6/30/2-15 NORMAN AMPS 198 WOO HOO +6 327 I don't know what to do anymore

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Cindywith4cutecats

Cindywith4cutecats

Member Since 2014
Norman is having a wonderful day. He is up and he is BOSS cat this morning. He did not nag me or nip me to get up and feed him after his usual 5 am feeding. He usually starts nagging by 8:30 in the morning. Norman let me sleep in till 9:30 1 3/4 units of Lantus , yesterday AM was our fist increase to this dose.
His AMPS 3304 303 7 265 +10 307 PMPS 308 + 4 233 + 6 198. Now he starts his day with a 198. this is when I had the problem in the past when he was diabetic. I wasn't following protocol correct cause I flat out was so sick with being Hyperthyroid myself and pretty much close to having a heart attack that I was not functioning. This time around I have to follow tightly . I feel much more at peace but at the same time I know the ride we are taking from here on out. At least this time around I am not ill like I was and am not having the cognitive issues as a result of the hyperthyroid.. Any cat that is Hyper I totally feel for them .....Back on track here, will be testing him the + 6 +9 also today. Have to watch him so close now....but I feel such relief..+6 I get a 327, the only thing I can figure is we have a storm going on but I had him purring and calm before testing


previous condo http://www.felinediabetes.com/FDMB/...-amps-330-4-303-dose-increase-this-am.140141/
 
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just tested and got +8 317. We had some nice blue showing up and now after his 3rd shot of the dose increase we are back up again. next stop is going to increase him half a unit instead of quarter units.
 
That's great that Normal spent some time in the blues last night. :cool: It's been a while since he's seen blue, so he's bouncing badly, but I'd hold this dose at least 6 cycles to see if he can get back there. And the next increase would be .25 units to 2.0U if he doesn't get to green on this dose. You slow down the increases as you get closer to the good dose. You'd only go to .5U increases now if he was over 5 units for his dose.
 
Ok...I will keep hopeful and watchful . I hope he can get back to some blues for me, it felt so good and even this morning with him having the same number as last night of the 197/198 it was a relief but only short lived
 
I know it's frustrating and you want him back in good numbers all the time NOW. Couple reasons you want to only raise the dose .25 at a time...one is safety, a main theme of the protocol, but another reason is you don't want to pass over his 'good' dose whatever that may end up being.
If you try to hurry him to get 'there' and raise him too quickly, he may end up bouncing which actually slows your progress and makes it confusing trying to figure out what is going on. At that point you are trying to overcome the bouncing, riding that out vs. slowly, methodically progressing until you find the right dose he responds to. He is going to go up and down until you hit his good dose.....he will get there I know. Hang in there and follow his lead. :bighug:
 
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it gets so disheartening when you see a lowering of the numbers and then BAM high numbers all through this cycle...we started this cycle at 198 to end up PMPS 326. I went to bed last night with a+6 of 198 , so I really had hope we found a dose that we could start working with considering it was only his 2nd shot. oh well tomorrow is another day and maybe just maybe he is bouncing and this will level out
 
You have got to try and roll with it. Cooper did that all the time. Started lower and went higher. Very frustrating I know, but look at where he is now.
 
I am so concerned about organ damage being done while he is so unregulated. I can tell his numbers are high right now, he is under the bed sleeping. Only hides when numbers are high or there is thunder and we have no thunder now....at this rate if follows in the foot steps of some other cats I am months away from any sort of normalcy with him. How was your cats quality of life during all that period he was unregulated
 
Cindywith4cutecats said:
I am so concerned about organ damage being done while he is so unregulated. I can tell his numbers are high right now, he is under the bed sleeping. Only hides when numbers are high or there is thunder and we have no thunder now....at this rate if follows in the foot steps of some other cats I am months away from any sort of normalcy with him. How was your cats quality of life during all that period he was unregulated
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I know, I have been concerned about organ damage too. But there is absolutely nothing you can do about that outside of working the protocol to find the right dose and getting blood work checked periodically to keep a check on things. Cooper acted fine when he was at high numbers. He peed and drank a lot more water, but he was still Cooper. I would be very upset too if my kitty was in remission and then fell out of it, but you are really not far along at all in getting him treated this time. You have no reason to think you're not going to get him regulated!
 
I didn't believe I would still be sitting here 17 days later with the same numbers. I really believed I would see a decline in the numbers by now. I guess Norman was just awesome the first time around and this time around he is going to take his sweet old time finding a dose, I have seen some SS that cats 4 months later are still not regulated and on really high doses of insulin..that really scares me.
 
