2/5 Max AMPS 354~PMPS 403

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Randi & Max (GA)

Randi & Max (GA)

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Yesterday's Condo

Happy Friday LL

Well this morning was the 9th cycle at this reduced dose of 5.5 and we have not see that much
action in a few days. Not that I am an expert in analyzing his ss that well but green has come and gone a while ago and we have only seen some mid blues.

Is there such a thing as a fat 5.5, for a midbie??

I am not sure what the protocol says about this. Hang in for a while more? I don't want him getting too comfortable in the yellows.

WCR: All 3 cats were waiting outside the bedroom door for their morning routine. Max took off on a run, yes he almost gallopped, to his testing chair and was purring and gurgling as he had his treats and got tested. Ate about 1/3 can of FF for his breakfast. Now he is relaxing
on his chair.
His coat is very silky and there is little dryness or dandruff which is so nice.
LB action has been working very well. He likes the dining room for now.

Have a great day!
 
Re: 2/5 Max AMPS 354

Max's ss mystifies me. What do those greens mean? He clearly has a schedule in mind and is trying out the greens to see if he is ready yet.
 
Re: 2/5 Max AMPS 354

Well I don't understand it very much either and it doesn't look like
Max is interested in trying anything out besides pink today. Probably or hopefully
he will hit yellow at +6.
 
Re: 2/5 Max AMPS 354

Ronnie & Luna said:
maybe Max is taking his sweet time
Click to expand...

Oh yes, take his time so I can stay up all weekend??
No idea where he is going to go.
Right now this Mommy bean is not very happy with him.

Let me check about that lunch Ronnie, you???
 
Re: 2/5 Max AMPS 354

Carolyn and Spot said:
Hi Randi,
Has Max always been an inappropriate pee'er or only recently
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Carolyn
It started a few years ago in one area of the basement. Went thorugh crystals and bladder stones surgery. Plus we thought it was a bit behavioral.
Then it would happen from time to time in the same spot.
Last week it happened in the kitchen so that was pretty strange. The other time back in Oct when it happened in the kitchen was right after he had catnip.
Do you have any thoughts?
 
Re: 2/5 Max AMPS 354

Generally, inappropriate peeing is the big red flag that something is going on. With his past, you may have your work cut out for you with the thinking, to decide if it's behavioral or not... Have you had any recent craziness in the house? Specifically, a new animal, human or trauma like the loss of somebody? If no, I'd be watching to make sure something is not wrong. I would probably want to go get a C&S via cystocentesis to make sure something wasn't going on medically. Regular external pee samples will be of little to no use here.

If something happened.. you could try Prozac. We have some board kitties on it for IU.

One thing you might try is Cat Attract litter additive. Sometimes that alone is enough to get them going back to the box. Feliway is another recommended idea, though I don't know if that will help.

To be honest, IU is SUCH a red flag, I'd not be quick to dismiss it, even with his past.

I know you don't know me from Adam, but the notes in his SS caught my attention and his numbers are just wonky enough to lead me to suspect outside interference. By the way, it looks like he's about to break, number-wise. I hope he does :smile:
 
Re: 2/5 Max AMPS 354

Carolyn and Spot said:
Specifically, a new animal, human or trauma like the loss of somebody? If no, I'd be watching to make sure something is not wrong. I would probably want to go get a C&S via cystocentesis to make sure something wasn't going on medically. Regular external pee samples will be of little to no use here.
Click to expand...

Carolyn, although I have not seen you in my condo, I do now you from Adam, lol. I have seen your posts. Thank you very much for taking the time to look at Max's ss and offer some suggestions.
1. There have not been any traumas or changes in the house at all.
2. Urine was collected via needle, not externally about 2 weeks ago. I do not know what a C&S is (can you tell me) but a culture was grown. No bacteria or infection was found in his urine.
I would love to know if there is another infection brewing somewhere else that could affect his numbers.
3.I finally got a hold of cat attract sprinkles (I used to use the actual litter but cannot get it where I live) and so far he is using the LB.
4. I also got my hands on the feliaway diffuser and put it in the area he had peed in the kitchen. So far there have not been any incidents.
Any other suggestions are welcomed for sure.
Thank you so much Carolyn.
 
