11/12 Remi PMPS 113, +2 70, +4 83

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phlika29

phlika29

Member Since 2014
Morning

I was a little disappointed with remi's AMPS it's been a while since he has been that high. I am inclined to thing this dose reduction to 0.75f from 1 unit has failed and think he should go back up and would love others opinions. His curves are not nice and flat as before.

His actually passed a motion since late on Saturday. I have put it down to the period of vomiting on Sunday and the lack of food but I. Think if he doesn't pass anything today I will need to ask the vet about it.

Finally I started a new vial of Lantus. I seem to get through it quickly as I draw up much more than required and then squirt out the excess in order to get rid of the air bubble and fine tune the dose.

Hope everyone and their kitties has a good day.

Update-he's had a little poo! He doesn't seem uncomfortable at all.
 
Re: 11/12 Remi AMPS 129

Interesting comments from Libby the other day about going green and trying to keep kitty green. Remi has been nadiring at 58 for both cycles yesterday. We do dose on the nadirs, and I'm not sure I'd want to go much lower as a nadir, unless you are trying to kick start him down again.

Is Remi getting anything for constipation? Several members here have noticed that their kitties numbers go a little higher when they are waiting for something to pass.

Those BD syringes are very bubbly. I usually draw up at least a .5U more than I need to get rid of those darn bubbles. I found the cartridges a little easier than vials for bubbles.
 
Re: 11/12 Remi AMPS 129

Hi Wendy

What I can't understand is why remi's cycles are more bouncy than before? what I was thinking was the the 1 unit would flatten him out so he stayed in the greens all day and night like before.

Perhaps I was spoilt with how remi reacted to the lantus but before it took him a day or two to level out and then straight back down to business. I guess I am mainly worried about getting glucose toxicity again from any numbers above 120 and today he started at 129 and so seems to be trending upwards but ofcourse I hadn't really thought the nadir but then again on the higher dose his cycles were flatter and so he didn't really drop like he is now. This is so confusing.... :?

I updated my thread as you were posting. He has done a little poo :-D small but it doesn't look too hard which was what I was worried about. I hope he passes some more later on.
 
Re: 11/12 Remi AMPS 129, +1 113

Wendy

Maybe I am thinking about it wrong. As you say he was only just above 58 at his nadir. I think I am confusing myself more and more. Not hard :lol:

So today his figures were

AMPS 129
+1 113
+2 81
 
Re: 11/12 Remi AMPS 129, +1 113

Have you tried miralax? Since Max started to have hard poop when he became diabetic I give him 1/8 teaspoon every morning. Some give it even twice a day.
 
Re: 11/12 Remi AMPS 129, +1 113

Yeah for some poo!

I meant that we mostly dose on the nadirs and since Remi was getting nadirs in the 50's, that's about ideal. There is some consideration given to preshots. If you increase, you will have to do it when you can monitor closely.
 
Re: 11/12 Remi AMPS 129, +1 113

tiffmaxee said:
Have you tried miralax? Since Max started to have hard poop when he became diabetic I give him 1/8 teaspoon every morning. Some give it even twice a day.
Click to expand...

I used to but with the change to wet food he had gone a little too soft so stopped. When he was sick on Sunday I gave some but then worried he might get too soft so stopped. He he doesn't go more by tonight I will try again.
 
Re: 11/12 Remi AMPS 129, +1 113

Wendy&Neko said:
Yeah for some poo!

I meant that we mostly dose on the nadirs and since Remi was getting nadirs in the 50's, that's about ideal. There is some consideration given to preshots. If you increase, you will have to do it when you can monitor closely.
Click to expand...

Perhaps it is a bounce from the sharp falls as he was getting down to 58 at +2. Maybe if today it is a slower drop it might be more even and he won't go back up over 120.

Perhaps I need to stop worrying so much and things will settle today!
 
