8/24 Reuben AMPS 464 +6/161 PMPS 438

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Alexa and Reuben

Alexa and Reuben

Member Since 2012
Yesterday
8/24 Reuben AMPS 464 2)391 3)329 4 )222 5)194 6)161 7)180 8)222 10)382 pmps 438

Good Morning Lovely Land Land Friends!!

This is where we are at:

Reuben recieved a .25u dose increase this morning, and is up to 2.0u
.05ml bupe
2.5mg pepcid

no apparent nausea
eating well (a lot)
free feeding, as restricting food intake seemed to be implicated in the stomach upset and crisis of 2 days ago
(he seems to need to eat right at the moment he is hungry or his stomach gets upset)

Glucose Toxicity is a genuine concern, and treating this as if it is - in my mind - is the logical response. If I understand correctly, we lost valuable time - and might have exacerbated this possible condition - by sitting at the 1.0 for too long. So we need to be at the front of this wave now, guiding the surfboard down to the beach. (Can you tell that I realllly need a beach vacation soon? :lol: )

If anyone has any thoughts, experiences, knowledge, perspective or a magic wand to wave over this situation, (just kidding! well, unless you actually Do have one, :lol: hahaha :lol: ), - we are all ears! (One of us with lots of pokey on their ears :roll: hahaha)

Hope everone has a great day!

- Alexa, Reuben and Zack
(Zack has requested that he be included in our posts, and I agree. This little trooper has had to adjust his life to our temporary infirmary-like lifestyle, and has no one to hunt lizards with! So the least we can do is let him come play on the board with us! dancing_cat And, he gets BG testing treats too, the least we can do!)

P.S. I need to learn how to upload pictures. It is sooo fun to see all your kitties!
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329

Yay for a new condo! :mrgreen:

Hey, don't say "in the pink" toa forum full of FD kitties :lol:

I think you've got a decent plan worked out with the advice you've received so far. Are you happy to get that (+4)?

Would you like a recap of the most recent advice? I can post one here if you want.

Jane

P.S. I'm not sure how everyone else uploads photos, but here's how I do it. I edit a photo taken with our digital camera (usually around 3 MB in size) to make it about 300x400 pixels. Then I upload the photo to my facebook profile FDMB album. Then, I selec5t the "Img" buttong here in the post, and go to the facebook photo, right click on it, select "copy image location", and insert the image location into the thread (it looks like this:
). I'm sure there's a quicker way though :mrgreen:
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329 +4 222

Jane -

Yellow!!!

I deep-sixed the pink :lol:

Yes, let`s recap the plan, just to have it front and center. I am considering taking him to the vet to get subQ's started. The vet said he was at 2.5 on a scale of 1 - 5 for dehydration the other day. Oral hydration seems not aggressive enough to me now. What`s your opinion on this?

Thanks for the picture uploading instructions, I^ll try to get one up today!

- Alexa
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329 +4 222

Look! numbers! and another! and another!
The big picture is looking better every day!
Yay Reuben!
You deserve to feel better.
Shadow wants you to come visit her soon down in the green surf.


If anyone has another way to do pictures then what Jane said. Please come over to me and tell me how.
I dropped my facebook like a big ol' rock when they started admitting to more privacy invasions and
trying to cash in. The only time I miss it is when there are fires around us. That was a faster way to hear
what's happening.
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329 +4 222

Hi Rhiannon, Yay for numbers, truly!!

I don't know if you use twitter, but I have found it to be extremely helpful for up to the minute information on unfolding events. I pretty much keep my twitter account active for that reason.

Thank you for your cheery and un-flagging support in our quest for numbers!!

