9/6, Atlas, Amps 312, PM +3 241 slider

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Beth & Atlas

Member Since 2010
Good Morning Every One!!! I am gonna need an extra ~O) . This worried bean was up for the +6 spot check last night!

Yesterday's Slide into Blue

Today should be a gorgeous day, maybe take that walk out the back door. It's been calling me for several days.


Last HOLIDAY of the summer! Ya'll have a great, great day.
 
Re: 9/6, Atlas, AMps 312

Dont worry bean...it wont be like this for long..lol
Thanks for the utube it made me tear up.
Im sure Atlas will be in the blues and greens before you know it. Have a great day and yes go for a nice walk.
 
Re: 9/6, Atlas, AMps 312, +3.5 418

sorry to see that ugly red color rear it's head ... but now at least mocha isn't alone .. hey, I have to have something to be positive about, right??
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Oh Blue...we know you didn't choose that ugly red. :YMSIGH:

What's up with that dude? Why the red????
And Atlas Shrugged...

That was so bad... :-Q

sorry....I couldn't help myself... :lol:
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Pat+Raja+Shadow said:
Oh Blue...we know you didn't choose that ugly red. :YMSIGH:

What's up with that dude? Why the red????
And Atlas Shrugged...

That was so bad... :-Q

sorry....I couldn't help myself... :lol:
Click to expand...


I have two thoughts on why the red?

One, he continued to drop last night after the 1am spot check. I did give him another half can of food at that time too, as he was still on his slide. So either we're still waiting for his system to adjust or we're at too much insulin or he should be ...OMG! SID?

Two, his system is sensitized from the fast drops on N, that anything below a certain point causes a liver dump. Whether he got there slowly or fast. So, if he is just being sensitive we ride this out for another few days.

Edit: In any case a more experienced opinion would really help in this regard.

Atlas Shrugged? Yikes! Who is John Galt?
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Hi Blue!! WElcome to LL--I have not been able to post much on this awful loaner computer!
Moonie was also on N in the beginning, which did strange things to her-
The adjustment to lantus took quite a bit of time, but I could see physical improvement quickly
One thing we need to remember-
IT"S NOT ALL ABOUT THE NUMBERS!!
LOOK AT THE WHOLE CAT!!! Is he playing, eating well, happy, 5 p's, looks better, more affectionate--You can tell when he is feeling good!! That counts so much!
Looks like you are doing a very good job here--Keep up the great work & you will see Atlas thrive!
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Hi Ronnie,

He has been doing Ok on N up until a month or so ago. Then it started to get pretty erratic, with the fast drops from Hi's. We thought it was a duration issue.

I have lots of time to contemplate his dose for tonight. These curves just look so whacked out. First I thought I should go up, then down, now down again?

I was trying to work from the protocol the first week, but the guidance is so vague in regards to my actual numbers.
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Looks like we're setting up for another slide in lower numbers this evening.

What the heck does a slide mean and how the heck does one "manage" it. I can't be up all hours of the day & night, hold a 40hr job, and run my own business...

So let's see...from Wikipets I picked up that cats metabolize lantus faster than humans. With humans that equates to 50% of the lantus still at the injection site 24 hours later.

So that would mean 1u in a human would only be 0.50 units in 24.

What is happening with slidage? What am I observing?

In a cat that would mean 0.50 units in 12. (too low to notice yet)
So you give another unit at 12. Now there is 1.5 under the skin. (slide starts)
Twelve hours later the left over is 0.75 and 0.75 used. Day one. (bounce, not rebound)

Day two is 1.75 with half used 0.88 at 12. (Start on the bounce, then slide)
Add another unit= 1.88 and half used is 0.94 ( continue longer slide, bounce in the last hours lack of insulin ) Doesn't explain fast rise, but the time release in the depot explains the fast clearing of what appears to be a rebound, but is actually a bounce?)

Day three is 1.94 half used at 0.97 at 12 (start on the high bounce, then slide late in cycle)
And another unit=1.97 and half that. 0.98 (start to even out at this point)

So 3 days to fill that one unit around the clock.

