6/20 Lucian +6.5/165,+9/153,+10.5/186,PMPS 582,+3/322

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Re: 6/20 Lucian AMPS 463

nckitties3 said:
acckkkk! It's 4:05 am and I've been laying in bed for over an hour and 45 mins..........nothing! :-x I'm gonna shave Lucian and paint his toenails pink to get even! :lol:

Guess I'll try to find an old '40's horror flick, there are tons of them on Roku, I love it! :-D

When is the pedicure happening for Lucian?

And inquiring minds want to know, is the "Shave" going to be a Mohawk or some other cool doo?
 
Re: 6/20 Lucian AMPS 463,+6.5/165

That's a surprise to wake up to. I didn't get to sleep till after his shot this morning.

With such a drop, I'm afraid he'll bounce all over again. Hate to get back into that pattern.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

ok, the bad news is he's still over-reacting to lower numbers, but the GOOD news is he's clearing those bounces pretty darn fast... on his own!
bottom line: i see progress being made here! :mrgreen:
 
Re: 6/20 Lucian AMPS 463,+6.5/165

So what're you thinking about doing - continue with R, switch to Lev in hopes it gets better duration, or consider split dosing?

With the R at +2ish +10ish, you're already shooting about 4 times a day, which would be the same with split dosing. Levemir would be just every 12 hours, if the R weren't necessary.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

I think whichever I use, the R might be necessary.

Jill, what do you think now? Do you want me to hold it a couple more cycles to see what he can do? Over time, his SS will show that the Lantus can get him down, it just can't handle the bounce. What would you do with him? If you look back, not the last time he was on 2.0, but the time before, without R, it dropped him to 38 but he'd bounce to 600+. It can get him down there, but....
Do you understand what I'm saying? I'm pretty foggy right now. What do you think?
 
Re: 6/20 Lucian AMPS 463,+6.5/165

BJM said:
So what're you thinking about doing - continue with R, switch to Lev in hopes it gets better duration, or consider split dosing?

With the R at +2ish, you're already shooting about 4 times a day, which would be the same with split dosing. Levemir would be just every 12 hours, if the R weren't necessary.
BJM: i'm not seeing R being given at +2ish. it's not what you want to do with lantus because you'd run the risk of the basal & bolus hitting nadir close to the same time.

fwiw, i don't know how many years i echoed others by saying lev offered kitty "more duration"... until i had one of those "a-ha" moments. lev doesn't necessarily last longer. lev kicks in later and can be seen later in the cycle, but if you compare the hours the insulins appear to be active in the cycle... you're talking about close to the same duration with lantus and lev.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

I think BJM was thinking 2 hrs before shot and wrote +2. I do that stuff all the time. :lol:

What do you think about 8 hr dosing?
 
Re: 6/20 Lucian AMPS 463,+6.5/165

nckitties3 said:
I think whichever I use, the R might be necessary.

Jill, what do you think now? Do you want me to hold it a couple more cycles to see what he can do? Over time, his SS will show that the Lantus can get him down, it just can't handle the bounce. What would you do with him? If you look back, not the last time he was on 2.0, but the time before, without R, it dropped him to 38 but he'd bounce to 600+. It can get him down there, but....
Do you understand what I'm saying? I'm pretty foggy right now. What do you think?
if i were in your shoes i would stick with lantus only for a couple more cycles... for no other reason than it'll give us a good idea of what he's capable of without R. he's clearing his bounces faster than he has ever before... without R. now that doesn't mean you should throw the R away. keep it handy. lol!

an example:
amps today was 463. ugly number, right? let's say you had given R this morning. it would have brought him down and then the lantus would have kicked in/grabbed onto the lower number. without R he's dropped almost 300 points by +6.5. if you had given R, chances are the drop would have been in excess of 300 points. this is where the use of R can become counter-productive because the drop will only set him up for yet another bounce. undoubtedly he'll bounce from this drop as it is. however, if he continues to recover as quickly as he's currently showing us without R... holding off on the R for the moment might be better for him. i dunno. the verdict is still out.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

Sorry - yes, meant +10 or -2, as the case may be.

