9/30 Ozy AMPS-107,+2-128,+4-117,+8-195

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donaleen and Ozy

donaleen and Ozy

Member Since 2013
Yesterday http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=105411

We raised Ozy's dose back to 2.75 and he responded with normal numbers. So good to see. He feels much better. And he isn't so ravenous any more.

I also think I am going to make it a practice to feed him a little more when his numbers are high and he is ravenous like that. It seems his body isn't processing the food as well when he is high.

I am wondering if we should go to a scant 2.75, given how quickly he came back to normal. I will be watching him closely today.

Thanks for all the support and information yesterday.

donaleen
 
Re: 9/30 Ozy AMPS-107

I guess you're supposed to hold the dose for 3 cycles, unless he earns a reduction, but I think with both our cats they didn't hold their most recent reduction very well, so I'm interested in seeing what advice you get. You're using Lantus, right? So you have to wait for the shed to deplete a bit anyway.
 
Re: 9/30 Ozy AMPS-107

You hold the dose for 6-10 cycles, depending on this and that. But I think those rules are to be applied more stringently when you are raising the dose and trying to find the correct dose for the cat. What we need to do is make micro adjustments to the dose. 2.75 is a bit high and causes low numbers. 2.5 is a bit low and makes high numbers. So, at this point, I am not sure what the hold the dose adjustment rules are.

Also, for both of us, pancreatitis can throw things off. And that may make for dose increases. Since pancreatitis can happen anytime, then the rules should bend for that.

And we still have a really hard time with adjusting the syringe. I spent a long time even getting 2.75. I swear our syringes like the half unit marks. It is hard to get the quarter adjustments. And now we if we need a fat 2.5 or a skinny 2.75, well, that is even harder.

My little brain says, hmmmm... why not do 2.75 in the morning and 2.5 in evening (smaller dose at night). I don't see why that should be forbidden. It's consistent.

Just where I am...
 
Re: 9/30 Ozy AMPS-107,+2-128

OR and "I am but an egg" as Michael Valentine Smith says, stalling a shot is a dose decrease, n'est-ce pas?
So rather than tweak the dose, tweak the time?

But we're supposed to give the same amount, twice a day, at 12 hour intervals. Is that the rule, always, or are there exceptions?
 
Re: 9/30 Ozy AMPS-107,+2-128

I am still getting a handle on the finer points of the rules, but I think ECID gets into the mix. And your idea has merit as well...maybe going for the same dose but adjust the cycle times. Maybe make the daytime cycle 13 hours and the night cycle 11 hours.
 
Re: 9/30 Ozy AMPS-107,+2-128

I have the same problem as you regarding judging the microdoses. My eyes can't focus properly on fine details, because of a rather unfortunate laser surgery. So if playing with time = increasing or decreasing a dose, that's in a way safer for me than guesstimating the amount of insulin.
 
Re: 9/30 Ozy AMPS-107,+2-128

The suggested "guidelines" in the Tight Regulation Protocol are just that... guidelines. Not hard and fast rules.
The Tight Regulation Protocol is a great place to start, but once you gain experience and knowledge of YOUR cat's response to insulin you may find yourself in need of tweaking and refining your approach to treating your cat's diabetes. "Every cat is different" is not just a slogan. Following suggested guidelines is a great place to start, but some kitties will force us to think outside the box. Bring up any concerns you may have. Chances are someone else has been there, done that and may be able to help.
Click to expand...
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

If I were to get another sugar cat, and I were to use Lantus...
I would try my best to follow the TR protocol to the letter. They make "this" so much easier, IMHO, than using an insulin that doesn't even come with a "set of rules".
At some point, where I felt that for whatever reason my cat was "outside the box", even though I'd done everything by the book, then I'd do exactly what the red letters above say to do. And I'd probably take quite a while before making that decision, to be certain that I was being forced to think outside the box. To be sure that my patience pants had completely worn out.

I think I would probably try manipulating the carb content of the food, and the timing of the meals first. Before I'd consider tiny tweaks in dose or shot timing. And I'd try to play with only one variable at a time, so I'd not get confused over what was working or not working before I tried another tactic.

And I'd sure ask for lots of people who have had to think outside the box because they'd dealt with the same issues I was dealing with to help me understand what my options might be and how to go about implementing them. I'd try to identify a "non-conformist kitty", and I'd study the hell out of its spreadsheet too.
 
Re: 9/30 Ozy AMPS-107,+2-128

Thanks, Carl, great response. The thing is, Ozy feels so bad when he goes high. It is hard to leave him high because he feels bad. The last four cycles were excrutiating for both of us. If I had it to do over, I would have raised his dose sooner than last night. The one thing I want for him, even more than a long life, is an enjoyable quality life.