Sorry for the overthink on this...I just sometimes need to write it out!
 
Re: 9/6, Atlas, AMps 312, +3.5 418

I need to preface this with my newbie status and the fact that I was told not to test often when I first started, but from the little information I did have, Weeble had a similar slow, downward trajectory after the shots. Before I got to this board, I kept not shooting because of it. Eventually it evened out, but then she wandered into honeymoon territory so we don't have any long-term data to help.

Also, even when a vet switched me to Humulin-N (which didn't work for her) I was getting really inconsistent readings--as though I was missing shots even though I wasn't. Then I changed the injection site from her scruff to behind her shoulder and made sure I held the plunger for 5 seconds or so after injecting and the really WTH? readings went away.

Again, I'm new so maybe this is all old news, but I thought I'd throw it out there...
 
Re: 9/6, Atlas, AMps 312, +3.5 418

Your assumption is that:
Blue said:
One, he continued to drop last night after the 1am spot check. I did give him another half can of food at that time too, as he was still on his slide. So either we're still waiting for his system to adjust or we're at too much insulin or he should be ...OMG! SID?

Two, his system is sensitized from the fast drops on N, that anything below a certain point causes a liver dump. Whether he got there slowly or fast. So, if he is just being sensitive we ride this out for another few days.
Click to expand...

I tend to think this is the most parsimonious explanation and does not rely on Atlas being sensitized by his experience on N. You see the same pattern from the AM cycle the previous day - he's responding to the blue numbers with a bounce. Most of our kitties go through this process whether or not they have been on another type of insulin.

I'm not sure I understand your explanation of Lantus metabolism. In humans, the duration of action is a maximum of 24 hours. I'm not clear on what you mean by 50% of Lantus is at the injection site after 24 hours. Cats metabolism is double that of humans, hence a 12-hour duration and BID dosing. If you are referring to the depot that's formed, only a small portion of what's injected goes to the formation of the depot. As Lantus is metabolized after the depot is formed, you are continually adding more to the stored pool as it's used. If a dose is increased, it takes a few days for the depot to be replenished. If a dose is reduced, there can be a bit of "overflow" the next cycle due to there being more in the depot than is needed. On a day to day basis, the depot allows for overlap between doses so there isn't the precipitous drop you see with shorter acting types of insulin.
 
Re: 9/6, Atlas, AMps 312, +3.5 418, +10 317

I'm not clear on what you mean by 50% of Lantus is at the injection site after 24 hours. Cats metabolism is double that of humans, hence a 12-hour duration and BID dosing.

--------------------------------------------------------------------------------------------------------
According to wiki, 50% of lantus is literally still at the injection site, in humans after 24 hours. For cats it would 12 hours.

Absorption studies in humans[15]indicate that 24 hours after being injected, approximately 50% of the Lantus dose remained at the injection site; after 48 hours, the amount was about 20%. Cats seem to absorb and use Lantus about twice as fast as humans. http://petdiabetes.wikia.com/wiki/Lantus
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As Lantus is metabolized after the depot is formed, you are continually adding more to the stored pool as it's used. If a dose is increased, it takes a few days for the depot to be replenished. If a dose is reduced, there can be a bit of "overflow" the next cycle due to there being more in the depot than is needed.
Click to expand...
I am sorry, this makes absolutely no sense to me. Did you mean the exact opposite? Why would a dose increase cause the depot to be need to be replenished? Why would a reduced dose cause an overflow? I know I read this up in the sticky, but it doesn't make sense.

I am glad to here all the kitty's have gone through this type of adjustment...the question is we're again repeating yesterday's event and is it too much or too little insulin? What do I do? I am trying very, very hard to understand how to get this cat into regulation. Last night I shot the dose and was up half the night on a slow hypo-watch. Only to finally get up this morning to these crazy high numbers today?

I am tired and even aggravated at this point. Is it a bounce, is it rebound...do I put at him the vet to get regulated. I give-up...

I hate shooting without any answers to justify my decisions.

