BJM
Member Since 2010
from http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=72914&p=791412#p790827
"...what's your impression of Chip's Lantus spreadsheet"
"...what's your impression of Chip's Lantus spreadsheet"
6/12/2012 Dale 'n' Chip had a question
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BJM
Member Since 2010
First, I can see you are new to using Lantus. And the first thing to plant firmly in your mind is that Lantus dosing works best with consistency ... lots and lots (and lots) of consistency.
And tell us a bit about Chip - age, gender, weight status (high, low, OK), current diet, how he feeds (grazer, scarf 'n' barf, mini meals, etc),and any other health conditions that may affect his glucose levels - infection (dental/bladder), pancreatitis, inflammatory bowel disease, renal disease? I see a note about Clavamox - what is that treating?
On May 26th, Chip went down to a 52, which concerned you enough to give him some syrup on his tongue. The next day, likely due to the unfamiliar low glucose level Chip experienced, he bounced big time up to 522.
He had been on 1 unit for 3 1/2 days prior to going that low and you had dropped the dose to 0.75 that morning, so some of that low was carryover from the 1 unit dose because Lantus has a cumulative effect.
After 3 days of 0.75 units, you resumed a dose of 1.0 units for 4 1/2 days, then went down to 0.5 units for 5 days, then 0.3 units for 1 shot, then 1.5 for 1 day, then 0.72 for 4 days.
Er ... not real consistent there, so you can't really say much about the spreadsheet showing any trends, other than you're not at the ideal dose yet. He may need less than 1 unit and more than 0.5 units, but you are treating some sort of infection with an antibiotic, so its too soon to tell for sure.
So right now, your first objective is to have and to HOLD a stable dose long enough to follow the protocol for dosing Lantus. And note that treating an infection may lower the insulin requirement, so until you're done with the Clavamox, just hang in there, grit your teeth, and wait that out.
And tell us a bit about Chip - age, gender, weight status (high, low, OK), current diet, how he feeds (grazer, scarf 'n' barf, mini meals, etc),and any other health conditions that may affect his glucose levels - infection (dental/bladder), pancreatitis, inflammatory bowel disease, renal disease? I see a note about Clavamox - what is that treating?
On May 26th, Chip went down to a 52, which concerned you enough to give him some syrup on his tongue. The next day, likely due to the unfamiliar low glucose level Chip experienced, he bounced big time up to 522.
He had been on 1 unit for 3 1/2 days prior to going that low and you had dropped the dose to 0.75 that morning, so some of that low was carryover from the 1 unit dose because Lantus has a cumulative effect.
After 3 days of 0.75 units, you resumed a dose of 1.0 units for 4 1/2 days, then went down to 0.5 units for 5 days, then 0.3 units for 1 shot, then 1.5 for 1 day, then 0.72 for 4 days.
Er ... not real consistent there, so you can't really say much about the spreadsheet showing any trends, other than you're not at the ideal dose yet. He may need less than 1 unit and more than 0.5 units, but you are treating some sort of infection with an antibiotic, so its too soon to tell for sure.
So right now, your first objective is to have and to HOLD a stable dose long enough to follow the protocol for dosing Lantus. And note that treating an infection may lower the insulin requirement, so until you're done with the Clavamox, just hang in there, grit your teeth, and wait that out.
Dale 'n' Chip
Member Since 2012
BJM said:
Dale 'n' Chip said:
Chip has no other known complicating issues and has never had steroids. Going to be 7yo this summer. Diagnosed 13 months ago in DKA.
What is unique about his case, the vet took him off his first round of NPH after a few months because of very low fructosamine tests. He went without insulin for 2 months eating only prescribed Hills MD dry. Apparently most of that period his pancreas was attempting to keep up. His next Fruct test was 503 (poor control) ketones negative, so she put him back on 2.0U NPH bid. After I started shooting that again, he stopped eating almost entirely and lost 2 lbs in 6 days. Of course I freaked out and found this place. I was hometesting about a day later and saw that 2.0 U was way too much. I cut him to 1.5U and he started eating again, and I finally made the connection between the hypo low and the voracious eating. So I kept doing curves and had him weaned back off NPH about 3 weeks later, and switched him to FF classics wet. He went through the winter with only sporadic whiffs of NPH.
In the spring his glucose went back up so I tried to knock it down staring with 0.5U NPH against the low carb wet and he just bounced to black. What was missing was the dry MD time released carb buffer. I chased that bounce for a few months before starting Lantus and here we are now.
