5/10 Biscuits amps High +5.5 486 pmps HI+2.5 569

Sonia & Leo said:
Poor little Biscuit, sending you both happy vines :bighug::bighug::bighug: and best wishes for the R insulin.
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Thanks, I haven't started the R. I don't have a good feeling about this. It seems he's feeling worse with these increases. I think he's going to have to go in for sub-q q fluids again. Getting dehydrated.
 
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Oh Bisquits, bring it down!
My Alice was HI last night.

I'm interested in how you came to be considering the R? My vet mentioned it to me....
 
Those high numbers are so frustrating! I also hope to see Biscuits react more favorably to the R insulin. You never know until you try :)
 
I’m so sorry, Sandy, that I’m not able to help you with the R right now because we are still gone and with family most of the day end evening.

I’ve been trying to think of others (sorry, I thought Paula had R experience) so you can get started.

I’m sorry he’s not doing well today. The dose increases cause the NDW and that just drives him up higher so he doesn’t feel well. I can’t think of any of our overseas members who have used R that could normally get you started early in the day.

:bighug::bighug::bighug::bighug:
 
AliceMeowliss&Cassandra said:
Oh Bisquits, bring it down!
My Alice was HI last night.

I'm interested in how you came to be considering the R? My vet mentioned it to me....
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We suggested it to Sandy since Biscuits was just diagnosed with acromegaly. We use it in non-acro cats, too, but there are specific times and conditions to use it so we strongly advise that members new to its use don’t start it alone.
 
Hi Sandy, I might be able to help you with R with the PM cycle. It will require testing at preshot, plus +1, +2, +3 and +4. Possibly more if you see a lot of action. But frankly at 0.25 units I am not expecting that. The experiment could still help us identify the R onset and nadir. You want to learn those so that you don't have the two insulins actions overlapping and causing big drops. Remember, we are interested in a drop of no more than 100 points. Using R is like a nudge in the right direction.

It is also possible the following cycle could see more action if you get the overall numbers lower. A lower number to start with can let the Lantus do it's job, which is the goal of using R correctly. If we do the R experiment, we will hold the Lantus dose for a total of six cycles.

So what do you think about tonight? I have one proviso to make, I may have to jam out at the last minute but will let you know before your 7:30. My car is in the shop and may or may not be ready to come home this afternoon.
 
Wendy&Neko said:
Hi Sandy, I might be able to help you with R with the PM cycle. It will require testing at preshot, plus +1, +2, +3 and +4. Possibly more if you see a lot of action. But frankly at 0.25 units I am not expecting that. The experiment could still help us identify the R onset and nadir. You want to learn those so that you don't have the two insulins actions overlapping and causing big drops. Remember, we are interested in a drop of no more than 100 points. Using R is like a nudge in the right direction.

It is also possible the following cycle could see more action if you get the overall numbers lower. A lower number to start with can let the Lantus do it's job, which is the goal of using R correctly. If we do the R experiment, we will hold the Lantus dose for a total of six cycles.

So what do you think about tonight? I have one proviso to make, I may have to jam out at the last minute but will let you know before your 7:30. My car is in the shop and may or may not be ready to come home this afternoon.
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Thanks so much. Tonight isn't good. It's one of those days . We have plans at 6 and will be late with pm shot , less than an hour late. Let me know when you're available. And thanks again !
 
OK, let's touch base again tomorrow. I am trying to find someone on the east coast. Have fun tonight.

Safety tip, you might want to wrap the R bottle or box with an elastic band, or something so that it feels different from the Lantus insulin.
 
Dyana said she can help you in the morning at AMPS, I’m on the way out but I asked her to post to you on this condo to make plans.

She’s s very long-term member, experienced, and has used R.
 
Hi Sandy. I'm Dyana, and I can be here to help you with the R tomorrow morning at AMPS.

For a little history, since I know you don't know me from Adam, my kitty J.D. was diagnosed in 2005 and I started posting on FDMB in 2008, two? forums ago, I think. J.D. was not a high dose cat, but I did sometimes use R for him as he was a big bouncer. He passed in 2014 (after 9 years of being diabetic, at 20), but I still log into FDMB 2 to 10 times a day (mostly 2) just because this place becomes kind of like a family :)

As Wendy mentioned, you never want to accidently confuse which insulin is which. The rubber band is a good idea. I used to keep my Lantus (or later Levemir), on the top shelf of the refrigerator and my R insulin in the door. The R was in a vial in it's box, and the L insulin was in a pen or cartridge. Sometimes, we become sleep deprived or have distractions, and an accidental mix up of the two insulins could be disastrous. I used to take out my L insulin and measure the dose and put that syringe on the counter and put the L back in the frig. I would then take out the R insulin, measure the dose, put that syringe on the counter, and put the R in it's special place.

