2/20 CRYSTAL - dosing advice for tonight please?

[suki & crystal (GA)]

last night

@julie & punkin (ga) @Wendy&Neko @Suzanne & Cobb(GA) @Sandy and Black Kitty @Marje and Gracie

Hello “team Crystal” - thank you all for checking in last night for Crystal's R run. I just wanted to check whether you think it's okay to increase her Lev dose tonight, she has been 4 cycles now at 26u, although I held the previous dose for 6 cycles. Julie had suggested going up 2u when I next increase. She's still running pink and flat so far today, (my little pink pancake!)

I think I might leave the R off for a few days (to give her poor ears a rest) following last night's rather inconclusive R experiment and see how she does with just increasing the Lev – what do you think?

Just a point, as I only have syringes with 30u markings (which will not take me long at this rate to reach) how do I dose more than 30u? is is okay to do 2 separate injections in roughly the same spot or should I try and find syringes with a bigger capacity?

thanks, Suki

 

[Suzanne & Cobb(GA)]

Hi Suki,

I agree with going up by 2 units. One thing to note, that is the max you'll ever increase by. You won't bump up by 3 units ever. If you decide to continue to increase the Lev, yes, you'll use two separate syringes. I will tell you that we stopped at 31u. I eyeballed that extra unit in one syringe, but I couldn't afford to keep going up with the Lev -- don't know how much it is in France, but it's about $250 a vial over here.

I also think you should get back to increasing every 4 cycles until you start seeing some blue. I know you can't get the IAA diagnosis, but it looks to me that Crystal has some insulin resistance going on -- just going by seeing some yellow numbers for a few cycles and then they disappear. Antibodies are a b***h.

I also think Crystal needs more R. I wasn't around last night but looking at her SS, it doesn't look like the .25u increases is really doing anything. Personally -- and others may disagree -- I think you should do 1uR next time, and if there isn't more movement, go up to 1.5uR if she's over 300. This is how you will ultimately develop an R scale - trial and error of seeing what dose of R does what with where her BG is at PS.

Others will weigh in, but if you haven't shot already -- and I think I may have missed your shot time by about 30 minutes - go up by 2 units.

~Suzanne

 

[suki & crystal (GA)]

HI Suzanne, no I'm still at +10 so plenty of time before shot. Thanks for that advice, I'll do the 2u increase with an increase every 4 cycles. That's what I thought you would say but just wanted confirmation. Re the cost of insulin, yes it is expensive here, everything is (except wine!) but the strips are the worse and I'm going through at least 250 a month - another reason to get these numbers under control.

I'll wait and see what Sandy says about the next dose of R and when would be best to do it.

Thanks BJ for pointing out my typo, amended now.

 

[BJM]

Good luck with the trial.

 

[Wendy&Neko]

Here's a working link to yesterday's action. (First w cut off somehow in the address above) I agree with the increase tonight. I think Julie was talking about 10% increases, so that would mean going to 3 units in the 30's. For Suzanne/Cobb it was a bit different because he was seeing better numbers by the 20 unit mark. Something (probably IAA) is impeding progress for Crystal and sometimes you need a bigger hammer to whack it down.

When you go to larger doses, you can shoot twice, separate syringes and the shots don't need to be close together. I have seen some postings where people said they saw a difference (more action) when spitting the dose. And some not - ECID of course.

We can come up with some strategies to help you reduce the number of test strips, unless you are doing an R trial. For example, since she's on Lev which has a later onset, if she has a preshot of pink, I wouldn't bother getting a next test until +3 or +4. If still pink, you can get one around +7 to +9 and then nothing until preshot. If she's pink at PMPS, I'd get a before bed test and that's it, other than getting a periodic test in the back half of the PM cycle to see if she's going lower then - as per Sandy's suggestion yesterday. Although it's interesting to gather data, I always say to myself "what would I do different with this test" and "will she be safe". You have enough data now on what her pink cycles look like.

Good luck with the increase.

 

[suki & crystal (GA)]

Thanks for correcting my post from last night Wendy. Crystal was 340 at PMPS and I'll get just a couple of tests in tonight. Looking back at her SS I agree the best times would be +3/+4 and +7/+9 as if she is going to change, that seems to be the time. (Not so sure about the +9 on the second cycle though, that would be 03.00 in the morning!). However, if I do a bathroom run in the early hours (quite likely) I'll take advantage of doing a quick test for her at the same time.

On a slightly different note, I've noticed her acromegaly symptoms getting worse, there is an increase in growth around her muzzle, her lower lip is now quite visible and her chin has become quite pronounced. Haven't been able to have a look inside her mouth, she doesn't want to cooperate on that one. Also the noise she makes whislt eating and drinking sounds worse lately. My fear is that her air passageway and throat will start to constrict as the soft tissue develops. Did any of you acro moms have these symptoms in your kitties?

 

[Wendy&Neko]

Neko has some soft tissue growth on her gums. It was to the point where her upper canine tooth was rubbing the lower gum line sore. A dental vet a year ago shaved back the tooth a bit so there wasn't any more contact. Neko's grinding started up again late last year and she had a bit more of another tooth shaved at a dental in January. It didn't 100% solve the problem and she still does some grinding noises which drive me crazy (nails on blackboard ). So far we've been lucky on the air passageway. That's a known concern for acrokitties, especially if they need any anesthetic and kitten size intubation may be needed. Next time Crystal has to go into the vet for anything, you might want to see if they can look into her mouth. I have a limited time window to examine Neko too.

As for the PM +9's, you'll develop a feel for when to test them. If the before bed test is considerably lower than the PMPS, that might be a good time to check. Or as Jill has suggested, drink a large glass of water before bed and test when you get up.