9/15 Tigger AMPS 323 PMPS 378

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Re: 9/15 Tigger AMPS 323

Yes, gave 1u of R this morning.
He's not super high, but trying to get to the yellows and fluctuate in there for a while instead of the Pinks!
Hoping to be yellow for PMPS and will continue to use the R even if its high yellows. Have to up to 19 tonight for Lantus, forgot this morning was the 5th shot on 18.
Man there's so much to keep on top of, my poor little brain can't keep up sometimes!
 
Re: 9/15 Tigger AMPS 323

Have you considered holding, or even reducing the Lantus dose and upping the R?

I can't speak to the Acro side of things, however with the IAA it's important to remember that one day it will break.
My concern is that 18u ofo Lantus has created a shed the size of Lake Michigan. As an example, BK was at about 13.5u of Lantus in Oct. 2008. At that time my R scale was very aggressive-

400+ >>> 6.5u AM /PM PS, AM+6 -6.0u
375-400 > 6.0u AM /PM PS, AM+6 -6.0u
325-375 > 5.5u AM /PM PS, AM+6 -5.5u
250-325 > 5.0u AM /PM PS, AM+6 -5.0u
200-250 > 4.5u AM /PM PS, AM+6 -4.5u
180-200 > 4.0u AM /PM PS, AM+6 -3.5u
160-180 > 3.5u AM /PM PS, AM+6 -none
Under 160 - No R

Around the end of October 2008 things started changing. Because R does not have a shed, by not shooting R at that point I had an instant decrease of ~12u (based on the above scale) and less of a concern about any shed action keeping him too low. The ability to eliminate the R left me with just the Lantus dose/action to monitor and adjust. Had I been using a different Lantus to R ratio at the time the IAA broke It may have been a very different story.

With IAA the insulin binds to the antibodies. When it beaks, whatever antibodies happen to be around release the insulin that was bound to them - resulting in an increase of insulin of unknown quantity . Under those circumstances even if you skip a Lantus shot altogether, shed action from a huge shed plus the release of insulin from the antibodies could spell big trouble.

I want you to be aware of the potential consequences of a large shed at the point when the IAA breaks, which unfortunately is an unknown.

You said it yourself a while back, Hope for the best, plan for the worst.
 
Re: 9/15 Tigger AMPS 323

I have thought about what happens when the IAA breaks with that shed, but the Acro is also outcompeting the insulin to the cells (from what i've read here and researched) so its much different than just IAA. Everyone says Acro trumps IAA and i don't totally get how the two work together in this mess.

It sounds like once the IAA breaks there's still the issue of Acro which will prevent a super drop like a regular diabetic cat, if I understand this correctly.
So you have to be aggressive to get on top of the IAA and the Acro with Lantus and R I believe.
Just started messing with the R and the dose will be increasing, but when i'm not around to test (work days) i give the 1u which I am comfortable with. If i am around I will up the dosage and test hourly to see how it affects him. Tonight i will probably use 1.5u of R again to get some numbers.

Once i'm comfortable with 1.5u i'll go to 2 and use the 1.5u on work days. That's the plan anyways, but subject to change like everything else in this world of FD-Acro-IAA!
:lol: :lol:

Also, I like your scale there and I'm in the process of working up to something like that with the R, just not there yet.
 
Re: 9/15 Tigger AMPS 323

hnkstr said:
Everyone says Acro trumps IAA and i don't totally get how the two work together in this mess
Click to expand...

As I said before, I can't really speak to Acro as I don't have personal experience and my knowledge is limited. That being said, I don't know what "Acro trumps IAA" means exactly, other than IAA is self limiting and will end one day and Acro will not.

The goal of managing an IAA only kitty is to try and get kitty into, and keep him at, a safe number range, one that avoids organ damage, as much as possible until it breaks. I could be wrong, (someone please correct me if I am) but I believe that is also the goal of Acro management (keeping kitty in a safe range).

This was very challenging with BK, especially since he went into DKA twice early on. The R scale I outlined was the most aggressive, at the height of it all (when I look at it nowadays it's downright shocking). It was just one of a seiries - we worked up to it, step by step. And when the IAA broke our R scales evolved very quickly in the other direction. I'm in the process of putting BKs R scales on the 2nd tab of his ss, with thier respective date ranges.

So you are feeling your way through the R dosing, which is all you can do. I'm just wondering if more focus on R increases rather than rapid Lantus increases may be a better strategy at this point.

just my $0.02 :idea:
 
Re: 9/15 Tigger AMPS 323

I hear ya and what i've gathered is the R doesn't replace the Lantus in Acro Kitties, it only helps to give the Lantus a chance to kick in?
I've asked the same questions around the R, does it help to limit the amount of Lantus needed and what i've gotten back was that it doesn't in Acro kitties.
Its a tool to assist Lantus, not replace the dosing level.

Its all new to me and from his spreadsheet I think we are getting close to something, he is spending more time in the Yellow than he has, but still does jump and then we work him back down with the increase of Lantus and now the R to help.

With the higher levels of Lantus lately, i've seen a positive change in his attitude as well. Last night he got a flash of spunk and tore around the house like he did when he was a kitten. It didn't last real long, but it was a surprise and I think we are getting closer to that magic dose.
 
You're telling me! Somedays I struggle here, like today.
Just making sure I put Lantus in that syringe instead of R is sometimes nerve racking when i'm shot.

Well, he came in at 420 at +10 and starved today. Gave him some food and 2u of R and his PMPS came in at 378.
And he's still starving, i'm gonna have to make a Walmart run, down to 8 cans of FF which may not be enough until I get home tomorrow!
 
I have to say Brent that you are amazing. I'm so glad Sandy is here....her experience with IAA is invaluable.

Keeping our paws crossed that Tigger will safely break and come down slowly.
 
Thanks Marjorie, but I don't know if I'd say i'm amazing. :lol:
I would say it does take some effort to do this stuff, as everyone here can attest to!

Like I said once before, I think it's God's messing with me since I'm single with no kids, he wanted me to have more responsibility and adversity!
:lol: :lol:

Hey God, I get it man, i'll start looking for my wife once you heal me so I can have the energy for it!
:lol: :lol: :lol:
 
hnkstr said:
Just making sure I put Lantus in that syringe instead of R is sometimes nerve racking when i'm shot.
Click to expand...
I used to have 3 stickie notes stuck on the countertop, one for each syringe (I had to split the Lantus into 2 syringes because my hands were not steady enough to shoot much over 7u at once). Each stickie was marked with a dose - Lantus 7.0u, Lantus 6.5u, R 5.0u. First I'd fill the R, place the syringe on the corresponding stickie, and put the R away. Then prepare the Lantus syringes and lay them on their places.

There was a member back in the day who had a HD kitty and was using R and Lantus, the Lantus being the (much) higher dose. One night she thought she may have pulled the R in the larger dose by accident. It resulted in a rush to the ER. Everything turned out OK, she clearly did not make the error. But that's' the danger of being on "auto pilot" That scared me into my OCD behavior around all the shots!
 
That is exactly what scares me some days when i'm "foggy"!
One mistake like that and, well it won't be a good thing.
 
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