual change" on Lantus. I was really worrying about that, thinking that maybe Buzz was one of the freaky ones for whom Lantus doesn't work, so thanks for that info. :)

Thank you for all your words of encouragement and hope. I really needed them today. :)

ETA: Heather, no kibble around. The dog food (only dry food in the house) is now sealed up and put away. I hide/put away human food obsessively, so I am 100% sure that there is nothing she can be getting into. :)
 
(((Sarah)))) I'm sorry that you are not having a good day. It's totally a normal feeling.

May I suggest that you look around at a few SSs to give you a bit more hope. Recently, MAx&Randi got their 1st bloo and Max went up the dose to 5 units.

I hope you can find the enough crumbs of patience to make it through another day.... and take it day by day.... there is hope! Buzz will be looked after, don't you worry!!!
 
((((sarah)))) I feel you, believe me! I am feeling the frustration too. But what Libby said helped right? Hang in there, you are not alone on this roller coaster ride dancing_cat
 
AMPS: 495
+6: 399
PMPS: 385
+3: 405

Arguing with fiance, who wants to take her off Lantus and put her on ProZInc. Avoiding vet's calls so that I don't have to defend Lantus to her when she sees Buzz's SS. Vet thinks she should be on ProZInc, knows nothing about Lantus, was willing to prescribe it because I asked her to.

I am glad this day is over.
 
Just two more cycles on this dose. If she doesn't see any change tomorrow (any yellow or blue), I would take the dose up to 1.75u on the AM cycle of 1/21.

((((Sarah))))
 
Cassandra and Sasha said:
Just two more cycles on this dose. If she doesn't see any change tomorrow (any yellow or blue), I would take the dose up to 1.75u on the AM cycle of 1/21.

((((Sarah))))
Click to expand...

Oh good, a half-unit jump! That should pacify the natives. ;)

I'm sorry that I have been so negative today. I really appreciate you guys talking me through it. Please understand that I am not doubting the insulin or doubting anyone's expertise. It's been a rough week or so for me personally in addition to the insulin woes and I'm just overwhelmed. But not too overwhelmed to realize how great you guys all are. (((EVERYONE IN LL)))

I told my fiance I would ask these questions so here we go:

1. How long do we wait before determining that Lantus doesn't work for Buzz?
I don't even remember what #2 was. :oops:
 
Today was only day 11. I've seen it take as little as a week or as long as a few months to work up to the right dose. It all depends on the kitty. I would give it at least a month or two before switching, because truly I have never seen Lantus not work for someone if they follow the protocol and are aggressively increasing when it is called for. That's just MHO, though....do with it what you will.

The 0.5u increase would be because her nadirs have not been below 300:

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

You can take the dose up in the AM to 1.75u if you would like. We usually hold for 3 days here in LL, but the protocol does allow for 2 days and sometimes people are more aggressive with high numbers like this. You do need to monitor very closely if you dosecrease early, though, especially with a 0.5u increase. It really just depends on how aggressive you want to be and how much monitoring you are able to do.

Everyone is negative in the beginning. This is hard to watch for anyone, no doubt. I've told you, I was really a mess during the first 2 weeks Sasha was on Lantus. I think that's pretty normal. But Buzz will come down. It may take one more increase or it could take five.....there is just no way of knowing what dose will break through for her.
 
I can't recall if anyone mentioned putting more focus on Buzz and how Buzz is changing, not just the numbers.
It's likely that you are going to see improvements in Buzz way before you see improvements in the numbers, and I don't think there is a single person here who can't say they better numbers before better cat.

Look for the signs like drinking less if Buzz was drinking lots before. Things like urination a great deal before in odd places, or eating habit changes or just the general habits that Buzz had but stopped - it is that sort of sign that will show you the insulin is slowly, very slowly starting to work.

If you look at a few of the ss that others have for their kitties, you can get an idea how slow some progress, and some quickly. Also, you can see how long the kitties have been on a particular insulin.

Also, because ECID, each cat is different, their individual perfect dose must be reached by following the protocol.

I think a very good way to visualize it, think of baking a cake. If the recipe protocol says to bake at 300F for 50minutes, but you are impatient, what do you thiink would come out of your oven if you cranked it up to BROIL for about 15minutes? I am pretty sure you would get a horrible cake that is not edible!

The same goes for the protocol in our search for the perfect dose. you've got all those minimun number of days to wait for each dose, and depending on the results during those days, your increase may be small 0.25 or even less when decreasing or tweaking.

Ugh, it's maddeningly slow, so that is why I say look for the signs in Buzz because you WILL see them. The next thing you will be saying is Yeah, Buzz is better but what about the numbers???
Don't worry; they will come.
 
Good Morning Sarah and Buzz!!! Just wanted to let you know I was thinking of you...hang in there...you are doing a great job. You really are. You asked great questions and look at all of that great advice!!!

:RAHCAT

Wishing you a better day!
 
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