7/10 Jack: 311@amps, 196@+3: still holding 10.5u

Jack & Mopem'sMom

Very Active Member
I can't believe it's the 10th of July already- life has been too insane to even begin to explain/complain about, but apologies for not posting in such a while. I hope all the kitties and humans have been well.

I am still holding the 10.5 unit dose for Jack because his am and pm mid-cycles are nice greens. Most mornings we get blue or yellow amps numbers, with the odd pink, but I think that's directly related to the awful weather we are having. Unfortunately the pmps number is almost always pink- it's like the insulin wears off between +8 and the pm shot. I want to talk to the vet about possibly giving him a small dose of a short acting insulin around that time...any thoughts on that? He eats less at night, so that's not much of a concern for the overnight +8 time frame.

The heat & humidity are unbearable and I can't seem to get the house to cool off; I haven't seen temps under 80 all week, despite running the AC 24/7 and having a fan on the other side of the house on exhaust. Jack is miserable, just laying around, not really moving much, eating less, generally cranky. The rest of the herd is acting the same way, as is their mom ;) I was sick for the entire long weekend, so no curve unfortunately. Maybe this weekend, if I don't end up dealing with family issues (again)

Hope to catch up with everyone today!
Last post: https://www.felinediabetes.com/FDMB/threads/7-1-jack-203-amps-80-3-holding-dose.291695/#post-3190509
 
Hi Christine , Oh man sorry to hear you were sick , I see Jack has been getting some nice numbers. I hope one of the members gives you their thoughts on the short acting insulin. Yep the weather has been unbearable !! Can't wait to see the electric bill !
Thanks for popping in on my thread about Tyler . Talk to you soon :bighug::bighug::bighug:
 
I want to talk to the vet about possibly giving him a small dose of a short acting insulin around that time...any thoughts on that? He eats less at night, so that's not much of a concern for the overnight +8 time frame.
I wouldn't. There are a couple reasons for which we suggest giving R, the usual short acting insulin used. First is in a ketones situation, where the caregiver needs to give more insulin, but still wants to increase the Lantus at a safe pace. Second is in a high dose cat that's not seeing good numbers yet. Or to help manage the large depot. For example, we had one person giving 50 units of Lev and 30 units of R to an acro cat. That is correct, I don't have an extra zero after those numbers. :eek: When her kitty started earning reductions, she didn't want to have to deal with a 80 unit depot influencing the cycles. All she needed to do was not give R and reduce the Lev per the protocol.

Lack of duration is not a reason we typically suggest adding a short acting insulin. Side note, using R requires more, not less testing and I see with your previous post that life is getting even busier.

One of the many tricky things about using R is that you don't want to cause fast drops, setting off a bounce and worse high numbers. Jack isn't bouncing, just losing duration. I was looking at his spreadsheet and trying to see when you could safely give R such that it would be in and out before the Lantus/glargine starts to drop him in the next cycle. I see lots of times in the PM cycle where he does fast drops at onset. So you wouldn't want any left over R action when that happened as that could speed the drop and cause a bounce. So we know when the R action would have to be over, which is before +2. Next question, when could it shoot in the previous cycle? I see lots of times on his spreadsheet where his +10 is still a reasonable number, but he zooms up like crazy to PMPS. Meaning it might mean shooting after +10. The problem is that R typically lasts at least 4 hours in the cat (a little longer in Neko). So you couldn't shoot after +10 and have it out of the system before +2. The math doesn't work. Hence the reason it's not a solution for lack of duration.

What is Jack's feeding and eating schedule? Just wondering why he's losing duration. For more on thoughts on duration, see this post: Discussion: Thoughts/Ideas on how to extend duration

Unfortunately a lot of the ideas come down to being able to manipulate food and carbs given. And Jack has a solid reputation on being stubborn about his food. :cat:

What is your reduction point for Jack? If you had been able to follow TR (see point above, sigh!), you could give him a dose that takes his nadirs down to close to 50. When you do that, you generally bring down the higher numbers too. Though I do see a 59 a few nights ago. Hence the question.
 
The problem is that Novo Nordisk have announced they will stop selling Levemir in the US at the end of this year. Otherwise I would have suggested it.
 
