2/15 CRYSTAL ready to go on R - Comments on result please

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suki & crystal (GA)

suki & crystal (GA)

Member Since 2014
@Sandy and Black Kitty

Hi Sandy, we are ready to go this end in about 15 minutes. Just did the PMPS and Crystal is now eating as we speak. Her SS is up to date but for ease of reference, here are today's numbers:

AMPS 322
+2.25 308
+4 281
+5.25 286
+7 292
+10 344
PMPS 337

I am just preparing her Lev dose in one syringe and 0.25 of R in the other waiting for your confirmation.

Suki
 
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Suki

Julie is sick...not sure where Sandy is but I'll be around so go ahead and shoot. Remember..R in the scruff only. I'll see you at +1.
 
Hi Sandy, thanks for being there. Okay, I know I will testing every hour for at least 4 perhaps 5. I can calm down now and just wait ....
 
A 50-100 point drop from a shot of R is the ideal. Anything more has potential to cause a bounce, which we don't want.
In giving the R at PS time, what we want is for the R to pull down the numbers a bit so that the L has a better starting point at onset.
It's like a relay - R onsets fast and then the baton is passed to L for the balance of the cycle.
 
That's a very good analogy Sandy, let's hope Crystal understands what is supposed to happen (fast asleep in front of the fire at the moment).
 
I think that's fine. With Gracie, her most active test times on R are +2 and +3. We may find that Crystal might need a little more R but we have to start lower and see.

See you in one hour at +2.
 
Thanks Marje, just a simple chilli tonight, I pushed the boat out last night so something nice and easy tonight.

Well +2 is 342.

She's looking for something to eat but don't know if I should feed her. If it's okay, I have some plain poached rabbit, she normally gets another light feed at about +3 and then a little bedtime snack around midnight - would this still be okay or should I hold off feeding? - she won't be very happy if I have to.
 
My thought would be to do what you normally do, so you can see how the R works with your normal routine.
(been lurking).
 
Going in the right direction :cool:

Regarding the feeding, with BK unless he required steering, I stuck to a consistent feeding schedule.
My $0.02 - If you can wait, it would make the effects of the R easier to read. Adding an additional meal would be adding another variable to the picture.
Lets see what others say:coffee:
 
I've always done the same thing with Gracie as Sandy did with BK.....I fed her normal schedule except a few times when she decided to come down quickly on the R :oops::oops:
 
That's good...and she'll probably drop a little more to +3 but she's having a nice response so looks like she also onsets somewhere after +1 and before +2.

See you in an hour.
 
Likely. R typically lasts 5-6 hours with its nadir near the middle of that period.
Data is good, though. It will help you build a process to optimize the insulin dosing.
 
She notes a snack after +4 on the spreadsheet, though I thought she was giving it after +3.
 
BJ, thanks for confirming that. Sandy, no I didn't feed at +3 but just gave her a small feed now after the +4 test (her usual LC raw chicken mix) so the figures aren't influenced by any food so far.
 
Looks like it. I have never had R last 5-6 hours. Ever. Typically, it's a four hour insulin. If Gracie continues down after R+4, it's because the R opened the door for levemir to work and do it's job.

If you look at Gracie's SS on 2/12, you'll see what, to me, is a perfect situation with R. It brought her down and then the lev kicked in and worked beautifully.

Good job today!! I would be sure you test in a couple hours just to have the data.
 
Just watching by the sidelines, interesting experiment. I was wondering whether the R you got over there would behave any differently.

OK Crystal, time to let the Levemir do it's thing. How about some more sunny yellows today?
 
I see what you mean on Gracie's SS, perfect numbers. I'll carry on testing for a couple more hours yet just so I have as much data as possible.

Thank you all so much for your invaluable moral support and comments, good to get this first trial out of the way.

Hi Peg and Wendy, thanks for dropping in to check on our progress.
 
Cheered on from the sidelines, Suki. Crystal, your turn to work the Lev.

Excellent work today for the "experiment." What a great team.

Marilyn and Polly
 
There is one exception to to the typical 4-ish hour duration of R-
If Insulin Antibodies have developed and continue to develop the duration could stretch out longer
 
Sandy, are you talking about IAA? Haven't been able to confirm whether or not Crystal has IAA as unfortunately there is no test for it available here in France.
 
