3/22 Oren; amps-380;+3-470;+6-439;+9-429;PMPS-474;pm+4-463;

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Sorry you're so frustrated Megan...We all really do understand how you feel though. We so much want to see some kind of positive results, especially when we're working so hard.

I wonder how some of the others might feel about trying to fast track Oren? That just means increasing every 4 cycles instead of every 6 until you start seeing some better numbers, but it's VERY aggressive so it's even more important that you're able to test enough.

I'll tag @Sienne and Gabby , @Wendy&Neko , @Marje and Gracie, @Jill & Alex (GA) ....see if they might have any ideas or opinions for you

Hang in there :bighug:
 
Megan, I know this is hard. :bighug: Neko got up to 8.75 units and first saw green at 3.75 units. I felt like I was hitting my head against the wall for the longest time. And I did a lot of crying, but the people here are very supportive and helped me out a lot. Sometimes there are other things going on (such as the need for a dental or other secondary conditions) that means kitty needs a bit more insulin and are harder to regulate. The best thing you can do is to get Oren as quickly and safely as possible to a dose that will allow him to spend most of his time under renal threshold. Follow the protocol, including mid cycle tests, and you will get there. If you get a before bed test tonight and you don't see yellow, I think you are OK with taking him up to 4.5 units tomorrow morning.
 
Megan, did you check the food quantity for Oren according to the calories? Dr. Pierson has a formula for figuring out how much food per pound of kitty. I'm not familiar with FF (here's a chart for those selections, too) but if it's similar to Friskie's, Zoey weights 10.5 pounds and according to the chart, she gets less than 2.5 cans, which is what it looks like you're feeding Oren. Of course, different varieties have different counts so perhaps you're already feeding a selection that's really low calories and you're good to go. I really hesitate to suggest anything because I'm so new to this ... so take that into consideration and seek out the wise ones. (I posted a question on the main forum regarding food quantity today if you want to read the information there. BJM posted a link to Dr. Pierson's article where she's talking about the calorie formula.)

Even with the changes we've made to food, Zoey moved up to 3 units today. She did surf the blues .... but she's right back up there with a big ole bounce to 454. (sigh)

Hang in there. Y'all will get him to his perfect number.
 
thanks Wendy; i took a peek at your other spreadsheets; was the 8.75 Lantus? or Levemir? I think you're on Levemir now?
And, forgive my ignorance, but what is SRT? something related to Neko's acromegaly? Seems like after that treatment things started to turn around for Neko..

to clarify, IF i see yellow (doubtful) i would hold at 4 for now? I was so surprised by the big rise at +3 today, not what i expected at all.

But he sure has been acting pretty good. his pees are not huge (and only 2 today, he has only had about 1/4 c of water all day, played w/ a string a bit earlier and has been sitting w/ me while I work on a drawing purring away and very cuddly... it just seems odd that he can't budge even close to yellow or blue yet, but is fairly flat today in red...
 
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thanks Rose; keep in mind that fancy feast comes in 3.3 oz. cans, not the larger 5.5 oz. like Friskies. My other kitty Patty (non diabetic) gets Friskies pate. Wow, I'm very stupid w/ that chart, where is the actual formula for figuring out the calories per lb. of cat? Oren is currently about 8.5lbs, when I got him 8 yrs ago (at age ~4) he was 9.0 and has fluctuated from 8.5 to about 9.0 over the years.
 
Hi Megan. I'm happy to hear Oren is feeling well in spite of the high numbers! Chris tagged me (amongst others) to take a look at the possibility of fast-tracking Oren up the dosing scale.

The answer to these questions will help everyone in determining the best course of action:

-- Is dry food out of the picture?
-- Do the Fancy Feast Classics mentioned in your signature contain less than 5% carbs?
-- If you were to take the dose up after every 4 cycles (fast-track) until you begin to see better numbers, are you willing and able to get a mid-cycle test every day and at least a before bed test at night? That before bed test may help to determine whether further testing is necessary that night. As Chris mentioned above, to keep kitty safe... more testing is required when fast-tracking a kitty up the dosing scale.

@Sienne and Gabby , @Wendy&Neko , @Marje and Gracie


And I agree with Wendy, I would take Oren's dose up to 4.5u in the morning... unless anything unusual happens between now and then.
 
Hi Jill;
FF classics should all be 5% or less as far as i know. The Pierson chart doesn't list some of the varieties that I get him, but I read somewhere, can't remember where now, that the CLASSIC varieties are the low carb ones. I do not give him dry food AT ALL anymore, since Jan of this year. A mid cycle test will be very tough, if not impossible on the 3 days I'm in the office, but I can do a before bed test.

Is there any chance my Lantus is losing potency? It has been refrigerated all along, I bought it Jan 26th... it's the 10ml vial not the cartridges..

perhaps I should get back w/ the vet to have her look more carefully at his teeth? In anycase, I guess it's upto 4.5u in the morning

what do I take from the rather flat red curve today?
 
Megan & Oren said:
Is there any chance my Lantus is losing potency? It has been refrigerated all along, I bought it Jan 26th... it's the 10ml vial not the cartridges..
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Most can get 6 months or more from a vial. There's always "a chance" insulin has lost it's potency, but I think it's more likely the dose simply isn't where it needs to be yet.

