6/24 Henry PMPS 355

Suzanne & Darcy said:
Blue! You need to slow the drop with higher carb food.
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Yes, agree...though I am sure it feels counter-intuitive. You want to keep him about where he is and not let the R pull him down more.

Somewhere here I read, the L works better on lower numbers so the R has done its job to bring him to a better range for the L to work with. (I know someone can explain this better!)
 
Hi John, I just wanted to let you know that I have spoken to Wendy and she is really caught up this weekend and is not sure she will be able to pop into the thread or not, but she is aware how things are going.
She said don’t expect the R to work the same each time, and that R doesn’t always reduce the numbers every time but that keeping a lid on the bounce is a good reaction.This variability means we need to try a dose several times before tinkering with the R dose. Data gathering is needed before changing.
Also Lantus is a depot insulin. The dosing method works. so you need to be patient.

I can see you gave 0.25 R with the last two BG under 350 instead of giving 0.1 R
Please follow Wendy’s suggestions on dosing of R. I think it is a good idea to say online what you are going to give with the R so someone can check with you, while you are so tired.

Liz & Minnie said:
Somewhere here I read, the L works better on lower numbers so the R has done its job to bring him to a better range for the L to work with.
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Yes this is correct.
I can see the R has dropped the BG ny more than 100 by +2. I would also feed a little higher carb. We don’t want it to drop too much and cause another bounce.
 
Liz & Minnie said:
Yes, agree...though I am sure it feels counter-intuitive. You want to keep him about where he is and not let the R pull him down more.

Somewhere here I read, the L works better on lower numbers so the R has done its job to bring him to a better range for the L to work with. (I know someone can explain this better!)
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Yes. Wendy always used to explain it to me that the R would bring down the numbers and give the Lantus (or Levemir) better numbers to “work with.” This makes sense since these depot insulins are not good at shooting down high numbers.
 
The downward momentum has slowed at +2.75 to 172 on the nova and 242 on he libre. I do wonder how much my measuring skills play into this as I've spent a couple of hours now trying to be able to nail .1U and .25U doses, and it's very very hard. Maybe its because I don't have enough experience yet, but there are time when I "think" I got a .1U dose and when I hit the plunger nothing at all comes out on the paper. Also as I've said before these syringes are not manufactured uniformly. In some the plungers don't go all the way to the zero line, but others do. Makes it difficult for dosing such small amounts. I try to do a test shot on paper for each new syringe first. Anyway, I'm happy to finally be out of the reds and hopefully ketones go down now. In previous R doses we usually see a tick back up by +3 or +4. I expect we'll see that soon.

edit: In the FAQ it says it possible to dilute insulin, although the sanctioned dilutants aren't sold commercially anymore, but that sterile water can be used as a dilutant. Seems like being able to dilute the R would make for more accurate measuring.
 
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John & Henry said:
This is a good explanation. So the counter regulatory hormones are released from a fast drop and not just a low drop? How much of a fast drop? I've read 100 is ideal. What about going from 450 to 250 in a couple hours, is that too fast? I do like how you explain why (counter regulatory hormones).
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Depending on the cat the release of counter regulatory hormones can be triggered by a drop to a number lower than the cat’s body is accustomed to, a fast drop or even the length of time spent in the lower than accustomed to numbers. ECID. The important thing is to “know thy cat”

John & Henry said:
sometimes I have a hard time accepting things deemed to be canonical without an explanation as to why. Especially in non-standard situations like Henry's.
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Our situation was about as non standard as they come.

Sometimes you have to take a leap of faith. :cool:


 
John you can try these U-100 syringes with half unit markings, I see a lot of members like these
https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct
:bighug::bighug::bighug::bighug::bighug::bighug::bighug:
adw-coupon-dia10.jpg

10% off your next order!
 
John & Henry said:
edit: In the FAQ it says it possible to dilute insulin, although the sanctioned dilutants aren't sold commercially anymore, but that sterile water can be used as a dilutant. Seems like being able to dilute the R would make for more accurate measuring.
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I’ve never diluted insulin or known anyone who diluted insulin. I see no reason to do so.

Do the best you can. Your 0.1u is your 0.1u. The important thing is to be consistent.
 
What’s the WCR (whole cat report)?

All Ps in place? (peeing, pooping, playing, preening and purring)

Appetite good?

Caloric intake at 1.5x what’s required to maintain ideal weight?

results from today’s ketone tests?
 
Sandy and Black Kitty said:
What’s the WCR (whole cat report)?

All Ps in place? (peeing, pooping, playing, preening and purring)

Appetite good?