He was on clavamox that first round of NPH and since he hadn't had any AB in almost a year, I wanted to try it again for UTI or anything else, but nothing obvious.
Dale 'n' Chip
Member Since 2012
BJM said:
The question is what that dose should be. Most guidelines say anyone ketone prone should raise by 0.5U every 3 days if flat pink or above for 24 to 48 hours.
But he wasn't totally flat pink or above until now.
Dale 'n' Chip
Member Since 2012
Chip was just under 15lbs at the new vet getting the Lantus script.
Last week he was up to about 16, maybe down a little the last few days.
He was 14.5 lbs when he came out of the initial DKA, and up to
almost 19 lbs when the vet took him off NPH that first time.
Last week he was up to about 16, maybe down a little the last few days.
He was 14.5 lbs when he came out of the initial DKA, and up to
almost 19 lbs when the vet took him off NPH that first time.
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BJM
Member Since 2010
So he's had ketones before, the Clavamox is/was a test and he's not still on Clavamox(?)
How are his teeth - redness, tartar? Has he had a dental in the last year?
If you aren't already, feeding mini-meals in the first half of the cycle can reduce food spikes if he does that (ex pre-shot, +2, +4 OR pre-shot +3 +6). Alternatively, putting out half of the meal frozen may have a similar impact.
A new trial at 0.75 for the 3 days seems reasonable to me (I know it would be easier for me to estimate that on a syringe vs 0.72! but then, I have crappy vision)
If you are shooting less than 2.0 units of Lantus AND there were no ketones, I would make increases of 0.25, not 0.5 because it seems like he's a 'bouncer'. At least he certainly bounced the first time he did 0.75 units! Very gradually increasing may be less likely to trigger the bounces.
If you will be there to monitor, and he is high in the last 3 hours of his cycle, and in the black number-wise, that might be the time to test a tiny bit of R (1 drop) if you were going to do it. Then you'd test hourly to see how that works for him over the 4-5 hours R lasts, still doing the pre-shot and Lantus at their regular time. If you found it took as much as 0.5 units of R to cover that, and his nadirs were above 150, I think that would suggest adding more Lantus and reducing or eliminating the R.
I believe the regular Lantus users will encourage you to keep working with the Lantus.
How are his teeth - redness, tartar? Has he had a dental in the last year?
If you aren't already, feeding mini-meals in the first half of the cycle can reduce food spikes if he does that (ex pre-shot, +2, +4 OR pre-shot +3 +6). Alternatively, putting out half of the meal frozen may have a similar impact.
A new trial at 0.75 for the 3 days seems reasonable to me (I know it would be easier for me to estimate that on a syringe vs 0.72! but then, I have crappy vision)
If you are shooting less than 2.0 units of Lantus AND there were no ketones, I would make increases of 0.25, not 0.5 because it seems like he's a 'bouncer'. At least he certainly bounced the first time he did 0.75 units! Very gradually increasing may be less likely to trigger the bounces.
If you will be there to monitor, and he is high in the last 3 hours of his cycle, and in the black number-wise, that might be the time to test a tiny bit of R (1 drop) if you were going to do it. Then you'd test hourly to see how that works for him over the 4-5 hours R lasts, still doing the pre-shot and Lantus at their regular time. If you found it took as much as 0.5 units of R to cover that, and his nadirs were above 150, I think that would suggest adding more Lantus and reducing or eliminating the R.
I believe the regular Lantus users will encourage you to keep working with the Lantus.
Dale 'n' Chip
Member Since 2012
Vet looked breifly at his teeth and said they looked ok, no anesthesia, no dentals. Clavamox for the last 5 days, planning to continue 14 to 28 days at 62.5 bid which is a low dose for his weight.
Right now with *some* fear of ketones I'm just tryting to keep him eating whenever he's hungry. He eats before each shot and midcycle after each clavamox tablet. And not closer than 2 hours to AMPS PMPS testing.
The 0.72U dose is front of the stopper flange to the back of the half unit mark. My earlier 0.75U was centered between the marks so was actually 0.82U. So overall he had a stretch of 11 days of 0.82 to 1.0 units and it just seemed like a rut. But not as bad as now, so maybe the clavamox is kicking in? The 5 days @ 0.5U seemed better, he felt better and I believe saw a better average glucose level, more yellow, a few blue and lower pinks.
So 1.0 units it seems like we've been there done that, so perhaps it takes slighly more to quash the liver respose?
