8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 491

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Re: 8/21/14 Michael AMPS 91

:mrgreen: :mrgreen: :mrgreen: :mrgreen: :mrgreen: That is how to clear a bounce, Michael. Nice to see kittehs who handle them so well.
 
Re: 8/21/14 Michael AMPS 91

Wow looks like Michael cleared his bounce quickly, you will probably see a bounce from him going into green numbers.
 
Re: 8/21/14 Michael AMPS 91

Thanks Ann & Darin.
Darin Just got back from the Vet's. She changed the dosage again. If he is 250-300 give lu. If over 300 give 1.5u. Do not give insulin if he is below 250. This is really discouraging.
Normally, I don't give insulin if he is below 100, but when he was @ 91 this am I gave .75u. When we were at the Vet's, she tested him again he jumped to 252( this was abour 9:15am +3). He real y jumped. Had to be stress or maybe he bounced. The reason she tested was she thought by me giving him .75u this am that he would be lower. He wasn't.(252) she was surprised. I don't think she understands. Every time I go to see her she keeps changing everything. I like her. she is a good vet. I don't know what to do, I'm darned if I do and Darned if I don't. This disease is so stressful! Any thoughts would be appreciated.
Paula
 
Re: 8/21/14 Michael AMPS 91

Nice job shooting that 91 this morning. Lantus does best if you do the same dose morning and night. Most of us nod our head at the vet's suggestion then go home and dose according to the protocol. We dose according to the nadir. Your vet is suggesting dosing according to the preshot which is how some of the older insulting are dosed. You might want to print her a copy of the protocol.

Micheal is bouncing this morning, so is my kitty. :roll:
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

Stress from being at the vet is the reason for the higher +3 Paula. It can raise the BG up to 200 points, so tests done at the vets are pretty much useless....especially when deciding on a dose!

If you've got your insulin and there's no other reason you need to take Michael to the vet, I'd just stop going. If she's interested in knowing how he's doing, send her the link to his spreadsheet. Once she see's that he's improving, hopefully she'll get on the bandwagon.

The older insulins that vets are used to using (mostly Caninsulin on dogs) is dosed on the pre-shot value...the higher the pre-shot, the higher the dose, but Lantus just doesn't work that way.

I know we've told you this before, but if you have to go, no matter what she says, just nod your head and say Thank you...then go home and do what the protocol says. Some vets will learn along with you, and some won't. We've even had cats go OTJ and their vets are still telling their beans that they "should be doing things their way" (which has included continuing insulin on a cat that has normal numbers!)

And CONGRATULATIONS on shooting the 91! That's really awesome!! It's really too bad you had to go to the vet today and got that stress number. Shooting those lower numbers usually ends up giving a nice, flat green cycle with lots and lots of pancreas healing time!

Even though you got the high +3 due to the vet visit, you still deserve the BOS award!
balls_of_steel_zps5fb131a2.jpg
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

Thanks Chris.
I'm really not that gutsy, but when his bg was 91 my gut told me to reduce the dose. So l gave .75u. I felt I had to keep some insulin in him. I really don't know what I'm doing. I don't know that I will do that again.
Right now I am so discouraged and confused that it seems that there isn't any hope for Michael.
He is so hard to regulate and it seems that in the future he will just waste away. This breaks my heart.
I'm doing everything I can to keep him comfortable. On a happier note, he seems to be o.k.
As for me, constant stress. Trying to deal with my Health issues and Michaels. I hope I don't end up end the Hospt. Michael needs me!
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

You could print her out a copy of the tight regulation protocol that is located in the stickys. That is what we follow here.
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

Do you have the tight regulation protocol sticky and how to handle low numbers sticky printed out for yourself? I have that printed out and keep it in the bathroom where I do all of Charlie's testing.
I wish there was a way you could get more testing in at night. I understand that with your disability you are not able to stay up past +3/+4. Would you be able to move the am shot time earlier. The reason I am asking is with the tight regulation protocol there will come times when Michael will drop below 50 which would earn him a reduction, but at the same time you need to be feeding a higher carb food to keep him above 50. That is all explained in the stickies I spoke about above.
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

Thanks, Darin.
I do have the sticky printed out and I do refer to it.
Sometimes i can stay upt later, but not very often.
btw, do you still go to the same vet I do? If so, What do you tell her when she asks about dosing?
Paula
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets)

Paula:

How about sharing the research article on how to use Lantus with your vet?


