3/7 Chino|AMPS=387|+8=341|PMPS=390|+2=417|+4=359

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Adrian and Chino

Adrian and Chino

Member Since 2016
Yesterday...

This is the 4th cycle since the fur shot on the 5th cycle of the dose increase to 7 units. Seems like his BG is just going up. We've had 3 days of solid pink and red now. Unless something miraculous happens tonight or tomorrow morning, we'll be going up to 7.5 units tomorrow evening.

He got 1 unit of R this morning. Would it make sense to give another dose at +8 if his Lantus peak is over 300 (as it has been for the last 10 days)?
 
Hi Adrian:cool:

As long as you are prepared to monitor and guide the overnight cycle if needed, you could experiment with giving an additional dose of R after the AM cycles Lantus nadir.

Since it will be a first for Chino maybe go with .5u rather than 1u and see how it goes. What do you think?

BTW, Has Chino been tested for IAA? If so, what was the result?

 
Thanks. His IAA result was 0. I'm reluctant to give R with the PM Lantus dose, since I don't know until +4 if it will be an active cycle, but if I give it at +8 during the day, that gives it time to do its thing before my PM +2 and +4 checks. I would rather stay up 4 more hours tonight to monitor yellows/blues/greens than sleep through another pink/red PM cycle.
 
AMPS = 387
[7 units Lantus, 1 unit Novolin R]
+1 = 407
+2 = 446
+3 = 415
+4 = 430

This cycle looks even worse than the fur shot of 2 days ago, and I'm pretty sure this was NOT a fur shot since the fur wasn't wet and didn't smell like insulin. At this rate, I'm probably going to give 1 or 1.25 units at +6, give 7 units of Lantus again for the 5th cycle tonight, then increase tomorrow morning. I know I'm supposed to wait 6 consecutive cycles, but in the meantime, he's living in dangerous numbers.
 
If he doesn't come down anymore tonight, I think you are OK increasing the Lantus tomorrow. Sometimes we will fast track cats stuck in higher numbers. The issue with Chino is that he likes to tease with the occasional green so he's not what I would call high and flat generally, just now. :( The effects of a fur shot can be seen in later cycles, so it could still be in play.

As per Sandy, I wouldn't give a higher R dose for your first midcycle use of R.

I hope he comes down soon.
 
Thanks. This wouldn't be my first mid-cycle use of R (see 3/05 at +6). I gave a higher dose than the AM dose at that time. What I had originally asked about was giving it at +8, but if he's still in the 400s at +6 then I don't want to wait.
 
Using R in the middle of a cycle with no Lantus action is a little different than using it when you have to worry about timing with Lantus nadirs.
 
In that case, would it be better to give another dose of R at +6 or +8, given that his usual Lantus nadir is at +8? (All of his daytime Lantus nadirs have also been over 300 for the past 10 days.)
 
Just line up the action of the two cycles so you reduce the size of the drops. If he's still stuck at +6 it will be past onset and probably not matter.
 
OK. I won't give another full unit, but I'm inclined to give 0.75 if he's over 400 and 0.5 if he's over 300. Thank you both for your guidance with this.
 
+6 was 392, so I gave him 0.5 units. He now starts purring when I approach him with the lancet and meter because he knows he's getting a treat, so while I'm stressing over his blood sugar between hourly checks, he's probably having a great day :rolleyes:.
 
I was thinking about how horrible the AM cycle looked, and how I'd remarked that it looked worse than the last fur shot. But then it occurred to me... if I only look at the +4 and +8 for the past few AM cycles, they really don't look much different from his usual. I only started testing before and between those times when I started giving R. It could be that his BG is over 400 a LOT more often than I thought.

What really bothers me is that his spreadsheet doesn't look much better now on 7 units than it did a month ago on 5 units. And a month before that, we were regularly seeing yellow during the day on 3-3.5 units. It just doesn't make sense.
 
Remember that the acro tumour can pulse and grow, sending out more growth hormone, which in turn increases the IGF-1 which blocks the cat's own and injected insulin from getting into the cells. Thus more and more injected insulin is needed, until the tumour stops growing or some of the tumour cells die off. This means that there can be periods where you are playing catch up. Julie likened it to trying to out race a speeding train. In the summer of 2015, the same happened to Neko. She was mostly blue and green, then the tumour started to grow again. I would catch up and get good numbers, if lucky for a week, then we were off to the races again. Frustrating - YES! :bighug:
 
Wendy&Neko said:
In the summer of 2015, the same happened to Neko. She was mostly blue and green, then the tumour started to grow again. I would catch up and get good numbers, if lucky for a week, then we were off to the races again. Frustrating - YES! :bighug:
Click to expand...
Was this before the 1st SRT or after?
 
First SRT was in August 2012, so this was 3 years later. At the time I emailed the folks at CSU and NCSU and they both said that while uncommon, it was possible for the tumor to come back. It does in humans. One of the reasons it isn't commonly seen in acrocats is that a lot of them are older to start with and don't live long enough past SRT to see it happen.
 
Adrian and Chino said:
What I had originally asked about was giving it at +8, but if he's still in the 400s at +6 then I don't want to wait.
Click to expand...
Have a look at some of my R scales (they are on the sixth tab) these are from the phase where BK was drowning in a flat sea of relentless pink. For quite a while I regularly shot R at +6.

For context here are the Lantus doses corresponding to the R scale dates:
07/17/2008 - 8u Lantus
07/18/2008 - 8u Lantus
08/11/2008 - 9u Lantus
09/21/2008 - 12.5u Lantus

It is highly customized to BK and the circumstances at the time and how things evolved with our R use.
Developing your R scale will take time - it is something that evolves as you gather more and more data.
Adrian and Chino said:
What really bothers me is that his spreadsheet doesn't look much better now on 7 units than it did a month ago on 5 units. And a month before that, we were regularly seeing yellow during the day on 3-3.5 units. It just doesn't make sense.
Click to expand...
You've got a huge unpredictable variable with Acro. Hang in there, cycle by cycle and shot by shot your knowledge of Chinos reactions will grow and you will find the right balance of doses. Along the way your instincts will sharpen and that will make things easier.

Back in our day, (FDMB class of 2008-2009) a vet tech by the name of Jojo was one of the 'gurus' of LL. She had a philosophy for the tough cases,of which BK was probably the toughest. I've paraphrased below :

A tank will carry on until it reaches its destination
Be the Tank.
 
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