Re: 11/12 Remi AMPS 129, +1 113, +2 81, +4 102, +6 118

Well remi popped briefly into the greens and then back into the blues. I guess I will have to see what his preshot number is.
 
Re: 11/12 Remi PMPS 113

Okay his evening PMPS is 113. So still in the blues and still not sure whether I should be taking him back to 1 unit.
 
Re: 11/12 Remi PMPS 113

sorry I'm too late for your PMPS, but maybe you'll see this by morning.

Alex's spreadsheet

This spreadsheet belongs to Jill & Alex. There are multiple tabs. Take a look and you'll see that she kept Alex tightly regulated mostly in green for years. The first two times Alex was on insulin, she went OTJ fairly quickly. The third time, she had multiple other health issues and Jill knew she probably would not go OTJ again. Still, Alex clearly felt better when she was in green, so that's where Jill kept her.

You can see that Jill often increased the dose even when nadirs were fine if she needed to pull the preshots down, but then would feed to prop the nadir up if necessary. Once she found herself doing too much propping, she would try a dose reduction. You can also see very clearly that when Alex wasn't feeling well, the numbers and dose went up, sometimes by a lot. Then once she was feeling better, the dose came back down.

The last few months cancer was messing with Alex's numbers, but if you look anywhere else you can see a lot of examples of what I'm talking about.

Just to be clear for others who are reading this, I'll repeat that I'm referring to cats that are already tightly regulated and then start to lose it. Remi was surfing easily in all green, and now he's *almost* there, but not quite. This is a more advanced technique, but you and Remi seem ready for it.

About Remi's dose - our protocol states that if a reduction fails, you can go right back to the last good dose. In your case that would be 1 unit. In my experience, usually increases work best when done in increments of 0.25u (not just increasing by a drop), but it was worth a try to see whether it worked for Remi. Sometimes we'll sneak a dose down by a drop (by skinnying the dose) if a cat doesn't tend to hold reductions well, but when it comes to increases, most of the time it is best to go ahead and increase by the whole 0.25 unit.

His low +2's are interesting. I wonder if that is actually his nadir from the previous cycle (+14 nadir). Some more late cycle tests might help figure that out. If that is actually his nadir, then propping it up could actually be pretty easy.

Sorry if we're confusing you by presenting different opinions. That's the beauty of an open board - different people chime in with their thoughts, giving you plenty to think about as you decide what you want to try. I enjoy posting to people who are trying to think things through. :smile:
 
Re: 11/12 Remi PMPS 113

Libby

I do feel abit like the forum tart asking for different opinions on the dosing front :lol:

Many thanks once again for such a detailed response. Looking at Jill and Alex's spreadsheet really helped me to visually understand what you mean. What a fantastic partnership they made. I have never seen a spreadsheet quite like that. I had the mindset that going back up was like going backwards and further away from my goal but I think I see now that in fact it could get me and remi closer to it. Jill really kept on top of those numbers by only allowing a couple of blue cycles before upping the dose again.

You almost have to chase the greens by changing the dose even if the nadirs are low. For tight regulation you ideally want to see greens right the way through and if you aren't getting them you just adjust the dose according. Then wait for the seven days or a below 50 reading and then lower accordingly.

I had never noticed the low +2 until this reduced shot but the late nadir makes sense looking at it. I can try to get some late readings but that wouldn't be until Friday. I give the insulin at 6am and 6pm and it would literally kill be to get up any earlier but I can sometimes get home from work to do a +11 and my partner works odd hours and so can get some later ones and then there is the weekends.

So I think I have decided that unless I see a green preshot number tomorrow morning I will up the dose to 1 unit. In order to control the late +14 nadir I guess I should try and feed again at +1. Having said that I think my partner might not be able to monitor remi tomorrow morning as much in which case I might wait until tomorrow night to increase he dose again.

I guess my only real concern is that Remi's lantus curves appear more, well, curvy. But I guess they should level out on the 1 unit again :?

