6/2 Neko PMPS 426 +2 435 +3 494

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Wendy&Neko

Wendy&Neko

Member Since 2012
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Yesterday http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=72283 had a nice yellow start and then bounced to the blacks mid day followed by a black start going down to yellows and possible toe dip into blue then ending with black again this morning.

We have now had 5 cycles at this dose, and if anything it seems worse than the previous couple because the blacks are back and I just saw the first blue. Neko really isn't comfortable in the blacks and seems to be feeling worse than at the last couple doses because of it.

I probably don't need to ask and can guess the answer by now, dosecrease tomorrow? No signs of green unless it is happened at an odd nadir overnight. There have been so many bounces at this cycle that the dose hasn't really had a chance to do it's thing.

OT: weather finally sunny now. We had hail and thunder a few hours ago which caused Neko to dive under the bed. Rowing this morning was 15km with only one stop. I am bagged! Good snuggle time naps with the cats until the weather turned foul mid morning.
 
Re: 6/2 Neko AMPS 564 +3 392 +5 220 +7 213 +9 180 dosecrease

Wendy.....yes, I'd increase her .25u tomorrow UNLESS she continues the downward trend tonight. If she keeps coming down, then we need to wait and see what she does, ok? She looks like she's clearing
out this bounce and who knows....maybe this is the magic cycle where she'll settle in and start giving you some better numbers. Paws crossed!
 
Re: 6/2 Neko AMPS 564 +3 392 +5 220 +7 213 +9 180

Thanks Marje, that's the answer I was expecting but wanted to double check. Neko is showing more signs of hunger now which usually means going down, but it could be a reminder about snack time. :-D I think her +9.5 snack will be no carb today to see what might happen. Normally she gets something no carb and 1 tsp raw 4% carb.
 
Re: 6/2 Neko AMPS 564 +3 392 +5 220 +7 213 +9 180

Hi Wendy,

I know it's frustrating but don't let it get you down. Racci took forever to regulate! I thought she would never get regulated! It just takes some of them a little longer than others. Neko looks like she's going down nicely now. She just wants to be a rainbow kitty for a while. :razz:

Seriously tho, once she gets over all the bouncing and you find the right dose for her, it will be all downhill coasting from there.

Hugs,
Melanie & Racci
 
Re: 6/2 Neko AMPS 564 +3 392 +5 220 +7 213 +9 180

You can go ahead with .25u increase, but stop and think how small that increase is... your current dose is 6u.... go with .5u as your increase so that you hold the resistance back.

A .25u increase at 2u is alot bigger than a .25u increase at 6u.
 
Re: 6/2 Neko AMPS 564 +5 220 +7 213 +9 180 +11 291

If Neko has not been diagnosed with IAA or acro, I would follow the protocol and increase by .25u.

Also....does she need that +9.5 snack for some reason? Sometimes feeding that alte in the cycle (except for an almost OTJ kitty) can slow the effects of the insulin and cause your PS to be higher.

Good luck with the Dosecrease....she was not being cooperative :-D
 
Re: 6/2 Neko AMPS 564 +5 220 +7 213 +9 180 +11 291

Marjorie and Gracie said:
If Neko has not been diagnosed with IAA or acro, I would follow the protocol and increase by .25u.

Also....does she need that +9.5 snack for some reason? Sometimes feeding that alte in the cycle (except for an almost OTJ kitty) can slow the effects of the insulin and cause your PS to be higher.

Good luck with the Dosecrease....she was not being cooperative :-D
Click to expand...

OK, no problem to go ahead with the .25u increase... that's what I said, but some point, that .25u dose change becomes tiny.
A diagnosis of acro or IAA has nothing to do with dosing; I am not quite sure how you see that it's OK to step outside the protocol. The dose can be 2u or 20u, you still come to a point of needing to microdose.

