5/4 Asia AMPS 409,+6 160m PMPS 292 Lab results & more R questions

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Stacy & Asia

Stacy & Asia

Member Since 2017
http://www.felinediabetes.com/FDMB/threads/5-2-asia-amps-366-6-87-cardiology-report.195022/

Asia’s BGs continue to mystify and upset me these past several weeks. :blackeye: Until we can figure out what is going on with her, if we can figure it out, all I can do in the meantime is try to get her numbers down to support her healing herself from whatever is happening.

I got her labs back from the vet where I saw the cardiologist. Some good news, finally got the p down! Woohoo!!! :woot: HCT is up ever more, yay!

The weird stuff: SDMA is the best it’s ever been since we’ve measured it, yet BUN and creatinine are creeping up, that makes no sense at all to me, she hasn’t lost any weight or anything. I’m sure just like our meters, there’s a little wiggle room on accuracy, maybe the BUN/Creatinine are all basically the same for the past 3 labs, but it looks to be trending up to my eyes. Antibiotics for a little over 2 weeks, I don’t know how long before those numbers start moving, but I would hope it would have done by now.

Her potassium has always been a bit on the higher side, but now it’s borderline too high and that’s very scary, especially since I can’t really give her fluids (and I wouldn’t want to give her lactated ringers anyway since it has K in it). I read insulin can bring that down, not sure how I could give her more. Reticulocytes are high out of nowhere and HCT is up, not too low, don’t know what else that would mean. If anyone has any lab insight I would really appreciate a look. I think @Marje and Gracie is away.

I’m having DH get some R from Walmart out of the city, they charge $180-$300 for the same stuff at non Walmart pharmacies here. :eek: Can you believe that? For an ancient insulin that most diabetics only resort to using if they are uninsured and can’t afford the newer ones?! Unreal. These insulin manufacturers are crooks, I feel sorry for uninsured diabetic humans that don’t live near a Walmart.

Some more R questions. So if it’s action is only about 4 hours, but it stays in the system for 8-12, what exactly does that mean? Can affect the next cycle how? Is it like stacking insulin and the next shot of L will have more dramatic effect than without it? I’m not sure when I might want to try it for the first time, I guess I would start with AMPS, but ideally I think she should have it at +10/+11 in the pm cycle because sometimes she can drop 100+ points quickly with just the L, sometimes not, not recently anyway. Thoughts anyone? @Jill & Alex (GA) @Sandy and Black Kitty @Wendy&Neko
 
Stacy & Asia said:
I’m sure just like our meters, there’s a little wiggle room on accuracy
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I was thinking exactly this looking at your labs. I think that as with BG, we need to look at "big" things rather than minute details.

I'm sorry her BG is misbehaving, and really hope that something clicks soon -- whether R or something else.

:bighug::bighug::bighug:
thinking of you
 
Hi Stacy, I'm sorry not to be able to comment on R or the other lab values. But I can send some vines for better numbers! And a few :bighug::bighug::bighug:s for you. I hope you hear from some of the knowledgeable people soon.
Amazing about the prices for R! I was under the impression that it was inexpensive (but then, it is NYC!).
Hang in there,
 
Awesome news on the P! :woot: SDMA did the hokey pokey at one point too. Her vet didn't rely on it as an indicator.

R's typical onset is +2 and typical nadir is +4. Neko wsn't typical, late as usual. :rolleyes: Because of that, I almost always preferred to shoot around +9 or 10. Her Lev onset and nadir were also later. I wanted the R drop out of the way before the L drop. I thought of it as graphing or plotting the Lev cycles and putting the R on top to avoid big drops. In the beginning, you could assume Asia would be more typical in her R behaviour. Test ever hour at least the first 4 hours or maybe longer.

R can give L a better number to work with, which can impact the following cycle. Then for some kitties, there is the random behaviour of antibodies, which could also impact the following cycle. Not there for Asia, but you may see it on some spreadsheets using R. But it does mean you need to consider your ability to monitor the following cycle, as well as the cycle using R.

I think I paid $23 Canadian for a vial of Humulin R.
 
