8/19 Pumbaa - +10/52 and still dropping - WTF

[Pumbaa]

No time to type. Working and watching Pumbaa dive, yet again.

This has got to stop! :YMSIGH:

+10 and he's at 52 and still dropping.
+10.5 = 60
+11 = 60 (new box of test strips)
PMPS = 72 (I shot the full skinny 2.50U. I don't know if I will regret this or not. Only time will tell.)

 

[Dale 'n' Chip]

That really sucks going below 50 right during PMPS. I don't see any choice but the chicken shot?

I can tell you Levemir has it's own quirks but it doesn't do that quite the same way. nailbite_smile

 

[Dale 'n' Chip]

Or a skipped shot, just sleep all night and regroup later?

This is getting to be a weekly ritual.

 

[Carl & Polly & Bob (GA)]

I would skip, Suze. I think that is more likely to put the brakes on whatever is going on. You're right, you can't keep living this way.

eta: too late...

Carl

 

[Dale 'n' Chip]

That was surely a good move to shoot. And overall these numbers look good. Below the renal threshold most of the time.

If only Chip could ever do that. :YMSIGH:

 

[Pumbaa]

Carl, yep...too late. But that's okay, I appreciate the input. (((HUGS))) (Not ignoring you, Chippendale's...just finished sending proofs to a client and will get back to everything soon.)

I hate skipping shots and giving BCS's and losing momentum, as in momentum to get Pumbaa to stop bouncing and diving.

I hate not being able to figure out how to prevent Pumbaa from bouncing and diving like this. It's got to be hell on his little body, not to mention what this is doing to me.

I hate looking at his past history and trying to figure out what he's going to do, and then have him do the opposite. Especially when I am trying to make "inject or not" decisions, like tonight.

I love my little guy, but this FD could be the straw that broke the camel's back, because my life before FD was already very stressful and there already wasn't enough time in a day to do all that I need to do. But, this isn't Pumbaa's fault. He didn't ask for FD. He hates me poking him and injecting him, and I don't blame him. Yet he still comes and snuggles with me at night, when I finally manage to make it to bed instead of napping on the sofa with an alarm waking me up to test him. The cat the that bit me at the vet a few months ago, and who had to be muzzled for them to draw blood, let me test him 19 times on Friday because he loves me, and he knows how much I love him. Even if he doesn't understand why I am torturing him, daily.

I made a lot of progress today trying to convince my mom to get her cats off of dry food. That's one huge plus.

 

[Pumbaa]

That really sucks going below 50 right during PMPS. I don't see any choice but the chicken shot?

I can tell you Levemir has it's own quirks but it doesn't do that quite the same way. nailbite_smile

Chip still took a dive yesterday on Levemir, but at least he had a nadir and came up before the PMPS.

Or a skipped shot, just sleep all night and regroup later?

This is getting to be a weekly ritual.

But the current injection isn't supposed to influence the current cycle!

This is getting to be a near-daily ritual. That is the hard part.

That was surely a good move to shoot. And overall these numbers look good. Below the renal threshold most of the time.

If only Chip could ever do that.

Only time will tell if this was a good move or not. It will be a good move if he was starting a bounce. If I am up all night because he keeps diving, it will not be a good move.

You don't want to wish this on yourself and Chip. You want Chip to come down in numbers evenly, and not have these bounces and dives, and never know when a dive is going to occur. Trust me.

 

[Carl & Polly & Bob (GA)]

Just my opinion...I think you should have taken the full reduction yesterday. I don't agree with Dale's statement that it "failed miserably" last time.
I also subscribe to this way of thinking -
Don't assume that what worked yesterday will work tomorrow. And don't assume what didn't work yesterday won't work tomorrow. With FD, or with anything else in life for that matter.
Carl

 

[Dale 'n' Chip]

...But the current injection isn't supposed to influence the current cycle!

This is getting to be a near-daily ritual. That is the hard part.