Many thanks once again

Sarah
 
Re: 11/12 Remi PMPS 113

phlika29 said:
Many thanks once again for such a detailed response. Looking at Jill and Alex's spreadsheet really helped me to visually understand what you mean. What a fantastic partnership they made. I have never seen a spreadsheet quite like that. I had the mindset that going back up was like going backwards and further away from my goal but I think I see now that in fact it could get me and remi closer to it. Jill really kept on top of those numbers by only allowing a couple of blue cycles before upping the dose again.

You almost have to chase the greens by changing the dose even if the nadirs are low. For tight regulation you ideally want to see greens right the way through and if you aren't getting them you just adjust the dose according. Then wait for the seven days or a below 50 reading and then lower accordingly.
Click to expand...
It will make Jill's day to read this. :smile: She intentionally tested frequently and documented everything in detail specifically so it could be used as a teaching tool. I agree that their partnership was something special.
 
yes, you sure did make my day! i think libby and jojo are the only ones who have fully understood the how and why i did what i did with alex in order to keep her tightly regulated for years. happy to see all the documentation put to good use. hopefully, remi will return to greens and stay there! :mrgreen:
 
Re: 11/12 Remi PMPS 113

phlika29 said:
Many thanks once again for such a detailed response. Looking at Jill and Alex's spreadsheet really helped me to visually understand what you mean. What a fantastic partnership they made. I have never seen a spreadsheet quite like that. I had the mindset that going back up was like going backwards and further away from my goal but I think I see now that in fact it could get me and remi closer to it.
Click to expand...

Hi Sarah,
I'm very happy that Libby linked you to Jill & Alex's spreadsheet, and that you were able to grasp things by seeing it in living color(s)! When my cat, Bob, needed insulin, he was on compounded PZI which is a totally different world than Lantus. It took me quite a while to gain an understanding of how the two types of insulin worked so differently. And I learned all of what I know about Lantus from hanging out here for a couple of years. I must have asked thousands of questions, and thankfully, people here never got tired of my inquiring mind. I have to say that the first two dozen times I looked at Alex's spreadsheet, I pretty much looked like this: :shock: :shock: :shock: :shock: :shock: So I did the logical thing and asked Jill to explain what I was looking at. I've learned things from many spreadsheets here, but I'd have to say that the mantra "know thy kitty" hit home once I began to understand what Alex was telling me. :lol: And I'm not close to grasping it as well as people who have been here a lot longer than I have either.

What I wanted to comment on was the line I highlighted from your earlier post. My cat was one of the very fortunate ones who was on insulin for a pretty short period of time (10 weeks). I've seen cats go OTJ even faster than that, but not too often. Some kitties seem to just need a short time before a dose seems to "kick in" and then it can be a very quick progression - numbers come down, dosage goes down, lather, rinse, repeat, and "poof", the cat is in remission. But it doesn't happen all that often. Instead, there's this "battle" where you make great progress, and it stalls, and for whatever reason, you have to increase the dose after it had been going down regularly. And sometimes when that happens, the care-giver gets confused, or frustrated, and they see it as a "step backward" or a setback. Nobody really knows why it happens, but it seems to happen to most cats that I've observed. What I see from reading this condo is that you "get it", which is awesome. To me, the key seems to be "know thy cat". That enables you to be aggressive, provided you are able to test accordingly. Every cat reacts differently to insulin, to food, and to dozens of other things, external and internal, on a daily basis. They don't much care that there's a protocol that lays out what is "supposed to happen". Don't get me wrong -- the protocol is a protocol for many good reasons. It's been followed by hundreds if not thousands of caregivers, and with fantastic results. I guess the whole trick is to know when to wander off of the "path", and that's specific to each cat and each caregiver "learning" how their cat responds to insulin.

Anyway, a belated welcome to Lantus Land to you and Remi. I'm glad to see you doing so well!

Carl
 
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