12/31 Mikey TR PMPS 429 +2 221 +3 176 +5 327

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Marycatmom

Marycatmom

Member Since 2014
Yesterday: http://felinediabetes.com/FDMB/threads/12-30-mikey-pmps-277-1-303-2-283-3-301-pm-food-change.130644/

Good Morning!

Ms Knee-Jerk Reaction is at it again. This morning when I saw Mikey's AMPS, I fed 3% instead of sticking with the 8%. I missed a post on here from Marje, and didn't fully understand that plan. I've kicked myself thoroughly. I guess I need to take a deep breath and realize that this isn't a dangerous mistake, and that Mikey is safe. I'll get him back on the 8% tonight, although I'm having some trouble wrapping my head around this. I know I'm not the newest newbie anymore, but I'm still a newbie, and when you mix that with Mikey's being a difficult cat, I still don't know what's what.

So let me make sure I understand the plan. We go back to 8% food and stay there. The goal is to get him to be flat. If he doesn't come down, we raise his dose. Do I have that right? How many cycles do we give him to come down?

Don did a great job with Mikey last night, and I did really well relaxing, and mostly letting him deal with it. There may have been a bit of online stalking of the spreadsheet going on, but I deny those charges. :) My only complaint was that I came home to discover that Don didn't want to disturb Mikey's relaxation, so he fed him his +2 snack on our bed! :) Gross.

We're not sure yet how we'll handle tonight's cycle. Mikey may be coming with us to my brother's. I don't think Don wants to be there the whole time, so Mikey may not need to go along. I guess we'll have to figure it out.

One other thing on this long condo, my nephew is a PhD student at the University of Utah in the Pharmaceutical Technology field. His specialty is developing new methods of delivering medications. I was talking to him about the problems we have dosing Lantus, since it can't be diluted. That sparked his interest. He's a fellow cat lover, so I'm hoping he'll have some ideas that may proved useful someday. The kid is brilliant!

Happy New Year's Eve to all!
 
Hi Mary. I tried to find Marje's suggestiion for you but couldn't. I "think" it must be to feed a bit higher carbs all the time so as to get him to flatten out? Food manipulation can really help so I think it is worth a try. Max was a bouncy cat for almost the whole year that I've been treating him. I started feeding him to avoid reductions and his bounces are now usually high blue/yellow and don't last too long. Good luck. You will figure this out because Marje, Wendy, and Julie are really good at this.:bighug:
 
Marycatmom said:
There may have been a bit of online stalking of the spreadsheet going on, but I deny those charges. :)
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If you think that's bad, listen to this - more than once, I caught myself checking Lucy's spreadsheet from work during the day to see how she was doing. But I LIVE BY MYSELF!!! I don't know if I thought Lucy was going to test herself and post to her spreadsheet or what. It never worked. :(

Jill and I were talking about Mikey yesterday, and unfortunately we got pulled in another direction and didn't have a chance to fully work out our thoughts. One thing we noticed that bears watching, though, is that almost all of his low greens have come after a cycle in which he was dropping into the preshot, and he just kept on dropping.

For example, on 12/15:
AMPS - 453
+10.5 - 300 (quite a drop, bounce clearing here)
PMPS - 280 (still dropping)
+1 - 165 (dropping fast, no food spike)
+2 - 100 (still dropping fast and it's probably just now time for the insulin to onset, so this is probably not from the insulin, it is still momentum from the bounce clearing)
+2.5 - 66 (this could be where the insulin kicked in - so you have the momentum that was already in place, plus now the insulin starting to pull too).

So if you can learn to anticipate those cycles, you might be able to prevent him from dropping too low by maybe upping his carbs at his main meal when you see this pattern happening, or maybe feeding a bit more at preshot in those cycles or try some other things. As Jill said, it's going to take some experimentation to figure out the right combination of dose and food for Mikey.

I don't know what your schedule is, but it looks like you are able to get a test around +10 most days. I think I would try to pay attention to those - get a +10 or +11 when you can, get the preshot test, and if the preshot is a lot lower then consider whether you want to intervene and how you want to do it. As you do that, you should be able to start to predict when his bounces will clear and just grab the +10 on those days instead of every single day.

It's always a little tricky to deal with those cats who need a tad more insulin to be able to combat the bounces, but then sometimes that same tad more insulin causes them to bottom out. There's a balance, but it's not always easy to find.

And speaking of that, so far today looks like it has potential to be one of those days. Flat yellow yesterday, weird random high number this morning (high before the break?), and already dropping at +3. He could sliiiiiiiiide into preshot tonight if we're lucky (or he could bounce again if we're not lucky, but only Mikey knows).
 