You will be starting with a teeny dose of 0.25 units to see how he reacts. I know you're not used to such small doses, so here is a picture of what 0.25 looks like in a syringe. It will feel like nothing or next to nothing going in when you shoot.
upload_2019-5-10_20-5-21.png


R usually has a quick onset but does not last very long (around 4 hours, sometimes a bit more). You will need to test every hour for the first 4 hours (and maybe longer), to see how he's doing.

The timing of when to give the R dose is important. You never want the two nadirs of the two insulins to overlap at the same time. If you give the R at the PS time, it should be out of or close to out of his system by about +4. If you are using Lantus and it's nadir is around +6, then you are good because the R has done what it's going to do and is done.
When J.D. was bouncing really high, I used to sometimes give R around +10 too, as it would help to bring the numbers down a little and be out of his system by +2 of the next cycle (4 hours after shooting the R) just in time for the Lantus to onset at +2 and then the Lantus could more easily do it's job.
An example of the two nadirs overlapping would be if you were to give the R at +4 and it was working full force (from +4 through +8) when the Lantus nadir hits around +6. That's overlapping the nadirs and you don't want that.

0.25 may not be enough, but it is a safe starting point.
You'll want to add the R dose and when you gave it to your spreadsheet.
This is an example of one of my PSs on J.D.'s spreadsheet.
upload_2019-5-10_20-33-17.png


Just to let you know there is this weird phenomenon where sometimes giving R in one cycle, will for some reason affect the numbers in the following cycle.


I work a ton of hours so will only be around for the one morning cycle for you tomorrow. If you need further help, for other cycles, make sure someone is there to help guide you through it.


I'll see you in the morning. Let me know when your AMPS is due. :cat:
 
Dyana said:
Hi Sandy. I'm Dyana, and I can be here to help you with the R tomorrow morning at AMPS.

For a little history, since I know you don't know me from Adam, my kitty J.D. was diagnosed in 2005 and I started posting on FDMB in 2008, two? forums ago, I think. J.D. was not a high dose cat, but I did sometimes use R for him as he was a big bouncer. He passed in 2014 (after 9 years of being diabetic, at 20), but I still log into FDMB 2 to 10 times a day (mostly 2) just because this place becomes kind of like a family :)

As Wendy mentioned, you never want to accidently confuse which insulin is which. The rubber band is a good idea. I used to keep my Lantus (or later Levemir), on the top shelf of the refrigerator and my R insulin in the door. The R was in a vial in it's box, and the L insulin was in a pen or cartridge. Sometimes, we become sleep deprived or have distractions, and an accidental mix up of the two insulins could be disastrous. I used to take out my L insulin and measure the dose and put that syringe on the counter and put the L back in the frig. I would then take out the R insulin, measure the dose, put that syringe on the counter, and put the R in it's special place.

You will be starting with a teeny dose of 0.25 units to see how he reacts. I know you're not used to such small doses, so here is a picture of what 0.25 looks like in a syringe. It will feel like nothing or next to nothing going in when you shoot.
View attachment 44870

R usually has a quick onset but does not last very long (around 4 hours, sometimes a bit more). You will need to test every hour for the first 4 hours (and maybe longer), to see how he's doing.

The timing of when to give the R dose is important. You never want the two nadirs of the two insulins to overlap at the same time. If you give the R at the PS time, it should be out of or close to out of his system by about +4. If you are using Lantus and it's nadir is around +6, then you are good because the R has done what it's going to do and is done.
When J.D. was bouncing really high, I used to sometimes give R around +10 too, as it would help to bring the numbers down a little and be out of his system by +2 of the next cycle (4 hours after shooting the R) just in time for the Lantus to onset at +2 and then the Lantus could more easily do it's job.
An example of the two nadirs overlapping would be if you were to give the R at +4 and it was working full force (from +4 through +8) when the Lantus nadir hits around +6. That's overlapping the nadirs and you don't want that.

0.25 may not be enough, but it is a safe starting point.
You'll want to add the R dose and when you gave it to your spreadsheet.
This is an example of one of my PSs on J.D.'s spreadsheet.
View attachment 44871

Just to let you know there is this weird phenomenon where sometimes giving R in one cycle, will for some reason affect the numbers in the following cycle.


