7/5 Neko PMPS 420 +3 317 +6 140

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Wendy&Neko

Wendy&Neko

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Yesterday http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=74387 was flat pink with some brief yellows. Both last night and the night before she was rising before I went to bed at +4 so didn't get middle of the night tests.

7/4 Recap
AMPS 267 +3 340 +6 310 +9 294
PMPS 379 +3 323 +4 333

Neko has inhaled all of her meals and is hanging around the kitchen hoping for more - that's because of her high numbers. The +3 actually tested at 526 on the Relion, but I couldn't post a black ohmygod_smile :oops: so the number you see is from the Contour which shows lower in high numbers. She's had some good purring/DH lap cuddle time and a couple of yard patrols but is more sedate now as the numbers are rising.

Any ideas why her numbers might be up so much? This is the 4th cycle of this dose and she doesn't usually have NDW this long. I worry that because I only did 5 cycles at the previous dose that this is a bit much. I hate being aggressive for that reason. I've always gone at least 6 cycles before.
 
Re: 7/5 Neko AMPS 374 +3 425 - still NDW?

no answers for you Wendy.. just to say that Rupert misses his buddy.. so come on down Neko
 
Re: 7/5 Neko AMPS 374 +3 425 +7 399 - still NDW?

+7 399 at least she has come down to pink again. I could tell because the sisal ball was getting a workout and it makes a noise.

The down side to Neko being so high is that she targetted the bath mat again, it's been weeks since that happened. The up side is I finally got a ketone test, it'd been a while. :roll:

I got a call from the vet about the B/W. I'm going to go down and pick them up and compare to the prediagnosis ones. He said other than her blood sugar being high at the time (I knew that), cholesterol was a bit high but the rest is fine. I'll try to scan and post or at least post the highlights after I get a copy. I was talking to the older vet, I deal with the younger one there but it is her days off. He asked if the no fructosimine test was a conscious decision - I said yes. He was also worried about the "hypo" on the night of June 26, good thing he didn't look at the 21st! I explained the difference between human and pet meters. He says they don't usually see night time tests - but they always recommend lowering the dose at night, and very few of their clients test. I think I'm 1/2 of them. :lol:

The vet also said the "exotic" tests might be a while, and I got to explain to him that MSU runs the acro test on Wednesdays with results on Friday and the IAA could be sooner. Thanks to Sienne and Julie for making me sound like I had done my research!

@Pip - I keep on pointing at Rupert now being a role model. I hope she'll listen soon.
 
Re: 7/5 Neko AMPS 374 +3 425 +7 399 - BW results

+9 383 - slowly coming down

The summary for the B/W says "hematology - unremarkable; biochemistry - hyperglycemia and glucosuria = DM also cholesterol, check fPL; endocrinology - normal thyroid; urinalysis - reflects dm well concentrated".

I've compared the B/W from Tuesday with the ones where Neko got her diagnosis 6 months ago. Here are the differences:

Glucose, was 22.8, now 17.9 (pretty much tracks with what I was testing that day)
Sodium now normal, was slightly low (146 when should be in range of 147-156)
Chloride still a bit low, now 110 was 106 (range is 111-125)
Anion Gap - now normal
Albumim still a bit high, now 34 was 36 (range is 23-33), may mean a bit dehydrated so will add more water to food.
ALP, ALT - now normal, were high. ALT went from 137 to 34 (ref range 28-76)
Lipase, now a bit high, now 201, was 134 (range 10-195)
Cholesterol still high, was 7.49 now 7.89 (range 2.0-6.0)
Calc Osmolality 317 now a bit high, was 310 (range 285-314), what I've read says may be higher with FD
Lymphocytes now normal 2.244, were low 1.515 (range 1.770-6.560)

All in all, a much better report than before diagnosis. I am really pleased with the ALT much lower. Both reports suggest checking fPL but when I asked the vet on Tuesday about pancreatitis she didn't think it was likely. I'm just trying to cover all the bases for Neko's numbers.

I wasn't really expecting to see anything out of ordinary with these tests but at least we have the current data. Now we wait for the next test results.
 
Re: 7/5 Neko AMPS 374 +3 425 +7 399 +9 383- BW results

The BW report sounds fine to me! Congrats Wendy!
Neko, you can come down now, no more stress k! Did mumbean tell you , your test showed improvement? Today is your turn to take action!
 
Re: 7/5 Neko AMPS 374 +3 425 +7 399 +9 383- BW results

That's great that the BW is good. You did do your research - you talked to the experts. :-D Neko, you can just come right on down from way up there!
Liz
 
Re: 7/5 Neko PMPS 420 - BW results

PMPS 420
So far I am really unimpressed with this dose - worse numbers than the last one. I'll wait a bit longer to see if things settle in. The annoying thing about going up in dose is that she has all this time in ugly numbers, whereas she was at least blue in the last one. Time for patience.

@Liz - I didn't mention who the experts were. This vet is a bit on the old fashioned side. Great vet technically for other things though.

@Helen - yes, much happier knowing some of the original numbers have improved. I still have 3 more tests to get results for but they''ll be a while longer. I also agree it is time to come down miss Neko!
 