The method your vet is giving you is not the way Lantus is dosed. Lantus is a long-acting, depot-type of insulin. You vet is giving you instructions that are typical of a non-depot insulin that often has a shorter duration. The result of dosing Lantus like ProZinc or Humulin N is really wonky numbers. The best way to think about dosing is that Lantus likes consistency. If you change the dose at every shot, both you and your vet will be very disappointed in what Michael's numbers look like. I suspect your vet may not be familiar with how to dose Lantus.

You haven't had much experience with shooting numbers below 100. Reducing the dose was a reasonable strategy. As you get more experience with managing lower numbers, you'll be more confident when it comes to shooting lower numbers.
 

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Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets) + 9 376

This is what I see on your spreadsheet

You recently increased to 1.5 and it had just started to get Michael into the blues

On 8/19, he dropped from 272 to 226 at +2...that's a significant drop and I would have probably set an alarm to get a test in even later than the +4 of 184, but just that kind of drop on a new kitty can cause a bounce....which is what happened on 8/20

8/20 he started at 320 but was slowly clearing the bounce. The 1.5 given that night at PMPS brought him all the way down to 91 by this morning...A number his body probably hasn't seen much of lately, so between the vet visit and that, he's bouncing again (which is why the stinky pinky at +9)

By tonight's PMPS, he may be in the pinks or reds. If he is, I think it'd be fine for you to go back to the 1.5 dose BUT it may be that he needs a dose in between 1 and 1.5 (the dreaded 1.25 dose) I know they're awful to draw up, but as long as whatever you decide is 1.25 is consistent, that's all that matters. It doesn't really matter if it's really 1.2 or 1.3

All I can say is that the protocol does work, but it does require you sometimes shoot when you're low. As long as you can be home to test, it's perfectly safe to shoot a low number (lots of us will shoot anything above 50) Another option for this morning might have been to stall, don't feed, and retest him in 20-30 minutes to see if his number was coming up on it's own (without food). If it was, that's a good indication that the number is on it's way up again and generally it's safe to give the "scheduled" dose....but you are always correct to give a smaller shot if you can't be home to test. It's always better to be safe!

We all understand your frustration! Bouncy kitties can drive us crazy!
 
Re: 8/21/14 Michael AMPS 91 +3 252(+3 done at Vets) + 9 376

yes I still use the same that she doesn't really ask about dosing I just tell her how many reductions Charlie has had an what dosing I am currently at and she's like wow you have a really this down pat. She has even cracked a joke about me putting on a feline diabetes seminar.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Thanks for all your thoughts. Greatly appreciated.

Chris, thanks for explaining again. I gave him 1.5u @PMPS 491. you were right. he went into the red.
I wonder how long It will take him to get back down? Is he bouncing? This day stared good and ended up a disater. Poor Michael!
Paula

Darin, I agree you should have a fd seminar.
Paula
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Hi Paula,
I hope that you will be able to dose Lantus consistently. As everyone has said, consistency is the key. And changes in dose are based on the nadir, not on pre-shots. I'm sorry that your vet is not "with-it".

I know that you have the issue of Hyper T to deal with also. The combination can be daunting, because Hyper T causes everything in the body to run "faster". Is Michael on the correct dose of Methimazole? You might ask your vet to do the T4 testing again, just to be sure he is.

Have a good evening, and do try to follow the Lantus protocol, regardless of what your vet tells you to do. (You don't have to tell her everything!)

Ella & Rusty
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

8/20 he started at 320 but was slowly clearing the bounce. The 1.5 given that night at PMPS brought him all the way down to 91 by this morning...A number his body probably hasn't seen much of lately, so between the vet visit and that, he's bouncing again (which is why the stinky pinky at +9)
Click to expand...

Yes, he's still in "bounce mode"....that 91 was pretty low, especially considering where he started last night. From 299 to 91 in 12 hours is a drop of 208 points...and his body hasn't been in "normal" numbers for a long time.