Just hang in there, try not to rush him, and follow the protocol. FD can be incomprehensible even when you are doing everything right. Some days are just weird. Try not to worry about all the things that can go wrong and you will be less frustrated. People say that the second time around can be totally different from the first. You can't compare then and now. Just accept the now!

Have a good evening and don't worry!

Ella & Rusty
 
Because of bouncing, it helps to get in the habit of looking at the spreadsheet for the past 3-4 days, rather than a single cycle at a time. That gives you a more accurate picture of what the cat's really looking like - after 3 days you won't see New Dose Wonkiness, you will have seen something in between bounce cycles. I always ask the question "how low will this dose get this cat?" and right now, it looks like the 1.75u can get him below 200.

This post has a good explanation of several things, but primarily I'm thinking you might like to read the part about why we wait x amount of time for a dose increase. Take a look and see if it's helpful.

That was great to see the blue numbers creep in early this morning - celebrate it! He's making progress! As Wendy said, it's really common for cats to show pretty much no movement in their numbers until you increase methodically and hit the sweet spot that suddenly starts moving them. You're getting closer to that sweet spot - so hang in there.

The increase amount is decided by the TR Protocol guidelines. To decide how much to increase, you'd look at the ss for the previous 3 days or more on the same dose and decide how low the dose takes Norman - right now it would mean a dose increase of 0.25u unless something changes in the next few days. You'd only do 0.5u if he was constantly over 300, or if he was a higher dose cat and his dose was over 5u.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
I saw your comment on the spreadsheet about skipping his dose a few times then giving a larger dose. Lantus really works best if you just increase methodically. You can't use it to knock down high numbers.

When you skip shots, you're messing with the depot. You can think of the depot as being sort of like timed release. When you increased to 1.75u, the depot was in an equilibrium with the 1.5u dose. It needs to "grow" to become in equilibrium with the 1.75u. After it gets there, then it will slow release a larger amount, because the dose is now larger than it was at 1.5u. So there is a relationship between the size of the dose you inject, and the size of the depot within his body. The best results with Lantus happen when you understand how it works and use it to your advantage.

By the same token, when you decrease a dose, the depot was built at the higher dose, and it will need up to 6 cycles to reduce the depot and be in equilibrium with the new smaller dose. When cats have low numbers and get a dose decrease, sometimes they'll see low numbers again in the next 2-3 cycles after the dose decrease. Depending on the situation, often people will suggest that those low numbers are still being caused by the depot from the previously larger dose.

Hope that helps explain why you just want to follow the dose adjustments - time and amount - suggested by the TR Protocol.

Glad you're feeling better this time around with Norman!
 
When I looked back he was put on a high dose since he was in the 400 to 500 range and it knocked him right down and dose decrease within 6 days. His numbers increased for 3 days and then that was it. He coasted down. I feel like I am harming him right now, nothing is getting him moving. If you look back a 5 or 6 days ago he was on 1 unit and gave us a nice blue number and low yellows, then that went to hell. I keep looking to make sure he is not being overdosed or not enough. Todays numbers are horrible, they are no better at all than when this nightmare started. I would think since his eating schedule and food has not changed from the cycles then even if we are not a great working dose that the dose would keep him from getting worse ! I look at his sheets and he is no better off at 1.75 than he was at .25 dose...as I currently look at these 1.75 cycles he would require a dose increase at the end of 6 cycles and then the dance is deciding which increase , will have to weigh out the number of nadirs , mostly purple, yellow or BLUE , if we see blue then we hold a few more days to see what it will do...I guess this Time Norman is making me work hard for it ...being patient is not something I have mastered at all.. I keep thinking maybe just maybe the 1 unit dose was correct looking back at that sweet low blue number but he couldn't hold it for some reason..
 
The look of his spreadsheet is not especially unusual. It's not uncommon to see a peek of better numbers and then have to go up in dose. I know it can be discouraging to not see an immediate response, but there is a dose that will move Norman into normal numbers. You'll get to it! You just want to do it safely by being methodical. There's just no way to rush diabetic regulation.

