4/20 Oliver amps 331 pmps 313 +2~346 +4~310 +6~304 +7~NC

[Blue]

Yesterday’s Condo for Oliver

Happy boy now; hungry boy at 5am! He gobbled up a half can of friskies, the big cans. Then he had a wee nap after his gobble and shot, and now out and about, scavenging for more foods. It's a good thing he left himself some in his own bowl, and it's a good thing that Shadoe has her feeder or I am sure they would be go hungry all day long once the feline vacuum emptied all the bowls.

I am seriously thinking of getting him one of the 2-section feeders.

We are not getting much progress on his numbers, they seem stalled in 300s, so it may be time for a change of plan. Maybe even considering a switch back to Lantus. Thoughts?

 

[Pat+Raja+Shadow (GA)]

Re: 4/20 Oliver amps 331

Hope someone will be around with thoughts about switching....it's frustrating when they stay in the pinks....
Hope you guys have a good day....Oliver sounds like a hungry character indeed! :lol:

 

[Blue]

Re: 4/20 Oliver amps 331 +2~455 +4~409

I think I am going with some R soon if he does not come down.
This shot is cycle 4 so he's going up tonite - maybe 6u?

 

[Barb & Checkers (GA)]

Re: 4/20 Oliver amps 331 +2~455 +4~409

Wish I could help, Gayle. I'm still at the 'needing help' stage.
I wish Checkers was a good eater like Oliver; he eats only what he has to.
I hope an advisor comes in soon to help.

 

[Blue]

Re: 4/20 Oliver amps 331 +2~455 +4~409

Barb, careful what you wish for! One day, your little nibbler may decide he's now a hungry man and you won't be able to open the cans fast enough!

So long as they eat, I am happy.

 

[Randi & Max (GA)]

Re: 4/20 Oliver amps 331 +2~455 +4~409

Oliver does need a break from these numbers Gayle.
Gosh he is reminding me more and more of Max.
Paws crossed for the same results.
We have no idea the life he had before coming to you and how long
he was diabetic.
Can't help with the switch back to Lantus but I know you are
taking amazing care of him.

 

[Blue]

Re: 4/20 Oliver amps 331 +2~455 +4~409+5~394

I think we may as well have as little disruption and change for him until we know what's up with him. That being said, we will stick with the Lev because if he turns out to be resistant, it would be another switch, and he's not getting any worse numbers than on Lantus so they are both about the same for him.
Yeah, it would be great if we got up to 6 or 7u and then he broke through and came down like Max. I would love that!
Time will tell.

 

[OptOut]

Re: 4/20 Oliver amps 331 +2~455 +4~409+5~394

I don't think switching back to Lantus will provide you any benefit (just as I don't believe switching TO Lev provided any benefit)...from what I hear, they really do work the same. The reasons I've heard that people switch to Lev is that 1) it possibly stings less and 2) it possibly lasts longer.

If Oliver is simply insulin resistant, then there is conjecture that switching insulins will cause him to become resistant to both insulins (Sharyn/Fiona found that information somewhere). I think he just needs more and more, until you get a breakthough. If he's like Max, maybe he'll do what Steve/Jock said and and he'll come bounding down the dosing scale. He's lucky he's in the capable hands of someone who has already had to handle a massive reduction in a short time.

Of course, my two cents are basically worth that. I know that Jojo has been watching you and I know Oliver is safe. We just all wish he would show some reaction to something (it is scary that he barely bats an eye at R!).

 

[Blue]

Re: 4/20 Oliver amps 331 +2~455 +4~409+5~394 +7~331

Heather, thanks for the warning about switching back; no way we are moving off Lev now!
I had pretty much figured that we are looking at higher doses, for whatever reason, so we may as well stick with the one that may sting less. Especially if he gets to Shadoe's level when I split the shots since some have mentioned it could help with better absorption.

So Lev it is. And tonite, we will go up to 6u, following the protocol.
I feel like I am just following by rote, but with little hope that we are close.
Today, it has taken Oliver till +7 to get back down to his amps! His curves are upside down, crazy cat!

I had been of the mind to use R at ps times and maybe at +6 if needed, but Oliver has decided to make his own rules and his highs are not at ps at all.
Today, his amps was 331 and his +2 soared to 455; who knows how come there.

I cannot blame his foods because he gets identical to Shadoe, all low carb.

I guess if he's still responding poorly, I'll arrange for his testing at msu mid May, even just to rule resistance out.

 

[Blue]

Re: 4/20 Oliver amps 331 pmps 313

Oliver's got one weird curve, no way I can tell his nadir.
Anyways, just going by his past cycles, I gave him .75R because I bet he is on his way up at ps, and that low number has fooled me in the past. Oliver is a tricky boy.

