10/5 Oberon +9 327, AMPS 351/5.8, +3 346, +6.25 312

Heard anything from the vet on the R issue? Ketones are a worry. Good to see him close to yellow today, would like to break that pink logjam.
 
Had a somewhat frustrating chat with the vet tech just now. The vet I saw isn't in until Wednesday. The tech passed on my concerns to the internist on duty, and he thinks we should stick with the current dose of Lantus and wait until we get the IGF results back before doing anything. (IGF isn't in yet, which means not until Friday.) I think he just didn't really want to mess with this since it isn't urgent, it's complicated, and he isn't familiar with the case. Tried to ask about the anemia, too, and didn't really get a response.

Meanwhile, though, I've got some R coming from a FDMB member (thanks, @Bobbie And Bubba!) but it won't get here until Thursday. Still may be faster than getting it from the vet, though. So I could plan to start that on Thursday night, maybe?? Or Friday morning?
 
Have you tried calling local pharmacies? I have heard some people say they didn't need a prescription for it. Not sure if it's state dependent.

I can't help you on Friday morning - I'm west coast - would have to find someone else to help. Maybe Thursday night.
 
Even better, the CVS a block from me has it in stock. I'd looked online before and everything I saw suggested it was prescription only, but I called and they have it OTC. I'm off to get it right now and then we can think about timing for an initial trial. (Tomorrow's my long teaching day, so not a great day for hourly checks. Things are pretty open after that.)
 
Great news! Things to consider on timing. First, you don't give R on the same cycle you do an L increase. Which would be Wednesday night if you didn't listen to the vet. Though you could delay the L increase a cycle. You also don't want to give it if he's breaking a bounce.

Could you try it tonight? I'd give 0.25 units R at the same time as the L, and test hourly for 4 hours after. You will also need to build a routine for making sure you keep the R and L separate. We have some people give the L dose of R. :eek: I had Levemir in cartridges and R in a vial in a different part of the fridge, so it was easy to keep separate. Some people load the syringes and lay the L on a sticky note with L on it, the R syringe on a different colour with R on it. Just find some routine to keep them separate.

Things to consider with an IAA kitty - this will be a new insulin and may at first confuse the antibodies. You could get a strong initial reaction, part of the reason for a small starting dose. Second, some kitties, especially with IAA, have a stronger reaction the cycle after giving R.

The nice thing about R, is you don't have to give it if you can't monitor that cycle.
 
Wendy&Neko said:
Great news! Things to consider on timing. First, you don't give R on the same cycle you do an L increase. Which would be Wednesday night if you didn't listen to the vet. Though you could delay the L increase a cycle. You also don't want to give it if he's breaking a bounce.

Could you try it tonight? I'd give 0.25 units R at the same time as the L, and test hourly for 4 hours after. You will also need to build a routine for making sure you keep the R and L separate. We have some people give the L dose of R. :eek: I had Levemir in cartridges and R in a vial in a different part of the fridge, so it was easy to keep separate. Some people load the syringes and lay the L on a sticky note with L on it, the R syringe on a different colour with R on it. Just find some routine to keep them separate.

Things to consider with an IAA kitty - this will be a new insulin and may at first confuse the antibodies. You could get a strong initial reaction, part of the reason for a small starting dose. Second, some kitties, especially with IAA, have a stronger reaction the cycle after giving R.

The nice thing about R, is you don't have to give it if you can't monitor that cycle.
Click to expand...

Hmm... 8:15 now and he already got his Lantus at 7. Too late to start?
 
Read this after you are done the shot - the goal is to avoid overlapping nadirs between L and R. His L nadir (such as it is these days) seems to be +6 or even later. So if the R nadirs at R+4, you should be OK. Normally I'd do it at L shot time, but he's so flat these days I don't think the R a little later will be an issue. Plus we are starting with such a small R dose. Going forward, stick to PMPS time.
 
For the spreadsheet, you can note something like 330@1.5, 0.25uR. When you test in an hour, you can put it in the cell adjacent, but label it xxx@R+1.
 
Got it, thanks! Yeah, the only time I really get a sense of a nadir is when he dips, and it seems to be around +6 or +7. Oh, and following up on something you said above... I have no intention of following today's vet's advice on holding the dose. He doesn't know what we've been doing and just didn't want to mess with anything without getting input from the other vet. But I'll need to learn more about how doses get adjusted when R is in the picture. Do I still follow the basic TR plan, or are there tweaks?
 
