5/5Willy AMPS 220,+2~357,+5~349 insulin from canada/ dose+?

[Stephanie&Willy]

Willy's Condo from yesterday

Willy is doing well today, much less grumpy than he was yesterday. I am a bit disappointed, I thought he might come down today because his numbers from last night seemed so promising. However, I am very happy that we are seeing less red in the last few days! Yay!

My DH gets out of school next week and we are going to be making an appointment with our vet to talk about Willy's progress and such. To my knowledge, she just wants to talk with us and didn't specifically request seeing Willy (at least that was the message that was passed on). I have a few questions though...

I am not sure if I am just getting frustrated, or if I am being an overprotective-worrier-momma but I sorta feel like Willy should be responding a little better than he is overall. I discussed having Willy’s teeth cleaned with the DH and I periodically do full body checks on my pets and his teeth don’t seem too bad, but I’m far from an expert. Even though it’s pretty expensive, I would rather be safe and maybe it would help his numbers. DH agrees that it‘s worth a try, though they didn’t seem to think it was a big concern the last time he was at the vet. Other than dental, are there any other common co-occuring disorders that might be wise to discuss with my vet?

My other question is about economic insulin. I know the Lantus cartridges/pens are a much better deal (and typically keep a little longer) than the viles, but if Willy continues on such a high dose would they still be more economic for us? I don’t know if I am thinking about it wrong (most likely) but 3ML seems like a small amount compared to Willy’s dose (4.75u BID, potentially increasing). I’m sorry if this is totally silly, math was never my strong point.

I looked at the Supply Closet to see if I could find more information about ordering economic insulin and it seems like people have some luck purchasing at Sams Club (or is it Costco, I get them confused), Walmart, and from Canada. While I would love to be able to order from Canada (we pay $115 for insulin at Walgreens with Willy’s “prescription card” not sure how much pens/cartridges would be), I live in Northern Arizona. From experience, does anyone know if the insulin would keep all the way here (with the temp in this region none the less)? Do you think any of the companies would be willing to work with me and pack extra cooling to ship it all the way here? If it would cost even close to the same as we pay now, it would probably be better just to keep buying it as we are rather than risking getting a bad batch and fighting to get out money back. Glancing over where most people with success ordering from Canada live, they live up north… so maybe this would be better to try to attempt in the winter.

I appreciate any input and have a great afternoon/evening!

 

[Sienne and Gabby (GA)]

Re: 5/5 Willy AMPS 220, +2~357 ? cooccuring stuff/insulin

The disorder that seems to crop up the most often is pancreatitis. It sort of makes sense in that diabetes is a disorder of the pancreatic beta cells. I tend to think you'd know if Willy had pancreatitis, though. You haven't completed a Profile, so I can't check Willy's age. Hyperthryroidism occurs more frequently as cats age. If this hasn't been checked when you've had a vet visit, it can be checked as part of a routine blood draw.

IMHO, Willy isn't on a high dose of insulin. At the point that a cat is needing around 10u per shot, people often consider switching to a vial. At that point, it's more economical.

What I would suggest is that you read over the tight regulation protocol. I tend to think you're holding on to a dose longer than you need to. The longer you stay at a dose that's not bringing numbers down, the greater the chance that Willy will get used to being in higher BG ranges. Willy also looks like he's bouncing. As frustrating as that can be, you need to wait out the bounce before increasing the dose. I'm curious as to how the rest of the cycle progressed.

 

[julie & punkin (ga)]

Re: 5/5 Willy AMPS 220, +2~357 ? cooccuring stuff/insulin

at 7units on average, punkin goes through a pen ($41 here) in just about a month. you're far under that, practically half that dose, so it would totally be more economical for you to be using the pens.

i don't know the answer to the rest of your questions . . . we have had a lot of conversations recently about dentals though - i wish we'd done punkin's earlier. punkin's was on 3/29 if you want to look back to the discussion on that day.

 

[Stephanie&Willy]

Re: 5/5 Willy AMPS 220, +2~357 ? cooccuring stuff/insulin

Hi Sienne!

I hope you and your DS are doing well. We are working on our profile still, but I tried to include some of the information in my signature, if that helps. Willy is ~9yrs. old. And in general, seems healthy other than being a pound (possibly, it depends on the vet that sees him) overweight and the BG.

I have hypothyroidism and I didn’t even think about it as a potential problem for him! In the brief reading I did, it seems like a possibility because of his dry coat/skin. My main symptom is excessive dry skin despite having humidifiers and such in my house. He’s my only pet with this problem, but I always attributed it to his lack of grooming which has been something he’s lacked since he came to us as a stray. I went undiagnosed for 5 years without many complications (only getting diagnosed when I became amenorrhic), so I could expect that it could be similar for him. I will definitely bring this up with the vet.

I read through the tight regulation protocol and I know I held this dose longer than necessary. Unfortunately, we had an emergency on Thursday 4/28, which was the day he started his new dose (did not know about the emergency until much later in the day ohmygod_smile ). We didn’t have time to make arrangements, so he had to travel with us. He actually travels pretty well, but in all the chaos we forgot his insulin so he wound up waiting until morning when our vet could call us in a prescription.

I was concerned about increasing right away once we returned home on Saturday night 4/30 because I didn’t know how much stress hormones were affecting the numbers we were seeing (300-400). I was going to wait 3 days to get things back to “normal” and the third day, Tuesday 5/3, was when we saw the low numbers. Did I handle this wrong? I felt I had a good plan and was on the right track but the emergency really threw a monkey wrench into the situation and I didn’t want to be too aggressive so far from home.