Wendy&Neko said:
Awesome news on the P! :woot: SDMA did the hokey pokey at one point too. Her vet didn't rely on it as an indicator.

R's typical onset is +2 and typical nadir is +4. Neko wsn't typical, late as usual. :rolleyes: Because of that, I almost always preferred to shoot around +9 or 10. Her Lev onset and nadir were also later. I wanted the R drop out of the way before the L drop. I thought of it as graphing or plotting the Lev cycles and putting the R on top to avoid big drops. In the beginning, you could assume Asia would be more typical in her R behaviour. Test ever hour at least the first 4 hours or maybe longer.

R can give L a better number to work with, which can impact the following cycle. Then for some kitties, there is the random behaviour of antibodies, which could also impact the following cycle. Not there for Asia, but you may see it on some spreadsheets using R. But it does mean you need to consider your ability to monitor the following cycle, as well as the cycle using R.

I think I paid $23 Canadian for a vial of Humulin R.
Click to expand...

My vet also doesn’t rely on the SDMA, she said it’s too new. But it’s supposed to catch on earlier and not be influenced by outside factors as much as BUN/creatinine so I don’t know what to think about that (plus I’d like to be happy it’s getting lower even thought the others are creeping up). I am so happy about the p. I almost cried happy tears on that one! :)

Asia’s onset is +2 and her nadir is all over the place recently, but when not clearing a bounce is often +6/+7 am cycle and +5/+6 pm cycle. I guess it will take some experimenting to see if it’s better to give R at the rise and if it’s more effective at +8 or +9 or +10 or +11. I’m assuming whatever is the earliest onset for R, that will be the case for Asia (if you can use her L onsets to make such a determination). I think if it in my head like counteracting and upward wave with a downward one and hoping the BG comes out somewhere in the middle. Like this: ( ) but horizontally?

I feel like if I give it at AMPS it will get too much downward momentum if they are both going at the same time. It might bring numbers down to where I want them, but I think it would happen way too fast and cause more problems with bounce. I don’t know if anyone would be around for a +10 ish pm cycle to hand hold me (that’s 0600 EST)? I can’t really set a date in advance because I have to see how a cycle goes, but ideally on a cycle where she has some greens in the middle, even an am cycle, is usually a sure bet she shoots way up when she’s done with that, somewhere in the +8 to +11 range. So what should I do, just holler out on my next green cycle and see who’s around?

I can monitor whatever I need to monitor, if it impacts the next cycle by giving a number for Lev to work with, I would consider that an overwhelming success, I’m very skeptical this will work out but it sounds slightly less exhausting than TID so I want to try it first. It’s keeping the trend going that will be tricky. I hope it can somehow reboot her and she can pick up some of the slack, that may be hoping for too much. I think something is going on in her body and I’m trying to put a bandaid on the numbers for the time being.

It’s $25 usd at Walmart, we just don’t have one here, but DH went to one for me. :)
 
Ella & Rusty & Stu(GA) said:
Hi Stacy, I'm sorry not to be able to comment on R or the other lab values. But I can send some vines for better numbers! And a few :bighug::bighug::bighug:s for you. I hope you hear from some of the knowledgeable people soon.
Amazing about the prices for R! I was under the impression that it was inexpensive (but then, it is NYC!).
Hang in there,
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Thanks Ella! Vines are helpful too! :)

There are lots of people in NYC that need affordable insulin, maybe I just didn’t price shop in the right neighborhood, but I somehow doubt it.
 
Stephanie & Quintus said:
I was thinking exactly this looking at your labs. I think that as with BG, we need to look at "big" things rather than minute details.

I'm sorry her BG is misbehaving, and really hope that something clicks soon -- whether R or something else.

:bighug::bighug::bighug:
thinking of you
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Thanks, Stephanie!

Yes, I have to remind myself to do that with her labs right now. It wouldn’t be a problem if I knew what was going on, it’s worse knowing there’s something and not being sure what, that’s when the lab number magnifying glass comes out. :rolleyes:

Something will click, I have to believe that or else I’d have a breakdown. :confused:
 
R can be tricky. Sometimes it does nothing, sometimes it has an immediate effect and then sometimes it impacts the following cycle instead. I know, not what you wanted to hear, but this is what I have experienced with Bronx however he was a big gulper at that time, ECID of course. It is a great tool to have though once you figure out what dose works for Asia.
 