The other thing is, that moving the cycle really throws off the feeding schedule. As you were witness to, I had to stall 2 hours because he went low. The feeding schedule is so tied to the cycle that it is another variable that changes. Ozy had adjusted pretty well to eating every 4 hours or so and then his cycle time changed and we are still struggling with the food schedule. It affects all the cats, actually.

I don't want to be willy nilly BUT I don't want to be rigid when the rules don't quite seem to fit.

And I am pretty exasperated with trying to adjust those #^&**^ syringes. Arrghh.

So, this is my time of figuring it out and thinking about it.

donaleen
 
Re: 9/30 Ozy AMPS-107,+2-128

Donaleen,
This is NOT criticism, so please don't take it that way.

As you were witness to, I had to stall 2 hours because he went low.
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(emphasis mine)

I have no beef with you stalling at all. But "had to" and "choose to" are not the same. Absolutely the "hardest part" of the TR protocol that I try to wrap my head around (asking myself "would you shoot???") is shooting low numbers. My "PZI Brain" kicks in. Even though I shot low numbers with PZI, it was tiny less-than-one-unit doses. Therein lies my shying away, for the most part, with yelling "SHOOOOOOTTTT!!!!" when I see someone stalling and I look at the dose and it says "2.5u"...

In fact, on the evening you are talking about, I was PMing one of my "tutors" as I like to call them. ;-) And I'm thinking "she can't shoot that, right?" And you know what she told me? She said "leave your pzi brain at home." She explained to me that the size of the dose is irrelevant because of the way that Lantus works. And that although the low preshot number "matters", it isn't the preshot that you are focusing on. It got through my thick skull (for now anyway!) and when I saw you shoot the +14, I was smiling. :-D

At the root of all of this is "KNOW THY CAT". That's, IMHO, the MOST important aspect of dealing with feline diabetes, no matter what insulin you use or protocol you follow. And that requires a good bit of experimentation and testing to see what "an idea" will do for you. Whether it's stalling, changing feeding routines, adjusting a dose, whatever. You try it, you gather data, and then you evaluate the results. If it fails once, don't assume it will fail a 2nd time. If it succeeds, still no assumption it's going to work every time. Every day is a new adventure. And every day you learn something new.
 
Re: 9/30 Ozy AMPS-107,+2-128

Nice blues for Ozy this morning. I hope you can find a shot schedule/dose/feeding time that works best for Ozy. I know exactly what you mean about adjusting the syringes. You'd think they would make them easier to move. Do you use calipers? They help me greatly in keeping Furball's dose consistent.
 
Re: 9/30 Ozy AMPS-107,+2-128

Yes, Carl, you are right, stalling wasn't the only option. Because it was both a low number and a falling number, shooting on time was not a good idea. So that left stalling, a reduced dose, or skipping.

Reduced doses seem hugely frowned upon in Lantus land. I can't say I understand why. The reasons I've read seem to refer to the depot nature of Lantus, but the depot nature to me seems like an argument FOR small adjustments. Nonetheless, even though I don't understand it, I didn't go against it.

Skipping was also uninviting because he had had a pretty good run of numbers and I didn't want to rock the boat. Skipping seemed like a BIGGER change than stalling.

I didn't even consider the effect that stalling would have on the feeding schedule. But it does have a big effect. And because I am trying to help Ozy lose some weight, that complicates it further.

Because I had already shot several pretty low numbers, the 55 didn't scare me so much. I knew he was likely to go low and get a dose reduction. Maybe I should have thought about that harder. The lower dose didn't do the trick for him.

And I take no offense. I am just trying to figure out how to make all this work the best it can for Ozy as well as for John and me.

I keep looking at that run of great numbers and asking myself what I could have done differently to keep it going. Not taken that last reduction? Taken a smaller reduction? Taken him back up to 2.75 earlier? What Know They Cat lesson should I learn from it all?

I think one Know Thy Cat rule for Ozy is that more than two cycles of yellow and pink are enough to make him feel pretty bad. But there must be more to learn from it.


donaleen
 
Re: 9/30 Ozy AMPS-107,+2-128

And, Carla, no, I haven't tried calipers. I find it difficult to adjust the syringe finely. I screw it, I concentrate on it. It just seems physically difficult to control the slide of the syringe. I don't know what I will do if Ozy goes way down to the drops cuz I don't think I can manage it. But we are far away from considering that.
 
Re: 9/30 Ozy AMPS-107,+2-128,+4-117

I understand about having trouble sliding the sryinge. I do too sometimes. I twist and twist and it doesn't seem to move.