:bighug:
 
It helps me to remember than insulin is a hormone, not a medication. There is an entire system at work. You can only do so much yourself, the rest is up to Norman's body. It's very common for kitties to see an initial reaction to insulin, then have the numbers look worse for a while. Just keep following the dosing guidelines in the protocol. You will get there. :bighug:
 
all that glares out at me is the purple numbers. we have purple and yellow nadirs...so as a result of so much purple would we increase him by .50 units or still only the .25 units. It seems like when we go .25 units his body just get use it and it doesn't do a thing for him. I wanted to do tight regulation and I thought tight was to start at .25 units per kg of weight.......but now I am screwed since I started the go slow method. I would have loved to have seen improvement at some point but my husband is getting upset with me cause Norman is taking all my time and I have to be home for testing and meds...I will chose Norman first , he is always first even at the cost of hubby number two
 
You can still do tight regulation even if you started with the start low go slow method. I would still only do increases in .25 units. Reevaluate every 6 cycles. You really should not be increasing in .5 units. That is for kitties on high doses of insulin, which Norman is not.
 
Also, I kept thinking we were overdosing Cooper when he had high flat numbers and that was not the case at all. I would decrease the dose and it would get worse. He needed more insulin. You just haven't found the right dose for him.

Make sure your injection technique is right too. When we first started posting here on FDMB, Cooper had terrible numbers. Marje on the board asked me about our technique. We realized we were shooting too flat. We were only tenting the skin a little and shooting kind of parallel to his body on his side. Now we pull up the skin as high as we can on his flank and inject at the very bottom of the skin at a 45 degree angle to ensure we are getting into the subcutaneous skin layer. Once we started doing that, we instantly started getting improvements in our numbers. I don't think he was getting all the insulin we were giving him before.
 
most of his nadirs are in the purple now, what yellows we see are at the high end anyhow. So I had read that when the nadirs are over 300 to increase by .50 unit !?! So I am questioning what increase tomorrow ? I have court in the morning and hate to increase while I am not home to test but I don't think he will require testing anyhow...his numbers just go higher and nothing works any how..looking for video on how to shoot in the flank area....i was taught by vet to tent between the shoulder blades and inject there and the bottom of the tent ..I move my actual injection site on the shoulder area from side to side
 
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He's bouncing due to the blues he got a couple of nights ago. Bounces can take up to 6 cycles to resolve. Don't look at the nadirs on the bounce cycles. Instead think "how low can he go on this dose when he's not bouncing?". The answer is under 200, so you increase by .25U per the protocol Julie quoted above.

The second time around on insulin can be much different and often much harder to get into regulation. I get how frustrating the waits and slow increases can be. Neko has two high dose conditions and we started seeing green over 3 units, meaning .25u increases, but didn't get her first reduction until 8.75 units. I'm not saying Norman has conditions like that, just that many of us here know the feeling of frustration and wanting to hurry up the dosing scale.:bighug: Safety first. The TR protocol is already fairly aggressive, you can't hurry more than that.
 
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ok that makes more sense..I will increase by .25 tomorrow morning. I think he should be fine while I am at court..I would be able test +4 and then not again until +8 or 9..at this rate I don't think he will dip down to low out of the clear blue.. I have been looking for videos on injection technique, someone said flank area is better but no luck on videos
 
It doesn't necessarily have to be the flank. I was mentioning that the technique is important. You can see what I am talking about here. Pull skin up high, inject at 45 degree angle at very bottom of where you have pulled up to make sure you get into the subq skin layer. Don't rub the skin after the shot like that though. The injection is around 47 seconds.

(Ignore the annoying talking of the guy giving the shot)

 
I shoot at 45 degree angle and I move from spot to spot...same as I did in the past so I dont think its that...I am just sick over this and I get upset that his numbers just keep rising with no hope of ever coming down...he has more purple number now than when we started....I will keep going but I honestly don't know anymore...I have tried everything I know to do
 
He hasn't even been back on insulin a month. Look at tons of other spreadsheets on this board and you will see that the numbers can bounce all over the place. You need to try and be patient and stop freaking out. I know it's very upsetting, but you have absolutely no reason to believe you won't get him regulated again. You don't know exactly why he fell out of remission (maybe the medicine in the food, maybe not). You can't control what his body is doing right now. All you can do it test regularly and follow the protocol. If he has worse numbers when you started, it may be that there is some glucose toxicity because you haven't found the right dose and his body is getting used to sitting in higher numbers. This is where you have to methodically go up the dosing scale until you find the right dose.
 
