4/18 Merlin AMPS 426,+3/292,+5/142,PMPS 327,223,208,241

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Merlin

Merlin

Very Active Member
4/18
Micro
AMPS 426; 1.2U

Good Morning. Unfortunately, I have to leave for the vet at 10:45am for my other cat who has Valley Fever so I won't be around to test at the +4 mark but fortunately, we have had this number several times before and a 1.2U works pretty good.

I don't know why he didn't go lower last night. He just doesn't want to dip into the lower numbers at night. He probably did a little but am assuming not much.
 
Re: 4/18 Merlin AMPS 426

Fingers crossed for another nice cycle today. :smile: Good luck with your other kitty today! Feel better vines headed your way. :smile:

I'm thinking that some of the PM cycles that are a little flatter are due to bouncy hormones as a result of the lower numbers Merlin had during the AM cycle. The way I think about it is that "bouncing" sort of has two components. You have the release of glucose from the liver which results in a spike in the BG that is usually fairly short lived - i.e., high AMPS and PMPS spikes. The other component of "bouncing" is the release of counter-regulatory hormones that actually counter-act the effect of the insulin - i.e., they make the cat temporarily insulin resistant, so the resulting cycle looks rather flat. The nice thing is, it looks like those bouncy hormones, and the relatively flat cycles clear out fairly quickly for Merlin - within about a cycle or so. My guy sometimes sits flat for several cycles due to bouncing. It's hard to tell sometimes whether those flatter cycles are due to not enough insulin, or due to bouncing. In Merlin's case, I tend to lean towards bouncing.
 
Re: 4/18 Merlin AMPS 426

Agree with Jen. Recently Lucian had a flat cycle in the 300's, never had one before. I'm guessing it was due to a lower number a cycle or 2 prior. All you can do is work with it.
 
Re: 4/18 Merlin AMPS 426,+3/292

I agree, that bounciness can cause crazy cycles. Hoping the 1.2 does it for ya!

Hope your other kitty is okay. Sending good thoughts!
 
Re: 4/18 Merlin AMPS 426,+3/292

You're seeing a lot of movement. Don't know if your schedule would permit, but you may want to consider doing TID dosing. You'd take the total insulin given in 24 hrs, and divide by 3, shooting every 8 hrs. Kim did this with her Kitty, and she was able to keep her nicely regulated... and it kept her from the steep spikes.
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142

4/18
Micro
AMPS 426; 1.2U
+3 - 292
+5 - 142

I made an apt with the vet for next Monday for Merlin. It has been since last October, so I thought it would be a good idea to have an overall wellness check. I am sure she will want to perform a fructosamine test. Do you know if that is just a blood test? Or does Merlin have to stay there all day. I also think I don't need it since I have all this data on his spreadsheet. I don't know what this test is going to tell me that I don't already know based off the data of the ss. I understand that it averages the BG level for the past two weeks and then the vet adjusts the insulin dose from that. (I think...?)

I plan to come armed with information in case she needs it. Info that I plan to bring is:
* ProZinc protocol
* Copy of Merlin's SS
* Conversion table for U100
* Glucose Reference Chart (compares human/pet meters readings)

I also have some questions too. You all know Merlin just as much as I do, so if you have any suggestion for questions, please add to the list.
* Why did she choose Prozinc for Merlin?
* Lantus vs Prozinc?
* How many of her patients are diabetic? Success rate to OTJ?
* Is she interested in his SS periodically?
* Discuss with her the change to LC wet food. (I don't think she ever discussed diet with Alex)
* What was his weight when 1st diagnosed?
* Confirm his neuropathy. Anything else we can do?
* Has had some constipation in the past week. Miralax, squash?
* Continuous congestion, runny nose and sneezing. Allergies?
* Check dental. What pain med & antibiotic do they use?
* Is he in a good enough condition to have a dental clean/check?
* Are there any teeth need to be pulled?
* Discuss with her the testing of ketones. Go to vet if trace or more?
* In her opinion, what is her prognosis of Merlin?

Currently taking:
* 5mg of Methyl B12 daily
* 500 mg of Lysine daily

Thanks.
 
Re: 4/18 Merlin AMPS 426,+3/292

Great list!

The fructosamine is just a blood test; usually it takes a day to get results. But yes, it will only give you an average of his bg levels for the past few weeks and you have a great picture of that already with the ss.

I hoe she will be impressed with all the research and work you have done; she should be. But realize that sometimes vets are really threatened by your basically knowing more than they do about diabetes. You might give some thought about what to say, if that is her reaction.
 
Re: 4/18 Merlin AMPS 426,+3/292

I kind of think that I may run into this. I have already sent her my SS before and I could tell that there may be some reluctance. Half of our animals go to another doctor and I have already interviewed him. I think he primarily does Lantus and has had some success with that insulin so I think he sticks to that one only. So I don't know if I should change vets if Prozinc is the insulin for Merlin. I really don't understand or know how to tell if an insulin is the right one. I get the impression that a vet will use only one insulin, but I don't know for sure.
 