I'd love to try a bead of Humulin N to to *bump* the flat red, but for him N can last for 8 hours. Don't have any R but I believe it's over the counter at Wal Mart. So no Humulin of any flavor just yet. Just need to decide what Lantus dose to try next. Bump back to 1.0U some more? Or go for a bit higher to suppress that liver response?
Right now with *some* fear of ketones I'm just tryting to keep him eating whenever he's hungry. He eats before each shot and midcycle after each clavamox tablet. And not closer than 2 hours to AMPS PMPS testing.
The 0.72U dose is front of the stopper flange to the back of the half unit mark. My earlier 0.75U was centered between the marks so was actually 0.82U. So overall he had a stretch of 11 days of 0.82 to 1.0 units and it just seemed like a rut. But not as bad as now, so maybe the clavamox is kicking in? The 5 days @ 0.5U seemed better, he felt better and I believe saw a better average glucose level, more yellow, a few blue and lower pinks.
So 1.0 units it seems like we've been there done that, so perhaps it takes slighly more to quash the liver respose?
I'd love to try a bead of Humulin N to to *bump* the flat red, but for him N can last for 8 hours. Don't have any R but I believe it's over the counter at Wal Mart. So no Humulin of any flavor just yet. Just need to decide what Lantus dose to try next. Bump back to 1.0U some more? Or go for a bit higher to suppress that liver response?
MommaOfMuse
Member Since 2010
Personally looking at his spreadsheet I think if he was mine I would raise the Lantus dose to either 1.25 and exactly more likely 1.5 considering how high he is and hold a little longer than the standard 3 days to see if he needs a little longer to settle down on a dose. Unless of course he hands you something in the 40s - 50s of course. You may need to raise him just a little higher to hit a breakthrough point with him.
Mel, Maxwell, Autumn & The Fur Gang
Mel, Maxwell, Autumn & The Fur Gang
BJM
Member Since 2010
I see you've gone with 1.2; lets see how he does with that for at least 3 days, while checking for ketones and snagging what-ever mid-cycles you can. I only mentioned the R because you'd asked in the other thread.
Sometimes Lantus can be a bit jumpy before stabilizing in some cats. If you can hang in with it, the response pattern may level out.
Sometimes Lantus can be a bit jumpy before stabilizing in some cats. If you can hang in with it, the response pattern may level out.
Dale 'n' Chip
Member Since 2012
So far uneventful but at least it's not flat red.
I'll likely finish 3 days of 1.2U and if it doesn't shake up then move to an easy 1.5U.
He can survive the lower pinks with the dip to yellow for now. He was pretty active today.
I'll likely finish 3 days of 1.2U and if it doesn't shake up then move to an easy 1.5U.
He can survive the lower pinks with the dip to yellow for now. He was pretty active today.
max&emmasmommie
Member Since 2012
Go, Chip, Go!
Dale 'n' Chip
Member Since 2012
Flat mid pink drifting back up to flat red? :-|
We'll finish another day but it doesn't seem to be breaking the bounce.
We'll finish another day but it doesn't seem to be breaking the bounce.
Dale 'n' Chip
Member Since 2012
Well here we are, what do you think BJM?BJM said:
I suspect there is a completely separate problem to how much insulin he really needs. With the Lantus holding him in pink so long it may be making his liver set point worse.
BJM
Member Since 2010
If you have the time to do a curve this weekend, I'd hold and do that first, then follow the standard Lantus protocol for dose adjustments.
Otherwise, I'm thinking you could take it up to 1.5 and again hold it for at least 3 days (6 cycles/shots). If he tends to have major reactions to dose increases, making them smaller than 0.25 (which this will be) may cut down on the bouncing, but make it necessary to increase at 3 days if the dose is still giving you high nadirs. (aka "rinse and repeat!")
I'm not seeing any major dips and he has been above 200 for a week. I know you are concerned about the possibility of ketones, so keep checking those too, when you can.
Otherwise, I'm thinking you could take it up to 1.5 and again hold it for at least 3 days (6 cycles/shots). If he tends to have major reactions to dose increases, making them smaller than 0.25 (which this will be) may cut down on the bouncing, but make it necessary to increase at 3 days if the dose is still giving you high nadirs. (aka "rinse and repeat!")
I'm not seeing any major dips and he has been above 200 for a week. I know you are concerned about the possibility of ketones, so keep checking those too, when you can.
