2/24 Nova - AMPS=144, +6=157, PMPS=189, +2=135, +3=70

[Dawn & Nova]

Nova's good.. she's definitely feeling better in the blues.. Her mom however has been slacking on condos.. too many work pressures in the morning.

So if Nova continues as I expect.. then tonight I'll probably see a dip into the greens.. with her surgery coming I have a question.

If prior information holds true, 1U is slightly too much insulin.. and 0.75U is too little.. with her surgery coming up on Monday.. and her human really wanting to get some sleep this weekend to prepare for a possibly stressful week with recovery.. I'm thinking about trying something slightly less then 1.. 0.9 or thin 1 or whatever I can end up with.. so that I won't have to worry too much about testing her lots this weekend and worrying about low numbers.. (let us both get some sleep hehe).

If I see a dip into green tonight I was thinking of starting this AM or PM tomorrow.. any thoughts?

P.S. I'm expecting something like what happened around 02/09/10 (pm) or 02/10/10 (am/pm).. but my guess could be wrong.. she is after all.. a cat .

 

[Ronnie & Luna]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

Nice to see u back Dawn and Nova

I'll let the more experienced advise on your dose q's...big day coming up for Nova on Monday!

 

[Ronnie & Luna]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

hey Dawn

can u refresh - whats on tap for mondays dental? what is she getting done?

 

[Dawn & Nova]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

Well.. we don't really know for sure until the dental x-rays are done once she is under.. at the very least she is getting a cleaning that has been much needed since her dx 5+ months ago.. but with her age (she's at least 9.. though as she has aged, they''ve been thinking the animal shelters guess of 3 years old, 6 years ago, was probably low), and no extractions yet.. the doctors told me they would be surprised if they weren't removing teeth..

Honestly.. I have the attitude that they should be pretty aggressive about removing any possible problems.. she's starting to get up there, the less surgeries the better.. I've got a kitty who had all his molars removed a few years ago.. and I'm short a shwack load of teeth myself (jaw too small/teeth too big.. I don't look weird I swear ).. neither of us miss any of them..and with Nova on wet food for the rest of her life.. she doesn't actually need any of them.. though I admit I'd be really sad if some canines had to go (she's always had significant staining on them so I worry about them).. it might change how her face looks, and I love her face, she's gorgeous!

 

[Libby and Lucy]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

and I love her face, she's gorgeous!

I love her face too. :smile:

I'm curious what you see in Nova's spreadsheet that makes you want to reduce her dose?

 

[Roni and Moonie]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

Not to worry--She will still look just as beautiful without the canines--Moonie had 5 teeth out in 2008 and 4 out in 2009, & she is just as beautiful as ever--They arent like people whose faces sink in :lol: :lol: :lol: They have fur to beautify them :mrgreen:
Hoping that the surgery goes smoothly & quickly..Do you have Jill's dental check list?? It's somewhere in the site here--I'll try to find it for you tomorrow...
The all blue numbers today can lead to some green maybe tomorrow-- As for The dosing, Moonie responds so quickly to just a little increase. Why would you change the dose right now?..Hope you find the right dose--I will send the pictoral of dosing:
http://www.romlin.com/jock/SyringeFineGradations/ check out the photos on the left..maybe they'll help.
Have a good sleepus!

 

[Jill & Alex (GA)]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

hey, roni... "jill's dental list" is outdated. dr. lisa and jess have numerous dental comments in threads on Health based on the latest thinking/research.

dawn, like libby, i'm curious as to what makes you think a reduction would be a good idea...

 

[Dawn & Nova]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

Yeah I guess her face won't cave in or anything..but when she's really happy she sleeps on her back with all her feeties in the air and you can see the tips of her canines poking out..it's adorable!

Not sure I found the check list.. i did go through all the posts I could find with info from jill.. "questions" about medications and stuff with the staff at the vet hospital.. everything checks out (including only using antibiotics if absolutely necessary).. except can't get buprenex in canada, so using what we feel is the best alternative. Have all the supplies I can think of.. but there's probably stuff I haven't thought of .

As for her dose.. I never actually saw her totally settle in 1U.. she was mostly settled i imagine, but went down a tiny bit each day.. I think she'll probably be ok on 1U.. I just don't want to test her much this weekend.. or worry because I'm not testing much.. I want her to have a nice relaxing weekend where I'm not waking her up every few hours to test her..