I was just mentioning the calipers in case you wanted to check into them for giving Ozy in between doses.
 
Re: 9/30 Ozy AMPS-107,+2-128,+4-117

Because it was both a low number and a falling number
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My only comment on that is that sometimes we see a falling (or rising) number that isn't "really there". There were four tests from +12 to +14 that night.
65, 55, 58 and 55 according to the SS.

I don't see a rise or a drop in those 4 numbers. No doubt the +12 (65) was significantly lower than the 121 you saw at +9. That slide from AMPS to PMPS was for sure "falling". It was a bounce going away. When I see people that see a 10 point "drop" in numbers, or a 10 point "climb", and use that observation to make a decision, it usually makes me cringe. Because of meter variance. These meters cost what, 20 bucks? They probably cost 3 dollars each to mass produce. Definitely not high-tech scientific precision measuring devices. I'm willing to bet that if we test 4 times in the space of 4 minutes, we'd get 4 numbers probably close to the 4 you got that night. In general, if I see numbers within 10% of each other, all I can call that is "flat".

I was actually sitting here that night thinking "I hope she sees a 90" so there won't be any doubt it's rising. And if I remember right, you had fed at +12, so I was fully expecting the number to jump up? And it didn't. In hindsight, I wish I'd said "go ahead and shoot" sooner. Since he'd eaten, you gave the food a 2 hour "head start" on the insulin, which probably had an effect on the rest of the cycle in terms of when onset, nadir, etc. happened.

Water under the bridge at this point. I think he was going to bounce like he did no matter what.

The reasons I've read seem to refer to the depot nature of Lantus, but the depot nature to me seems like an argument FOR small adjustments.
Click to expand...

The concept I think about when trying to grasp what the depot is, or how it acts, is sort of the same way a water tower works, which I could try to explain later if you're interested. But I'm wondering if you could expand upon what you mean as to why small adjustments seem logical based on the depot nature of Lantus. Just because I don't understand what you're thinking? Or how to help.
 
Re: 9/30 Ozy AMPS-107,+2-128,+4-117

It was the 121 to 65 that I thought of as falling. I knew the rest were essentially the same. The feeding threw a bit of confusion in there. When I saw that 55, it was Pavlovian. I just reached for the food and then realized it was the wrong thing to do.

As to why I think of the depot as an argument for small adjustments, it is because the adjustment is even tinier than it seems due to the depot. If I drop a quarter from 2.75, that is even less of a percentage because the depot has insulin in it. So it would seem that small steerings with insulin would work.

I see steering Ozy with food as problematic because Ozy's glucose level is NOT real food sensitive. Others have commented on that as well. I have to give him more calories to make a difference in his glucose level. And that gets in the way of weight maintenance. I see his weight management as important because his legs are so weak. I don't want them to have to carry more than they already do. But maybe I can deal with that by adjusting when I feed him and expect to give him more food at his nadir time. If only his nadir were more predictable...
 
Re: 9/30 Ozy AMPS-107,+2-128,+4-117

Ozy gets zobaline every day (it's in his SS comments). And once a week he gets a B12 injection. One kind for his neuropathy, one for his pancreatitis.

I don't know if all of his leg problems are neuropathy. The vet talked about arthritis as well.
 
interesting discussion you guys have had today!

a couple of thoughts - i wouldn't dose differently am/pm. better to find a dose that you can stick to twice a day. the shed is the reason. when you decrease a dose, the shed can continue to affect the BGs for the following 6 cycles. your goal is to flatten out ozy's blood sugar and changing the dose would work against that - at least that's my understanding.

you can use carbs to lift up the nadir with a higher dose. that might help while you are thinking you're inbetween an even dose. there are some high carb gravy foods that have as much as 24% carbs. not sure of exact names, but you could check the catinfo.org list. you wouldn't necessarily need that high, but i'm responding to your comment about Ozy not being carb sensitive. i usually used a 16% carb on punkin. it might be that you've got a lower HC gravy than others are using.

donaleen, did you lose power in the storm? we were out from dinner til the middle of the night last night. what a monsoon - we had 3"ish of rain just from sat-sun!
 
Hi Julie,

I would put this in his new condo and quote what you said if I knew to how to quote between threads. I haven't figured that one out.

Sorry I didn't respond last night. I will be reading about the shed. It seems to me that such a concept could have an impact on the string of reductions he had so close together. Not a very nice thought.

As to carbs, Ozy is allergic to grains (he gets asthma) and all the higher carb foods I can find use gluten to raise the carb content. So I use maple syrup added to his regular food.
 
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