As for the snack, have you heard about the 'no food for TWO HOURS prior to shots' guideline? I would say that a snack is OK at 2 and 1/2 hours before a shot time.... If you don't understand the reasoning behind the 2hours, please ask.
There is absolutely nothing wrong with a snack at +9.5, and I made a point of giving my cats something to eat at +10.

Can you explain how a snack at that point in the cycle slows the effects of the insulin?
 
Re: 6/2 Neko PMPS 426

PMPS 426

Both the Boomp and Rand study and the Tilley Protocol talk about increases of .5 units for "higher dose cats" without actually describing what a higher dose cat is. Since it'll be just DH and not me home tomorrow, I'm going to stick to the .25 increase for now.

The reason for the +9.5 snack is historical because Neko always used to get her main evening meal then and it's hard to shake that habit. It has been reduced to a snack and mostly no carb. I know, we have to be tough, but I'm trying to compromise.
 
Re: 6/2 Neko PMPS 426

Looks like Neko and Rupert are hanging together on that nasty red floor tonight!!! ohmygod_smile good luck with the dose change!
 
Re: 6/2 Neko PMPS 426

Gayle and Wendy are both correct. The option to go to increases of 0.5u is viable once a cat is at a larger dose of insulin. However, within the protocol there is no indication of what constitutes a larger dose. There is also the option to increase the dose every 2 days. (I'm not sure that I'd want to increase the dose by 0.5u every 2 days at this point, though!)

All of these are possibilities. However, context is important. If Wendy isn't going to be around to monitor, I'd also be leaning toward a 0.25u increase. I'm not sure that I'd call this a "large" dose quite yet. What I do think is that Wendy knows Neko and whether to increase by a larger amount or increase every 4 cycles is her call.
 
Re: 6/2 Neko PMPS 426

Wendy

Yes...I understand what the protocol says but you are correct that it doesn't define high dose. It might be a good question for Jill or Libby. Gayles concept is valid but it all boils down to what is high dose and the fact that she is getting blue on this dose. Maybe a little more will work? Hard to say.

When we were new, many people were feeding +9 snacks because someone read on a members condo...regarding an OTJ kitty...that a +9 snack would bring down the PS. Yes it can for Kim ttys whose pancreas are working...it gives them some encouragement. But the general consensus was it was not a good idea to bring down the PS of other kitties not about to go OTJ. And that it could result in the opposite effect.

I'll see if I can find those posts for you but if that is when Neko likes to eat and it's low carb....you should do what you know is best for her.
 
Re: 6/2 Neko PMPS 426

Marjorie and Gracie said:
Yes...I understand what the protocol says but you are correct that it doesn't define high dose. It might be a good question for Jill or Libby. Gayles concept is valid but it all boils down to what is high dose and the fact that she is getting blue on this dose. Maybe a little more will work? Hard to say.
Click to expand...
no, the Tight Regulation Protocol does not define what is considered to be high dose. "we" used to start thinking about the possibility of high dose conditions once a kitty reached around 5u BID without seeing much movement. in the last few years we've seen several kitties surpass that 5u BID mark, reach a break through dose, and then come down the dosing scale. two kitties who immediately come to mind are Randi's Max and Kathy's Kitty (Kosmo) ... both eventually went OTJ. Max was never tested for any high dose conditions. Kitty (Kosmo) was not positive for acromegaly/IAA despite his early doses of 10 units.

when making a decision to increase by 0.25 unit or 0.5 unit i look at the current data. if there's little to no movement (meaning kitty remains in the 200s or 300s at nadir), i usually suggest an increase of 0.5 unit at this stage of neko's dance.

if the current dose results in nadirs in the mid-100s or below, i usually suggest an increase of 0.25 unit. again, at this stage of neko's dance.

as the dose increases, there comes the possibility of increasing in even larger increments because as gayle said, "A .25u increase at 2u is alot bigger than a .25u increase at 6u." it's not uncommon to increase in increments of full units or more with high dose kitties.

so, the point i'm trying to make is there are no hard and fast rules about the amount of an increase... nor should there be. the current data will offer a huge clue as to a logical amount to increase. the amount of the current dose and how low the dose is taking the cat are primary considerations. a close second is the caregiver's comfort level and ability to monitor. and of course, should there be a confirmed diagnosis of a high dose condition... it may very well factor into the decision making.

fwiw, just my thoughts...
 