Caloric intake at 1.5x what’s required to maintain ideal weight?

results from today’s ketone tests?
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Ha! Hadn't heard about the Ps yet. Finally caught him in the box and got a ketone test. Its reading "trace", two poops, I wouldn't say he's acting particularly bright like he was after he had just came home, several months before the first DKA he had stopped grooming himself (I should have taken that as a sign in retrospect), he started grooming for about 2 days after he came home after the first DKA, but hasn't done it since. The vet says they stop to conserve energy and since he's mostly just a skeleton with skin at this point, he may still be trying to conserve energy. He's always a purrer whenever I pick him up except when he's really sick/lethargic/won't eat, and even then he'll usually do a few very quiet purrs if I love on him a bunch.

Appetite is ravenous as always, he's had about 2 1/2 cans in the past 7 hours. Last blood ketone test was at PMPS +6 and it was 1.1, urine ketone trace. Think I should do another blood ketone soon? I'm not as worried now that he isn't in the 300s, hopefully they'll come down now. I was planning on one at PMPS tonight unless his BG gets real high again. Doing AMPS +5 reading right now.

edit: for some reason he's been lying on the welcome mat at the front door since last night. This isn't a normal spot for him to hang out. Maybe he misses all the vet techs? They all seemed to love him (or maybe they just tell that to all their patients parents)
 
I think @FrostD called it at +1, bounce is breaking. Impossible to tell how much of the drop due to breaking bounce vs impact of the R.

What have you been feeding him up to now? LC or mix of LC/MC?
 
Liz & Minnie said:
I think @FrostD called it at +1, bounce is breaking. Impossible to tell how much of the drop due to breaking bounce vs impact of the R.

What have you been feeding him up to now? LC or mix of LC/MC?
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Yes, he's had 2 cans of FF LC and about half a can of DM. I think offering him the LC/MC mix right now would be a good idea, huh?

edit: he just loves the FF more than anything now. I'm afraid he'll just his nose up to his former favorite Friskies which is 18%
 
Yes, I would mix LC/MC now. As you said a couple of messages back, we don't want to trigger another bounce. For future reference, I would have started mixing the LC/MC as soon as he had such a steep drop at +1.

Which DM do you have - pate or savory selects (chunks in gravy)? The pate is 6% and savory selects is 10%.

ETA - Minnie loves the FF too so I keep these on hand (can usually get both at Walmart and the HC beef is almost everywhere)
  • HC 20%: FF Gravy Lovers Gourmet Beef Feast
  • MC 12%: FF Grilled Chicken Feast
  • MC 12%: Prescription Hill's ad (you can buy a few cans at the vet to see if he likes it then get it a bit cheaper from chewy)
 
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alio said:
Hi John, I've only partly been following Henry's story, but I just wanted to pop in and say what you are doing for Henry is very heroic, I can only imagine how stressed and exhausted you are. Henry is very lucky to have you!

With the bubbles in the syringe, I too struggled with that for a while. What worked for me (most of the time):
* hold the syringe with the needle up and flick the bubbles to the top
* still holding it upright, draw in more air to make a big gap of air at the top
* still holding it upright, slowly depress the plunger til the air is gone

It seems counter-intuitive, but, for whatever reason, the big air bubble likes to stay together when it gets expelled, whereas the tiny ones just seem to get stuck up the top.

The times this hasn't worked for me, is when there is insulin somehow above or on the side of the big air bubble, but, you can normally flick it into place. Sometimes it takes a couple of tries of redrawing more air.
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Thank you for those tips Alio! I've tried all of that and yes, it seems its the tiny bubbles that get stuck at the top, even after pulling in air. It's like they're stuck on the edges of the plastic. I've ordered a different brand recommended by @Diane Tyler's Mom
 
You can mix it in with the FF.

I keep these on hand. The HC beef is in most supermarkets, the grilled chicken I found at walmart. Re-writing this since I added to an earlier post after you read it :)
  • HC 20%: FF Gravy Lovers Gourmet Beef Feast
  • MC 12%: FF Grilled Chicken Feast
  • MC 12%: Prescription Hill's ad (you can buy a few cans at the vet to see if he likes it then get it a bit cheaper from chewy)
 
John & Henry said:
Thank you for those tips Alio! I've tried all of that and yes, it seems its the tiny bubbles that get stuck at the top, even after pulling in air. It's like they're stuck on the edges of the plastic. I've ordered a different brand recommended by @Diane Tyler's Mom
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I wonder if it's something about the coating that particular brand uses inside the syringe that attracts the air somehow. Hopefully, you have better luck with a different brand!
 
Liz & Minnie said:
You can mix it in with the FF.