Obviously it may influence the current cycle for Pumbaa. And don't the people that say it doesn't, advise skipping shots to play it safe?

I wish Chip could surf below the renal threshold on a depot insulin. The old vet sure was able to achieve that pretty effortlessly (and comparatively affordably) with NPH and prescription food. I wish I could just go back, plop down a credit card and say fix him, kind of like I did the first time. But if he's acro/IAA it's going to cost an even bigger fortune. Who knows what will happen.

This nightmare as been going on for too long already and there is really no end in sight.

Perhaps all those friends and family who say we are crazy to do this have *some* point? :YMSIGH:

 

[Pumbaa]

Carl,

I just want you to know that the reason I trust your opinion SO VERY much is because:

1) You have made it a point to educate yourself about all of the different protocols and insulins, and have no problem admitting when you don't know an answer;

2) You always put the individual cat and caregiver first, instead of just reciting protocol mantras;

3) You are a safety-first kinda guy;

4) You take the time to really, really look at the SS of the cat in question, instead of just glancing at recent numbers and offering advice. I can't tell you how many times you've pointed out things to me in Pumbaa's SS that I would not have noticed;

5) You are willing to stay up all night with people like me, and hold our hands when you could be sleeping or doing something much more productive than hand-holding;

6) You pledge no allegiance to any one insulin or any one protocol.

You are a true sweetheart, Carl. (((HUGS)))

 

[Dale 'n' Chip]

Just my opinion...I think you should have taken the full reduction yesterday. I don't agree with Dale's statement that it "failed miserably" last time.
I also subscribe to this way of thinking -
Don't assume that what worked yesterday will work tomorrow. And don't assume what didn't work yesterday won't work tomorrow. With FD, or with anything else in life for that matter.
Carl

That's not my opinion, it's from the protocol... so don't blame me ;-)

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot/shed".

Apparently you let the bounce clear from the low, then if they are still above blue, you raise them to the last good dose on the next shot. Personally I wouldn't even know because Chip has never earned a reduction. :-|

 

[Pumbaa]

...But the current injection isn't supposed to influence the current cycle!

This is getting to be a near-daily ritual. That is the hard part.

Obviously it may influence the current cycle for Pumbaa. And don't the people that say it doesn't, advise skipping shots to play it safe?

Yes, but the same people will admit that they failed to tell the caregivers that skipping/giving BCSs won't have an influence on the current cycle, and blame it on the shed. So, who is right? Does the current injection influence the numbers in the current cycle or not? It's a yes or no question. BTW, you are the very first person who brought up that the current injection could be influencing Pumbaa's numbers. I appreciate that insight, more than you know!

I wish Chip could surf below the renal threshold on a depot insulin. The old vet sure was able to achieve that pretty effortlessly (and comparatively affordably) with NPH and prescription food. I wish I could just go back, plop down a credit card and say fix him, kind of like I did the first time. But if he's acro/IAA it's going to cost an even bigger fortune. Who knows what will happen.

This nightmare as been going on for too long already and there is really no end in sight.

I hear you about the nightmares and no end in sight. And wanting to plop down a CC and say "just fix him". But Chip did respond to the Lantus and is now responding to the Levemir, so why do you think he might be acro?

Perhaps all those friends and family who say we are crazy to do this have *some* point? :YMSIGH:

I spent some very tearful times the last few days thinking about Pumbaa and me, and what his FD is doing to my stress levels and my health, and how, if I keeled over tonight due to what I have been going through with him, there are so many people/animals who would not be taken care of. I am ashamed to say that I actually thought about putting Pumbaa to sleep, before his FD kills me. But I can't do it, because FD doesn't cause him to be a terminal patient, and because he acts so normal, and loving and devious so much of the time. It's not HIS fault he came down with FD, it's my fault for feeding him dry food all of these years. I just pray that I have the strength and energy to keep caring for him, on top of everything else. (I'm crying again.)