He is on cycle 4 of what I presume is a bounce with his numbers back in the 200-300 range. I was planning to increase his dose tomorrow AM where I can keep a close eye on him. Would this be ideal, or would it be better to wait another full day? I get confused with these sorts of situations (gut says to do it tonight because I think the green was an anomaly but the "safer" option is to wait until tomorrow).

 

[Stephanie&Willy]

Re: 5/5 Willy AMPS 220, +2~357 ? cooccuring stuff/insulin

Oh! thanks so much for the pen info Julie! that's really helpful because I'm pretty visual so the comparison was exactly what I was hoping for! Can I get the pen and remove the needle tip thing or is it better to get the cartridge?

Did Punkins dental seem to help? I will definitely search for the thread and take a look at the SS a little later.

 

[julie & punkin (ga)]

Re: 5/5Willy AMPS 220, +2~357, +5~349 ? insulin

you just use your regular syringes with the pen - don't let the pharmacy talk you into getting the needles that actually go with the pen. just put your needle through the rubber stopper. take a look here and you can see it:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

i think the dental started to help, but then he developed an infection at the site and we're still recovering from that.

i knew punkin's teeth likely needed cleaning because of his breath, but what i didn't know was that he had one tooth that was completely separated from the roots and only held in place by the tartar. ewww, i can't hardly even admit that, and it's gross besides! but it must've been a factor in his health. can't see how it couldn't have been a problem. so we're still doing antibiotics and will see what happens in the next weeks.

 

[Stephanie&Willy]

Re: 5/5Willy AMPS 220, +2~357, +5~349 ? insulin

Thanks for the information about the pens, I am telling my DH all about it right now cos I'm sorta excited about it (saving money, yay). :lol: After we get our new prescription, I will have to call around and price them.

Poor Punkin! But I bet he feels much better now and I hope he gets better soon!

Does you vet give antibiotics after the cleaning? My older guy (non diabetic) was cleared to have dental done in February and my vet prescribed antibiotics after the procedure just in case. His teeth were kinda yucky but they weren't too bad. She said you can't be too careful with all the scrubbing and stuff that they do, bacteria is bound to get into their system when they are working in the mouth and gums and such. She also gave us the option to get painkillers for him, we left that to her discretion and he got some while he was still there but didn't need any to take home. He is the first pet I have ever taken to get dental work, so I'm not too sure what the standard for that is.

 

[Sienne and Gabby (GA)]

Re: 5/5Willy AMPS 220, +2~357, +5~349 ? insulin

I remember the emergency trip and all of the ups and downs with it. Basically, stuff happens and you adjust. I was simply making an observation as an FYI not being critical.

It's possible that Willy is bouncing. He definitely took a bounce after the greens. It's possible that he dropped into the blues last night and what you're seeing today is either a bounce off of last night's numbers or a continuation of the bounce after the greens. A bounce can last up to 72 hours.

Regarding the pens, you can't get cartridges any more. They were discontinued. Definitely don't use the needles. The pens will only dispense in 1.0u amounts which is why you need the syringes. Also, if you don't want to buy a box of pens (most places will only sell a box of 5 pens), call some of the local hospital pharmacies. The outpatient pharmacy may sell single pens since hospitals have to break up boxes all the time.

As for dentals, some vets will give an AB at the end of the procedure but not send ABs home with you. It depends on whether there was an infection present. (Also, make sure that your vet doesn't give a shot of Convenia. It's a 2 week long AB and if your cat has a reaction, since it's a shot, there's nothing you can do.) Most vets do not give pain meds unless there's an extraction. This is a good description of what a dental should include.

 

[Stephanie&Willy]

Re: 5/5Willy AMPS 220,+2~357,+5~349 insulin from canada/ dos

I didn't take it as criticism, Sienne! No worries! It's really hard for me to convey emotions, in general, and it's even worse online. People never think I am being serious about stuff (I tend to make lightly of most situations I'm in- I'm usually too optimistic about the nature of people). *hugs!*

Prior to reading the protocol about a week ago, we were doing increases no sooner than once a week, that's why there has been such a delay. Depending on who we had spoken to (vet wise) is how often they recommended increasing and by how much. We received a lot of conflicting advice in a relatively short amount of time and shut down because we got overwhelmed. Now, I feel pretty confident in Willy's care (even if it's wrong, I'm learning a lot, doing the best I can) and I feel like I could handle a potential situation. Waiting 3 days is nothing compared to the 1-2 weeks (or longer) we were waiting. :lol:

I just don't know (genuinely) if I handled the situation appropriately by assuming stress as a factor and not increasing directly after. I was going back and forth the entire time on what to do and didn't have access to the internet but recalled some information about stress potentially influencing BG and decided to be safe since I have never taken him to a vet in that area. Forgetting the insulin at home was such a bonehead move, we were quite upset with ourselves (probably more so than about the actual emergency that dragged us there in the first place) but we did our best to make a calm, thought out decision and stuck with it in an attempt to be consistent.

Unfortunately, this probably will not be the last time something like this happens to us (the same situation happened ~4yrs ago). I am hoping to be better prepared in the future.

Based on your experience, when do you think it would be best to increase (I know it could change with a good AMPS reading)? I'm not sure what a bounce looks like when it clears and I know now that waiting too long to increase can be detrimental too. Do you happen to know if there's any information available on bouncing? I'm sorry I keep making you repeat yourself, Sienne, I just want to make sure my thought process is somewhat on par. :cry:

Thank you for your help!