2/17 Cobb PMPS 251 +2 246 +3.5 205 +5.75 149

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Suzanne & Cobb(GA)

Suzanne & Cobb(GA)

Member Since 2013
Yesterday

Well, I don't know what's going on. His morning preshots are a bit lower technically, but still much higher than they have been. I did drop the vial, but there are no floaties and it was before that beautiful blue streak. So I doubt gel here's anything wrong with the insulin.

All 5 P's are in place. Appetite is good as well.

Hope we see a change in these higher numbers soon.

~Suzanne
 
Re: 2/17 Cobb AMPS 349

Morning, guys

I saw on your spread sheet that you gave him 14.00u last night, and then dropped the dose amount back down to 13.50 this morning. He may give you higher #s because of this, so be prepared. His mid cycle #s are starting to improve with the 13.50u that he was given. It looks like you're planning on keeping him at 13.50u for a bit longer to see if he'll improve further like you did with the 13.00u, where you left him alone for 9 days, and are a bit unsure at this time of bringing him up to 14u. Hang in there. You're doing a great job! Someone once told me that in order to down in #s, you need to go up in doses. Don't be afraid to ask questions, especially dosing questions if you're unsure, no matter how redundant they may seem to you. That's what this board is here for. :-D
 
Re: 2/17 Cobb AMPS 349

Hey Angela,

I think I typed this mornings units in wrong. I did stick with the 14 instead of 13.5. I probably saw the 13.5 above it and just copied it down. Sorry!

I am curious though...when I originally joined the board, some people said that being above the right dose could sometimes result in higher numbers not necessarily hypo numbers. While I'm sure it isn't, could I have missed the right dose - possibly it being 13.25? Or would that miniscule amount not be enough to worry about bypassing it altogether?
 
Re: 2/17 Cobb AMPS 349

I don't know. Wish I had an answer for you, but I don't. If you want to try increasing by 0.25u instead of 0.50u, you can, and perhaps he may respond better by doing it that way. All you can do is try it and see what happens. Since you've started giving him the 14u, wait and see what he does, and then go from there. Sending you tons of lower # vibes for the both of you. Hang in there!
 
Re: 2/17 Cobb AMPS 349 +3 427 (.1 of R)

I starred the post...hoping to get some extra eyes. Cobb jumped into the 400s at +3 so I gave him .1unit of R to see how he reacts to it. I'll test him every hour for the next 5 hours.
 
Re: 2/17 Cobb AMPS 349, +3 427 (.1 R), +4 346 (R+1)

Hi, Suzanne. When Ozy dropped 60 point after R, I was told to feed him. This is even more of a drop. I'd say feed him.
 
Re: 2/17 Cobb AMPS 349, +3 427 (.1 R), +4 346 (R+1)

Thanks Donaleen!! I did feed him...I'll note that on the spreadsheet. I've got my hands full with him and the baby. I didn't quite think nap time through with the every hour test. Whoops. Matty will just have to deal with it!
 
Re: 2/17 Cobb AMPS 349, +3 427 (.1 R), +4 346 (R+1)

I think you mean YOU will have to deal with it all... poor thing. Wish I could help.

R isn't at all scary once you try it a few times and see how the cat reacts. Marje told me that it can affect a later cycle or two. Ozy went low a cycle AFTER the R and I dropped his dose. That was a mistake that cost us some time in higher numbers.

I used to think that there was ONE best way to do things. And looking back at the numbers, there probably is a way that is best. However, we all have to make decisions that affect the (immediate) future. And you CANNOT be sure what the best thing will be. But you can do your best and keep your cat safe (with adequate testing). I've gotten more relaxed since I came to terms with that. I was always trying to do it the RIGHT way. It's so easy to see what would have been best AFTER the numbers play out...

I keep an eye on you since we both have high dose kitties.
 
Re: 2/17 Cobb +3 427(.1R) +4 346(R+1) +6 302 (R+3) +7 327(R+

Ok. So it looks like the R is starting to wear off. At +7, he's heading back up a bit.

No idea where this 427 came from this morning. Very out of character right now.

Did the R do what it should have? Curious as to everyone's thoughts.
 