I work a ton of hours so will only be around for the one morning cycle for you tomorrow. If you need further help, for other cycles, make sure someone is there to help guide you through it.


I'll see you in the morning. Let me know when your AMPS is due. :cat:
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Hi Dyana , thanks for getting in touch with me. AMPS is 7:30 but I was an hour late tonight with pm shot. Does it matter?
Will I be giving R twice a day? If so I'm nervous to do that until someone is available.
You're available for the am 4 hours? He is consistently high with his lowest amps red. Not sure he has a nadir, at least I don't see a trend of lower number at a certain time of day. Still not great with the SS. As you can tell this is foreign to me. I am a nurse but this is a new ballgame!!! So very different train of thought. I'll take any info you have
 
You don’t have to give R twice a day, but many people do. Maybe once you have experience and are more comfortable with it. Or if the first time is a non event. The first few times you should have a helper on line with you as you learn when, and more important, when not to give R.

Over time you will build an R scale. What that means is you shoot a certain amount of R based on the BG at that time. The R scale can change over time. As an example, at one point Neko’s scale was a simple, over 300, give 0.5 unit, under 300 but above 200, give 0.25 units.
 
You'll need to stick with the 14 units of Lantus tomorrow if you're going to try the R. No increases tomorrow morning.

Mollycat said:
AMPS is 7:30 but I was an hour late tonight with pm shot. Does it matter?
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Normally, you want your shots to be as close to 12 hours apart as possible. That means, if you shot at 8:30pm tonight you would want to shoot at 8:30am tomorrow morning.
Normally, we say that you can work your shot schedule back in 15 minute increments per cycle, or 30 minutes once per day, without affecting the numbers too much. With him being so high... it's a little different story, but an early shot does act like a dose increase, so because of the R experiment, I would not shoot any earlier than 8:00am if you can tomorrow.
 
Mollycat said:
Will I be giving R twice a day? If so I'm nervous to do that until someone is available.
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You don't have to give it twice a day. You can give it when it's needed, and when you are going to be home and can monitor, and in the beginning when someone can be there to guide you. No worries for now. You can change your Subject Line tomorrow afternoon to ask for help with R guidance in the PM if it comes to that.
Mollycat said:
You're available for the am 4 hours?
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I'll be here as long as you need me tomorrow morning and into the afternoon.
Mollycat said:
He is consistently high with his lowest amps red. Not sure he has a nadir, at least I don't see a trend of lower number at a certain time of day.
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I know. The information I gave was for your reference for the future, when you do start to see the nadirs.
 
Dyana said:
You'll need to stick with the 14 units of Lantus tomorrow if you're going to try the R. No increases tomorrow morning.


Normally, you want your shots to be as close to 12 hours apart as possible. That means, if you shot at 8:30pm tonight you would want to shoot at 8:30am tomorrow morning.
Normally, we say that you can work your shot schedule back in 15 minute increments per cycle, or 30 minutes once per day, without affecting the numbers too much. With him being so high... it's a little different story, but an early shot does act like a dose increase, so because of the R experiment, I would not shoot any earlier than 8:00am if you can tomorrow.
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I can do 8 :00
 
Dyana said:
You don't have to give it twice a day. You can give it when it's needed, and when you are going to be home and can monitor, and in the beginning when someone can be there to guide you. No worries for now. You can change your Subject Line tomorrow afternoon to ask for help with R guidance in the PM if it comes to that.

I'll be here as long as you need me tomorrow morning and into the afternoon.

I know. The information I gave was for your reference for the future, when you do start to see the nadirs.
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Thanks so much! I'll be ready at 8:00! I won't do anything except test until I talk with you
 
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How are you doing, Sandy?
I would start to get the R insulin dose ready as it sometimes takes a bit more time to get any air bubbles out when measuring such a teeny one quarter of one unit dose.
I'm going to take my kitties outside for a supervised walk. I'll be back in 10 minutes and then feed them their 2nd breakfast.
I'll see you in today's condo at 8.
 
Dyana said:
How are you doing, Sandy?
I would start to get the R insulin dose ready as it sometimes takes a bit more time to get any air bubbles out when measuring such a teeny one quarter of one unit dose.
I'm going to take my kitties outside for a supervised walk. I'll be back in 10 minutes and then feed them their 2nd breakfast.
I'll see you in today's condo at 8.
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I'm here and tested . Both insulins drawn up. Ready for instructions
 
You can give the Lantus and his breakfast to make sure he's eating, and then give the R in a slightly different location (like give the Lantus on the Left and the R on the Right). Start a new post for today. I'll see you there.
 
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