Re: 7/5 Neko PMPS 420 - BW results

Wendy

What do you think about taking Julie's advice to take her up every four cycles if she's high? I would be thinking about a .5u increase for tomorrow. Would you be comfortable with that?

Great test results! Paws crossed on the MSU tests.
 
Re: 7/5 Neko PMPS 420

Marje - I would be VERY nervous about taking Neko up so soon so much. It seems she takes a while to settle into a new dose and it's like I'm not giving the shed a chance to fill. I guess I just don't know what to expect. What would be the signs if the dose is too high? This dose and the last seem worse than the one before. Can you tell I'm terrified? I had hoped to wait until the MSU results to know what I'm dealing with before going crazy with dosing. I'm also moderating an all day strategic planning session on Saturday so trying to work around that with any increases. DH can test, but he's not up on what to do with low numbers and I'd rather he not have to phone me that day.
 
Re: 7/5 Neko PMPS 420 - BW results

Wendy...above all, I want you to be comfortable and not worried or afraid. No matter what the numbers look like on a SS, what is equally important is the caregivers knowledge of their cat. So if it doesn't work for you, then it's ok to wait.

I agree with Julie that the goal is to safely get them below 120 and try and keep the, there as much as possible.

Because you have followed protocol, I would expect you would just see her numbers start down...but there are no guarantees at the speed.

I trust your judgment.
 
Re: 7/5 Neko PMPS 420 - BW results

I guess what I'm having problems with is that NDW takes Neko high. If I let a dose settle in, then her numbers get lower. Intuitively it seems that her having some time in low numbers is better than always being in NDW mode and being high, at least from a glucose toxicity point of view. I think I might be up to a .5U increase next but it has to be at a time I can monitor.

The other thing I'm juggling (as if there isn't enough whirling through my brain) is Lantus vs. Lev. If I switched to Lev, what would a starting dose be? When would be a good time to do the switch? What are the differences I can expect? How to manage the cycle with food? The usual learning curve stuff.
 
Re: 7/5 Neko PMPS 420 - BW results

Is there any reason why you want to switch to lev in particular? I think it is a great insulin but it sometimes can take weeks or more to see any progress. I thinkit was about 3 months for Gracie.

The starting dose is usually 70% of your current dose but we might want to tailor that a little for Neko. I'd rather think about that after I've had some rest and had more time to look at her SS. It doesn't really matter when you switch except you'd probably want to do it in the morning because sometimes it really kicks in the first few cycles. Check out Hersheys SS.

Lev onsets roughly at +4 and nadirs +8 to +12. But there is no guarantee that is what Neko will do. Gracie nadirs or gets her second dip from lev about +16.... So her morning shot nadirs after her evening shot. She onsets about +9 so she has a really wacky cycle...I think the long duration of lev works well for her. It has not totally stopped her from bouncing....but she does much better on it. But I am also more aggressive with her dosing as I've gotten more experienced.

So you could expect you might have to be up at night to test sometimes depending on when she nadirs and onsets and how low she might go. It takes a while to see what the cycle might look like and you have to tailor feeding to what her cycle is.
It takes patience to wait and see how her cycle might play out on lev.

I wanted to move agracie to lev earlier but I couldn't do it and work. I'm usually up st least twice every night to check her...sometimes more if she's low.

I understand about NDW...Gracie always got it on lantus; not so much on lev. If you know it takes her a while to settlein, then you re right to wait. I was just thinking back on what Jukie said.

I've got to get to bed but let me know of any other questions you have, ok? I'll answer tomorrow.

Good night Wendy.
 
+6 140
Finally some nicer colours with this dose. Still not exactly what I'm looking for, but at 7.0 units the green surf didn't happen until cycle 9.

Regarding lev, it's still an "if I switch". I'm trying to figure out if the larger dose is bothering Neko. She usually wants out after her meal and complains when I stop her to shoot, but I don't know if the complaint is the shot or impatience with waiting. I think it's the latter.
 
Higher doses on Lantus sting according to human diabetics and some cats actually do react to shots, as my Shadoe did, and she was better after switching to Lev.

Lev does not take a long time for you to see a change in how the cat reacts to the insulin. You can post on the Lantus or Lev forums to ask others how long it took their cats to react to the change.
I noticed a change within days; Shadoe no longer was tense and did not react to the shots at all.

For a switch, it is often recommended to start at around 70% Lev, just to be safe, but many do end up with a dose slightly less or equal to the previous Lantus dose. My Shadoe used less Lev, but Oliver was about the same after he was switched.

Shadoe's nadir did not change at all; it remained around +5. Oliver was always a late nadir around +10, but he was not on Lantus for long after I adopted him to know if there was any change in his nadir.

Because each cat is different, and many do need a bit less Lev than Lantus, the 70% guideline is used for cats who are regulated. There is a difference in sheds, so while you are using one, you are filling the other... the storage of the 2 insulins is different in the body, so you may see an improvement in Neko within days, but the settling of the sheds will take a bit longer.

Lev is being found to be a smoother insulin, kinder and gentler for some cats.
 
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