Re: 2/17 Cobb +3 427(.1R) +4 346(R+1) +6 302 (R+3) +8 345

I'm glad Donaleen was on and able to give you advice during the R cycle. I'm not an R user (although I've thought about it) but from what I've seen others do and recommend, it's suggested not to give R so that the nadir of R and Lantus are at the same time. It's better in the later half of the cycle when you see a rise or at the very beginning. That big drop at R+1 looks like R and Lantus had their onset around the same time. Unfortunately big drops can set in motion subsequent bounces. :roll:

As for bypassing a good dose, I don't think a .25U extra at Cobb's current dose would cause an overdose that would look like too much insulin. Paws crossed he'll get over the NDW and start working the extra juice soon.
 
Re: 2/17 Cobb +3 427(.1R) +4 346(R+1) +6 302 (R+3) +8 345

Hi there :cool:

cobbsmom said:
Did the R do what it should have?
Click to expand...
He didn't go higher, which I'm assuming was your goal
I'm glad you fed him - a 50-100 point drop is ideal. Anything more and you risk triggering a bounce.

regarding timing -
you never want the nadirs of the basal and bolus insulins to coincide.
so you have to be very careful to not give R at a time in the cycle when the nadirs for R and lantus might overlap, OR when both insulins are working hard at the same time. if you have R pulling him down at the same time the lantus joins in and starts pulling down even harder, then you can get into a situation where it is hard to control the drop.

I recommend (as long as he is not in process of clearing a bounce) your next trial be at an AM or PM shot time, or at a time after Lantus nadir.

cobbsmom said:
Well, I don't know what's going on.
Click to expand...
cobbsmom said:
No idea where this 427 came from this morning. Very out of character right now.
Click to expand...
Remember, there is still an important piece of the puzzle missing Suzanne - the reason Cobb is a big gulper
 
Re: 2/17 Cobb +3 427(.1R) +4 346(R+1) +6 302 (R+3) +8 345

I'll try to time the R better next time. I didn't want him to go higher, but I knew to feed him with the drop, and he was a hungry guy anyway.

Sandy and Black Kitty said:
Remember, there is still an important piece of the puzzle missing Suzanne - the reason Cobb is a big gulper
Click to expand...
Yes, I know we are still missing that piece. I will be calling shortly to schedule his vet visit and get the tests run. I know I've said that, but he is due next month so it'll probably be 3-4 more weeks before we have that answer.

I'm still curious as to what will change in what I'm doing if it comes back with a positive acro or IAA diagnosis. What would I be doing differently?
 
Re: 2/17 Cobb +3 427(.1R) +6 302 (R+3) +8 345 +10 292

Sorry, I don't have experience with Acro or IAA, so I can't answer that question as well as others who do can.

I agree with Sandy, in not giving R at +3 or whenever the two nadirs of the two insulin can coincide.
Sometimes, I really want to give R too, but can't because I have to wait until after nadir or until PS time.
 
Re: 2/17 Cobb +3 427(.1R) +4 346(R+1) +6 302 (R+3) +8 345

The foundation of a safe and effective treatment plan is to know thy cat

With IAA, the focus is pretty much BG beat down. However one must always be mindful of the following:

•Injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars. How much goes to antibodies and how much goes to metabolizing sugars is anybody’s guess and a moving target

•IAA can retard the initial rise of available insulin after an injection.

•IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released back into circulation. Any increase in half-life can lead to prolongation of action.

•The release of insulin from the antibodies can happen at inopportune times

I don't have first hand experience with Acro, however I believe that as the pituitary tumors' hormone secretion waxes and wanes so do the BGs.
Also, an Acro kity may have functioning pancreas. That has potential to make guiding numbers with food tricky since active pancreas will react to food by producing insulin.

I can't comment on how the dosing strategy differs, since I don't have Acro experience. Wendy may be able to shed some light on that since Neko has both IAA and Acro.
 
Re: 2/17 Cobb +3 427(.1R) +6 302 (R+3) +8 345 +10 292 PMPS 2

A good day overall. The R stopped a potential climb this morning, although I will time it better next time.

A much nicer number for our PMPS - although a dropping number so I'll watch him carefully for the next few hours before the before bed test.

Hope everyone had a nice Monday!

~Suzanne
 
Re: 2/17 Cobb +3 427(.1R) +6 302 (R+3) +8 345 +10 292 PMPS 2

I hope Cobb has a nice safe blue surf tonight.