Oliver is eating well as usual, helping himself to Shadoe's leftovers when it suits him and she is not in hissing range.

We also increased his dose by .5u to 6uLev so I guess it's shed filling time.

 

[Blue]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

True to Oliver's pattern lately, he has chosen to ignore the R again and continue on up.
I guess he'll start coming down in a couple hours.
I think I need to learn he could use more R to help him down.

Anyways, the Mister is stretched out and catching the breeze from the window.

 

[Dawn & Nova]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

Here's my thoughts.. take'm or leave'm.. preferably discuss them, so we can maybe all learn something new .

High numbers can cause greater insulin resistance.. I think that the protocol might be leaving you chasing and not catching up.. increasing 0.5U when a cat is on 1, 2 or 3 units.. is a lot bigger change then at 5 or 6U..

We know full well that any of us could shoot a bunch more insulin than the cat needs..and feed through it and turn out fine.. so my thought is.. hit him with some crazy amount.. go up like 3U at once (no R ).. which isn't a heck of a lot different then increasing 0.5 at 1 or 2 units.. be ready not to sleep much.. be ready to feed him through it.. and see if he moves..

If he's staying around the same numbers because you are just keeping pace with his resistance increasing.. you'll see a change.. if you don't.. maybe it's time to consider working more with considerably more R (or an even faster insulin like humalog??.. no idea about which, if any, of the rapid insulins are cat safe).. to me it's a lot less scary to shoot a higher dose of an insulin that wears out in half a dozen hours.. than an insulin that hangs around for 1.5-2 cycles..

 

[OptOut]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

High numbers can cause greater insulin resistance..

I think that's the accepted belief for an IAA kitty. It's not true for an acro kitty. Have no idea about just a regular, tough kitty.

increasing 0.5U when a cat is on 1, 2 or 3 units.. is a lot bigger change then at 5 or 6U

I would also agree with that statement. In fact, the protocol addresses this, although not clearly. It states that you can raise in .5u increments if the dose is "high"...but never clarifies high. Personally, I think 0-4 u is low; 5-9 u is high' and greater than that is crazy (i.e. IAA or acro)...However, there are no hard guidelines about when you can start increasing by 1.0 u or more. Also, if Gayle were to do that now, w/o a diagnosis in hand, some people on the board would tar'n'feather her! (and we like her, so we don't want that). :mrgreen:

maybe it's time to consider working more with considerably more R

This is actually safer than raising the basal dose too much. Gayle has already tried 1u; she can certainly try higher amounts and at more frequent intervals (twice a cycle if she's around). Too bad all the experienced R-people have jumped ship.

 

[Dawn & Nova]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

This is actually safer than raising the basal dose too much. Gayle has already tried 1u; she can certainly try higher amounts and at more frequent intervals (twice a cycle if she's around). Too bad all the experienced R-people have jumped ship.

Yeah.. this is what I was talking about.. high dose faster acting insulin is a lot less scary to me.. but I was worried about the tar'n'feathering factor there too (sometimes I get the impression that my thinking fast acting insulin is less scary, is backwards from many, if that makes any sense? ).. so don't know which would result in less freaking out .. Whichever route.. some sort of bold-ish step to see if it's a race..

The experienced R people got that way some how.. Gayle watches her cats really close, tests lots.. time for a new pro I think! .

Edit: I had it in my brain that cats that remained high for a considerable amount of time were often more resistant and/or harder to "break".. I'll have to go do some reading to figure out where I got that idea from because I really have no idea where my brain picked that up.. (I would suspect casual comments in condos, but I'm not sure), so I should look into it more..

 

[Blue]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

For increases, on Shadoe, I kept to the .25u increases until we hit 6u Lantus, then we went up by .5u until we hit 10u Lantus. At that point, I just threw my hands up in the air and went to full 1u increases. If she had not gotten the tests and the dental and ultrasound all in a short period and I had not decreased for those events, and she had not gone into free fall, I may well have tried more of an increase of Lantus.

By not knowing about Oliver, it may be better to go with more R at ps and +6 or when needed, just to pull him down and see if the Lev can carry him along at the lower level.
Because the R is in and out quickly, too much R is less scary than too much Lev because the Lev will last for hours longer. As it is now, I am pretty sure that Oliver is snickering at me when he gets a shot of 1uR.

We are still not near Oliver being settled as he is still having the odd little urine 'accident' outside the boxes. I have big absorbant pads outside the boxes for that purpose, just in case, as Shadoe had the same problem before.