Sandy makes an excellent point and I was just discussing in general not knowing if Crystal is IAA.

What I like about using R at the beginning of a lev cycle is that as the R is tapering off, the lev is onsetting. Also, what I've observed is if the BG goes back up at +4, you might not see another big drop with lev onset. But again, that's in Gracie who is on a tiny dose. I don't know what you might see in Crystal.
 
Yes, IAA.
Since you can't confirm one way or the other, best to be mindful of the possibility when making decisions.
I can't comment on Acro however 3 months of excellent monitoring and methodical increases to 23u without one single blue makes me wonder if there is IAA activity.
 
Could well be a possibility Sandy but I will never know for sure, I even tried gettting the RVC in London to test for me but they couldn't do it either.

Crystal at +5 is 342. I'll certainly do a +6 (which will be midnight here) and then perhaps call it a day, or do you think I need to carry on longer?
 
That range was probably based on non-high dose cats!
Click to expand...

@BJM perhaps you could publish Spitzer's and your Gracie's SSs to the web so we can see an example of R dosing and where you got a longer duration from R? I'd appreciate that.
 
Thanks Sandy, I will be very interested to hear your thoughts on tonight's trial and how I should proceed in future. Crystal is due another increase tomorrow morning after 4 cycles.
 
Okay last test for the night, wish I could stay up longer but I'm totally pooped and need my bed.

+6 = 335, coming down a little from 342 at +5. If I get up during the night, as I usually do, I'll get another test in before AMPS. Check in with you in the morning, night night everyone and once again, many thanks for all your help.
 
Spitzer is the only cat I used R in and he had comorbid IBD or intestinal lymphoma (I'll never know), so he was erratic at best, and not a good comparison to a cat with a somewhat consistent high dose condition.

Due to the unpredictable, intermittent vomiting, diarrhea, and/or inappetance which bumped his glucose around like a psychotic yo yo, I couldn't increase the Lantus, so I tried 3 different approaches. When he had a high pre-shot, I combined it with R, which didn't last long enough, then I tried combining it with N, which didn't last long enough either, and finally, I tried combining it with ProZinc (which by itself hadn't lasted long enough, but at least was more flexible than Lantus). I was starting to be able to plan out the amount of ProZinc I needed to add to the Lantus when Spitzer was high, when he threw the saddle thrombus and was euthanized. (I have never heard a cat in so much pain and I hope never to hear that again.)

And a lot of folks on FDMB were horrified that I was trying the latter 2 combinations. I got a lot of flack for trying NPH on top of Lantus, and then trying ProZinc on top of the Lantus, but I couldn't increase the Lantus, and I had to try something to bring down his numbers.

Gracie was untreated for a long time by her original owner due to cost. She is very stable on 0.8 to 1.0 units of ProZinc and seems to have no other issues at this time (knock on wood!).
 
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Didn't find the original citation where I though I saw the 4-6 hours for R.
Did find this article abstract, though, on PubMed.
Excerpt:
"...The mean time interval between insulin administration and time to reach peak concentrations was significantly shorter for regular insulin than for NPH or PZI insulin (0.5 hr vs. 1.6 hr for NPH and 4.1 hr for PZI, P less than 0.05)....
There was also a significant difference (P less than 0.05) in the mean time interval between insulin injection and return of serum insulin concentrations to baseline values between regular insulin (5.6 hr) and NPH (7.7 hr) or PZI (13.1 hr) insulins...."

The above research was done on 7 normal cats, so again, may not apply to high dose cats.

***************************************​

Here's a different web page that has a table a bit more than halfway down, again, probably based on "normal" cats.
 
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Thanks for the info but a sample size of seven cats does not convince me of anything. I'd more likely go with the ECID approach.
 
Second citation in the above post is from an excerpt of The Pocket Companion to the Fourth Edition of Textbook of Veterinary Internal Medicine. Edited by Stephen J. Ettinger. 1995. It doesn't say how many animals were used. I still suspect that it was on allegedly normal cats and dogs, though.
 
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