If you can schedule TID dosing of every 8 hours, that could do it. Sum up the total insulin dose from the 2 shots, and divide by 3 to get the dose for every 8 hours. Shooting early is like a dose increase, so you'll want to time it to line up the 8 hour cycles with what works best for your schedule.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

nckitties3 said:
What do you think about 8 hr dosing?
it's a tough schedule, debbie.
can i get back to you on that? i have a client coming any minute now and i'd like to spend some time studying lucian's ss before commenting.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

That's what I wanted to know. I have no problem holding him another couple cycles/days so you have more to go on. You see things that I don't and all I have is what I can see from the past on his SS.

You think he would have fallen farther had I given the R say at +10, but could it be that he wouldn't have bounced so much, high/low, if he hadn't gone so high to start with? Maybe his drop wouldn't be so intense if he wasn't allowed to get so high? Keep in mind, I ask because I want to understand how it works. That's what I was trying to do with the R and feeding up, keep him on a more level keel until he got used to it and hopefully could do it on his own.

Have you known anyone that has split the daily dose in 3 instead of 2? I can see where that looks like a possibility for Lucian, with his late cycle spikes. It seems like it would be even more restrictive for me, both sleep wise and being able to get out, since I would have 3 cycles to contend with instead of 2, but that's the way my brain works. @-) Of course, I'd give it a shot if nothing else works.

It's been a really hard 6+ months for both me and Lucian and I just want to get back to something similar to a normal life again. I know it will never be NORMAL, but we got to get it closer than it is now! :shock:

Yeah Jill, when ever, I'll be here.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

Another couple of thoughts - how much R are you giving?
And, would giving a small dose of an N insulin be less harsh in the drop and less likely to trigger a bounce than the R?

It isn't a standard protocol, so there are bound to be some dissenting replies to this.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

BJM, I have no schedule :lol:

But let's say I was to schedule his shots for 7am, 3pm and 11pm.........if I was out during the day, I'd have to run home to shoot his 3pm. OK, so I schedule my PT for 11am? Then he's running low that cycle, so I can't go. The thing I'm looking at is that I would have 3 cycles where he could run low and throw a wrench into what ever I needed to do, whether it be sleeping or having to go to PT, etc. At least with 2 cycles, I know there are some times that are reasonably 'safe' to schedule, ya know? Of course, then again, maybe with 3 cycles, being reduced doses each time, there may not be as many times that would be a problem. Maybe it would be more even then. I dunno. I am trying to weigh out all the options. There's just so much I don't know. You've been watching Lucian almost from the start, you know how erratic he is. So far, everything that works for a 'normal' FD kitty, hasn't worked for him. I'm hoping having another set of very experienced eyes on him (Jill) we'll all be able to come up with something.

I so appreciate your input. :YMHUG:

The R, I don't know what the dose is, but it's tiny, the plunger is touching the zero line. I don't see where it drops him that far. If I give it at +10 his amps will be 50-100 points below his +10, usually closer to 50. He drops much faster/further on the Lantus regularly. Don't know if I can get the N without a 'script'.

I realize it isn't 'standard' but neither is Lucian. :shock: I've lost count of how many experienced board members have told me "I dunno, I've never seen anything like Lucian" and have no advice. Desperate times require desperate measures. We'll keep at it until we find what DOES work for Lucian.
 
Re: 6/20 Lucian AMPS 463,+6.5/165

So right now, you're often giving insulin at 0 (Lantus) and +10 (R)

If you were to do split dosing of the Lantus, you could
a) divide each regular dose into 2 equal amounts
OR
b) divide in 1 larger and 1 smaller amount

One of the concerns is if each insulin shot somehow winds up metabolizing differently and the nadirs of both shots coincide. Well, that could be equivalent to the nadir you're getting now, and that has usually been OK.