I keep these on hand. The HC beef is in most supermarkets, the grilled chicken I found at walmart. Re-writing this since I added to an earlier post after you read it :)
  • HC 20%: FF Gravy Lovers Gourmet Beef Feast
  • MC 12%: FF Grilled Chicken Feast
  • MC 12%: Prescription Hill's ad (you can buy a few cans at the vet to see if he likes it then get it a bit cheaper from chewy)
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Thank you. I'll pick some of those up ASAP. He really loves the FF.
 
Will be interesting to see what his next BG is. Let us know the time between finishing the friskies and his next BG. (It should take about 20min for the food to have an effect)
 
Liz & Minnie said:
Will be interesting to see what his next BG is. Let us know the time between finishing the friskies and his next BG. (It should take about 20min for the food to have an effect)
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Looks like it's been almost 30 minutes and we just tested 125 for +6, so looks like we're leveling off. Let's hope we can just stay in the blues til PMPS in 6 hours.
 
Just giving you more choices of med and high carb foods
Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs
 
John & Henry said:
Thank you for those tips Alio! I've tried all of that and yes, it seems its the tiny bubbles that get stuck at the top, even after pulling in air. It's like they're stuck on the edges of the plastic. I've ordered a different brand recommended by @Diane Tyler's Mom
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I had a hell of a time with the BG syringes initially, now I realize it's less about the brand and more about the method. After some trial and error (and a bit of wasted juice:)) I have developed a technique where I'm getting maybe one or two, (sometimes zero) tiny bubbles that can be easily flicked up. I should mention I'm using a pen. The first bit is setting up a hands free rig:
https://www.felinediabetes.com/FDMB/threads/pen-syringe-hands-free-technique.264986/

As for the syringe priming method here's what I do:
*pull plunger most of the way out and move up and down (lubricates plunger)
*push plunger all the way in and WHILE PUSHING twist a couple times. (lubricates the area between zero and .5 where most of the bubbles hang out)
*KEY- while holding plunger pushed in, insert syringe into pen all the way. (no risk of contamination since syringe is empty)
*release thumb off plunger (this will instantly fill the area between zero and .10 (with zero bubbles if done correctly)
*then draw up your dose

All of this is much easier to do with the hands free method I posted I'm sure, although I have not dosed with one hand holding pen so can't speak to that.
Give it a shot! pun intended;)
 
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AbbottTheCat said:
I had a hell of a time with the BG syringes initially, now I realize it's less about the brand and more about the method. After some trial and error (and a bit of wasted juice:)) I have developed a technique where I'm getting maybe one or two, (sometimes zero) tiny bubbles that can be easily flicked up. I should mention I'm using a pen. The first bit is setting up a hands free rig:
https://www.felinediabetes.com/FDMB/threads/pen-syringe-hands-free-technique.264986/

As for the syringe priming method here's what I do:
*pull plunger most of the way out and move up and down (lubricates plunger)
*push plunger all the way in and WHILE PUSHING twist a couple times. (lubricates the area between zero and .5 where most of the bubbles hang out)
*KEY- while holding plunger pushed in, insert syringe into pen all the way. (no risk of contamination since syringe is empty)
*release thumb off plunger (this will instantly fill the area between zero and .10 (with zero bubbles if done correctly)
*then draw up your dose

All of this is much easier to do with the hands free method I posted I'm sure, although I have not dosed with one hand holding pen so can't speak to that.
Give it a shot! pun intended;)
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Thank you for all that. I have been trying to push in on the plunger before drawing, but didn't think about rotating to lubricate, that's a good idea. I just started moving it in and out to lubricate in the last day or two. I'm using a pen too. I'll check out the hands free rig. Excellent info!
 
John & Henry said:
60ml/day. Haven't given them today yet, but was just thinking about doing it as much I hate poking him with that needle.
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Please do.
Flush those ketones out.

I’m not sure if you have learned the basic how’s and why’s of ketone development and DKA but the way DKA happens is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
 
Sandy and Black Kitty said:
Please do.
Flush those ketones out.

I’m not sure if you have learned the basic how’s and why’s of ketone development and DKA but the way DKA happens is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
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Oh, I have. I've even been reading academic papers on it, and the number of chemical processes occurring is enough to melt my brain. Such a delicate balance with many variables. I worry Henry has very little muscle and fat left to be used as energy. He's a skeleton with fur at this point. We thought in the week or two after the first DKA he may have gained a little tiny bit, but that's all gone now. I'm trying very hard to fatten him back up!

This thread is getting a bit long so I made a new one: https://felinediabetes.com/FDMB/thr...5-2-198-3-163-4-151-5-126-6-125-7-133.265070/
 
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