Re: 2/5 Max AMPS 354

You're very welcome! Your vet seems to be all over it. A C&S is Culture and Sensitivity which is what your vet did and he/she did it via needle which is cystocentesis. I am glad you have a vet who does that, many only do external samples which can be described as probably inaccurate at best... any sample other than cysto/C&S is a waste of time and money. Other things that could be going on are too many to narrow down. Did he have a full blood screen?

IU can be caused by pain (such as neuropathy/arthritis), illness (such as CRF/pancreatitis) and get this: dislike of the food.. which I notice you have in your SS. What are you feeding? Doesn't happen to be Friskies Turkey and Giblets is it? LOL we had a major problem here with that this week.. but I digress. Things that cause pain:
1.DENTAL. Number one suspect. Diabetes causes too much sugar, which causes rotten teeth. Overly simplified but check for gingivitis. Gingivitis IS by definition an infection and is often the number one suspect unregulated bg's.
2.Also pancreatitis is a common affliction of our diabetic cats. That blood test is called the fPLI and is run separately from a panel. Not sure we're seeing pancreatitis, but keep it in the back of your mind if you start seeing bile vomiting, diarrhea, depression/lethargy, meatloafing and/or loss of appetite. They don't all do all those things, but if you see any of them, something's up.
3. Crappy BGs. He's got em, and they do make a cat uncomfortable enough to express annoyance by peeing outside the box.

Two things in the back of my mind, and by back, I mean WAY back.. I look at his numbers and I don't see what I would normally see in a high dose cat who's got Acromegaly. I don't know if anyone has mentioned that word to you. I wouldn't take that too seriously with him just due to the fact you're seeing green, which we don't normally see this early in an acro. I would be interested to know if anyone's brought up IAA to you. That's Insulin Auto Antibody. Again, just food for thought, I do not know your history and what all has been brought up before, or even what's already been tested. IAA is more possible than acro to me, but like I said.. I'm not leaning towards either quite yet. His numbers don't really seem to say either to me.

They say infection. I keep thinking about teeth. Without seeing his teeth. You may now call me Madame Kreskin. LOL

Anyway, I don't mean to send you off on a wild goose chase, but you are not achieving regulation at a pretty high dose, which makes me wonder why. All cats are different, and there may be backstory here that I don't know. I don't want you to think I just jumped in here to be all critical and overbearing, because I'm not at all. I'm curious about these numbers, and I'm curious as to what's going on. I've seen a lot of things on here, but I have never seen a cat on a good diet, in good health, fail a dose reduction in Lantus without something else going on.

Dosewise.. I'd hold your new dose for another couple cycles. Max. I think he might be about to break, but if he doesn't, he's gonna need to go back up. You are right that you don't want him getting too used to high numbers, because he is already used to them, and it's very easy to backslide. Normally new dose wonkiness can last quite a long time in an unregulated cat though, and you may well see a string of high and unflinching numbers right before a big drop. If he drops, he's gonna bounce so be prepared to not react to it.

Do you have any idea what I just said? My brain works much faster than my fingers LOL
 
Re: 2/5 Max AMPS 354

C & S is a Culture and Sensitivity. It's what the vets ostensibly do with the sterile urine sample collected via cytosentisis. If they cultured the urine, then the vet did a C & S. I don't think Max was on any antibiotics around the time you had the urine cultured. If he was, that could have effected the outcome of the culture.

While not related to related to Max's IU, he did have his teeth checked when he went to the vet, didn't he? Any chance he needs a dental?

Just as an FYI, Feliway also comes in a spray. If you can track it down, you could spritz the spot in the kitchen where Max anointed the floor.