Cindy-
It's not anything you are doing or NOT doing....it's not the insulin being bad, the wellness vs the FF, your shooting angle, batteries in your meter...it's just like everyone keeps saying...You cannot compare this time to last, or worry about every number or cycle even...you've only had him back on insulin a short time. Give him a chance... you are not seeing the forest for the trees. This is actually the time you CAN be out doing stuff...because he is NOT going low so you don't need to be there testing/monitoring all the time. Once he does start to respond and is dipping and diving, you will look back and wish for some of these cycles where you can have a break. SO take the break now! Check his nadirs when you are home, spot check here and there. But this is not a time you need to stand hover and watch. But that time will come so go now and spend time w/ hubby. Norman is safe and fine....and you could use the break and will likely feel better if you get your mind off him and go do something else. Take the opportunity on days like these while you can. he will probably benefit from you de-stressing as much as you.
 
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I am sure many parents have been where I am at right now. I will wait and see how he is the morning and make the determination if its safe to increase him while I am not home or wait till tomorrow evening to increase him....he is out of the purple zone right now so we shall see. thanks for talking sense to me, I get super stressed out and I go for a walk so as to keep him from knowing. When I am stressed out I do make my husband test him cause he's a man and he is a rock, nothing stresses him ....here's being hopeful that tomorrow brings some better numbers
 
Betty's got a lot of good advice in her post above. Norman leads this dance - your job is to respond appropriately. Fortunately, we have the Tight Reg guidelines to help provide that appropriate response to his blood sugar.

It is really common to make small incremental dose increases and not see a response until BANG, suddenly you hit the right dose. So while it seems like it's not doing anything, it might very well be. He would no doubt be higher without the 1.75u.

Which, by the way, is a dose above what you would've started with if you'd decided to follow Tight Reg and used the weight-based formula. That's water under the bridge - nothing you've done is causing his high numbers.

Just march on. You're doing exactly what you should be doing. :bighug:

It would be good to start a new thread/condo each day. Otherwise they get too long and unmanageable.
 
he just gave us a +5 259 which is a miracle at this point...will test in the morning and probably wait till tomorrow eve for his increase in dose. Going to wait out one more cycle since I really won't be home during the critical time tomorrow morning cause of court...PAWS CROSSED we are getting closer to a dose for him that I can actually see some lowering...
 
This is the first time I am looking at Norman's spreadsheet, but I am wondering if there was a reason you started at .25 unit on 6/14 and within 6 cycles you had increased to 1.o unit. I am not saying that this is the case, but maybe you didn't wait longer enough to see if Norman would respond to the lower dose and over shot his optimal dose. Typically if a cat is given too much insulin they will go too low and would earn a reduction, but ECID. So I am just wondering if there was a special reason for the rapid increase. I know Norman was coming off several months of OTJ and maybe that was the reason for the rapid increase.
 
Norman had gotten into some liquid clavimox that was sweetened based mixed in anothers cats food. We were totally unconcerned while feeding since Norman hates clavimox and won't come within a mile of it..Well over the 10 day course treatment we of course busted NORMAN in that food . So since we had been so unsure how many times he ate that cats food (which all my cats eat the same low carb food ) and futhermore that 10 day course was twice daily. We started low as thinking that maybe he just needed a jump start . We took him to his vet and he was the one who suggested to jump up to 1 unit and work from there. He had another cat do the same thing but it was bubble gum flavored amoxicillian. I can't remember how but the people had used a script that they had for their CHILD and gave it to their diabetic cat who was having a UTI and it took thats cats BG way through the roof.... While at teh vet the Vet felt looking at his numbers that 1/2 a unit was not going to help him at all. Norman is boss cat over the one that was on the medicine. We believe he got more of that clavimox that we thought at first. We have watched them switch dinner plates quite a bit NOW ...they get the same food but we think NORMAN is looking for that sugar high he had going on.
 
mstyles said:
Now we pull up the skin as high as we can on his flank and inject at the very bottom of the skin at a 45 degree angle to ensure we are getting into the subcutaneous skin layer.
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This may be a daft question, but which direction do you shoot? Up into the tent or down into the body?
 
Sue484 said:
This may be a daft question, but which direction do you shoot? Up into the tent or down into the body?
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I was originally using the 1/2" needles. Now I am using the 8mm (5/16 ") needles and I find it much easier to get the shot in with almost a straight down angle. Because it is shorter there is less chance of hitting muscle and even a small tenting is all I need to get the shot in. I did a few fur shots with the longer needles but since changing (anti-jinx) I have not had any.
 
Sue484 said:
I use the BD Micro-Fine + Demi 0.3ml. I can't see how big the needle is but it is quite short.
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Mine are the BD Ultra-Fine II .3ml, 31 gauge 8mm (5/16") I originally changed to these because the Terumo I was using before did not have the 1/2 unit markings. I was concerned because they were shorter, but once I started using them I was very pleased.
 
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