I also need to get as much sleep as possible.. I'm a chronic onset insomniac (dx 25 years ago when I was 7.. yeah having a diabetic cat when you have this condition is a real hoot.. blarg).. typically takes me 2-3 hours of laying still to fall asleep.. worse of course when I'm worrying (about things like surgery.. or if I should test her again)..

I feel how she does with the surgery and recovery has a ton to do with her AND my state of mind before hand..

 

[Jill & Alex (GA)]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

there are quite a few dental threads on health with a lot of good info.

dose... honestly, depending on how tonight goes... if no green, we'd be suggesting an increase because the reduction did not hold.
the usual dose adjustment made prior to a dental is shooting either a half dose or no dose the morning of the dental (depending on the numbers).

 

[Dawn & Nova]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

dose... honestly, depending on how tonight goes... if no green, we'd be suggesting an increase because the reduction did not hold.
the usual dose adjustment made prior to a dental is shooting either a half dose or no dose the morning of the dental (depending on the numbers).

Huh? Did an increase back to 1U 6 cycles ago.. so she's working on settling into 1U now.. I'm assuming you missed the dose change because there's no way I'm doing an increase when she's still settling into a previous increase!! (And I don't think you would suggest it either ).

Her doctor and dental tech said to do 1/2 her dose the morning of surgery.

 

[Libby and Lucy]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

I would have suggested an increase too. Nova hasn't seen green in almost a week, unless she gets there tonight.

 

[Jill & Alex (GA)]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

dose... honestly, depending on how tonight goes... if no green, we'd be suggesting an increase because the reduction did not hold.
the usual dose adjustment made prior to a dental is shooting either a half dose or no dose the morning of the dental (depending on the numbers).

Huh? Did an increase back to 1U 6 cycles ago.. so she's working on settling into 1U now.. I'm assuming you missed the dose change because there's no way I'm doing an increase!!

Her doctor and dental tech said to do 1/2 her dose the morning of surgery.

i'm sorry. i didn't word my comment correctly.
no, i did not miss the increase. the reduction to 0.75u did not hold. there's been no green in 6 days. if nova were my cat i would have increased the dose a couple of days ago. edited to add: correction. i would have increased yesterday.

 

[Dawn & Nova]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

I would have suggested an increase too. Nova hasn't seen green in almost a week, unless she gets there tonight.

Hmm I'm pretty sure there's some confusion going on here.. I simply can't imagine that there would be any suggestion to do an increase 3 days after a previous one when numbers are still trending down and in the blues now..

Just so I know everyone's on the same page..

A few weeks ago Nova was on 1U.. she settled into it and was getting lots of green.. after a 47.. we gave a dose decrease to 0.75U a shot.

She hung on to greens for a few days at 0.75U but started trending up.. hanging out in the all blues.. on cycle #7 she took a weird plunge into the greens so I held the dose for a couple more days .. during those days she was all yellow..

So I increased back to 1U.

Since the increase (6 cycles ago) she's been trending down.. except for 02/23/10 AM.. which could be a rebound.. because of work and meetings I wasn't able to test as much as I would have liked, will never know.. she seems to be trending similarly to when she was settling into 1U the last time (around 02/09/10).. if she does (and big if.. only time will tell) continue to trend similarly.. by the weekend she may be in the 50/60 range.. which means I'll need to be testing a lot.. which is what I would like to avoid.

 

[Jill & Alex (GA)]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

Hmm I'm pretty sure there's some confusion going on here.. I simply can't imagine that there would be any suggestion to do an increase 3 days after a previous one when numbers are trending down and in the blues now..

a reduction was taken to 0.75u. the reduction did not hold. the dose was increased to 1u bid. it's been 6 days since nova has seen green. the longer a kitty sits in higher numbers, the longer it'll take to bring them down... not to mention more insulin will probably be required.

nova had a nice run of greens. the sooner we get it back the better.
even with these blues... there's plenty of room for an increase. hence, an increase would have been suggested.

however, you're the one holding the syringe. ultimately, it's your decision...

 

[Dawn & Nova]

Re: 2/24 Nova - AMPS=144, +6=157, PMPS=189

a reduction was taken to 0.75u. the reduction did not hold. the dose was increased to 1u bid. it's been 6 days since nova has seen green. the longer a kitty sits in higher numbers, the longer it'll take to bring them down... not to mention more insulin will probably be required.

nova had a nice run of greens. the sooner we get it back the better.
even with these blues... there's plenty of room for an increase. hence, an increase would have been suggested.

however, you're the one holding the syringe. ultimately, it's your decision...