Dale 'n' Chip
Member Since 2012
What's the difference between high nadirs and perpetual flat bounce from too much insulin? Is there any practical difference? I can do a curve but it doesn't tell much when it's just flat red or pink. I'll keep tabs on where it's heading. It apparently won't kill him to hold 1.2U for another day, or 1.5U for 3 as long as he keeps eating. I wouldn't think there would be ketones with this much insulin since he's probably not acro or imunocompromised. And as long as he is not losing weight.BJM said:
One thing I can tell from the rapid yellow to black bounce, the pen is not bad. That high black would not happen so fast with too little or no insulin. And I don't think he should drift to high pink (on lo carbs) on his own without being steered by bounce reaction?
It's too bad I can't get back to 0.5U and hold that until I can figure something else out because he seemed to be doing better on that. Mostly lower pinks and dips to blue. If that were really too little insulin, would he still be having those dips to blue after more time in the yellow? I think it's unfortunate I didn't finish the 0.3U test because of perhaps unreliable ketone test strips. It is still my hunch that what he needs to reset the liver set point is a break from the insulin assault. I'm not really sure it will ever be possible to overpower his bounce by hitting him with more and more. But maybe that is the only way Lantus works, or maybe it simply doesn't work with such a highly resistant liver set point. Seems to work much better on cats coming in with no previous insulin. There may be two issues here; the liver set point from where he is used to being, and insulin sensitivity from too much.
So do I hold and then increase to 1.5U for a trial? Or how would I safely back down to 0.5U at this point? Is IAA something you can create by hitting them too hard for too long?
Maybe it makes more sense to trial the higher dose now while already up here. :?
He does seem to be feeling better today in spite of the numbers and he is eating well so maybe we are approaching the breakthrough dose.
BJM
Member Since 2010
All I can say is that glucose response is multifactorial - food type/quantity/carb content/timing, insulin type/dose/timing, activity levels, and comorbid conditions all can affect the numbers you are seeing. When he was at the 0.5, consider what other things were ocurring with those factors and perhaps note them on the spreadsheet. Then others can review and share their thoughts.
You hold the syringe; if you want to test 0.5 again, you certainly can do that if you will religiously test for ketones and are ready to return to the higher dose if you see them. It will take roughly 3 days for the shed to drain down to that dose, plus another 3 at that dose to stabilize so you won't be able to tell until perhaps next Wednesday or Thursday if you drop back to 0.5.
Mel (Momma of Muse) previously suggested you increase and she has more actual experience using Lantus than I do. If she says go higher, I'd follow that.
IAA is an autoimmune response to the insulin. If I understand correctly, the pattern observed is one of ever increasing insulin doses being needed to keep the glucose down.
You hold the syringe; if you want to test 0.5 again, you certainly can do that if you will religiously test for ketones and are ready to return to the higher dose if you see them. It will take roughly 3 days for the shed to drain down to that dose, plus another 3 at that dose to stabilize so you won't be able to tell until perhaps next Wednesday or Thursday if you drop back to 0.5.
Mel (Momma of Muse) previously suggested you increase and she has more actual experience using Lantus than I do. If she says go higher, I'd follow that.
IAA is an autoimmune response to the insulin. If I understand correctly, the pattern observed is one of ever increasing insulin doses being needed to keep the glucose down.
max&emmasmommie
Member Since 2012
PapaDale,
I agree -- I think you should follow Mel's advice. Go up and hold longer than 3 days. I would be so afraid of ketones that I would go UP rather than down at this point. Afterall, you are almost "there." Better to go up and come back down than start over low and have to go all the way back up again - as long as you do it slowly in small increments and are available to prevent a hypo.
This is a bit of a ramble – sorry – I had a lovely, organized post for you, then my log-in timed out, and I lost it. This is a do-over:
I have struggled with whether to go up or drop down for a long time.
I look back, and see that I got some blues at 2 units, and then I started getting nothing but ugly numbers. Then, I had a near hypo scare like you did. So, I lowered the dose, I lowered it again for my cat sitter while I was gone for 10 days. Nothing good came of it.
When I got back from vacation, I couldn't decide what to do. I raised the dose to 1.75 for a couple of shots, then I missed a shot. So, I decided that was a good opportunity to start over at 1 unit. I did two shots at 1 u, and then I chickened out when he was in the black for amps, pmps and the next amps. So, I decided to go up instead. I was going up again in .25 increments.