I don't think it's necessarily that Lantus can't be diluted - there must be a way - but that it's a human insulin so there's no real need to go to the trouble to provide a concentration that gives measureable doses for us sugarcat parents. Guess the manufacturer isn't interested.
 
Libby and Lucy said:
If you think that's bad, listen to this - more than once, I caught myself checking Lucy's spreadsheet from work during the day to see how she was doing. But I LIVE BY MYSELF!!! I don't know if I thought Lucy was going to test herself and post to her spreadsheet or what. It never worked. :(

Jill and I were talking about Mikey yesterday, and unfortunately we got pulled in another direction and didn't have a chance to fully work out our thoughts. One thing we noticed that bears watching, though, is that almost all of his low greens have come after a cycle in which he was dropping into the preshot, and he just kept on dropping.

For example, on 12/15:
AMPS - 453
+10.5 - 300 (quite a drop, bounce clearing here)
PMPS - 280 (still dropping)
+1 - 165 (dropping fast, no food spike)
+2 - 100 (still dropping fast and it's probably just now time for the insulin to onset, so this is probably not from the insulin, it is still momentum from the bounce clearing)
+2.5 - 66 (this could be where the insulin kicked in - so you have the momentum that was already in place, plus now the insulin starting to pull too).

So if you can learn to anticipate those cycles, you might be able to prevent him from dropping too low by maybe upping his carbs at his main meal when you see this pattern happening, or maybe feeding a bit more at preshot in those cycles or try some other things. As Jill said, it's going to take some experimentation to figure out the right combination of dose and food for Mikey.

I don't know what your schedule is, but it looks like you are able to get a test around +10 most days. I think I would try to pay attention to those - get a +10 or +11 when you can, get the preshot test, and if the preshot is a lot lower then consider whether you want to intervene and how you want to do it. As you do that, you should be able to start to predict when his bounces will clear and just grab the +10 on those days instead of every single day.

It's always a little tricky to deal with those cats who need a tad more insulin to be able to combat the bounces, but then sometimes that same tad more insulin causes them to bottom out. There's a balance, but it's not always easy to find.

And speaking of that, so far today looks like it has potential to be one of those days. Flat yellow yesterday, weird random high number this morning (high before the break?), and already dropping at +3. He could sliiiiiiiiide into preshot tonight if we're lucky (or he could bounce again if we're not lucky, but only Mikey knows).
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That's hysterical, Libby! I could so see myself doing that!

I'm a teacher, so on weekdays when school is in session, I get a test as soon as I get in the door. That's usually either +9.5 or +10, although there are some days when I can't get home until PS. If we figure out how I should intervene if he's dropping, I will do it.

As for today, I think I may have triggered a bounce by my food mistake. I'm still kind of beating myself up about that one. I'm packing Mikey up and taking him with me shortly, so I will get another test or two before PMPS to see which way he's headed. I will have internet, although no keyboard, so I will keep his spreadsheet up to date, and if he's dropping I'll do whatever you think is best. If no one is around, it's ok. I'm bringing a variety of foods, strips, etc. so I will be able to manage.

Thank you so much for your help, Libby. I know you're incredibly busy right now, and I do appreciate it.
 
MJ+Donovan said:
I don't think it's necessarily that Lantus can't be diluted - there must be a way - but that it's a human insulin so there's no real need to go to the trouble to provide a concentration that gives measureable doses for us sugarcat parents. Guess the manufacturer isn't interested.
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Hmmm... I wonder if it's something he could do in his lab. An I correct that there is no generic for Lantus at this point? So there's only one manufacturer making it?
 
No there isn't a generic for Lantus, but I think the patent is due to expire soon. I think the problem in diluting Lantus is that it can be contaminated very easily, even the lubricant on the inside of the syringes we use. That's why we never shoot the excess back into the vial or penor pre-fill syringes.
 
If you're "traveling" with Mikey tonight, it's probably not the best cycle to base much of anything on...stress from travel and being someplace other than home can cause some wonky numbers.

Most cats go higher during stressful events, some go lower (like China...she likes to be "different")

For tonight, I'd just enjoy myself and not worry so much about Mikey's numbers....He's a bouncy kitty now and I'll bet he's going to be a bouncy kitty in 2015 too...LOL

At least you have something new to try in the new year! Will be interesting to watch and see how the food manipulation works!
 
Found this study in infants -- insulin was diluted 1:100 in 0.9% saline. Looks like it was administered immediately, so I cannot speak to the solution's stability over time.
 