Megan & Oren said:
perhaps I should get back w/ the vet to have her look more carefully at his teeth?
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Forgive me, I haven't been following along. When is the last time Oren had a dental? Has anything been "off" with him at all? If you have any reason to suspect any problems a vet visit would be a good idea.

Megan & Oren said:
I guess it's upto 4.5u in the morning
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Good. Some kitties are thirstier than others. All we can do is give them whatever insulin they need.

Megan & Oren said:
what do I take from the rather flat red curve today?
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Honestly, I'm not making much of today's flat red. I'm pretty convinced from the data you've accumulated so far that Oren is simply under dose at this point.


Let's see where the new dose takes him. By then others will have weighed in on the subject of fast-tracking...
 
I like the idea of fast tracking, if you can get a second test during those cycles. It doesn't have to be mid cycle, but even an out the door or in the door test will tell us something, provided you aren't gone 12 hours of those days you go to work. Unless you see blue or green tonight, I'd increase tonorrow morning.
Megan & Oren said:
thanks Wendy; i took a peek at your other spreadsheets; was the 8.75 Lantus? or Levemir? I think you're on Levemir now?
And, forgive my ignorance, but what is SRT? something related to Neko's acromegaly? Seems like after that treatment things started to turn around for Neko..
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The 8.75 units for Neko was on Lantus. I switched to Levemir when I was getting desperate to try to switch her habit of going low during the night and high during the day. I'd tried everything else before then. It didn't work, :rolleyes: but now I prefer how Neko responds to Levemir. The SRT or stereostatic radiation therapy is a type of radiation therapy for tumors that are hard to reach and operate on. Acromegaly is a benign tumor on the pituitary gland that sends out excess growth hormone which is in turn responsible for Neko's diabetes. She also was diagnosed with IAA, which is insulin auto antibodies - think of it like an allergy to the injected insulin, since it's not cat insulin. Her numbers started going down after SRT, but it could also have been that her IAA was overcome around that time - it's a self limiting condition that lasts around a year.

We've also had several kitties here with bad teeth that had quite a turn around after a dental. I think it's been over a year since Oren's last dental? Neko's teeth were perfect a year ago and at this year's dental she had one extraction and two other teeth we are now watching. A lot can happen in a year.
 
unfortunately, I do work 10 hr. days, which doesn't leave a lot of breathing time on the 12 hr. scale, when you factor in commute time and lunch, I'm out the door roughly 1/2 hr. post AM shot and back about 1/2 hr. before PM shot. that's M,T and Thu. I telework Wed. so am home.
UTI was ruled out last week at vet, all that turned up in the urinalysis was slightly elevated white blood cell count.
 
Hi Megan!

Would you add to your signature line that you're gone the 3 days during the day? That way no one (me) will keep asking you if you can get mid-cycle tests on those days.

I think fast-tracking every 4 cycles definitely has a place in kitties that are staying flat and high. The companion piece to it, though, is getting a mid-cycle test in every cycle. It's riskier to go faster and you want to be confident that the increase is needed, and as we've talked about before, there are no hidden low numbers. At this point, i think you've got plenty of data to say that Oren just isn't to the right dose yet. On the days you are gone for 11 hrs, i'd make extra-sure to get a mid-cycle test in the pm cycle. By mid-cycle we just mean not at preshot, it doesn't have to be +6.

All of us with high dose kitties have gone through the discouragement of not being able to get on top of the blood sugar - you keep increasing but the blood sugar seems like it's not responding and it just stays high. It sucks. It may be that Oren has a high dose condition - i think i mentioned a couple of days ago that we don't suggest testing until a kitty gets to 6u per shot, but that recent research shows that as many as 1 in 3 diabetic cats may have acromegaly. I don't think you need to worry about it - but keep it in the back of your mind that this may be why he isn't responding to your dose increases.

I also doubt the insulin isn't good - unless you see floaties in it, or there are strands or it's cloudy, it's not even 2 months old and it's probably fine. Did you watch the video on how to draw up a dose (on the "Caring for your Insulin" sticky)? Have you see-sawed the dose regularly between the syringe and the vial? If you've basically done ok with caring for it, and there's nothing visible, it's probably fine.

If he were mine, I'd go ahead and increase his dose by 0.5u with his next shot.

You will get him to a good dose. You just have to be persistent - it's out there.
 
no floaties, no strings, not cloudy, hasn't been dropped or frozen. I did initially inject air into the vial (in fact doesn't that video instruct that?!) and a handful of times i injected back some overdraw, but not regularly. Now (at least for the last 3-4 wks maybe?) I expel all the air first, draw a bit more than I need, tap up air bubbles, draw in more air, then expel up to dose. I haven't had issues with air bubbles since. (can't remember who suggested that, Vyktors Mum maybe?)
 
It's not uncommon to see kitties like Oren who seem to need more aggressive dosing to get to the "right" dose that finally moves their blood sugar. It sounds like your insulin is likely fine. I'd assume the dose is the issue for now.
 
You can (and should) inject air into the vial...it helps to equalize the pressure...with the pens you don't inject any air since they're already under pressure

I agree with the others...You just haven't hit the dose that's going to work with Oren yet, but if there's any chance there's something going on with his mouth, I'd definitely get that checked out.
 
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