Hmm ok.. so yesterday you would have increased to 1.1U or 1.25U? I do not have big enough balls for that, that's for sure.. waaaay past my comfort zone. I would have a tough time making an increase THAT fast unless she was in the yellows during her peak or if it had been 5 days.. but mid-blues on day 3.. I still think your nuts! .

Maybe it's the best thing to do and I just don't know enough yet to see it.. I'd be interested in some reading I could do that would help me understand better.. Tilly protocol doesn't seem this aggressive? But I do want to learn more.

Turns out what I had figured would be just a touch into the greens tonight was a 70 at +3.. so it's all kinda moot anyways (this go around anyhoo, will probably be here again some day , and want to be as prepared as possible for it, so please still give me some stuff to read if you know of some )..

 

[Jill & Alex (GA)]

yes, i would have increased to 1.25 units.

sorry, all i have to offer is protocols, 3.5 years of experience reading 100s of spreadsheets, and links to otj kitties spreadsheets. unfortunately, the otj kitty ss link is not up-to-date.

Links to protocol guidelines:
Tight Regulation with Lantus or Levemir for Diabetic Cats
Dosing Protocol for Cats on Lantus/glargine or Levemir/detemir Using Daily Home Monitoring of Blood Glucose Concentrations to Adjust Insulin Dose

OTJ spreadsheets: http://spreadsheets.google.com/pub?key=pZ1soNpOWRCB5WKzukx_dHQ&gid=1

and as far as me being nuts... lol! maybe i am, but i have a pretty good track record. the first time alex went into remission it took an aggressive approach for that time period. we were just learning about lantus and feline use. we floundered around trying to figure out what worked. since 2006 we've learned a heck of a lot more about how to use lantus and levemir effectively in felines. when alex fell out of remission 2 years and 10 months later i was able to use all we had learned to get her back into remission after only 8 weeks on insulin. the difference in her lantus and levemir spreadsheets shows just how far we've come in a short period of time. btw, getting a kitty into remission the second time is a lot harder than the first time...

 

[Dawn & Nova]

I don't doubt that you know what your talking about.. I just want to understand without having to do all the hard work you did to get where you are.. that's reasonable isn't it??

 

[Dawn & Nova]

I'll tell you the same thing I tell her very knowledgeable and experienced doctors .. I don't doubt that you know what your talking about.. and I WANT to understand the best I can so that I can do the best for Nova.. because I could never willingly do anything I thought could put her in danger.

Now since you don't get paid.. this next section doesn't directly apply.. (though you should get paid...)..

It's your job to get me from not understanding and feeling I'm putting her at risk.. to understanding and being on board with your thinking..

Where I demand with her doctors because I pay them, that isn't appropriate with you since you volunteer.. so I simply just beg ..

It's not meant as disrespect.. I really do want to understand.. I need to understand.

 

[Jill & Alex (GA)]

that's why we put together the stickies. they're a cliff note version of all the stuff one needs to know.
read the stickies. click on every link and read the info. same thing with the protocols. study spreadsheets of OTJ kitties.
some of that info will click on certain days because you'll recognize it happening with nova.
some of it just comes with experience. eventually, you'll be able to pick out patterns on your own kitty's spreadsheet.

 

[Dawn & Nova]

Ok.. those protocol links are where I got my ideas from in the first place (I have read the stickies.. many times).. so the only thing I see in the protocol links about 2-3 day increases is:

"Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU"

She wasn't over 300 at all.. she wasn't always having nadirs over 200.. I don't have all the +6s.. but can at least get a decent guess from earlier tests in the same cycle..

cycle 1 - 261 (+4)
cycle 2 - 185 (+6)
cycle 3 - 122 (+6)
cycle 4 - 236 (+6)
cycle 5 - 151 (+3 - reasonable to guess that +6 would have been lower)
cycle 6 - 157 (+6)

After day 2 she was 50/50.. and one of those was the first cycle, so because of her depot changing.. she didn't get the full 1U anyways.. and by the end of day 3 it was 1/3...

So from what I gather.. your experience shows that the 200 cut off is not aggressive enough when increasing after an unsuccessful decrease.. where abouts do you figure it should be? 150? 100?

I can't find anywhere in those two links that mention this being different then a standard increase... and so far Nova is acting like it's the same.. but maybe she's weird and most cats jump back to the pre-decrease numbers much quicker?

I'll keep looking through more spreadsheets..