When using R, you still use the same TR concepts. Just don't use R on the same cycle as at L increase. The goal is to try to limit the drop due to R to no more than 100 points. Some cats show a marked response to an increase on the first cycle, so not using R avoids that.
 
Got it. Unfortunately his big dips have sometimes come on the first cycle after an increase, but also sometimes on the second or third. There doesn't seem to be a clear pattern that I can see. So tonight we're hoping for a drop to around 250, then?
 
Tonight our goal is to see what happens on this dose. We'll probably do a couple tests at 0.25 units to see what happens. It may or may not be the dose that takes him down a bit under 100 points. We want to learn the R onset and nadir. Typical onset is +2 and nadir +4, but not always. Neko wasn't typical at all.
 
OK, to be expected in a typical case onset would be in an hour. See you then. The part that will be slightly confusing is that the L will likely onset by then as well.
 
Lisa & Oberon said:
Yeah, but the L has barely been doing anything...
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Agreed. Yet to see if the R at this dose will do anything either. Another thing to note, sometimes you just don't see action on a particular R cycle, so that's one reason we do multiple tries at a dose.
 
Oh, another thing... I just realized that he hasn't gotten his fluids yet today. I was already planning to wait until later (maybe +4 or so). Any reason not to do that? I don't think it's a huge problem if I skip it for a day. He's not really dehydrated; this is to help flush the ketones out.

I also finally got the replacement antibiotics today- swapping Baytril tablets for Veraflox (pradofloxacin) liquid. I'm actually a little nervous about giving it because the insert mentions that it can cause drops in leucocytes, neutrophils, and lymphocytes if given for longer than 7 days. His WBC numbers are already decreased from July (though not technically low). And this is a "just in case" med, not because he's been actually diagnosed with an infection. So I'm reluctant to give him something he might not actually need that might make an actual existing issue worse. Thoughts?
 
Can you wait until after R+2 for the fluids? Sometimes fluids can drop numbers and I'd like to see what R does on it's own for it's +2.

How long are you supposed to give the Veraflox? Can you remind me again what the antibiotics are treating?
 
329 at R+2.

I can wait until pretty late for the fluids. No rush at all, and I don't want it to mess with the numbers. (Not that anything's happening so far...)

Originally I was given Baytril on 9/25. This was while we waited for the urine culture to come back. Culture was negative, but she wanted to keep him on it for 28 days in case he had infection elsewhere (kidney atrophy could be from infection). He hypersalivated when the vet tech gave him liquid, so they sent us home with tablets. I can't get the tablets into him so far (need to get better at that; haven't had to pill a cat in years) and now he's literally gagging at just the smell of them. So she switched us to Veraflox liquid, but it took me several days to get around to picking it up this afternoon. So he really only got that one dose of Baytril on 9/25 so far. It's only for 7 days but I haven't started yet.
 
Sheesh, talk about flat!

So the vet wants him on for 28 days? I'd ask the vet about what the insert says.
 
Not clear to me whether she wants him on the Veraflox for 28 days; we only got a 7-10 day supply. We got 28 days of Baytril, but it looks like we've given up on that. I'll talk to her on Wednesday before starting anything. After the dexa mess, I want to be cautious.

310 at R+3.
 
Sounds good. What's next? Repeat this at the same dose tomorrow? (I actually could test him all morning; I shoot at 7 and my class isn't until 11:15.)
 
Interesting to see those ketones come down a little bit.

As far as the morning, I think you can do another trial if he's low pinks or above at AMPS. This time shoot around the same time as the Lantus.
Lisa & Oberon said:
Tomorrow's my long teaching day, so not a great day for hourly checks.
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This is the only issue I can see, if by some chance he decides to respond to the R the next time. Are you teaching from home? Just wondering whether you'll be able to get anything past +4 if you needed it later in the day, or if you have an autofeeder you could set up just in case. There is also no rush if you'd prefer to wait until the evening. R is always optional.
 
I think that's in the noise for the ketones. They seem to bounce around a little.

I'm teaching from home; classes today 11-12:30 and 2:30-5, so I can squeeze in tests here and there and my husband will be home at noonish and could also test. BG is 302 at AMPS so I'm going to go for it. (Details in today's thread when I post it.)
 
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