I can see why you're thinking about possibly fattening the dose. The protocol would suggest you go back to the last good dose. I fatten and shave Gabby's doses because from experience, a full 0.25u decrease doesn't usually hold. The smaller changes seem to work better. We've fattened doses because Gabby's a drama queen. Her numbers can plummet by +2 or +3. I don't know if Max fits that sort of profile. Obviously, if you fatten the dose you can always add more. It might not be a bad idea if you put a note on your subject line a few hours before PMPS and ask for more input.
 
Re: 2/5 Max AMPS 354

Carolyn and Spot said:
.DENTAL. Number one suspect. Diabetes causes too much sugar, which causes rotten teeth. Overly simplified but check for gingivitis. Gingivitis IS by definition an infection and is often the number one suspect unregulated bg's.
Click to expand...
We interviewed a new vet last week and I had him look at Max's teeth because I was concerned about dental infection and the lack of insulin response. He said that they were not bad. What does that mean, I don't know but he did not think that was a reason for his hi dose.
Carolyn and Spot said:
2.Also pancreatitis is a common affliction of our diabetic cats. That blood test is called the fPLI and is run separately from a panel.
Click to expand...
Had that test done back in November, which I insisted on even and it was clear was good. No pancreatitis then.
I for sure have heard "acro" and "IAA" and have been poopoohed by 2 vets already. One thinks his dose should be 6.5 and doesn't think it is a high dose and the other vet wanted Max to stay at 5u becuase that was a good dose (are they normal)
Max eats only FF, chicken, turkey giblets,liver chicken (that's all that's availble in Canada) although for the past few weeks he had some variety with FF beef flavours that I "smiggled in from the states" Should I get rid of some of these flavours? I just tried the EVO 95% chicken and turkey. He likes all of the food I give him.
Sienne and Gabby said:
The smaller changes seem to work better. We've fattened doses because Gabby's a drama queen
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Gabby's a drama queen? no?? lol. Max had really nice results at the 5.75 (a little to drastic for me) but I am not liking this 5.5. I really don't know what to do. I have gone through 3 vets and no one wants to take me seriously. Maybe vet # one will do an IAA for me. Although 3 vets think his nu,bers are high because I test him too much.
Anyon for vet #4??
 
Re: 2/5 Max AMPS 354

Randi,

I have spent a good amount of time staring at Max’s spreadsheet trying to figure out if there is some sort of a pattern. I don’t know that I have figured much out, but this is what I see.

Max started to see more yellows in his cycle when he was on 4.75, but he wasn’t moving past the yellow. Then you bumped him up to 5.0 and he stated to see some blue, but not very much of it. He was bumped to 5.25 and he saw a little blue there too, but looks like even less than when he was at 5.0. He was bumped to 5.5 and again saw a little blue, but still not much. His break through looks like it was at 5.75, where he saw more blue and even some green. After a few days on 5.75 he started to show even more green, but then he would bounce afterwards. Luckily the bounce didn’t appear to last long, and after another dose of 5.75 he fell below 50 and earned a decrease.

Since his decrease back to 5.50 units he has still seen more blue and yellow than in the past, but only a little green.

Understand that I am not an expert and I know you have been doing this much longer than I have, but sometimes it just takes a different perspective. So knowing that, my thought is that you should probably bump back to 5.75, which really looks like his break-through dose. Hopefully this go-round, he won’t drop below 50 as quickly and he can experience more of those healing greens.
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Here is today's recap on 10th cycle at reduced dose to 5.5

AMPS 354
+4 306
+6 298
+9 358

I do not think this dose is working for Max and he is getting comfortable in the high numbers.
Should I be going back to 5.75 for AM shot.