I wasn't using the protocol. I got such horrible numbers that I felt he had to be bouncing constantly or the dose was way too low. (Not that I recommend going off protocol, btw.) I was so anxious and worried about the damage that was being done to his organs, and I held the doses long enough to clear bounces that never fully cleared. I couldn't get any numbers that would help me decide what to do.
I got terribly depressed about the whole situation. I stopped spot checking and doing curves. I couldn't get any help here because I didn't have the energy and frankly, the stomach, to put Max through curves and spot checks that I believed would only confirm my despair. At least you are testing Chip regularly, and that sometimes is all you can do until you or someone else sees something in your sheet that means something. If you get into a funk, keep testing or, when you come out of your funk, you won't be able to get any advice from the people on this board who are the most experienced.
Anyway, when I got back to 2.5 u, I got a too-low-to-shoot-blue at AMPS. I didn't know not to shoot through that, and I did. He was fine, but he bounced way up. There are no guarantees, but it seems that a bouncy cat is more likely to bounce than hypo.
At this point, I've been at 2.75 for a long time -- 50 days. I've been holding this dose so long because, at first, I couldn't get his
shot on time, then I got too-low-to-shoot numbers, then I didn't use the last of the pen properly and unwittingly missed doses, then I gave a fur shot, then he got dehydrated and constipated -- there was always something going on that meant I was screwing up the shed or something was affecting the delivery.
Now, I look at that curve on June 2, the one on the 3rd, and that gorgeous, beautiful, lovely, smashing, mesmerizing curve on June 4, and I think what if I'm at the right dose? I've had him well hydrated for 16 days, and I haven't missed a shot time for 9 days except for a fur shot 6 days ago. We had a lovely blue at AMPS yesterday, and now we are in the black again.
I still don't believe I'm at the right dose, I still feel despair, but at least I'm holding it together. I still think about dropping him down to 1 or 1.5 units and starting over.
Hindsight is always 20/20, but I now wish I'd had the energy and the time to push my vet to look at Max's teeth more thoroughly after the people on this board said that their cats all have dentals, and it's generally safe. My vet had said that he did not recommend cleaning the teeth of 16 year old cat because he's had some die a few months later. That freaked me out. The other day while I was talking to the vet, he admitted that he could at least do an inspection of his teeth with nothing more than a sedative, and we could decide what to do from there.
So, what I am saying is keep testing, keep posting, take whatever steps you can to find out if there are comorbidity issues, and if you get discouraged, try to keep it from affecting your actions.
Also, I highly recommend that you take BJ's advice and make extensive notes to the side of each day's readings. What didn't seem important that day may be really helpful to have noted when you are looking over the colors later on.
Hang in there!
I agree -- I think you should follow Mel's advice. Go up and hold longer than 3 days. I would be so afraid of ketones that I would go UP rather than down at this point. Afterall, you are almost "there." Better to go up and come back down than start over low and have to go all the way back up again - as long as you do it slowly in small increments and are available to prevent a hypo.
This is a bit of a ramble – sorry – I had a lovely, organized post for you, then my log-in timed out, and I lost it. This is a do-over:
I have struggled with whether to go up or drop down for a long time.
I look back, and see that I got some blues at 2 units, and then I started getting nothing but ugly numbers. Then, I had a near hypo scare like you did. So, I lowered the dose, I lowered it again for my cat sitter while I was gone for 10 days. Nothing good came of it.
When I got back from vacation, I couldn't decide what to do. I raised the dose to 1.75 for a couple of shots, then I missed a shot. So, I decided that was a good opportunity to start over at 1 unit. I did two shots at 1 u, and then I chickened out when he was in the black for amps, pmps and the next amps. So, I decided to go up instead. I was going up again in .25 increments.
I wasn't using the protocol. I got such horrible numbers that I felt he had to be bouncing constantly or the dose was way too low. (Not that I recommend going off protocol, btw.) I was so anxious and worried about the damage that was being done to his organs, and I held the doses long enough to clear bounces that never fully cleared. I couldn't get any numbers that would help me decide what to do.
I got terribly depressed about the whole situation. I stopped spot checking and doing curves. I couldn't get any help here because I didn't have the energy and frankly, the stomach, to put Max through curves and spot checks that I believed would only confirm my despair. At least you are testing Chip regularly, and that sometimes is all you can do until you or someone else sees something in your sheet that means something. If you get into a funk, keep testing or, when you come out of your funk, you won't be able to get any advice from the people on this board who are the most experienced.