Over the weekend, I will be able to do some good testing with R, and till then I'll stick with 1 or maybe 1.5R at ps, depending on his numbers. Mid cycle, I'd go with half the amounts because at mid cycle you have both insulins active.
Their +6 is in 10min; we'll see then what Oliver's doing.

 

[Libby and Lucy]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

I can't even believe what I'm reading here.

We know full well that any of us could shoot a bunch more insulin than the cat needs..and feed through it and turn out fine.. so my thought is.. hit him with some crazy amount.. go up like 3U at once (no R ).. which isn't a heck of a lot different then increasing 0.5 at 1 or 2 units.. be ready not to sleep much.. be ready to feed him through it.. and see if he moves...

Absolutely not. This is where I have to remind everyone that Oliver is a CAT. And he is Gayle's cat. He is a healthy, active, photogenic, adorable cat. He is not a science experiment.

Yes, high numbers can cause insulin resistance. Yes, the solution to break through the resistance is more insulin. However, risking a prolonged hypo is not the way to accomplish that. I'm not willing to risk putting a cat into a life-threatening situation just to see some yellow or blue. Sure, if Oliver is acro he might be able to handle a large dose increase. But what if he's not? We're pretty lucky in LL that we've seen a number of cats get through overdoses ok. I've also seen them on health, and on other forums, that did not. I'm still exhausted from Sammy's situation the other night and he's not even my cat, are you seriously suggesting doing that on purpose?

High numbers can cause greater insulin resistance..
I think that's the accepted belief for an IAA kitty. It's not true for an acro kitty. Have no idea about just a regular, tough kitty.

And this is the whole point. We can't make assumptions. The safety of the cat comes first, always. Gayle is increasing aggressively and SAFELY according to protocol, she is testing for ketones religiously, she is using R in accordance with her comfort and understanding of the insulin, and she WILL get to Oliver's breakthrough dose.

 

[Jill & Alex (GA)]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

very well said. thank you, libby.

 

[Sienne and Gabby (GA)]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

This may be an interesting theoretical discussion but it is a discussion that is more appropriate to Think Tank than here.

I would ask you to take several giant steps backward and give serious consideration to what you are suggesting. You are postulating that Oliver might benefit from a 3.0u increase in dose. Weigh the costs and benefits especially in light of the fact that Oliver carries no high dose diagnosis at the present time. Does it make more sense to work up to what may be a "good" dose of insulin in a systematic, safe way or does it make sense to pick an arbitrary amount of insulin and shoot? What are the risks of that course of action? Certainly a hypo is one risk. I know that Dawn followed the recent hypo here. I doubt that anyone would want to be responsible for giving another person the kind of advice that would require constant monitoring from the knowledgeable people here for 16 hours in order to prevent a situation that could have put another person's cat in jeopardy. Maybe the prevention of symptoms looked too easy. I don't know how many cans of HC or how much Karo Sammy consumed but it was a tank load. That's what kept him alive. How many times have people here derided a vet who suggested a 2.0u increase? Suggesting that a dose be increased by such a large amount scares me and, IMHO, is irresponsible. Perhaps thinking about what that kind of increase means in terms of body weight vs. percentage of entire dose will put it in another perspective.

You are forgetting that insulin is an exceptionally powerful hormone and if used incorrectly, it is lethal. I would never suggest to someone else what I would be uncomfortable doing to my own cat. It is also one of the reasons that research protocols exist -- they maintain a safe standard. I also think Gayle is smart enough to not put Oliver in harm's way.

 

[Blue]

Re: 4/20 Oliver amps 331 pmps 313 +2~346

I think the point in going slow is so that we don`t leap frog over the right dose. Yes, I do say UGH with each increase, but I would rather go slow and hit bang on with the Lev.

I will move up the R dose to find out how much it takes for Oliver to recognize I gave him something, but even the R should go up slowly. I started with .1 for Shadoe`s first TOR then move to.25R, .5R, .75R and then 1R. If you give too much R, you have a short time to worry about, but too much Lev and you have a much longer amount of time.

With Shadoe, I know to aim for bloo and not green. With a working pancreas, raising a too low number doesn't work the same because foods may just lower the number even more.
With Oliver, there is the unknown factor to explain his high dose needs. What if he has a resistance issue also? I don't know, so I prefer to err on the side of caution.
Always remember: you can't UNshoot a dose. Best to go slow, low and give more if needed.

This weekend, I'll spend some time using R to see if we can put together some sort of sliding scale for Oliver. Until the weekend, we'll just surf.

 

[Blue]

I am starting to think we can't even buy a yellow; the .5R at +6 hasn't registered yet.
If we see nothing at +8, I am calling it a nite, just like the kitties have done.