5/13 CRYSTAL AMPS 225 (gave R) +9 158 PMPS 187 gave R | Feline Diabetes Message Board - FDMB

5/13 CRYSTAL AMPS 225 (gave R) +9 158 PMPS 187 gave R

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suki & crystal (GA)

Member since 2014
yesterday

Hi all,

Bit late posting today, out and about but some good news, Crystal breached the yellow log jam and slid gently into the blues at +4, and is still there at +10 :cool::cool::cool: Very pleased that at last we seem to have broken the spell of the dreaded yellows after 8 cycles. This morning's AMPS was 225 and, on Suzanne's suggested revised R scale, I gave her 2.5u R - which seems to have worked :) (antijinx) I think she may even have gone lower after +6 but the little minx managed to scoff some HC food that I gave to Poppy. We were completely out of cat food so Poppy got Crystal's emergency HC rations, and left a little bit in the bowl and before I turned round, Crystal pounced and finished it off! My fault, just have to watch her more closely at feeding time.

So, now my dilemma is what to do at PMPS. If she is roughly in the same range perhaps just the 1.0 or 1.5u R - to be decided.

Thanks to everyone who posted yesterday, I am continually amazed and delighted at the strength of support and help available here - a heartfelt thanks from both of us. :bighug:

Suki & Crystal


Sandy posted late on yesterday's condo and I haven't had time to answer, so I've copied it over to here:

Hi there :cool:

Crystal has not visited the 4th floor in 2 months !
That is some serious progress.

So many variables - with Acro comes pituitary tumor activity (or lack of) as well as a pancreas that may be fully functional. . .or maybe not. When it comes to IAA, how much insulin binds to antibodies and how much goes to metabolizing sugar at any given time is anybody's guess. And there is the potential for periods of prolonged duration due to release of bound insulin back into circulation. (If only there was a meter that measured how much unbound insulin is in circulation). These are responsible for the ups and downs.

Pressing the pause button on the Lev increases and continuing to methodically increase and fine tune the R doses is a strategy worth trying. You can always 'unpause' and increase the Lev if needed.

I too suspect Crystal is IAA . Being that IAA is self limiting, it will break one day and insulin sensitivity will return. That's important to remember.

FWIW at the time BKs IAA broke, his R doses added up to nearly half of his total combined daily insulin. At the first sign of change I just pulled the R. It was a huge reduction - and an easy one. No depot - no drama (that came later).
Let me make it clear the L to R ratio was not calculated - we were flying by the seat of our pants.
It was serendipitous.

With a high dose kitty using L you are guiding an oceanliner over waters containing dynamic undercurrents that cannot be measured or predicted but most certainly influence the picture, With study and observation and through trial and error your management of Crysals unique brand of FD will continue to evolve.

Hang in there! :cool:


@Sandy and Black Kitty - Very well put Sandy and thank you so much for explaining the ups and downs of IAA which we all suspect Crystal has. I like the idea of the pause button on the Levemir, for the reasons discussed yesterday, and it fits in with how I want to proceed with the R, at least for the next week or so. I think over the coming days I will be experimenting with different doses of R to see what works but it certainly seems that that 0.5u increase has made a difference. Am I right in assuming Sandy that your max dose of R was 6u? Has anyone given more than that (apart from Suzanne's DH by mistake!), I just want to know if there is a limit?
 
I completely forgot to add that I received an answer to a couple of queries concerning Lev and R doeses from Ruth at the RVC:

Thanks for your email. It would be possible to use a larger 100 U/ml syringe to inject Crystal's Levemir. 100 U/ml syringes are available in 1ml forms, which would allow for her whole dose. I'm not aware of any evidence that injecting a large volume of levemir affects its efficacy but, unfortunately, Crystal's dose is higher than even a lot of human diabetics receive so this probably isn't something that has been investigated as it would not be relevant to a lot of diabetics.


I'm afraid it is not advisable to mix her R insulin with Levemir and Levemir's manufacturer's strongly advise against this.


Unfortunately, I think it’s most likely that Crystal's R insulin appears less effective because she’s experiencing a worsening of her insulin resistance because of her acromegaly. Acromegalic cats are notorious for having a variable insulin requirement and I think this is likely to be what is making Crystal’s insulin less effective.


Best wishes,

Ruth

Ruth's last paragraph ties in with Sandy's comments above, so at least we are all "singing from the same sheet".
 
Go Crystal go!!!

I'm thrilled to see her in blue and I'm very glad you got such great advice from Sandy and also from Ruth. I hope you can find the syringes.