I tend to think this is the most parsimonious explanation and does not rely on Atlas being sensitized by his experience on N.
Click to expand...
frugal explanation? I don't understand what you're trying to communicate with this statement?
 
Re: 9/6, Atlas, Amps 312, we're on the slide again!

I sympathize with your frustration. I really do. I also understand the desire to know why you're doing something when you do it.

For me, the two keys to understanding what was happening with Weeble and Lantus was "the shed" and "the overlap". The shed because I couldn't understand why, after two or even three days of using insulin, I was still seeing wildly high numbers. I think the concept of the shed needing to refill after raising a dose is because the dose wasn't high enough to fill the shed to begin with. Alternately, when you lower the dose, the shed is filled with the previous larger dose--that's why there's more in there when you lower it.

I kept not shooting or thinking that she only needed one shot a day because my cat, too, was getting the lowest numbers at the end of 12 hours. I couldn't understand how if she could get pushed down from over 500 to 150, that another dose wouldn't push her down below 0. I had personally considered the idea of an "overlap" but neither of my vets had mentioned it. So when I read about it here, a light bulb went off and I got the confidence to not only shoot at those numbers, but to slow down, stay patient and be content, for a few days at a time, to observe and see how things were working.

I think the most important thing, though, is that every cat is different. And these are cats we're talking about. They like to stray from the norm and surprise you. It looks to me like, even though those numbers are being stubborn, you have seen some movement, and likely will again. Right now you're gathering valuable information. I also found it helpful to look through everyone's spreadsheets--and see many others also struggled in the beginning, and even afterward.

I also found that I had to take a breath and a little step back--I acknowledged to myself that I wasn't going to be able to solve this right away, which relieved a lot of the pressure.

Hope this helps and that you keep up the good work!
 
Re: 9/6, Atlas, AMps 312, +3.5 418, +10 317

Blue said:
.....I am glad to here all the kitty's have gone through this type of adjustment...the question is we're again repeating yesterday's event and is it too much or too little insulin? What do I do?
I am trying very, very hard to understand how to get this cat into regulation. Last night I shot the dose and was up half the night on a slow hypo-watch. Only to finally get up this morning to these crazy high numbers today?

I am tired and even aggravated at this point. Is it a bounce, is it rebound...do I put at him the vet to get regulated. I give-up...

I hate shooting without any answers to justify my decisions....
Click to expand...


Blue,

I just want to say Atlas has been on Lantus insulin for 6 days now. I don't know the scientific lingo on this crazy sugar dance we've all been through, but I do know this:
Lantus takes and requires patience. Lots of learning and asking questions.
I can only offer you that support. It takes patience. Regulation does not happen in such a short time nor at the vets.
Bounces happen, crappy numbers happen. But look at the whole cat. How is Atlas today compared to months ago?

Ditto to Amanda's post

Amanda said:
I think the most important thing, though, is that every cat is different. And these are cats we're talking about. They like to stray from the norm and surprise you. It looks to me like, even though those numbers are being stubborn, you have seen some movement, and likely will again.
Right now you're gathering valuable information. I also found it helpful to look through everyone's spreadsheets--and see many others also struggled in the beginning, and even afterward.

I also found that I had to take a breath and a little step back--I acknowledged to myself that I wasn't going to be able to solve this right away, which relieved a lot of the pressure.
Click to expand...
 
Re: 9/6, Atlas, AMps 312, +3.5 418, +10 317

Blue said:
I am sorry, this makes absolutely no sense to me. Did you mean the exact opposite? Why would a dose increase cause the depot to be need to be replenished? Why would a reduced dose cause an overflow? I know I read this up in the sticky, but it doesn't make sense.?
Click to expand...

Layperson explanation (because that's what I am!): an increase doesn't cause the depot to need to be replenished, it causes the depot to need to be expanded. A bigger dose needs a bigger depot, so some of the insulin from the first few shots of a new dose needs to go into filling that extra space. Dose reductions cause an overflow because now the depot needs to be smaller, so there is excess insulin that needs to be pushed out of the way (back into the bloodstream).

