3/9 Chino|AMPS=399|+4=334|+8=378|PMPS=379|+2=315|+4=298

[Adrian and Chino]

We're almost at the end of the 3rd cycle on 7.5 units. I gave 1.25 units R, the same as yesterday, and with very similar results. (I'm going by yesterday's +3 and +5 - I think the blood sample was too small for the +4.)

The calipers I ordered arrived today and I measured 4 syringes. The instructions say to measure from the zero line to the first unit... but I measured that way and another way, and here is what I found:

From the zero line to 1 unit line was approx. 1.49 mm. 1.49 mm x 7.5 = 11.175. Opened to 11.17 mm and held up to all 4 syringes, it measured an 8.25 unit dose.

From the top of the 1 unit line to the top of the 2 unit line was approx. 1.44 mm. 1.44 mm x 7.5 = 10.8 mm. Opened to 10.8 mm and held up to all 4 syringes, it measured a 7.5 unit dose.

The most important thing that I learned from this is that the syringes I use are pretty damn reliable. I was considering switching brands because a box of 60 UltiCare syringes costs about the same as a box of 100 syringes from most other manufacturers, and if I'm using up to 4 a day now, that makes them twice as expensive as they were before. But I've never had any problems with bubbles, while I used to struggle with them every time when I used the CarePoint syringes.

 

[Wendy&Neko]

I never measured from the zero line on my BD syringes, cause often there was a lot of daylight from the zero line to the actual top of the syringe. Occasionally as much as 1/3 to 1/2 of a unit. Neko's dose the last couple of months was mostly UNDER the zero line. But if your current syringes are reliable, I might stick with them.

OK Chino, show us what this dose can do! And I mean something other than pink.

 

[Adrian and Chino]

I was hoping that using R during the day will help in the meantime while we wait to find an effective dose of Lantus, but if I can't increase the R during a Lantus increase, how do I find the right dose of Novolin R? If he's still showing nothing but red/pink after 6 cycles, should I wait another 2 cycles before increasing the Lantus so I can increase the R? I don't know how many Lantus increases it's going to take to get him from dangerous blood glucose levels to somewhat less dangerous levels... and ultimately to the normal range.

 

[Wendy&Neko]

but if I can't increase the R during a Lantus increase, how do I find the right dose of Novolin R?

Don't increase R the same cycle as a Lantus increase. But that doesn't stop you from experimenting on other cycles after that. Just do it cautiously with small changes when you can monitor.

I would prioritize the Lantus increase over an R increase. Nothing beats getting to a better dose on the basal insulin.

I like the direction that +2 is going.

 

[Adrian and Chino]

I like the direction that +2 is going.

Wow! I posted that less than 3 minutes ago!

Thank you for the advice. I know it's the logical thing, but when I see Novolin R bring his BG down while his Lantus nadirs remain high, it's hard not to favor the R.

And this is SO FRUSTRATING: For the 2nd time this week, the vet called and I picked up the phone RIGHT as it stopped ringing. Both times were after business hours so I couldn't call back, but it's clear at this point that he isn't getting my e-mails... unless he's ignoring them. Again, he said he doesn't think 317 is high enough since all the papers say it needs to be above 1000. So I faxed the MSU Endocrinology Reference Range document and the Endocrinology Conversion Factors chart this time and the equation is on the cover page:

317 nmol/L divided by 0.131 (per MSU Conversion Factors) = 2420 ng/mL, which is well over 1000 ng/mL.

 

[Adrian and Chino]

I think I'm just going to have to find another vet, or a specialist. This will only get worse without treatment, and treatment is not as achievable as simply managing the condition and symptoms as they arise. I had a reality check this morning when I learned that a medication that costs me $500 every 2 months out of pocket will now be $540. I stopped taking one of my medications last month when it went up to $80 (and that one IS covered by insurance). I don't want to compromise his health for the sake of mine... so I end up compromising mine for the sake of his, and that's not good for either of us. Things might be different if I knew for sure that SRT would put his diabetes in remission, reverse the hyperthyroidism, and keep his kidneys functional enough for at least 2 years, since the cost of management might equal the cost of treatment at that point. For now, I need to focus on getting his blood sugar under control to limit the damage that's doing.

 

[Wendy&Neko]

So, does the vet think Chino does not have acromegaly? Right on the paper copy of the bloodwork I have for Neko, the IGF-1 reference range is listed as 12-92 and the MSU comment is that acromegaly was the differential diagnosis.

One option, if there is one near you, is to ask the vet to refer you to an internal medicine vet. I think with hyperT and acromegaly, Chino is now out of your vet's league. The original consult with Neko's IM vet cost a bit more, but he was really responsive to emails and willing to look up things if I asked. At that point, Neko's regular vet had thrown her hands up and admitted she was too complicated.

There is no guarantee with SRT. I think something like 30% of SRT kitties go into remission. But I was pretty happy with Neko's dose being mostly below 3 units for the last 4 years, and for a lot of that around 1 unit.

 

[Sandy and Black Kitty]

I was hoping that using R during the day will help in the meantime while we wait to find an effective dose of Lantus, but if I can't increase the R during a Lantus increase, how do I find the right dose of Novolin R?

You can as long as you use caution - cycle 1 is generally safe unless your kitty has a habit of showing action on the first cycle. Avoid cycles 3 and 4 of a new dose if your kitty has a history of new doses showing action in cycles 3 or 4.

I think I'm just going to have to find another vet, or a specialist.

Good idea.

I don't know how many Lantus increases it's going to take to get him from dangerous blood glucose levels to somewhat less dangerous levels... and ultimately to the normal range.

You will get there. It's kind of like trying to draw smooth curved lines with an etch-a-sketch... twist a bit on the left knob, twist a bit on the right knob, at times twist both simultaneously - and with practice one day you have a nice smooth curve.

Hang in there. If you get discouraged look at BKs crazy ss - it was 5 months before we saw blue - 6 months before we saw green and a full year before he tasted HC food...

Remember the movie '300' ? The story of King Leonidas leading an army of 300 Spartans in battle with the Persians at Thermopylae?
BK spent so much time in pink that I took to calling him Mr 300 or Leonidas.
well, a fellow member of the LL "class of 2008", who is the talented graphic artist that created the OTJ parties (and many other hysterical photos) back in the day, gave BK his Halloween costume that year-