I was having a discussion with Jill about another topic and just mentioned Crystal's thickening under her skin. She told me that, at one point, she noticed this with Alex as well and that she happened to read a post from another member that said if you are seeing the thickening, it likely has more to do with technique rather than shooting in the same spot. Mill was not able to shoot Alex in other locations either for the possible being bitten issue. Jill realized that she had been shooting the insulin more into the fatty layer right under the skin instead of getting below it into the subq area. It wasn't affecting absorption but it did seem to cause that fatty area to become inflamed. She reviewed the info on shooting technique and realized she was not shooting at an angle that allowed her to get under the fatty tissue and into the subq area. Once she did,my he inflammation and thickening went away. She suggested you check your shooting technique and be sure you are getting under the fatty layer and down into the subq area.

When I shoot, I always make sure I have enough skin drawn up and then roll back to expose bare skin (for me that prevents a fur shot but is not necessary for everyone to do) and then make sure the needle is going in at a 45 degree angle.

I think it is well worth checking out.
 
Hi Marje, that's an interesting theory, one I'm going to look into. Actually the needles I use are the 8mm ones, I wonder if it would be better with a longer needle. I'm going to check out the videos on injecting, I think I might not be doing the 45 degree angle, more flattish, i will check and make amendments if necessary.
 
Not sure what you mean by "half unit needles". Do you mean syringes? I believe that is elated to the syringe type. Most syringe makers do have a short and long needle. Terumos do not but they quit making insulin syringes.

If you just got an order of short needles, don't worry about it. Just use what you have and check out your technique. While I've read anecdotally that longer needles help with absorption, I think that might be ECID. I could not tell they made a difference in Gracie.
 
Sorry, yes syringes with .5 marked as well as whole numbers, so 1.0, 1.5, 2.0, 2.5 etc. very useful for the R but not necessarily so good now for the big doses of Lev.

184 at +2 so coming down gently.
 
Am I right in assuming Sandy that your max dose of R was 6u?
If it was a PM cycle the highest R dose was 6u, if it was an AM cycle 6.5 (BK ran lower on the overnights).
Has anyone given more than that (apart from Suzanne's DH by mistake!), I just want to know if there is a limit?
I don't know if anyone has (purposefully) given higher doses or R, however it is likely. I also don't know of any limit to how much R can be used . . .
I like the idea of the pause button on the Levemir, for the reasons discussed yesterday, and it fits in with how I want to proceed with the R, at least for the next week or so. I think over the coming days I will be experimenting with different doses of R to see what works but it certainly seems that that 0.5u increase has made a difference.
Excellent - that's how it's done. One shot at a time. You can see how BKs R scale evolved and expanded all the way down to PS of 160 in September of 2008. I would have kept going up in dose as needed however in October of 2008 the IAA broke. After that, insulin sensitively returned and I had to really watch it with R - a little went a long way.

BK developed some thickening of the scruff during the phase where I was shooting R both AM and PM and +6 as well so 6-8 injections every 24 hours was common. I moved shots around withing the scruff region. I had to split his L dose into 2 syringes as I was experiencing an increasing tremor of my right hand (which turned out to be young onset Parkinsons). Being that I'm right handed the tremor caused an increase in fur-shots (sometimes back to back :mad:).
I like Marjes suggestion about reviewing proper technique and making angle adjustments if needed.
Longer needles didn't work for me - I shot through the 'tent' often :oops:.


I think using more R will give you the elbow room to better manage the pesky inconsistencies inherent to Acro and IAA and be able to "go with the flow" :cool:
 
I have used the longer needle syringes for Spartacus - his skin is much thicker than Grayson's ever was. G always used the shorts.

Great to see the response from RVC. And yes, I've seen R doses as high as 15. I can't even imagine! Especially when you see some kitties respond to barely a sniff of it.
 
Wendy, Suzanne, Sandy, Marje, Lu & Bron - thanks everyone for looking in and offering your support and/or great advice. Sandy, thanks for confirming your highest R doses, I might have a way to go yet! Very sorry to hear that you have early Parkinsons, hope you are getting the best of treatment and are coping well, hugs :bighug:
Lu - 15 uR !!! OMG

Just taken Crystal's bedtime test and she's a little higher at 230 but on the whole a very good day for her. Catch up with you tomorrow. night night
 
226 at AMPS so 2.5uR given, the same start as yesterday morning.
Was slightly late this morning, slept through alarm but Crystal woke me up by jumping on the bed saying "haven't you forgot something and where's my breakfast?" Bless her. Will adjust PMPS accordingly. She's feeling pretty lively this morning, managed to give me a good nip while I was messing about trying to make a good injection "tent".
 
You must be tired to sleep through the alarm:bighug:
Aren't cats funny the way they like their routine and heaven forbid anyone who changes it.
I hope the nip didn't break the skin.
 
I'm afraid she did draw blood Bron, ran my finger immediately under the tap as I've had a septic finger before now from her. I'm on penicillin at the moment anyway so that should stop any infection.
 
Ouch! Poor you. Cat bites hurt. I would bath your finger in an antiseptic solution even though you are on the antibiotic in case the antibiotic isn't one that covers those bugs.
Poor Crystal, I am sure she wouldn't mean to hurt you.
 
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