RAZ - (Reuben, Alexa and Zack dancing_cat )
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329 +4 222

Here are the quotes from the last thread, with the plan so far:

"Jane wrote: You're coming up on the 8th cycle on this dose, and on the 14th day in mostly black, red and pink numbers. IMHO, I think it's worth considering another increase by 0.25u to help Reuben out of those unhealthy ranges. He did see that one pretty blue BG on the 22nd - I'd like to see him show more of that kind of number, to give his pancreas more time in the healing-range BGs. I would not go straight to a 0.5u increase, just to rule out going past a dose (in this case, 2.0u via the 0.25u increase) that could do some good for Reuben.
The reason I'd go for the increase now rather than on the 5th day (TR Protocol suggests 3-5 days on a new dose to see what it can do, depending on the nadir range) is that Reuben has only had that one single dip into the blue, and the rest of the time, he stayed above 200, and often even above 300, with his nadirs. Glucose toxicity remains at the forefront of my concerns for Reuben. Here's the quote from the protocol:
Quoted from TR Protocol Sticky:
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.
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.
So, to sum up: I would try an increase by 0.25u, making his dose 2.0u (also nice and easy to measure :lol:) for the next shot."

Dyana and Sienne backed up this plan.
I think you're good to go with this.
Jane
 
Re: 8/24 Reuben AMPS 464 +2 391 +3 329 +4 222 +5 194

Awesome --- all numbers!!!!! Gooooooo Reuben!
:RAHCAT :RAHCAT :RAHCAT
 
Re: 8/24 Reuben AMPS 464 2-391 3-329 4-222 5-194 6-161

Wow Reuben baby sing those blues! Alexa it looks like your plan is already helping! Before you know it, you will be ready to start preventing Reuben from going too low, just imagine that :smile: .
Hope you, Reuben and Zack have a great day!
 
Re: 8/24 Reuben AMPS 464 2-391 3-329 4-222 5-194 6-161

Leslie - I was reading your 8/4 condo just now! We are getting ready.... :mrgreen:

Thanks for the visit!

ZAR (Zack, Alexa & Reuben)
 
Re: 8/24 Reuben AMPS 464 2)391 3)329 4)222 5)194 6)161 7)180

Reuben is resting his pancreas in the blues this afternoon, HALLELUJIA!! He threw up +6, but he didn`t have food available (got an emergency call from out of the country just as I was taking his food up to him on the terrace - bean fail!) so that was probably it. He was happy and eating within 10 to 15 minutes after that. The morning dose of bupe is wearing off and he is alert, and gave Zack a little bath. I`ll dope him up again - in the interest of keeping whatever combination of factors that has brought him to blue stable.
 
Re: 8/24 Reuben AMPS 464 2)391 3)329 4)222 5)194 6)161 7)180

My advice would be to get a +10 and a +11 and post both as soon after you get them. At the time you post the +11 say "Help at PMPS?" or something like that in the subject line. That way someone can help you if you get a below 200 or below 150 pre-shot tonight. Then post the PMPS number and hopefully you will have some advice from someone about whether it is safe to shoot a full dose. Hope that makes sense.

Goooooo Reuben!!!!!!!!!!!!!!!
 
Re: 8/24 Reuben AMPS 464 +2/391 +4/222 +6/161 +8/222

Liz - Yes, it goes with his eyes!! I am trying to get a picture up so that he is no long a mystery cat!

Dale - thanks so much for the advice. Looks like he's moseying on back up. +8 222. Exactly the same number as +4 222. Nice job Reuben!!!
But I will remember it for when it does happen!
 
Re: 8/24 Reuben AMPS 464 +2/391 +4/222 +6/161 +8/222

WHAT?!?!?! Check out those numbers!!!!! dancing_cat Especially, those numbers at +6 and +6...and +8 and +4!!! WOOZERS! :-D You guys are rockin' that insulin!!!! Keep it up!!!!!

HAPPY WEEKEND!!!!

~Deborah & Shasta
 
Re: 8/24 Reuben AMPS 464 +2/391 +4/222 +6/161 +8/222 +10/382

What beautiful #s! Reuben is doing great!! How nice to see him blue for his nadir and most of the day. :razz: His organs got a nice break today! I hope he doesn't bounce tomorrow. He's doing so nicely.

Now that he has all his meds and he's on a good schedule with a dose increase he's going to get better and better in no time.

Melanie & Racci
 
Re: 8/24 Reuben AMPS 464 +2/391 +4/222 +6/161 +8/222 +10/382

NICE.....beautiful curve today. You guys are making awesome progress. I can't wait till you get some pics uploaded - I'm dying to see the handsome Rueben (and Zack!)!!!
 
Deborah - YeahHH!! Reuben did totally Rock the Numbers today, didn`t he!!! WOOOOO!! Thanks for the cheering on!