Re: 6/2 Neko AMPS 564 +5 220 +7 213 +9 180 +11 291

Gayle Shadoe & Oliver said:
There is absolutely nothing wrong with a snack at +9.5, and I made a point of giving my cats something to eat at +10.

Can you explain how a snack at that point in the cycle slows the effects of the insulin?
Click to expand...
i'm not good at analogies, but i'll give this a shot...

feeding at the end of a cycle *can* put the brakes on whatever insulin action is left in the cycle.

picture driving a car. there's a stop sign two blocks away (end of the cycle). if you take your foot off the accelerator (the action of the insulin waning), you'll glide to the stop sign (end of the cycle).

if you take your foot off the accelerator (insulin action waning) and then apply the brakes (feeding while the action of the insulin is waning), you'll stop before you ever reach the stop sign. in other words, the numbers will rise a whole lot faster than if you hadn't have applied the brakes (fed later in the cycle).

make sense? it's for this reason that i try not to feed alex past nadir.

now if a kitty is close to going OTJ... it's a whole different story. there's a working pancreas at play. feeding a snack later in the cycle (+8 or +9) will often stimulate the pancreas and bring the next preshot number down. we'll often suggest those late cycle snacks when kitties have pancreas' that are showing up for work.


wendy, some kitties are insistent about being fed late cycle. all you can do is feed a low carb snack... as you're already doing. we don't want any starving kitties!
 
Re: 6/2 Neko PMPS 426 +2 435

+2 435, looks like not much action tonight so up again tomorrow.

@Melanie - thanks for visiting. I guess you got good practice wearing patience pants like I am learning to!

@Gayle - thanks for the idea of the higher increases. It's an idea worth thinking about as a strategy for Neko.

@Seryn - yes, Neko does go in for drama and multi colours, just missing that very important colour called GREEN.

@Marje - Thanks for contacting Jill about higher increases in dosing. I am at home a lot so it's an idea worth considering. I am probably going to stick with the every 6 cycle increase for a while, because she is so bouncy and I need her to settle to give a dose a chance to work. I am also keeping an eye of the affect of her late snack - she doesn't get one for the AM cycle.

@Pip - did you get the thunder and lightning show today? I'm partially blaming Neko's numbers on that. That plus they are both rather dramatic about their bounces.

@Jill - very informative. Thanks for stopping by. You say
when making a decision to increase by 0.25 unit or 0.5 unit i look at the current data. if there's little to no movement (meaning kitty remains in the 200s or 300s at nadir), i usually suggest an increase of 0.5 unit at this stage of neko's dance.

if the current dose results in nadirs in the mid-100s or below, i usually suggest an increase of 0.25 unit. again, at this stage of neko's dance.
Click to expand...

Naturally Neko seems to be nadiring in the mid to high 100's, falling right in the middle. Also thanks for the examples of others. I like to ponder others spreadsheets to see if it can help me understand or see pattern's in Nekos.

I have just recently talked to my vet about my concerns about Neko's dose being higher than average. At some point soon I guess I should get her tested to see if she is IAA or acromegaly. It's unfortunate that I am the first client at the vet's office on Lantus, and it's not proving a great insulin for cats if you go by Neko's example. They had me started on Caninsulin and it was a locum who got me on Lantus (after me bugging them after doing research). My vet doesn't think Neko's dose is high, she has cats on higher doses. 11 units of Caninsulin. Yikes! The vet did talk about the possibility of seeing an internal medicine specialist, but that just seems like another expensive vet consult when all I want is a blood draw and tests sent.