If you just kind of glance back at his spreadsheet, you can see that pretty much every time he's got a high number, the cycle or two before had either a lower number or a drop of more than a few points quickly

If we can get him into those normal numbers more often, he shouldn't bounce as much (or as high) but some kitties are just extra bouncy! And we've had kitties that bounced all the way to OTJ, so just because they bounce doesn't necessarily mean they won't get there
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Yes this is a bounce could last up to 72hr (6 cycles) don't look at that high pmps as a disaster, All that will do is discourage you. Just remember sugar kitties like ours like to bounce as part of the process.
Also know that when his sugar drops to unfamiliar numbers, chances are he will bounce. As he visits these unfamiliar numbers more, the less he will bounce. I remember charlie bouncing bouncing on high blue numbers (199-150) now seams like he has to drop below 150 to bounce.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Do you have a hypo kit assembled
Karo syrup
High carb food - I use FF gravey lovers chicken and beef
Med carb food - I use friskies prime filet chicken
These items are a nessesity the deeper you get into this sugar dance.
Like tonight for charlie he will most likely drop under 50, when this happens he earns a reduction in insulin, but more important is that I have these items on hand to give him to keep him above 50 after he earns his reduction. And tomorrow I will see a bounce.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Since he is playing bouncy ball, When should I change the dose? I'm back to the i.5 u.
How can I tell if the bounce has cleared?
Michael can't eat FF. It's too rich for him. He gets nauseated and won't eat at all.
I have karo surup and Friskies Prime filets. Turkey dinner in gravy and Friskies Special Diet meaty bits Chicken dinner in gravy. I'm assuming that These friskies are high carb. What other friskies are Med. Carb?
I Thought anything with gravy was high carb. I don't know what to look for in the store. The printing on the labels are way to small to read, even with glasses. So the Brand names & types of cat food would really help.
Thanks,
Paula
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

She said to go back to 1.5 but he may really only need to be at 1.25
Hopefully she will check back before you go to sleep, if not recheck this thread in the morning.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Thanks.
Have a good night.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

I'd stick with 1.5U for now. The Binky's food list is out of date. There is a more current one on the Catinfo Website. Look for foods 15% or higher for high carb. Neko doesn't handle the gravy (wheat) in the FF well either, so lately I've been giving her Merck's Cowboy Cookout which is 18%.

The Friskies Special Diet Sliced Chicken in Gravy is high carb (15%). The Prime Fillets are all high carb, except Turkey which is technically medium carb at 14%. Take a look at the list and you can see a few options in the 10-14% category.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Paula the list that Darin gave you the link to is pretty old (2005 - 2007). Dr. Lisa Pierson has a more updated list, but even that is nearly 2 years old. Companies are coming out w/ new foods and changing formulas all the time.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Here's a short list of the foods Under 10% that's not so hard to print out when you go to the store.

The Merrick numbers I think are the only ones that aren't right on this one anymore. The others were taken off the master list Dr. Pierson did but Merrick changed their formulas.

The master list was updated 5/31/14

Yes, I think you should go back to 1.5 and hold it for at least 3 days unless he drops below 50 and then let's see where he's at
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Try not to be discouraged when you see high numbers. It is just part of the process and it often takes a while to get cats regulated. There really is no way to hurry the process. One day at a time. You will likely see these high numbers for 2-3 days. Hold the dose unless he goes below 50.

It helps if you try not to let your own mood be so tied up in michael's blood sugar numbers. We all do it some, but that is why people say "this is a marathon not a sprint." It helps to think of it as a long haul and mentally gear up for a marathon.

Your vet doesn't understand Lantus. Darin, maybe you can talk to the vet next time you see her about Lantus dosing and the need for consistency.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

julie & punkin (ga) said:
Your vet doesn't understand Lantus. Darin, maybe you can talk to the vet next time you see her about Lantus dosing and the need for consistency.
Click to expand...
I am surprised that the vet is changing the dose and setting no shot limits and different dosing based on PS vs nadir.
She is the vet that was very adamant about getting charlie on lantus. Plus her and the other vet went to a big feline diabetes conference a couple months ago. I guess that just goes to show that even "cat only" vets are still in the dark when it comes to FD.
Its really too bad that the info on the tight regulation protocol and lantus being a depot insulin is not getting into more Vets hand.
It just breaks my heart reading posts about vets discouraging home testing. But I guess if all vets had their clients do home testing and curves, that would be a lot of money not coming into the practice.
 
Re: 8/21/14 Michael APS 91 +3 252(+3 (at Vet) + 9 376 PMPS 4

Thanks for everything! You are great! All this info & encouragement helps a lot!
Chris thank you for the food list and dose suggestion.
Darin, The vets are going to another conference ( World wide Vets with expertise in Feline Endocrinology) in
sept.
 
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