Melanie - Wasn`t it beautiful today! He is going to need stronger stomach meds, as you suggested the other day. I`ll try and get them tomorrow, fingers crossed!

Amy - I`m working on the pix - hopefully this weekend! :razz:
 
Beautiful cycle for Reuben - well done, both of you!

I noticed something on the SS, though - Alexa, did you reduce the dose back to 1.75u for the evening shot?

I didn't see you being advised to do so (and as I explained, dosing advice should be given in condos, not PMs, to keep everyone as safe as possible) and I myself would have advised you to shoot the 2.0u. You had a safely rising red number at PMPS. Also, given that Reuben is not yet accustomed to safe, healthy, blue numbers, he was most likely going to bounce off those blues anyway (as he did on the 22nd, off the dip into the blues, he bounced into the black and, true to form, stayed high as the bounce slowly cleared).

A little reminder about bounces: A cat that isn't (yet) used to healthy numbers (low blues, and mid-range to upper-range greens, sub-120 overall is ideal) will often show what we call "bounces". What happens is that the liver 'recognizes' that the cat's BG is lower than what it is used to. When the BG drops low enough to warrant a 'panicky' reaction from the liver (OR if the BG drops very *quickly*, even if not that low, as for example from the 400s into the 200s in a short time, like and hour or two), the liver will release glucagon and counter-regulatory hormones, in order to push the BG back up. This often happens more forcefully than would really have been necessary - it's a "panicky liver" overreaction. The BG zooms up - this is called a "bounce." Bounces can take up to 6 cycles to "clear" (meaning, the time it takes the cat's body to flush out and deal with the extra sugars and hormones). It's also important to remember that bounces are NORMAL - they do NOT warrant a panicked reaction from YOU (since the liver is already doing that). What we like to advise *when it is safe to do so and the bean can monitor*, is "shooting through the bounce." When it's safe to do so, it can be a great approach to stick to the advised dose, even if there has been a drop requiring a reduction (a drop into the 40s or even 30s, which in this case Reuben was nowhere near, of course), or a drop making the bean nervous (like a dip into the blues for the first or second ever time :mrgreen:). Shooting through the bounce means the sugars and hormones released by the liver will clear faster.

For next time: Please post for advice/feedback *before* you change the dose in either direction. Lantus needs consistent shooting, and every dose normally needs at least 6 cycles to settle in. Dose-hopping makes it very difficult to assess patterns in Reuben's numbers, because it messes with the shed. Maybe you got confused about the phrase "making his dose 2.0u for the next shot" - that didn't mean *only* for the next shot, it meant "for the next 3-5 days, barring any incident requiring a change of plan". Or you may have felt uncomfortable or nervous because he spent some *more* time in the blues in the previous cycle? But remember, the blues is where we *want* Reuben to be! And greens, after that! :mrgreen: It can be nerve-wracking, but you're going to have to get yourself a pair of BOS (balls of steel :lol:) and stick to the dose, and ask for more eyes on a cycle you feel nervous about, ok?

If you have any questions about what I just wrote, please post them and we'll help and give you more information, alright? You're doing a great job with Reuben, and with consistent shooting and those BOS in working order, he's got such a great chance at making more and more progress!

Please post your AMPS (and, if you can, the +11 leading up to that). IMHO, if you get a red or even a high pink AMPS, and you can monitor and test throughout, you can stick to the 2.0u dose (which is to be his dose for the next few days, barring any incident suggesting otherwise). There will be people here to watch the cycle with you. If Reuben throws a surprise-AMPS, we'll re-assess - in that case, please stall (wait) *without feeding* and post for help (add "Help" to subject line). Ok?

Hugs,
Jane
 
Re: 8/24 Reuben AMPS 464 +6/161 PMPS 438 +7 132

Jane - No I did NOT do a dose decrease (I would not do that without getting advice in the condo) - I was tired and wrote the wrong dose. I`m sorry to cause so much trouble to you! I was not nervous about the blues at all. And now we have a +7 132! I will make sure he is on his way back up before I go back to sleep. I intended to do a an earlier test, fully expecting to wake up a few times as I always do. - I'll set an alarm for sure tonight.
 