Anyway, when I got back to 2.5 u, I got a too-low-to-shoot-blue at AMPS. I didn't know not to shoot through that, and I did. He was fine, but he bounced way up. There are no guarantees, but it seems that a bouncy cat is more likely to bounce than hypo.
At this point, I've been at 2.75 for a long time -- 50 days. I've been holding this dose so long because, at first, I couldn't get his
shot on time, then I got too-low-to-shoot numbers, then I didn't use the last of the pen properly and unwittingly missed doses, then I gave a fur shot, then he got dehydrated and constipated -- there was always something going on that meant I was screwing up the shed or something was affecting the delivery.
Now, I look at that curve on June 2, the one on the 3rd, and that gorgeous, beautiful, lovely, smashing, mesmerizing curve on June 4, and I think what if I'm at the right dose? I've had him well hydrated for 16 days, and I haven't missed a shot time for 9 days except for a fur shot 6 days ago. We had a lovely blue at AMPS yesterday, and now we are in the black again.
I still don't believe I'm at the right dose, I still feel despair, but at least I'm holding it together. I still think about dropping him down to 1 or 1.5 units and starting over.
Hindsight is always 20/20, but I now wish I'd had the energy and the time to push my vet to look at Max's teeth more thoroughly after the people on this board said that their cats all have dentals, and it's generally safe. My vet had said that he did not recommend cleaning the teeth of 16 year old cat because he's had some die a few months later. That freaked me out. The other day while I was talking to the vet, he admitted that he could at least do an inspection of his teeth with nothing more than a sedative, and we could decide what to do from there.
So, what I am saying is keep testing, keep posting, take whatever steps you can to find out if there are comorbidity issues, and if you get discouraged, try to keep it from affecting your actions.
Also, I highly recommend that you take BJ's advice and make extensive notes to the side of each day's readings. What didn't seem important that day may be really helpful to have noted when you are looking over the colors later on.
Hang in there!
Dale 'n' Chip
Member Since 2012
I think I will hold this for now, the bounce cleared black fast. And really I'm falling back on his clinical presentation here. He's feeling great today and eating well. I suspect his weight is up and his coat is better than it was before we started. More plush and he just smells clean and healthy, overly groomed. Yesterday he was lethargic and mopey after being active the day before. Since he's not falling suddenly too low, I'm inclined to try 1.5U tomorrow like Mel suggested. A good time to curve would be when he heads back into yellow.BJM said:
Thanks BJM for starting this thread and helping me think it though. :smile:
BJM
Member Since 2010
If you review the secondary monitoring tools in my signature link, you'll see the 5 Ps mentioned.
When the 5 Ps are all good, the cat is usually doing OK.
They may not be very precise measures, but as you mention - its the whole clinical picture of how does the cat seem to feel.
When the 5 Ps are all good, the cat is usually doing OK.
They may not be very precise measures, but as you mention - its the whole clinical picture of how does the cat seem to feel.
MommaOfMuse
Member Since 2010
One other thing to remember and this kind of goes along with BJ and the 5 Ps...Don't get so hung up on the numbers that you forget to look at the whole cat. Not a single one of them became a diabetic over night and they aren't going to go into remission (at least normally) over night either. This is a maraton not a sprint. 
We call this a dance for a reason, because when just starting out you are going to trip over your own feet, step on your partner's toes, stumble and fall down, but you just pick yourself up and dust yourself off and try it again. And slowly, with practice, the steps fall into place and before you know it you and your partner are gliding across the dance floor. The only problem with this particular dance is that only our cats can hear the music that we are dancing too. So we have to watch them for signals on what the next steps are going to be, and well afterall they are still cats. :lol: Some will waltz, some will tango or quick-step and some like my Maxwell will just decide that they don't want to dance and go OTJ.
Mel, Maxwell, Autumn & The Fur Gang
We call this a dance for a reason, because when just starting out you are going to trip over your own feet, step on your partner's toes, stumble and fall down, but you just pick yourself up and dust yourself off and try it again. And slowly, with practice, the steps fall into place and before you know it you and your partner are gliding across the dance floor. The only problem with this particular dance is that only our cats can hear the music that we are dancing too. So we have to watch them for signals on what the next steps are going to be, and well afterall they are still cats. :lol: Some will waltz, some will tango or quick-step and some like my Maxwell will just decide that they don't want to dance and go OTJ.