I really just do not know what is going on to barely have much success with Max.
What am I doing wrong?
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

I don't think you're doing anything wrong, first off.

can see why you're thinking about possibly fattening the dose. The protocol would suggest you go back to the last good dose. I fatten and shave Gabby's doses because from experience, a full 0.25u decrease doesn't usually hold. The smaller changes seem to work better.
Click to expand...

and I agree with Sienne's feedback, hopefully u will get the experienced eyes on this before tomorrow morning..... how's Max doing?
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Max is so so. I really need to get a Ketone test but he is not cooperating.
I like the idea of fattening the dose on a certain level but I am concerned that I will not be
consistent with my measure.
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Randi & Max said:
Max is so so. I really need to get a Ketone test but he is not cooperating.
I like the idea of fattening the dose on a certain level but I am concerned that I will not be
consistent with my measure.
Click to expand...

don't worry about fattening the dose right now, k? as carolyn mentioned, there are indications his numbers are about to break. i know it's hard to look at high numbers, but it can take up to 72 hours (3 days) for the bounce to clear. i *think* that ps number of 403 may be the high before a break. let's see how it plays out...
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Randi, I would go back to 5.75. It looks like his dose reduction hasn't held, so then we go back to the last good dose. Often it only takes a few shots at that dose to jump start things again. It's the weekend, might as well test, right? :lol:

Don't worry, Lucy had to go back up a couple of times before it finally stuck for good.
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

I vote for waiting a bit more, like Jill said.
Max may be just on the tip of something good.

Let's hope he comes down a bit soon.
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Do you think she should hold for tonight and tomorrow and then instead of fattening the dose
she would go right up to the last good dose...right? Is that the plan?
(The fattening might not do what you want at this stage of the game Randi...)

I hope you know what the plan is...I am confused...sorry. :roll:

I just wanted to stop by to see how Max did for his PMPS....hi :-D
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

I say do what Jill says. :mrgreen: She and I were posting at the same time. She is much more patient than I am, but she is also usually right. ;-)
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

:lol: You are voting for what Jill said? :lol: I am rather impatient myself...so I hear ya !
You are so funny Libby!! :YMHUG:
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Pat+Raja+Shadow said:
Do you think she should hold for tonight and tomorrow and then instead of fattening the dose
she would go right up to the last good dose...right? Is that the plan?
Click to expand...

Well tonight's shot is already done at 5.5. I guess I wanted a heads up for tomorrow morning since I knew the board would be more active tonight then at 6:30 am.

I don't think I would fatten his dose. We are not that experienced. I have been trying to be very agressive with his treatment that's why when I hit 10th cycle tonight I sent out the question. I am fine holding but that will depend on how many more cycles.
Libby and Lucy said:
I say do what Jill says. She and I were posting at the same time. She is much more patient than I am, but she is also usually right.
Click to expand...
You and me both Libby, lol. I saw that you posted at the same time and I was, oh no, not the same answer. And I value BOTH of your opinions!! you 2 are just totally amazing.

Any opinions on how many more cycles or we shall just see what tomorrow brings?
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

i'm seeing some of the same indications i believe carolyn is seeing in that the numbers will be breaking soon. that doesn't mean the dose will not have to be increased. let's see how tonight plays out before making any decisions...
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

Jill & Alex said:
i'm seeing some of the same indications i believe carolyn is seeing in that the numbers will be breaking soon. that doesn't mean the dose will not have to be increased. let's see how tonight plays out before making any decisions...
Click to expand...

Sounds like a good plan to me Jill. Hard to predict the future so you never know. My Mister Max might surprise me. If not, it's up we go.

You have seen a lot more ss's than I have.
I will go study Max's tonight so that maybe I could see what you see.
 
Re: 2/5 Max AMPS 354~PMPS 430 *Dose Advice*

in a nutshell...
the indicators to be considered: it can take up to 72 hours for a bounce to clear. today was 72 hours after the last dip into green. today's cycle was also relatively flat (at that range, there's less difference between a 300 and a 400 than we think because of a 20% meter error). a flat cycle often precedes a cycle with some action. today ended on a high note. oftentimes we see a "high" before a break.

none of these things is cut and dried. however, they are things that indicate the numbers *could* break. whether they will or not remains to be seen.
if they don't... there's more insulin where that came from. :smile:
 
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