Bronx's dad said:
R can be tricky. Sometimes it does nothing, sometimes it has an immediate effect and then sometimes it impacts the following cycle instead. I know, not what you wanted to hear, but this is what I have experienced with Bronx however he was a big gulper at that time, ECID of course. It is a great tool to have though once you figure out what dose works for Asia.
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Thanks, Paul. :)

So I keep hearing, I wish it cleared it up for me. :p

I hope it does something helpful and I can figure it out with Asia and her often unpredictable nature. It also sounds like a temporary fix, I’m hoping Asia is having a temporary problem! :facepalm:
 
Stacy & Asia said:
I’m having DH get some R from Walmart out of the city, they charge $180-$300 for the same stuff at non Walmart pharmacies here. :eek: Can you believe that?
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oh for crying out loud- that’s highway robbery! Nine years ago at our local Rite Aid we were paying $35 for a bottle...

Stacy & Asia said:
I guess I would start with AMPS, but ideally I think she should have it at +10/+11 in the pm cycle because sometimes she can drop 100+ points quickly with just the L, sometimes not, not recently anyway. Thoughts anyone?
Click to expand...
I agree In Asia’s case the bottom half of a cycle may be a better choice to start experimenting with R.
Stacy & Asia said:
I’m very skeptical this will work out but it sounds slightly less exhausting than TID so I want to try it first.
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Definitely less exhausting.
Stacy & Asia said:
So what should I do, just holler out on my next green cycle and see who’s around?
Click to expand...
Yup.
If someone with R experience does not respond and you feel the planets are aligning in favor of trying R, your first trial dose will be 0.1u. You know the drill- test every hour for 5 hours.
Stacy & Asia said:
I think if it in my head like counteracting and upward wave with a downward one and hoping the BG comes out somewhere in the middle. Like this: ( ) but horizontally?
Click to expand...
Yes, good analogy. I think of it as placing a ceiling over the cycle to thwart upward momentum.
 
Sandy and Black Kitty said:
oh for crying out loud- that’s highway robbery! Nine years ago at our local Rite Aid we were paying $35 for a bottle...

I agree In Asia’s case the bottom half of a cycle may be a better choice to start experimenting with R.

Definitely less exhausting.
Yup.
If someone with R experience does not respond and you feel the planets are aligning in favor of trying R, your first trial dose will be 0.1u. You know the drill- test every hour for 5 hours.
Yes, good analogy. I think of it as placing a ceiling over the cycle to thwart upward momentum.
Click to expand...

It is highway robbery, it’s not like they are currently doing R&D for a 30+ year old insulin. o_O

Thanks, Sandy. Will have to see what the next few days bring. These cycles are just getting wonkier. :( I hope Asia’s planets align...with TR! ;)
 
LizzieInTexas said:
Didn't find a post for today.

IDEXX has some interesting info on the SDMA test

https://www.idexx.com/en/veterinary/reference-laboratories/sdma/sdma-faqs/
https://www.idexx.com/en/veterinary/reference-laboratories/sdma/interpreting-your-sdma-results/
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Thanks, Lizzie. I did read those a couple times, I think I reread them every new lab result. I'm still pretty confused, especially when they said SDMA going down while the others going up is rare! :confused:

My vet doesn't trust the SDMA as much. Maybe it's past it's usefulness if you already have confirmed CKD? I don't know.
 
Stacy & Asia said:
Thanks, Lizzie. I did read those a couple times, I think I reread them every new lab result. I'm still pretty confused, especially when they said SDMA going down while the others going up is rare! :confused:

My vet doesn't trust the SDMA as much. Maybe it's past it's usefulness if you already have confirmed CKD? I don't know.
Click to expand...
Gizmo's old vet (I miss her so much) kinda felt the same way. Still looked at the BUN, Creat and ratio primarily.
 
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My vet told me SDMA is useful for detecting kidney issues before it starts being proper kidney failure. So, Quintus is stage 2, which is on the doorstep of CKD, and his SDMA are just above the norm.
 
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