My other possibility is to switch vets. My second kitty goes to a second vet (long story, short version is I needed a vet shop where all staff are female) and that second vet shop does have Lantus experience. I could switch Neko. I do like the original vet and one of their staff does petsitting for me and knows Neko so that is a factor.
 
Re: 6/2 Neko PMPS 426 +2 435

wendy, if you need a little help convincing your vet take a look at this link: Lantus and Levemir Kitties. You'll see tabs at the top of the page. there's an OTJ tab for kitties who followed the Tight Regulation Protocol. there's also a tab for OTJ (pre-TR) (Lantus & Levemir kitties who went OTJ before the Tight Regulation Protocol was widely accepted on the FDMB). lantus and levemir are great insulins! the Tight Regulation Protocol sticky towards the top of the page also has links to pretty impressive info about lantus.

if you have a vet you like, try working with them. it may be worth the effort. i've often told the story of how my vet said has said he learned about treating alex/feline diabetes with lantus and levemir along with me. six years later... he promotes hometesting, a low carb diet, and lantus and levemir. :mrgreen:
 
Re: 6/2 Neko PMPS 426 +2 435

Wendy

I can't take credit for Jill being in your condo.....I imagine it was Sienne. I was going to send her a note later....I've been busy with Gracie tonight. I'm glad she clarified things.

I have to laugh because I did find the condo I was referring to about the +9 snacks....then I get over here and Jill was here :lol: :lol:

Oh well, since I found it, here it is: Condo on Feeding

She's very consistent ;-) ;-)
 
+4 494 and we fade toward black, time to stop testing.

In spite of all the spreadsheets of high dose kitties I look at, I haven't seen any with as much black as Neko. She does like being different.

Grace - thanks for stopping by again, in spite of Grace. Congrats on the reducie. More reading for me tomorrow on feeding.

Jill - I think my vet might be open, but she is the junior vet of two in the office and the senior vet is "very old school". Even the locum (no spring chicken himself) called him that. Doesn't hurt to try to convert though. And the more data the better. Thanks.
 
sorry to bump yesterday's condo, but I wanted to chime in with my experience.

If you like your vet, then I think you'll be able to get her to work with you. They have been trained that acromegaly is rare, but we have learned that it is really not that uncommon (IAA still seems more rare, but not unheard of).

I had Jazzy tested for acromegaly and IAA at a lower dose than usual - I think she was at 5-6u, but I knew enough of her history that I was fairly sure she would test positive for acromegaly. My vet first said that she wasn't concerned because the dose was not really that high (true). She also said that there are a number of things that can cause a need for higher doses (also true). The vet felt that other causes would be more common than acromegaly and should be ruled out first (maybe true, but acro is more common than she thought). She mentioned pancreatitis (true, lots of FD cats have pancreatitis) and Cushings. Incidentally, Jazzy had already been tested for Cushings by a previous vet so we ruled that our right away. My vet said that if I wanted to start looking for a reason for the dose, a good place to start would be the Texas GI panel because it would address pancreatitis and some other things. Basically I asked her to humor me. The Texas GI panel is several hundred dollars, and the acro/IAA tests would be around a hundred, and my gut said that was it. She said that it was my money and she didn't have a problem sending in the blood if that's what I wanted. She was surprised when the positive result came back! I had a good relationship with my vet to begin with, but this actually made it stronger. Instead of being offended that I knew more about acromegaly than she did, she asked me some questions (starting with "how did you know she had this?!") and then she studied on her own.

I believe the tests do cost more in Canada, so having the tests done is not as casual a decision as it was for me. Gayle can probably help you find the best way to get it done, if/when you are ready.

About the black numbers, we've seen cats with a lot of black, with and without high dose conditions. Gus comes immediately to mind - what an ugly spreadsheet at the beginning, but Bev did a great job of getting him under control.
 
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