Possibly, but only the cartridges, which is what I used. I searched what some of the people here had said and it wasn't totally clear. Just looked at the Marks Marine website and it didn't say anything about discontinuation. Price of Levemir from Canada is now quite a bit higher than Lantus/glargine generics in the US though.
 
I wouldn't. There are a couple reasons for which we suggest giving R, the usual short acting insulin used. First is in a ketones situation, where the caregiver needs to give more insulin, but still wants to increase the Lantus at a safe pace. Second is in a high dose cat that's not seeing good numbers yet. Or to help manage the large depot. For example, we had one person giving 50 units of Lev and 30 units of R to an acro cat. That is correct, I don't have an extra zero after those numbers. :eek: When her kitty started earning reductions, she didn't want to have to deal with a 80 unit depot influencing the cycles. All she needed to do was not give R and reduce the Lev per the protocol.

Lack of duration is not a reason we typically suggest adding a short acting insulin. Side note, using R requires more, not less testing and I see with your previous post that life is getting even busier.

One of the many tricky things about using R is that you don't want to cause fast drops, setting off a bounce and worse high numbers. Jack isn't bouncing, just losing duration. I was looking at his spreadsheet and trying to see when you could safely give R such that it would be in and out before the Lantus/glargine starts to drop him in the next cycle. I see lots of times in the PM cycle where he does fast drops at onset. So you wouldn't want any left over R action when that happened as that could speed the drop and cause a bounce. So we know when the R action would have to be over, which is before +2. Next question, when could it shoot in the previous cycle? I see lots of times on his spreadsheet where his +10 is still a reasonable number, but he zooms up like crazy to PMPS. Meaning it might mean shooting after +10. The problem is that R typically lasts at least 4 hours in the cat (a little longer in Neko). So you couldn't shoot after +10 and have it out of the system before +2. The math doesn't work. Hence the reason it's not a solution for lack of duration.

What is Jack's feeding and eating schedule? Just wondering why he's losing duration. For more on thoughts on duration, see this post: Discussion: Thoughts/Ideas on how to extend duration

Unfortunately a lot of the ideas come down to being able to manipulate food and carbs given. And Jack has a solid reputation on being stubborn about his food. :cat:

What is your reduction point for Jack? If you had been able to follow TR (see point above, sigh!), you could give him a dose that takes his nadirs down to close to 50. When you do that, you generally bring down the higher numbers too. Though I do see a 59 a few nights ago. Hence the question.
Hi and thanks for your input here; lots of good info! Jack eats breakfast between 5:30 and 6am and dinner between 5:30 and 6pm. No snacks- he's too fat to begin with. I have not been successful with getting him off the Elsey's/Ziwi peak mix. He flat out refuses to eat anything without it...he is a big jerk about food--he took almost 3 years to get to pate only. The reduction I had come to was at 70 if I saw three cycles in an row 70 or below. I appreciate the duration link- I'll take a look at that. I am trying to get the labwork $ together so he can have his Cushing's test/IGF1 retest but we are at least a month or two away from that. I do notice he has higher numbers in the heat, so that's not helping us lately. Thanks again for your input, I greatly appreciate it!
 
Possibly, but only the cartridges, which is what I used. I searched what some of the people here had said and it wasn't totally clear. Just looked at the Marks Marine website and it didn't say anything about discontinuation. Price of Levemir from Canada is now quite a bit higher than Lantus/glargine generics in the US though.
@Bron and Sheba (GA) @Wendy&Neko Thanks for this discussion- the budget will not really support much higher prices, but I'm wondering if you know the cost offhand? I pay about $75 for the 10ml vial of glargine-yfgn insulin Biocon Biologics NDC 83257-014-11. I can probably go up to a max of $130, which is what I was paying for the generic glargine (not biosimilar) No stress though, i can check mark's pharmacy website
on my lunch break today
 
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Hi Christine,
It's been a brutal summer! Super hot and now smokey here from the fires in the West Coast.
I can't imagine how hot our furbabies are with all this heat!
As for the additional short acting insulin, I don't have ay idea how that will work. I'll tag some experienced members;
@Wendy&Neko, @Bron and Sheba (GA), @Bandit's Mom, @tiffmaxee

Sending you cooling vibes! :bighug::bighug::bighug:
Luckily we don't have smoke, just super hot/humid and it doesn't cool down at night...I actually bought a kiddie pool for the outside critters I felt so bad for them
 
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