Suzanne, we aren't pushing you to hurry testing, just letting you know that it's harder to suggest strategy or answer questions about what is happening without test results. So until then, it's a bit of a guess.

Neko is both IAA and Acro which provides a bit of a conundrum for me on strategy. Sandy has described nicely what you do for IAA and it means being aggressive to spend time in green. For Acro, since there may well be a working pancreas, the goal is not to earn reductions and heal the pancreas but rather to keep kitty in healthy numbers as much as possible. For me, that means keeping Neko at a dose where she is below renal threshold as long as possible so as much blue and green time as I can. However, due to the IAA component, I do try to keep Neko seeing some green, because I've noticed she bounces more when she's not which results in time above renal threshold. For me, a dose that gets nadirs in the 70s seems to do the job. The tumor in an acrocat can wax and wane, so it is a moving target. But sometimes it holds steady - last year I held a dose for a couple months.

A second part of strategy that varies based on test results is how to handle low numbers. I do have to be cautious when Neko is in low normal numbers, because food can cause her pancreas to kick in and lower the numbers further. For Neko, that means using HC. I still have to test MC, but she refuses to do a nice mid level surf during the day where I can experiment while I'm awake. :roll: I know that a higher % carb LC does NOT work and can cause her numbers to tank. When acro kitties get into reduction level numbers we do have to be extra cautious. Kitties with just IAA or "regular" diabetes may be able to get higher LC or MC to bring them up. This is where careful notes and experimentation can be your friend. Just in case, be cautious the first few times Cobb hits the 60s or less.

And lastly, if Cobb tests positive for acro, there are some side effects of the excess growth hormone that you'll need to be aware of and monitor. For example, organs including hearts can get enlarged so need to be monitored more closely. Soft tissue growth in the throat means smaller diameter intubation if Cobb has to undergo surgery. For Neko, knowing that she had acromegaly saved her canine tooth. Regular vetty saw red gum and thought tooth extraction. Dental vetty thought soft tissue growth on the gum and just filed the tooth back a bit. Cheaper and saved a tooth.
 
Re: 2/17 Cobb PMPS 251 +2 246

Thanks Wendy! That helps a bit.

I usually like to know all my options before knowing which one I'll use. I'm guessing it comes from being a news producer and walking into the control room expecting your first live shot to die and having to rearrange an entire newscast on the fly with about a 30 second heads up. That means I have to be prepared with a plan A, B and C from the outset. That's why I keep asking about what the strategy would be if Cobb comes back with an IAA and/or acro diagnosis. I don't want to put him through the trauma of the blood draw and the expense just to get a diagnosis for peace of mind so I can feel justified in continuing to up his dose. I already know that if he has acro, we aren't going to do the SRT - so we'd be managing the tumor with insulin only, but even that is going to have its financial limits. I can't go through a vial of $200 insulin every week. I don't know what we'll do if he has IAA to the extent of Black Kitty or Sooty. It certainly doesn't mean I love Cobb any less because I do love him dearly, but everyone does have their financial limits, especially with a 12yo cat and a growing child as well!

These are all discussions we will have with the vet in a few weeks. I just would like to know ok...if he has IAA, this is how we would initially proceed and how it differs from what I do now, ie. He spent two cycles in hours, but has started climbing, go ahead and bump up the dose before that 4th cycle so you can get ahead of the antibodies. Does that make sense?
 
Re: 2/17 Cobb PMPS 251 +2 246

FWIW - most acrocats do not get SRT. I don't know if you've ever looked at Tommy's SS but it's a good example of how things can vary. Lauren had him down to 1 unit last year but now he's back up again. He was originally Dx 4 years ago.

I can't answer your IAA question. I didn't have anyone around to provide advice when Neko got her IAA Dx and acro is more important so that is what I focused on. What I learned was by trial and observation.
 
Re: 2/17 Cobb PMPS 251 +2 246

Wendy, that makes sense. And I know there isn't a rule book because every cat is different.

We'll just have to wait and see what the test results say and then proceed from there.

I'll look at Tommy's spreadsheet for more info. Thanks for the reference and link!
 
Re: 2/17 Cobb PMPS 251 +2 246

I think he had a pretty respectable response...maybe a bit of a bigger drop than what you'd normally want but I agree it was due to close onset by both insulins.

I'm glad you're watching him closely tonight because that Lantus door just might be open and he might come down more tonight.
 
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