 

[Carl & Polly & Bob (GA)]

Well this goes back to what I asked yesterday....how many drops are in .25u of lantus? Pumbaa got a skinny 2.5, right? How is that different from a normal 2.5? Or a fat 2.25? How do you measure what I can't see with bifocals? Is it just squeezing out a drop or two? Is it ten drops?
I never dosed in increments less than .25, and that was purely guesswork for me, so this mini-micro stuff is impossible for me to conceptualize.
If you had tested that 52 five minutes earlier or later, it may have been a reduction earning 49. That's why I thought the full reduction made sense.
Carl

And I also tried to say yesterday that an increase would effect the current cycle more than a reduction or a skip, and tried to explain the logic behind my thinking that way.

@ Dale - it was the wording, I guess. I hadn't read "failed miserably" in the protocol, and I figured in Suze's shoes, it might have sounded sort of harsh.

 

[Pumbaa]

Just my opinion...I think you should have taken the full reduction yesterday. I don't agree with Dale's statement that it "failed miserably" last time.
I also subscribe to this way of thinking -
Don't assume that what worked yesterday will work tomorrow. And don't assume what didn't work yesterday won't work tomorrow. With FD, or with anything else in life for that matter.
Carl

That's not my opinion, it's from the protocol... so don't blame me ;-)

And I say "fukc protocol and deal with the cat in question!"

If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot/shed".

Apparently you let the bounce clear from the low, then if they are still above blue, you raise them to the last good dose on the next shot. Personally I wouldn't even know because Chip has never earned a reduction. :-|

The "protocols" are very sketchy for bouncers/divers like Pumbaa, and need to be changed/updated. I mean, geez, they still call for .25U to .50U dose increases and decreases, when people on these boards will admit that .50U both can be way too high.

So WTF do we follow? And why haven't these much-read protocols been updated?

I'm disgusted tonight.

 

[Carl & Polly & Bob (GA)]

Chin up, lady. They're protocols, not "all-the-answers-are-contained-within".

 

[Dale 'n' Chip]

So WTF do we follow? And why haven't these much-read protocols been updated?

I'm disgusted tonight.

I agree, these depot insulin's with felines are for the birds.

But I'm afraid it's really the best we have to try right now, we've already come this far.

Pumbaa is nearly on the verge of OTJ. So why not hold this dose for a while and cut back on the testing and get some sleep? @-)

 

[Carl & Polly & Bob (GA)]

Well at least the depot insulins have a protocol to guide you. Try advising a prozinc/pzi kitty and bean...or even worse, try figuring it out minus this board with a vet as your sole advisor nailbite_smile
Carl

 

[Pumbaa]

Chin up, lady. They're protocols, not "all-the-answers-are-contained-within".

But it's so confusing when different people quote different protocols, and the information in those protocols hasn't been updated, and you're trying to figure out your FD cat and do what is best for him/her!

In the last 4 months, since Pumbaa was diagnosed, I have been to so many threads and links and have read so much conflicting information (protocols as well as food charts, etc.) and advice, as well as by chance discovering pertinent info I would not have known had I not taken precious time to read so many threads/condos, I could just scream.

We are all busy people, and even busier nowadays with an FD cat. We don't all have hours per day to peruse the posts dealing with problems that might be pertinent to our cats. Heaven knows I try, but just can't keep up!

Thirty minutes before injection time and one person will advise to increase the dose, the next person will advise to stay at the current dose, and the next person will say to give a BCS or skip the shot. *LMAO* No ****...those are my three choices which I knew ahead of time. So what help am I getting?

I'm just venting because I am so frustrated trying to deal with Pumbaa. None of the above was directed at you, Carl. (((HUGS)))

SuZzzzzzzzzzze

 

[Pumbaa]

Well at least the depot insulins have a protocol to guide you. Try advising a prozinc/pzi kitty and bean...or even worse, try figuring it out minus this board with a vet as your sole advisor nailbite_smile
Carl

Carl, you know what? I would much prefer shooting Pumbaa based on his PS numbers, then having to try and figure out when it's the shed and when it's the current dose or when it's the bounce affecting his numbers!

