2/9 CRYSTAL - "R" trial questions

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suki & crystal (GA)

suki & crystal (GA)

Member Since 2014
previous long thread:
http://www.felinediabetes.com/FDMB/...-please-vet-appointment-monday-update.132625/

Hi all

Thanks to everyone for your invaluable support, research and advice for Crystal's forthcoming trial of R later this week.

Just to summarise, mainly for my benefit, the following points and a few (more) questions along the way:

  • Crystal is still running high and flat (I've changed the pink colour coding to a slightly lighter pink to make reading the numbers easier), so difficult to determine an onset, nadir and duration. Gave a 1.5u increase this morning on Julie's suggestion last night.

  • Will start the R in conjunction with Lev in 2 separate syringes at PMPS (18.00 French time) on Wednesday (? I will be out most of the morning and early afternoon so will not be a able to get too many tests, would it be better to leave until Thursday when I am at home all day?)

  • Dose is 0.01u of R (1/10th of 1u) – is that correct? To be injected into the scruff only. The syringes I am using are BD Micro-Fine 0.3ml (30G) x 8mm with half unit markings.

  • Only able to get ACTRAPID R insulin here in France but it's the equivalent to NovolinR and made by the same company. One good thing is that the Actrapid package contains 5x3ml cartridges so there is no chance that I will confuse it with my Levemir pen.

  • Will have plenty of strips to monitor every hour from PM shot, duration is approx 2- 5 hours.

  • Will have emergency kit of honey, and HC food with gravy just in case she dives.

  • Feeding: product info says Actrapid should be given 30 minutes before food, so what would be the procedure – test, shoot R, shoot Lev, wait 30 minutes and then feed?? And what about feeding throughout the trial, she's on home made LC high protein raw minced chicken, water added to make soupy consistency. I usually feed her roundabout +3, +6 and + 9/10. EDIT test, feed and then shoot both insulin. feed as normal throughout the cycle.

  • Frequency of R use? Providing all goes well, what would be the recommendation for using R going forward? I don't know how R works and how often I should consider using it. I wouldn't be able to monitor her that closely every day – but don't think it's a daily dose anyway but need confirmation.
Think that covers all my queries for now, sorry for so many questions but I know I will get the right answers from the right experienced people. I will get the R insulin tomorrow on the way to the vet so that she can read the product info, together with the above info, as it will be a learning curve for her as well as she is not familiar with using R.

Hope beans and kitties are all enjoying a lazy Sunday.

Suki & Crystal
 
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You do want to be able to curve the R when you first use it by testing hourly, so you need to be home.
Without clear onset and naidr, I believe the suggestion was to give both shots at the same time for now.
The intent is to bring down the glucose more with the R so that the Lev is able to work. Holding the food for 30 minutes gives the R a chance to start working before the food starts kicking in.
If it helps, it may become a part of all shots; once you have data on how it works, you may be able to cut back on testing every hour - that's to identify what the R is doing - and do your usual testing.
 
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Thanks BJ - I just need to clarify that if I'm out for a couple of hours prior to administering the first dose of R at PSPM (18.00) on Wednesday, and thus not able to get a full day's picture of the levels, would it not be best to start the R on the following day (Thursday) when I can start testing in the morning and right up to dosing at the PM shot, does that make sense? We obviously all have to agree which day to start.
Okay, so it's test, shoot both R and Lev and then wait 30 minutes before giving food, thanks for confirming that.
 
Its OK to be out before; you just want to be home during the period covered by the R injection so you can monitor what it does.
 
suki & crystal said:
Feeding: product info says Actrapid should be given 30 minutes before food, so what would be the procedure – test, shoot R, shoot Lev, wait 30 minutes and then feed??
Click to expand...
The directions you're seeing are for humans... not cats.

The procedure we use for cats is test, feed, then shoot (both Lev and Actrapid --- in separate syringes). The same is true when we use Humulin/Novolin R in North America... despite the same instructions included in the box for humans to shoot 30 minutes before eating. When dosing cats, you want to have food on board before the onset of Actrapid or any fast-acting insulin.

suki & crystal said:
And what about feeding throughout the trial, she's on home made LC high protein raw minced chicken, water added to make soupy consistency. I usually feed her roundabout +3, +6 and + 9/10.
Click to expand...
I've always fed as usual when I've used R.

suki & crystal said:
Frequency of R use? Providing all goes well, what would be the recommendation for using R going forward? I don't know how R works and how often I should consider using it. I wouldn't be able to monitor her that closely every day – but don't think it's a daily dose anyway but need confirmation.
Click to expand...
You're right. A bolus is not considered a "daily dose". You can pick and choose when you want to use a bolus. Initially, if you can't monitor, don't use it.

There's no way to know how often you should consider using Actrapid at this time. We have to wait to see how Crystal responds. Using a bolus is a method which you may end up using once or twice and then not using again for a week or two or more. On the other hand, using R/Actrapid might end up becoming an integral part of her treatment. Let's see how it goes. With help from others, you will develop a "feel" for it along the way.