If you go with option A, the nadirs of both may be higher because you're using half the insulin for each - think of 2 U shapes one on top of the other. Now make them half as tall and separate them side to side a little bit while still overlapping.

If you go with option B, you'll have the main nadir, which is still likely to be slightly higher due to less insulin, plus a 2nd nadir when the 2nd dose hits its bottom, probably slightly higher than current too. The duration, however, may, we hope, go a bit longer. Visualize a big U vs small u, superimposed, then separate them side to side a little bit while still overlapping.

Additionally, you want the amount of time between the a & b shots to be the same morning and night, and 2 hours might work with how the Lantus works (seems to wear off or bounce by +10), but not necessarily with your life (sleep!).
 
Re: 6/20 Lucian AMPS 463,+6.5/165

I understand the concept, more or less and that's all well and good with a cat that is even slightly consistent. Therein lies the problem, Lucian has never had 2 cycles even close, nadirs all over the place, etc. If he was consistent in anything, we could find a workaround. That's been an issue from the start. Not knowing what to do because you can never predict what HE'S gonna do in any given cycle. Used to be able to kinda expect a low cycle after a flat one, but even that's a crap shoot.

He's laying on the bathroom rug, preening, not a care in the world.........I wanna slap him in his head! :lol: You know I wouldn't, but dammmit, as stressed as I am over him, he could at least act like he's concerned! :lol:
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153

Perfect example of never knowing what he's gonna do. Although I do think the chance of him skyrocketing in the next hour or so, is better than him having a decent pmps. But again, you never know with him, which makes it so hard to figure out how to handle his treatment. confused_cat

After doing some reading, I realize that I am using the term 'split dosing' incorrectly and do not feel it is something that I will be trying with Lucian anytime in the near future, he is too unpredictable and I do not feel I have the experience to even consider something so far 'outside the box' at this time. 6 months from now, I may feel differently and I am so grateful to have all the suggestions and ideas I have been given. Without everyone's help, we would have never made it this far!

Thank you! :YMHUG:
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153

OMG! I just about had a stroke! :shock:

I have a couple pounds of cooked turkey meat in the freezer, so I decided to pull out this frozen, elongated chunk and use my cleaver to chop off the end, to thaw for Lucian to have as his CF snack, when needed. SO here I am, holding it with my left hand and whack it with the CLEAVER.............I felt the blade, ever so slightly, brush against my knuckle! My aim was off by about 3 inches! :o I thought I would hit the floor! I can't believe how close I came to doing serious damage to myself! :shock: I'm still shaking! :shock:
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153

Hon! I know better! I have the world's worst aim! WTH possessed me to think I could hit that meat where I wanted to? I know better! :o My aim is so bad, I can't even play Putt=Putt! :o
My anxiety meter has Red-Lined! I'm still shaking and trying to calm down. I can't believe I did that! There is nothing in my 56 years of history that would make me think I was capable of hitting that with any precision! :o Good Lord!
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153

I'm just happy it wasn't a kitty paw in the way of that cleaver!!!
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153

oh my gosh! thankfully you're alright!!!!!!

a few thoughts/comments...

re: the use of N
i'll be very honest. i don't think N is a good choice as a bolus because it lasts too long in kitty's system (6 - 8 hours usually). that said, in the years i've been on the FDMB i have seen 2 caregivers use N successfully as a bolus insulin (only two). one is no longer posting. kitty was highly suspected of having acromegaly, but was never tested. kitty is now a GA and to my knowledge the member hasn't been around for several years. the other is dale/chip. dale is using lev + N combo. if N is something you want to pursue, you should get in touch with dale and pick his brain about it. i'm not comfortable offering advice when i haven't used an insulin that acts so differently than lantus/lev + R.