Re: 4/18 Merlin AMPS 426,+3/292

Vets should use several kinds of insulin, whichever one works best for the patient. But they are dosed differently, so it is probably easier for them to stay with what they know.

I think it is too early to tell if ProZinc will prove to be a good insulin for Merlin or whether you should change. I was leaning toward suggesting a change when he was crashing at +3, but he seems to have smoothed out and you are getting nice cycles. It would be nice if he didn't bounce for pre shots, but that is not something unique to ProZinc. Almost every cat bounces on any insulin. But if you decide you need to change vets and the new one prescribes Lantus, then I would go with Lantus. It is important to have a vet that supports you and sees you as a partner, not just a patient.
 
Re: 4/18 Merlin AMPS 426,+3/292

I was worried about how my vet would respond as well when I basically went "rogue" and started dosing ProZinc on my own. Sue probably remembers my worried posts as it was not that long ago! nailbite_smile :lol: I was very pleasantly surprised when they were supportive after seeing the data I had collected with home testing. When I made the decision to switch to Lantus, my vet was totally on board as well. I'm sure vets vary in how they decide which insulin they prescribe, but my vet initially indicated they started with ProZinc because it's more flexible, and from what I've read, I suspect that they also prescribe it first since it's cat-specific. I think you can definitely point to the fact that changing diet for Merlin dramatically reduced his need for insulin, and that he was dropping dangerously close to hypo, which you would not have been aware of, had you not started home testing. I don't know how a vet could not be impressed with what you've accomplished with Merlin in such a short time. :smile:

I will say that when we very first started home testing, we caught some unexpected low numbers, which freaked me out. It was pretty evident that the 3u bid he was on was too high. I initially spoke with a tech who is not the one we normally work with, and she was unpleasant, and disagreed when we indicated we wanted to go back to 1u and go from there. We did it anyway. The next day, I got a call from our regular vet tech who was totally on board and supportive of us dosing based on what we were seeing. I sent her copies of the ProZinc protocol from FDMB, and also told her we were going to be using a conversion chart and u100 needles. They now provide the FDMB ProZinc protocol to new FD patients, and also encourage them to use u100 syringes and a conversion chart to make smaller adjustments. Since then, they've been nothing but supportive.

I'm fortunate to have found a wonderfully supportive vet, but I've seen it suggested elsewhere that you present your info, listen to what they have to say, and if they are completely unsupportive of what you're doing, you basically nod, and smile, and do what you were going to do anyway....and look for a new vet. I hope others will chime in with how to deal with an unsupportive vet.
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142

My vet was mostly supportive of my choices. However she did NOT agree about food. Kept insisting I use prescription stuff. I just said Gypsy wouldn't eat it at all. We never tried it but I didn't want to argue and possibly cause problems. I think you can listen and then do what you want basically. However, I agree with Sue that if you change vets and they want a new insulin you might want to go with it. That way, the vet is familiar with the insulin you are using and can help with it.
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142,PMPS 327

4/18
Micro
AMPS 426; 1.2U
+3 - 292
+5 - 142
PMPS - 327

522+ 1.4? Pending
420+ 1.2
390+ 1
330+ .8
250+ .6
200+ .4
175+ .2

Good evening. Thanks Sue, Jen and Rachel for your vet feedback.

Merlin's PMPS is a 327 which is the lowest BG PM number in a long time. Last night, I gave .8U for a 333 and still got high numbers probably as you mentioned because he had a pretty good day. I am still thinking of a .8U again tonight. I don't know if it is necessary for me to keep posting his sliding scale but I did (maybe I will put it on his spreadsheet somewhere) and this one is the most updated one. By giving him a .8 again tonight, am I pushing it too much? I can set my alarm to test. If I get another 200+ number for the +4 timeframe, then I think it is safe to go back to bed, don't you think?
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142,PMPS 327

I think if you get a 200 number at +4 you'd probably be safe. Might be interesting to get a nadir too. I know setting the alarm is a pain, but since nighttime numbers are so different, it would be good data to have. Maybe help us see what's going on with the PM cycle. Just my thought.
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142,PMPS 327

His nadir is usually at +5 so what's staying up one more hour. When I am up late, at least I can make sure he gets something to eat in the middle of the night. Thanks.
 
Re: 4/18 Merlin AMPS 426,+3/292,+5/142,PMPS 327

4/18
Micro
AMPS 426; 1.2U
+3 - 292
+5 - 142
PMPS - 327
+4 - 223
+5 - 208
+6 - 241

I am beginning to think that he needs a separate sliding scale for the PM and one for the AM! He just doesn't want to go past the yellows in the PM/early AM.

My observations of Merlin's SS are:
* Nadir typically occurs at +5
* PM/early AM - flat, higher numbers probably due to lower numbers in the day
* Very high numbers at AMPS & PMPS
* PMPS numbers are lower than AMPS & seem to be decreasing
* According to PM numbers, it appears that 320+ could increase to 1U however there is that one 394 on 4/17 that produced green numbers
* Dreaming of an AMPS or PMPS yellow number!

Is there anything else that you see?

Ok it is 2am so I need to stop thinking and go to bed. GN. :YMSIGH:
 
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