Mel, Maxwell, Autumn & The Fur Gang
Dale 'n' Chip
Member Since 2012
I need to cut back on testing as soon as the dose settles because that's another $75/month in test strips that seems to go on forever with Lantus. If we could even survive the endless sleepless nights. I'm fearing this excursion into LaLaLantusland may prove less than productive. If I would have just gone with U40 BPC PZI and clavomox even 3 months ago I'm quite sure we'd still be OTJ now. And life would be quite different. How are we supposed to know these things, well as you said hindsight is always 20/20. :smile:max&emmasmommie said:
Dale 'n' Chip
Member Since 2012
Can't believe I never saw this before:BJM said:
Handling fur shots with supplemental R
And here is a good example of using R to knock down bounces:
Boo Radley SS
Scroll down to 4/5/12 "Start of Levemir" and you can see what the (brown) R bolus did. I guess it did prevent ketones but apparently didn't help with regulation so she stopped.
I guess I'll hold this dose until I can recoup enough sanity to figure out the next move. I'm curious to know how he would do on a more appropriate microdose of NPH, instead of Lantus. At least I would know the results in only hours. @-)
max&emmasmommie
Member Since 2012
"Need to cut back on testing" -- I know. This can get expensive when you have to test a lot. I just mean don't go for too many days without getting something between +5 and +7 or you'll be sorry later that you don't have the data.
Dale 'n' Chip
Member Since 2012
Not a good time to be running low on test strips, but it looks like he just went 24 hours yellow or better. dancing_cat
Dale 'n' Chip
Member Since 2012
Going on 48 hours without a bounce? nailbite_smile
If he could do this in blue I strongly suspect he would be OTJ within weeks. That would sure solve numerous dire problems.
(Chip did you hear that?)
If he could do this in blue I strongly suspect he would be OTJ within weeks. That would sure solve numerous dire problems.
(Chip did you hear that?)
Dale 'n' Chip
Member Since 2012
max&emmasmommie
Member Since 2012
Wooooooo Hoooooo!!! Go, Chip, Go! :RAHCAT :RAHCAT :RAHCAT
Dale 'n' Chip
Member Since 2012
And we have another so soon, again right at the nadir. 
She may need a new title: the cat whisperer?
Sheila was on board for holding the dose. Tilly and the TR crew would have missed this one.
MommaOfMuse nailed what might be Chip's breakthough dose. How precise is that? :mrgreen:MommaOfMuse said:
She may need a new title: the cat whisperer?
Sheila was on board for holding the dose. Tilly and the TR crew would have missed this one.
Jill & Alex (GA)
Member Since 2009
with lantus & levemir, one dose builds upon the next.Dale 'n' Chip said:
chip had a dynamite response to 1u bid (yes, the greens on 05/26 were because of the cumulative effects of the 1u dose - unlike what you see when using NPH), but lost momentum when the dose was prematurely reduced to 0.75 unit (according to the guidelines in the TR Protocol). once momentum is lost with the long-acting insulins (including levemir), it's not unusual... to have to surpass the last good dose before you see another break through.
sorry, dale... tilly and the TR crew would have predicted this one. :mrgreen:
Dale 'n' Chip
Member Since 2012
Sorry is right. Shoulda coulda woulda. They plain and simply didn't.
Mel is the one who called this one. ;-)
Mel is the one who called this one. ;-)
Jill & Alex (GA)
Member Since 2009
there's a relevant bullet point contained in the Suggestions for Advice Givers.Dale 'n' Chip said:
it reads:
- Don't act as if you're entitled to tell people what to do. You can offer help and advice, but it's up to the other person to decide what advice to take for their cat. They won't always agree with you -- that's life. If it makes you crazy, move on to someone who is interested in what you have to say.
you've been extremely vocal in your disdain about lantus, the TR Protocol, and the TR forum. your negative comments are littered all over the board.
people move on... as suggested in the "Suggestions for Advice Givers". that doesn't mean they don't recognize the inevitable when it comes to using lantus.
Dale 'n' Chip
Member Since 2012
Well it's official. After one month on Lantus he's lost half a pound. He actually weighs less now than recorded at any point during his DKA. This is on two scales at the new vet for which we have records going back almost a year.BJM said:
Overall I think the *cat* still ok, this may be more a failure of the FF. He isn't crazy about it but he won't even touch any other wet. :?
As for the 5 P's, preening is excessive, very clean and plush coat.
Poohing and Peeing are in good shape.
Playing is down.
Purring, hardly ever really feels like purring these days. Poor thing.
Interesting that after all the ruckus and stress at the vet he was only up to 205. May have been a disrupted green nadir.