Blue said:
I am glad to here all the kitty's have gone through this type of adjustment...the question is we're again repeating yesterday's event and is it too much or too little insulin? What do I do?
Click to expand...

You wait. I know, that's hard. Jojo used to call Lantus the Zen insulin. It's especially hard for those who come from PZI or Vetsulin, where you have a more predictable relationship between what goes in and what results you get. With Lantus, not much happens until you get the overlap built up to where it works for your cat. That means most people see a whole lot of NOTHING, dose increase after dose increase, until one day BAM! There's green everywhere. I still don't really understand it either, but it happens almost every single time and it's fascinating. How long does it take to get there? ECID. Some cats are regulated within weeks. My cat took about 2 months to see a breakthrough after I started working the protocol, but I still wouldn't have called her "regulated" until right before she went OTJ. She was definitely a bouncer, but then one day all of a sudden she stopped bouncing. Look at the spreadsheets of other cats who have been here a while and are regulated, and you'll see that most cats have numbers all over the place, then one day suddenly it's all blue and green.

I think the fact that Atlas is getting blue already is a great sign. You have to learn to ignore the bounces, they happen, focus on the nadirs and you'll feel better. Good nadirs are your goal, and the rest of the numbers will fall into place eventually.

Follow the protocol, if things don't change after another couple of cycles then you can increase the dose. That should bring the whole range down. I wouldn't increase just yet, though, because Atlas has gotten some good blue on this dose so it's a good idea to wait a couple more cycles to see what happens when this bounce clears.
 
Re: 9/6, Atlas, Amps 312, we're on the slide again!

Let me see if I can use an example and be more clear. If your dosing based on 1.0u, the shed is formed based on that 1.0u. You then need to increase the dose to 1.25u. The amount in the shed though, is still based on your previous dose (1.0u). Not all of the new dose is going to fill the shed -- only a small portion. As a result, it can take a few cycles to 'top off' the shed so it reflects the increased amount of insulin needed. Then, when you need to decrease a dose, the shed is based on your current dose (which is now more than your cat needs). The shed still needs to play catch up with the smaller dose -- the same process but in reverse. As a result, there's too much insulin in the shed and it may take a cycle for the overage to be depleted so you're at the new, reduced dose.

I hope that helps. If not, maybe Libby's explanation was better.
 
Re: 9/6, Atlas, Amps 312, we're on the slide again!

Ok, that makes more sense. Thanks Libby and Sienne.

So way back up thread where I'm trying to figure out when the 1.0 shed is filled...is kinda accurate? So at the end of the next several days, if Atlas is still in the 200-300's we increase the dose. Until then, pretty much ignore all the other numbers other than for observation.

Another site/article called it "panicky liver" and is actually a false rebound lasting less than 24 hours. They said there was no explanation for it, but to ignore the fluctuations and focus on the nadirs. They indicated these can happen even with a dose increase. Which in some sense for Atlas who has fast drops to the 40's on N, would make sense his body/liver is freaking a bit at lower numbers.

So I need to put angry(2)_cat to bed and find myself a zen cat?

Zen_Kitty.jpg
 
Re: 9/6, Atlas, Amps 312, we're on the slide again!

OOhhh, i have SO been waiting for the "Atlas Shrugged" quote!!! No matter what you think of her theories, Rand has a command of language and logic that is amazing, and i find that passage to be one of the most stunning pieces of imagery in literature.

sorry for getting off subject, but have been in the entertainment retail business for 11 yrs.

you made my day, Blue!!

celi

Atlas, what did your bean say that got mine so excited?

Binks
 
Re: 9/6, Atlas, Amps 312, we're on the slide again!

hang in there, blue! im a newbie, but the explanations above certainly clarify for me what i've seen with my cat's SS. and while i know it's frustrating, the discussions you've generated are of great benefit to all of us newbies.

get some rest...and don't give up!

Celi & Binks
 
Oh for pete's sake....just when I thought I might get some sleep.

I have to go to work tomorrow!

This bean is tired and cranky!!! Now c'mon. Extra Alarm clock night again!
 
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