Hooray! I'm glad it was just a typo :mrgreen: Sorry to flood you with theory as a pre-emtpive measure :lol: You didn't cause *any* trouble, no worries!

That's a beautiful (+7) - almost perfect! If you're worried and can't re-test (via alarm), you can feed that number with some LC if you want. Better now than closer to the end of the cycle :smile:

Thanks for correcting the SS, well done. Sorry, again, that I jumped the theory-gun! Just wanted to make sure we're on the same page!
Hugs,
Jane
 
Jane -
I was just over reading Karre's profile again. I see that his pancreatitis was resolved quickly right at the beginning. I would love to know how you did that :razz:
I am not worried about the 132, it was a lovely surprise to get! You say it is an 'almost perfect' (+7), and I am wondering what a perfect one would be - so I^ll know it when I see it! I wonder how low he went at nadir (+6) . Wish I had seen that! (just to bask in blue-ness) (And, I assume +6 as the nadir based on yesterday's curve).
If it is not necessary to re-test now I won`t.
He is nauseaus - wants to eat but can`t. I need to get the correct medicine for this tomorrow - pepcid is not doing the trick. What did you give The Emperor?

- Alexa
 
reuben'smom said:
Jane - I was just over reading Karre's profile again. I see that his pancreatitis was resolved quickly right at the beginning. I would love to know how you did that :razz:
I am not worried about the 132, it was a lovely surprise to get! You say it is an 'almost perfect' (+7), and I am wondering what a perfect one would be - so I^ll know it when I see it! I wonder how low he went at nadir (+6) . Wish I had seen that! (just to bask in blue-ness) (And, I assume +6 as the nadir based on yesterday's curve). If it is not necessary to re-test now I won`t. He is nauseaus - wants to eat but can`t. I need to get the correct medicine for this tomorrow - pepcid is not doing the trick. What did you give The Emperor? - Alexa
Click to expand...

Hi Alexa

Yes, we were immensely lucky with how quickly Karre's pancreatitis resolved. Veterinary care here in South Africa is, I think, quite different from the way it's done in the US and Europe. You're in Mexico, is that right or am I mixing that up? Well, in any case, here meds can be a little hard to come by... Karre was given antibiotics (Synulox) to ward off any secondary infection, "squids" (subcutaneous fluids) at the vet, and pain meds (Temgesic) to keep him comfortable. His appetite remained pretty decent throughout and he showed no signs of nausea and did not vomit, so he didn't get Pepcid etc. and luckily, he recovered very quickly indeed. He's really not the norm - must be the royal blood :lol:

About the "perfect" (+7) - that's not to be taken too literally :smile: For Reuben, who has spent so much time in the blacks/reds/pinks, any blue number is pretty perfect :mrgreen: Like you, I wonder whether he went lower earlier in the cycle. Keep in mind that while the "standard" nadir is around (+6) on Lantus, many kitties have a different (or even changing/travelling) one. Karre's for instance is around (+3), but he's had nadirs at (+2) and (+4) anmd even a bit later, too. The more data you collect for Reuben, the more his patterns will emerge. Exciting stuff! As for the nausea, I believe Zofran (Ondansetron) and/or Cerenia are commonly prescribed for nausea/vomiting - but as I say, Karre has never had them. Re-post the nausea concern in your next condo, ok? That way you'll get more input on what to ask the vet for when you go to get meds for Reuben. There are also a number of appy stimulating meds, Cypro and Mirtz are commonly mentioned around here (but it's often emphasized that appy stimulants should not be given without also addressing nausea/vomiting via meds). If you have longer-term concerns about Reuben's appetite, there are some other options too (we had to syringe-feed Karre for a while due to DKA effects at first FD DX) - Karrie/Maverick will have plenty of info there, for instance, should the need arise.

Some other tricks to encourage eating, by the way: heating/warming the food a bit, sprinkling with Fortiflora (a probiotic made by Purina that works well as an appy stimulant), sprinkling with parmesan, sprinkling with crushed Liv-A-Little treats (freeze-dried chicken/tuna etc.). Sorry - probably info-overloading you again :mrgreen:

See you in your morning condo!
Hugs,
Jane
 
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