4/14 Tiggy PMPS 101 +1.5 95 +3 68 + 4 92 +6 101

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Wendy&Tiggy(GA)

Wendy&Tiggy(GA)

Member Since 2011
Previous condo

Where is the angry pink and flat yellow emoticons? Where is the disappointed mamabean icons? Day 4 of no greens. It almost feels like he is mid bounce right now and I am surprised since we only had high blues on the 12th which amazes me if he bounced off those. Unless he dropped low on the night of the 12th and I didnt catch it but usually his greens stick around longer if they were there that night.

He is in a happy playful mood with this blue ball he found, although he smells a bit of urine so isnt cleaning himself as well which happens when he is high. And his back legs are pretty shaky.

I am thinking to wait to tomorrow before increasing to see if this bounce does clear. I am trying to also work out what dose to tell the pet sitter. I had told her 6.75 since that was sitting on him really nicely but of course now its not looking so good. The issue is that she wont be able to test him and so I need a dose that isnt going to drop him too low. I guess thats 7 right now.

Also I have been watching what Dale and Chip do with this bolus thing and wonder if that would work to help Tiggy clear his bounces faster? Humalin?
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

Wendy&Tiggy said:
Where is the angry pink and flat yellow emoticons? Where is the disappointed mamabean icons?
Click to expand...

I have often wondered the same thing. There are plenty of icons over there that we don't use (at least I don't see anyone using) that we can surely find very appropriate replacements for. One of them should be for poopie vines and for dental vines, and angry bean, tired bean rotten kitteh, rotten numbers, more than 4 cans of cat food opened to try and get them to eat, etc.

I hope you get an answer to the dosing question. Rats on the numbers.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

I think I missed when you're going to be traveling. FWIW, I reduce Gabby's dose a fair amount when I travel. Gabby, diva that she is, doesn't permit anyone except me to test so the only way I'm sure she's safe is to reduce the dose. You might want to think about reducing more especially if you're going to be gone for a while.

I'm probably not the best person to provide advice about bolus dosing. If you look back over Gabby's numbers, she was a bouncier kitty earlier on in this process. I didn't use bolus dosing. From what I see on Tiggy's SS, overall, he's not in particularly high numbers and when he is, he's not there for long. I'm not sure that I'd be jumping to using a bolus insulin. However, that may be my inexperience with using R talking. I'll see if I can get Dyana or Libby to stop by and offer some perspective since they've both had a good deal of experience using R.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

This may not be "my final answer" but my thoughts are that I would not give a bolus to Tiggy at this point. I think you would have to give such a teeny teeny hair's width worth and it still could just set up another bounce if she comes down to fast from it.
My experience with R is that half the time it helps to get J.D. into good numbers when he's stuck in a bounce, and sometimes it helps to bring him back to good numbers if I catch the rise as soon as it happens. A lot of the time it sets up another bounce, because he dives too fast, and I mostly only give him zero line of R. But, I am also using it when J.D. is in the pinks and reds (mostly reds), and Tiggy is barely in the pinks. I would just wait out Tiggy's bounces.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

You definitely don't want to go crazy with increases or try a bolus before you get back in town. :smile:

Tiggy should be able to *coast* at a safe dose for the pet sitter until your return.

That said, I suspect what I do with the bolus is a little different than what I see in some cases. From working closely with Libby and Jill, I figured out that the goal with the bolus is not to "force" the numbers down, but rather to "nudge" or create an inflection point. And also to perhaps keep the bounce from going higher.

So it really is teeny-tiny. I don't want to move the numbers more than 50 points or so, and the Humulin N seems to be working great to do that for Chip. The smallest dose I can measure. The N lasts about 6 hours (as opposed to 4 hours for R) and I'd guess the N is a little more than half as potent as R. I generally try to shoot the bolus on the way up when Chip gets to about 250 or so. You have to be ready to test in 4-6 hours to see where it goes and steer or feed if needed. If Chip is still over 200 in 6 hours I sometimes repeat the process. It takes a lot of "know your cat" and testing to get it right. And make sure you don't go too far (or too fast) and cause more bouncing.

Looks like Tiggy's bounces are kind of slow and predictable, so the *right* bolus might be a useful tool when you want to "take the edge off" those pinks or upper yellows. I would get Libby to take a look and see what she thinks. This is not for any cat that is unpredictable or one with wild swings. It's likely more of a Levemir thing I suspect, but Tiggy does seem to have the kind of patterns which might work. And you test enough to keep it safe. You NEVER want to shoot a bolus when the bounce is clearing, only on the way up, and when high enough to be safe/appropriate. A bolus is no substitute for proper Lantus/Levemir dosing.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

Dale 'n' Chip said:
Looks like Tiggy's bounces are kind of slow and predictable, so the *right* bolus might be a useful tool when you want to "take the edge off" those pinks or upper yellows. I would get Libby to take a look and see what she thinks. This is not for any cat that is unpredictable or one with wild swings. It's likely more of a Levemir thing I suspect, but Tiggy does seem to have the kind of patterns which might work. And you test enough to keep it safe. You NEVER want to shoot a bolus when the bounce is clearing, only on the way up, and when high enough to be safe/appropriate. A bolus is no substitute for proper Lantus/Levemir dosing.
Click to expand...
another NEVER...
you never want the nadirs of the basal insulin (lantus or lev) to coincide with the nadir of the bolus insulin (R or N).

i rarely use R, but when i do, i use only the tiniest of doses (0.1u) to gently pull numbers down... 50 - 100 points maximum. in other words i don't want to yank the numbers down because that only sets kitty up for yet another bounce. sometimes the R pulls numbers down a little more than i like. for this reason, i test frequently whenever using R.



edited to add:

i know dale uses N as a bolus, but he had a real good handle on chip's response to N prior to lantus and lev use. in most cases, i would recommend R rather than N as a bolus insulin because R is out of kitty's system faster than N.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

I am only going away for 5 days (away Wed am and back Sun pm) so I think 6.75 will keep him safe.