Happy to see you've increased Crystal's Lev dose.
You're very well prepared. I'm sure others will add their suggestions and comments as the day goes on.


O/T -- I like how you lightened the pink cells on her spreadsheet! :)
 
Hi Suki!

Just to help me get the time straight - would you make a post today or tomorrow and say "NOW is the time I'll be available to try R on Wednesday" please? It sounds like Wednesday is fine for crystal, but it's the timing on this end - we just want to make sure someone with R experience is here to monitor with you.

Good job on the dose increase. There will be a point when she will respond and we'll see her out of those pinks. Every cat has an amount - we're just not there with Crystal quite yet. :smuggrin:

Great preparation - you're ready to do it. And yes, some cats use R with every shot, some use it occasionally as needed. It will be up to you and decided by her BGs and your schedule.
 
If you want to change the color of the data cells, you may adjust the conditional formatting. This is where the cell is colored based on rules that were defined.

The cells which automatically color code based on the glucose reading have a conditional format. This is a format which colors the text and cell color based on the value in the cell.

Click on: Format, Conditional Formatting, and a dialog box displays.
Find the row which colors the magenta/pink color; it should say something like
Is between
and then show the selected background color.
Click on the color and a panel of color options comes up; select the desired background color.
Save Rules.
Now, use the Paint Roller icon and paint the conditional format to all the cells you want. You can do a large section at a time.





 
Thanks for your comments Jill, duly noted. As you rightly say, a lot depends on how she reacts to this first dose as to how we proceed in future - I will have plenty of Actrapid as I can only buy it in the 5 cartridge pack. Glad you liked the colour change, I was having trouble seeing the numbers on my tablet when I checked her SS, hence the lightning - if only I could have changed it to blue I would have been a very happy bunny!

Okay Julie I'll do as you suggsst, good point to coordinate the timings. missed it for tonight though, just coming up to a +2 Pm shot so I will do it tomorrow at about 15 minutes before my normal dose time of 18.00 French time (GMT +1) . Time now as I post is 19.55.

BJ, I've been doing the changes manually, cell by cell, so I'll give your suggestion a try, thanks for the info.
 
So right now would be your pm +2? That's good enough. It's 11am here, meaning that your pm shot is at my 9am. I will be at work at that time, so going through my mental list of possibilities of who could stay with you on a Wednesday morning, I'll see if Sandy is available to be with you then. She has extensive R experience (every shot) and BK was a high dose kitty (iaa only.)
 
Okay Julie, that sounds good, we'll go for Wednesday PM then, sorry you won't be around to guide me but no doubt you will check in when you can.
 
I'm not positive Wed will work - I'm looking. If I can't find anyone available at that time, would the weekend be a possibility for you?
 
Yes, that would work for me, no plans this weekend, not Friday though (Valentine's dinner planned) whatever is convenient your end I can fit in with, no problem.
 
ok - working on it. we'll find a time. :smuggrin: in the meantime, i'm hoping she'll respond to the dose increase. Sometimes it takes more than one cycle to see the effects.
 
Okay Julie, wait to hear from you with a time and date. Let's hope for an improvement soon in Crystal's numbers in the meantime, paws crossed.
 
Come on Crystal work the new dose with Toby. These cats have got to get with the program. Hope the R works for you. Take Care Peg and Toby
 
Julie, am I correct that would make it noon on the East Coast?

I have a doctors appt at 1:30 and 2 (it's a two part appt), but can check in. I don't have to go back to work.
 
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Hi there :cool:

I too am able to help you learn the safe use of R for Crystal. I used it throughout BKs journey.
Keep us posted on upcoming dates/cycle shot time (AM/PM) that look promising for your first trial.

I am however wondering if, in Crystals case, .25u R may be a better starting dose . . . let's see what others think.
 
Hi Suzanne, Sandy & Dyana. Thank you all for your comments and offers of watching our first run. I think Julie is trying to co-ordinate the timing and date. I can do any PM shot this end any day, which is my 18.00 (and Julie's 09.00am). Having said I can't do Friday (thinking it was Valentines Day) it's apparently Saturday, so I would like to keep Saturday free as we will be having a nice meal and a bottle of bubbles but any other day, including Sunday is fine. I will just fit in with you guys, just let me know what is convenient.

I purchased the Actrapid insulin this morning and also went along to my vet for a chat. Apparently she has used the R insulin with Levemir and had good results so at least she knows what we are trying to achieve. Got back home about +7 and did a test and got a 284 - the first time in the yellows for about 10 days so I'm hoping that we might be on a downward trend. Have to pop out this afternoon but will do a post in approx 3 hours as per Julie's suggestion at my exact PSPM time just so everyone can synchronise their clocks - sounds a bit like Mission Impossible!
 
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