re: shooting TID
like i mentioned earlier, shooting TID is pretty rough on the caregiver. although, michelle/doodle (GA) did an awesome job with shooting TID: https://spreadsheets.google.com/spr...PidCi0ocDBBNHpXMUV1WUVTZ0NsZGNFSklrVFE&gid=14. imho, you're not at the point yet where i would suggest shooting TID. personally, i'd rather see you switch to lev before attempting 3 shots a day just because it's so darn hard on the caregiver!


honestly, considering the recent progress we're seeing on lucian's spreadsheet (clearing bounces pretty fast), if i were in your shoes i would increase the lantus dose to 2u BID. what you would want to do is bump him up with food before nadir to keep him from dropping too low. this'll take a bit of experimenting at first, but it's do-able. the increased dose *should* offer a little more duration.

you might be thinking it didn't work last time you tried. the difference is lucian has changed. now he's clearing bounces faster than he was before. i think it's worth trying... so much so that it's the method i would choose if lucian was my kitty. i've gone down the road of shooting as needed with alex. it's not quite the same as shooting TID, but similar in that you're basically chained to the cat 24/7. it's hard. it wears you out because you rarely get more than a couple consecutive hours of sleep... not to mention you have no life outside of feline diabetes. i don't wish that on anybody.

you still may see some ugly numbers with an increase to 2u BID, but he IS clearing bounces faster than ever before... which is taking him into better numbers overall.

i'm trying to offer some balance... you having a life along with lucian's care.

just my thoughts...


ps- i have to work for a few hours tonight, but i'll be back later.
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153,+10.5/186

He's climbing a bit....... had to calm down so I could test him :lol: WOW, what a day!

Have you ever done something that made you look back and say "What was I thinking??" :o That's how it was for me! :lol: It's funny now, that it's over and I WASN'T injured.
It terrified me for a while, the 'what ifs', ya know? Maybe not, I'm one of those 'what if' kinda people, which is why I'm such a preparation freak.........that just in case thing. :-D
That will most certainly go down on my list of one of the stupidest things I've ever tried to do. :lol:

Back to Lucian, yeah, it scares me to increase again because of the past and trying to figure his nadir, which changes every cycle. The reason I usually test at +3 or +4 is cause I can tell if it's gonna be a low day, USUALLY early on. But that's a crap shoot too. Of course, raising the dose will keep me locked in trying to feed up for several hours each cycle too. Did that for a while, but at least I can schedule my PT appts for late afternoon and be fairly sure he's safe.

What makes this so difficult for me, is that I am a factual person needing explicit instructions to function properly. You know, if the number is XX at +X, then do this..... But I realize that is not possible. SO it makes it hard on me trying to figure out what to do when I have too many options. :lol: Does anyone understand what I mean? I realize because ECID there are no set rules and that's what makes me crazy! @-) I need set rules! :lol: Without options that I have to make a decision on! :lol: Aw geez, you do what ya can. :-D

As far as changing dose scheduling, he's too erratic and I'm too inexperienced to try that. No worries there, at least not for a long time. :roll:
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153,+10.5/186,PMPS 582

Nobody bounces better than Lucian! :shock:

I did up his dose to 2.0. If this doesn't change in a few days, what about adding back the R?
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153,+10.5/186,PMPS 582

nckitties3 said:
Nobody bounces better than Lucian! :shock:
J.D. bounces pretty good, too :-|

I did up his dose to 2.0. If this doesn't change in a few days, what about adding back the R?
Good luck with the new dose ;-)
 
Re: 6/20 Lucian AMPS 463,+6.5/165,+9/153,+10.5/186,PMPS 582

nckitties3 said:
I did up his dose to 2.0. If this doesn't change in a few days, what about adding back the R?
absolutely! a few years ago in LL we used to call R "my little friend" for a reason!
hope you can get some sleep tonight. you must be beat! I-)
tomorrow's another day...
 
Yeah, I'm extremely tired, but not very sleepy. Hope to get to sleep in an hour or so.

Have a good night.
 
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