5/20 Merlin AMPs 331.+6/128,PMPS 399,+5/185

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Merlin

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5/20
AMPS 331; 1u

Hmmmm. Looks like after the +5 or even before he stayed in the 300's. I am happy with that. Today, I will drop off his spreadsheet off at the vet again today. I am sure he wants to run another preliminary dental blood test and fructosamine. I think I am going to just go with the pre-dental blood test unless anyone thinks there is a reason to get the fructosamine test.

I am also thinking about printing off the Lantus protocol and giving it to the vet to read to see what he thinks. Since he is not too familiar with it, maybe he can do a little homework to see if Lantus is a possibility. What do you think about doing that?
 
Re: 5/20 Merlin AMPs 331

I like both ideas, Cindi. A fructosamine test will only give you an average of his numbers for the past 2 weeks. Not only do you have that with the data you already collected, but since the doses varied so much, it won't be real valuable info (IMHO)
 
Re: 5/20 Merlin AMPs 331

Morning Cindi!

That flat cycle looks like Merlin might possibly be ready to bounce break and you might have a better (busy?) cycle this AM.

Sue beat me to it, and I agree the fructosamine is really not necessary since you are doing at home blood monitoring. On the other hand, a diplomatic approach with the vet on the fructosamine test might be better in the bigger picture - if the vet wants to see the fructosamine, even though it's probably not going to reveal anything exciting, it might be best to proceed so the vet is satisfied and hopefully allow Merlin to proceed with the dental (assuming he's otherwise healthy enough to do so).

If you're interested in discussing Lantus with the vet, here's a link http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 to the most recent Roomp/Rand study which includes the Lantus tight regulation protocol. It's a linked PDF towards the top of the page called "Management of Diabetic Cats with Long-acting Insulin." The protocol we use on the TR forum is really pretty much the same thing, just worded in a different format. :smile:

Edited to actually include the link I referred to. ;-)
 
Re: 5/20 Merlin AMPs 331

5/20
AMPS 331; 1u
+6 - 128
PMPS - 399; 1u (updated) drats...too high.

Yep you are right...a much flatter am cycle today and hopefully leading to a better PMPS number.

I think to summarize Merlin's dosage; the higher the dose means higher AM/PM PS but lower nadirs...the lower the dose means lower AM/PM PS but flatter and not so low nadirs. So having that knowledge, is Prozinc still the best insulin or would another insulin be better i.e. Levemir or Lantus?

Isn't it better to have the latter scenario i.e. lower AM/PM but flatter cycle and not so low nadirs? Or is it better to get to those lower nadirs but dealing with higher AM/PM PS?

What is "relaxed" Lantus?
 
Re: 5/20 Merlin AMPs 331.+6/128,PMPS 399

I think I'd vote for lower preshots without the bigger drop to nadir, so a lower overall dose. The hope would be that he would eventually drop overall because he wouldn't be bouncing and dropping.

There is no way to know whether he will do better on Lantus than PZI. It's an ECId thing. Some people switch and the cycle becomes flatter and lower. For some, the numbers are about the same as PZI. The only way to know is to try.

Relaxed Lantus is a forum that goes with the Start Low, Go Slow approach rather than the Tight Regulation protocol. Often people posting on that forum cannot do all the testing that TR requires, and they want to go slower with the insulin rather pushing for low numbers.
 
Re: 5/20 Merlin AMPs 331.+6/128,PMPS 399

Hi Cindi,

Darn on that higher PMPS.

It looks like so far, the 1.0u is doing about the same thing as the 1.4 or the 1.2. I'm not seeing any major differences yet. But then again it's just been one cycle. I think you can generally extrapolate that the 1.0 you previously shot during the week of 4/28-5/5 did result in overall lower pre-shot numbers but the nadirs look more or less the same on the 1.4u, the 1.2u and the 1.0u. My thinking is that you keep doing what you're doing and hold each successively lower dose for at least 6 cycles to evaluate to hone in one the dose that gets you the overall lowest numbers.

Merlin said:
Isn't it better to have the latter scenario i.e. lower AM/PM but flatter cycle and not so low nadirs? Or is it better to get to those lower nadirs but dealing with higher AM/PM PS?

This is a million dollar question. I guess whichever approach allows the most time in numbers that are under renal threshold is what you'd probably want to aim for. Sometimes kitties settle down the bouncing and you can keep aiming for those lower nadirs even if it causes bouncing, but there are ProZinc kitties that seem to do better with a flatter cycle.

On which insulin is best for Merlin, its probably not possible to say for sure unless/until you try something different and see if it works. Lots of kitties do well on Lantus or Levemir, but some do better on ProZinc. I personally like how Eddie's responding on Lantus but I know Debbie's Lucian didn't do very well on Lantus. Merlin is responsive to insulin and he's not stuck in high flat numbers that won't budge, so if I had to guess any insulin will lower his BG - it's just which one will (might?) help you gain better regulation. I hope others will speak to this, so it's not just my two cents being tossed in here, but I'm thinking that you may not be able to get a flat enough cycle out of ProZinc for Merlin in order to get reasonable duration with normal BID dosing. On the other hand, Merlin is a cat, so he may just surprise us all if he likes a lower dose and he'll all of a sudden flatten out and start getting better pre-shot numbers. :smile:

Merlin said:
What is "relaxed" Lantus?

I post in TR, but I'll give you my interpretation of Relaxed - basically it's people using Lantus/Levemir that may be taking a slower approaches to dose adjustments than called for in the TR protocol, or they may be using L/L that aren't able to test as frequently mid-cycle as is generally necessary to follow the TR protocol for dosing adjustments, or they may be tweaking the protocol in various ways to meet the needs of their kitty. Others do pretty much follow TR and post in Relaxed anyway. There are also people in TR that follow a more "relaxed" approach to the TR protocol, too. There's not really any specific rules or "membership requirements" to post on either forum. I post on TR. I know Lucian's Debbie used to post on Relaxed. Hopefully, she'll also add some input about TR versus Relaxed.

Before I switched Eddie to Lantus I had some questions and concerns about whether it would be a good fit, so I posted in TR asking some of those questions and got some very helpful responses. If you have any specific questions about Lantus, I can certainly try to help answer Cindi, or you might think about posting something like "Thinking About Switching" on either the TR or the Relaxed board, giving a synopsis of Merlin's situation, and asking any questions you might have about the protocol or whether Lantus/Levemir might be a good fit.

Edited: I cross-posted with Sue above. :-D
 
5/20
AMPS 331; 1u
+6 - 128
PMPS - 399; 1u
+5 - 185

Thank you so much for all the information above. I don't know if I am going to ask to switch to Lantus or not. I am hoping that we will be able to do a dental soon and I thought I would make a decision after that. I want to see how he does with Prozinc after the dental. In talking to the vet today, we have decided to run the pre-dental blood test tomorrow at noon. I am sure hoping that the kidney indicators somehow are a little better. I am not sure why it would improve at this point because I am not sure if anything has changed since then but one can hope.

Oh, I have one more question. To be under renal threshold, which I believe it under 250 right? Is that 250 with a human meter or pet meter?
 
Hi Cindi! I don't have ANY lantus experience but I agree with everyone else....it just depends on the cat. I do like the idea of the dental and then a switch if necessary. That way you at least get to see if that factor is part if the issue....and if you still don't get the numbers you want you can maybe switch.

I believe you are looking for under 250 on a human meter.
 
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