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that's a really interesting research doc, MJ. Looks like they diluted several insulins, including Lev, but the baby had a severe hypo in response to the Lev and did ok on the diluted Lantus (which was diluted 10x more than they diluted the Lev). If you are interested in pursuing the idea of diluting the Lantus, I'd contact the manufacturer and ask if there is a diluent that they could provide. I talked to the pharmacist at a local compounding pharmacy about diluting R insulins and he said he could if he had the diluent. If I'm spelling that right - it's the base fluid used to dilute it.

Don't beat yourself up, Mary. Everything is a learning opportunity - so just take this as an opportunity to see if the 3% made a difference. I can see his tests til +8 today and it doesn't look like it did. That becomes valuable information. This is trial and error for all of us, because none of us knows how Mikey will respond. I think given the lack of response to the 3%, maybe I'd stay with it, or mix it with the 8% to have a 5ish% and see how he does on it.

I'd probably go with increasing the % carbs when you think he may be starting to dive in order to flatten him out, as Libby is suggesting.
 
Eddie had that kind of pattern for a while too - slide down out of big bounce for an entire cycle, and crash shortly after his next dose as the bounce broke and the next dose onset at the same time. On a couple of occasions, if I was able to see that his +10 was lower than his +6 and his pre-shot, I could anticipate that it was going to be a bounce breaking slide, and I fed a tiny bit of food towards the end of the cycle (around +10 or so depending on when we were home) to give him a little extra food on board try to soften the onset of the next dose. This did seem to work to help with the early-cycle crashes on the handful of occasions Eddie let me try that experiment out. Thought I'd toss that one out there, too.
 
Seems like the manufacturer websites are all OMG, DON'T DILUTE LANTUS! whereas some insulins like Humulin do have a diluent available. I find it hard to believe that an appropriate diluent for Lantus/Levemir does not exist. It's just a matter of being able to test the functionality and stability of the diluted insulin, which the average person cannot do.
 
If you look at the paper, Management of Diabetic Cats, which is attached to the TR protocol sticky, it talks about dilution of Lev on the eighth page in. Novo Nordisk does have a dilutant for Lev.

Have a great evening Mary, I hope Mikey behaves for you.
 
Mikey, Mikey, Mikey! I took Mikey with me to my brother's house for our family New Year's Eve party. All of my adult or almost adult nieces and nephews are here playing board games and eating cheese balls and homemade cookies and snacks. Unfortunately, the noise got to Mikey. I did the test, feed, shoot thing, but after I shot, he stopped eating. Don, who wasn't up for the noisy party, had to come down and get him. By the time he got him home and tested him at +2, he was 221 down about 200 points! Let me back track to say Don fed Mikey as soon as he got home. I had Don give him some 10% food (8% is what we gave before) and he will test again at +3. Is there anything else we should do? I will probably be heading home earlier than expected, but Don can do whatever needs to be done. I'm about in tears. FD runs my life, and it's hard not to resent it. Imagine how Mikey feels! He's the one getting poked.
 
no tears. Mikey's dose is so low that even if he goes low, he shouldn't have an actual hypo. I see that he has slowed down in blue at +3, so I think he'll be fine. Give him 18% if that's what it will take to let you enjoy your holiday. I used to do that often when I went to work. It will affect him for a few hours, not for the rest of his life. It's fine.
 
Aaannnd we have bounce! ARGH! Mikey, Mikey, Mikey! You are not a rubber ball! At least I knew this one was coming.
 
Libby and Lucy said:
no tears. Mikey's dose is so low that even if he goes low, he shouldn't have an actual hypo. I see that he has slowed down in blue at +3, so I think he'll be fine. Give him 18% if that's what it will take to let you enjoy your holiday. I used to do that often when I went to work. It will affect him for a few hours, not for the rest of his life. It's fine.
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Thank you, Libby. I'm so exhausted from this. I'm home with a cup of tea, and I will in bed before midnight. All I have to say is that Mikey had better plan on snuggling after all he's put me through today. I want snuggling, kneading, and purring. His three specialties!
 
I think way back "when", we discussed Mikey dropping into PMPS and that feeding him a little bit just before +10 might slow him down some. I would try again, as Libby suggested, on days that he is clearly dropping.

I'm sorry your night didn't go as planned. At some point, and I don't remember when that was for us, but you have to learn to not let it affect you emotionally. I think it takes a while to get to that point because the first few monts are just utter exhaustion and stress. At some point, you start learning to function with all that and roll with the punches a little more. But it's hard and you're at a very vulnerable place right now.

:bighug::bighug::bighug:
 
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