Another interesting new development is that he has apparently had little bounce since the last green run. If that holds up it may be big news. :smile:
Dale 'n' Chip
Member Since 2012
BJM take a look at it now. Looks like he is doing it in blue for real this time, anti-jinx. After 12 days of holding the dose.Dale 'n' Chip said:
Seems like he feels pretty good. I heard him purring louder than I remembered he could. cat_pet_icon
BJM
Member Since 2010
What a nice run of blues!. Vetw who are unfamiliar with tighter control practices would be very happy with this.
Since he becomes very erratic with dose changes, do you want to continue with this dose, or do you want to see if you can get him any lower, safely? (Don't you just love it when we throw it back in your lap?) With him it seems to require lots of checking since his levels go haywire for a while.
Since he becomes very erratic with dose changes, do you want to continue with this dose, or do you want to see if you can get him any lower, safely? (Don't you just love it when we throw it back in your lap?) With him it seems to require lots of checking since his levels go haywire for a while.
Dale 'n' Chip
Member Since 2012
I'm not sure what is really going on here. Will it continue? Or will it edge to green and bounce to pink/red?
It seems like blue is the new yellow. :thumbup
So I will hold for now. Since this is his lowest daily average level since he was OTJ.
The last time he eased down to staying mid blue or lower, his pancreas started sputtering and pulled him green with no regular shots.
So he may not be the type to need rigid TR.
It seems like blue is the new yellow. :thumbup
So I will hold for now. Since this is his lowest daily average level since he was OTJ.
The last time he eased down to staying mid blue or lower, his pancreas started sputtering and pulled him green with no regular shots.
So he may not be the type to need rigid TR.
Dale 'n' Chip
Member Since 2012
He was all warm and fuzzy and purring loudly again before PMPS. This time I think he really was yellow then since we got the full red bounce. And I decided he is a little skinny, he needs to gain about a pound or two. And that may not be possible on wet food. Perhaps until I start making my own?
If I were to decide not to hold the dose, what would a good option be? What would the protocol dictate with these numbers?BJM said:
BJM
Member Since 2010
If you choose to increase, then because his dose is under 2 units, increase no more than 0.25 units.
With a tendancy to become erratic, doing the "fat" or "drop" increase may work better, if you can be consistent in measuring it. Also, he's made it down to the 80s at times on 1.5 units, so a 0.25 unit increase could get him into hypo territory.
To dose as consistently as possible using the drop method, take an empty syringe and fill to 0.5 units with water. Carefully squeeze out 1 drop at a time (try twisting the barrel of the syringe), until you can get the same number of drops consistently. Practice to literally "get the feel" of it and develop some muscle memory.
With a tendancy to become erratic, doing the "fat" or "drop" increase may work better, if you can be consistent in measuring it. Also, he's made it down to the 80s at times on 1.5 units, so a 0.25 unit increase could get him into hypo territory.
To dose as consistently as possible using the drop method, take an empty syringe and fill to 0.5 units with water. Carefully squeeze out 1 drop at a time (try twisting the barrel of the syringe), until you can get the same number of drops consistently. Practice to literally "get the feel" of it and develop some muscle memory.
Dale 'n' Chip
Member Since 2012
After 7 days he finally hit some perfect greens on that dose, but then stopped. :?BJM said:
If that repeats every 7 days or so I suppose it might mean 1.5 is too much and he is over-bouncing?
I've practiced the drops and it really does take muscle memory to be consistent. However Lantus is so thick it makes better drops than NPH or water. Sheila has a methodology of looking for reference points on the syringes, and it seems to be more consistent (where I got 0.72, 1.2) but must be adapted to each brand of syringe and markings.
Dale 'n' Chip
Member Since 2012
Look at that BJM, 12-14 days later another perfect green surf on the same dose out of nowhere.BJM said:
Do you think such a pattern might suggest 1.5U is too high?
If I were to reduce the dose, would I want to take the elevator down to 1.0U, without stopping on any other floors first, and then hold for 7-14 days? :?
Dale 'n' Chip
Member Since 2012
We changed the L and started over. :smile:Dale 'n' Chip said:
Looking back on that now, I'm not thinking 1.5U was necessarily too high. The pattern may have been caused by working through temporary insulin resistance, since he really wasn't bouncing much once the dose settled.
Thanks again BJM for an interesting thread. Going back to one of the original questions, I'm thinking in Chip's case it's likely better to get the right dose of the base insulin, than a bolus of R.
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