 

[max&emmasmommie]

Hugs! Suze! You are so tired, I know, and that messes with your emotions in a situation in which you have every reason to be emotional in the first place! Bless your heart. You are trying so hard. That has to count for something. I hope you got some sleep last night while Pumbaa was up there in the Blues!

(I slept through a below 50 reading last night -- I just know it!)

 

[Pumbaa]

I wound up breaking a toe last night (actually, this morning around 2 am) chasing Pumbaa around the house trying to catch him for a test since his numbers were dropping. I gave up at that point, prayed that nature would be kind to Pumbaa and keep him safe, and finally went to bed.

I truly appreciate all of your support, and listening to me vent my frustrations last night. I actually feel better this morning after venting and crying. I'm still physically exhausted, but feel stronger mentally, and ready to take on the day's challenges.

I told my mom last night that I wouldn't wish FD on my worst enemy, and, because she knows what I've been going through, she is actually more open now to at least thinking about getting her cats off of dry food. If she does that, and realizes that it's no harder to feed only canned food than it is to feed canned and dry, maybe she will help convince other family members to change their cat's diets as well.

I need to go back and re-read some of my daily threads, and compare information/suggestions/observations to Pumbaa's SS, as I've been so busy lately some things haven't sunk in.

I also need to order new syringes, as I ran out of the Monojects yesterday and am now using the UltiCare U-100 Vet Rx Half Unit Insulin syringes. I don't like the UltiCares at all for dosing. The Monojects were so easy to see, even .25 units, and were so much more accurately marked than the Relions I had used in the beginning. The plunger always lined up on the zero line, the markings were never cattywompus, etc. I don't know if I will reorder the Monojects or try the Terumo's. Unfortunately, I'm stuck using the UltiCares until I get more syringes in.

Now I need to get back to work...

Suze

 

[Pumbaa]

Well this goes back to what I asked yesterday....how many drops are in .25u of lantus? Pumbaa got a skinny 2.5, right? How is that different from a normal 2.5? Or a fat 2.25? How do you measure what I can't see with bifocals? Is it just squeezing out a drop or two? Is it ten drops?
I never dosed in increments less than .25, and that was purely guesswork for me, so this mini-micro stuff is impossible for me to conceptualize.
If you had tested that 52 five minutes earlier or later, it may have been a reduction earning 49. That's why I thought the full reduction made sense.
Carl

And I also tried to say yesterday that an increase would effect the current cycle more than a reduction or a skip, and tried to explain the logic behind my thinking that way.

Carl, for me, a skinny is one drop less than the full dose, 'cause when I do a .25, it's 2 drops less than a full dose. And that's with the Monoject syringes. I'm sure this is different for everyone as drop sizes are different, and the drop sizes depend on how easily the plunger glides in the syringe. This mini-micro dosing stuff makes me, crazy, too, especially with syringe inaccuracies and problems. Plus, why don't they use red ink to print the lines on the syringes instead of black, since the plungers are black? That would solve a lot of problems right there. I can't imagine being able to use calipers, but someone said that they mark a toothpick with the correct dosage line and use that as a guide. I might have to try that, especially with these UltiCare syringes.

Yep, that 52 yesterday could very well have been a 49 a few minutes earlier. Who knows. But the reason I'm trying to go up and down by drops instead of a full .25U is to try and stop radical changes in the hopes that it helps Pumbaa stop bouncing and diving. It hasn't worked so far, but I'm an eternal optimist (sometimes).

I do have to go back and read all of that information that was flowing on the Friday/Saturday thread as I know I missed a lot due to how tired I was. I need to be able to wrap my head around how an increase can affect a current cycle more than a reduction will.

Suze

 

[Pumbaa]

Thank you, Mommadale! I just checked and Max is doing simply wonderful!!!!! I just noticed that his nadirs are pretty early...is that helping you get some rest?

Suze