Not sure this bolus theory will work then. Still hoping Libby will chip in.

What I am trying to do is stop the bounces from lasting as long. He never seems to bounce over 350 (touch wood) but and drops back into mid-high 200s fairly quick but then he sits in this flat yellow for a day or longer. And gradually I think thats damaging his pancreas, and I end up having to increase the dose. I am trying to be more aggressive with the dose so that I increase when a dose stops working but its not really helping and here we are at 7 units.

I have been doing this now for a year and am wondering what alterative stuff I can try to at least hold him stable on a dose. If anything.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

Hi Wendy, I got your PM.

I think you could probably use R at the beginning of a bounce. If you know he is bouncing, then give 0.1u of R at the very beginning of a rise, as long as it is not at a time that might conflict with his Lantus nadir. The goal would be to keep the bounce from going quite as high. If the number is not as high, then the Lantus has an easier time kicking in and pulling the whole range down a little bit. It should still accomplish your goal of helping with the bounces without "yanking" the numbers down. If the bounce is already starting to clear, or if you think there is a chance the bounce might start to clear in the next few hours, then it is too late to give R. Data, data, data.

You would need to do some more testing for a while until you learn how to catch the very beginning of a rise and so you will be able to tell if it is a bounce or just a regular end-of-cycle rise. Then the first few times you use R, you would need to plan to get a +1, +2, +3, +4 after the R shot so you can learn its onset, nadir, and duration. Only then would you be able to possibly be able to use R at any times other than the beginning of a bounce.

Like Jill, I prefer R over N as a bolus because it is quicker in and out.

Also, I wouldn't assume that Tiggy didn't drop on 4/12.

And (yep, one more thing!), I do think he needs a Lantus dose increase. If you want to experiment with R, though, then you could hold this dose for a bit longer and learn to use R in lieu of a Lantus dose increase. It looks like he is building some resistance on this dose, though, so don't sit on it long unless you'll be using the time to learn to use a bolus.
 
Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

There you go. I suspect the bolus is worth trying for your purposes. It's one way you can perhaps directly deal with a bounce without messing up your Lantus dose or depot.

And if you aren't leaving until Wed perhaps you ought to increase now, if you can keep monitoring. Just so Tiggy doesn't have to *coast* longer than necessary.

Once you return, you might start with R so you can work closely with Libby, Jill, and Dyana getting up to speed. If you ultimately find the R is "yanking" too hard or if he goes right back up after 4 hours, you could still try N down the road once you get it figured out. Perhaps if you decide you want something slightly *smoother* and with a hair more duration.

The Humulin N is only $25 for a vial at Walmart in the US. Not sure what it is up north. My vial of N has been open almost a year and is apparently still going strong. So not a big investment.




The above gives you an idea of how Humulin R and Humulin N generally compare. I like the fact that I'm able to shoot the bolus of N in some cases every 6 hours (or 12 hours) until a bounce fades, depending on how closely I can monitor. The way I'm doing it seems pretty safe, and really doesn't require a lot more testing than usual. Of course for me that's already somewhat frequent and I know Chip pretty well after so much testing.

I am shooting the bolus more than I thought I would, but the biggest benefit is I don't have to leave Chip sitting above the renal threshold while I'm waiting out a bounce or settling an increase. Or returning to the last good dose.

After leaving Chip pink for a month when I first started Levemir, he really doesn't need more of that. I can generally have him back to lower yellow (or below) within hours and usually he pretty much stays down. So I think it's a rather useful tool for Chip.

The key being "nudge" don't yank, figuring out when you can and can't safely and effectively do it, and most important keeping in mind it's no substitute for proper Lantus dosing.

Certainly not for most cats here, but maybe for Tiggy?
 

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Re: 4/14 Tiggy AMPS 270 - dosing and bolus??

He is coming down from his bounce so I think I will increase tomorrow morning when I can watch him all day. So he gets all day Monday and Tuesday on the new dose 7.25. Then I have to back off to 6.75 when I am away which sucks because he will probably develop insulin resistance to it but I don't know if he is safe being left on the new dose. Or maybe 7?

Definitely want to try the humulin r. I looked online and looks like it is $25 for a 10ml vial here too. But not till I get back and see what's going on with him. That will be a week tomorrow.

Wendy
 
Re: 4/14 Tiggy PMPS 101 +1.5 95 +3 68 + 4 92

Nice numbers Tiggy! Thanks for the PJ Party Wendy! Zoey is coming up too, so we are off to bed; hope you're getting some sleep!!!
 
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