Add "R" or "N" for Rocky's Bounces?

[Tina & Rocky]

Hi,

At Tricia's suggestion I am pulling this question out of Rocky's condo today and creating a separate thread for it. I am just going to post what I already responded to Suzanne, Shelly, and Anne here. This question came up for me because I was reading Suzanne's condo from today and saw that she had used 'R' to lower Cobb's BG while he was bouncing from some green numbers. I know that Cobb is considered a high dose kitty, but I don't know why the amount of Lantus given makes any difference in wanting to get a cat's BG to a lower number during a bounce.

Hi Suzanne, Shelly, and Anne,

Thanks for weighing in on R. Yes, I could see how even one drop might instigate another significant drop in BG and then the possibility of another bounce. However, Rocky's bounce numbers are very high to me, and i would be willing to try just one drop if it was going to bring those BG numbers into the 200s rather than the 300 and 400 level.

Research in humans and mice has shown that organ damage begins to occur when the blood sugar is above 140. If you look at Rocky's SS, since January 10, 2014, Rocky has spent WAY MORE hours and days in the pinks, reds, and even touched a few blacks, with a BG of above 140.

I have been reminded many times that this diabetes/insulin dosing is a dance, but it seems to be a dance that Rocky's liver is not learning. I am wondering if it can ever learn to do this dance, and in that case, as his caretaker I should do whatever it takes to keep his BG as low as I can keep it as his liver is not doing it.

I woke up at 4AM and took Rocky's BG both yesterday and today specifically so I could get his Nadir. It was above 300 on both days.

I am not sure if "R" or "N" would help or hurt Rocky. I guess one wouldn't know how their cat might respond until it was used on their cat.

 

[Marje and Gracie]

Tina

The dose the cat is getting doesn't matter when using R. I use R for bounces occasionally and Gracie is on a very low dose.

Humulin N is not usually used as a bolus although we have one member, Dale, who uses it for Chip because he is very experienced, he had N instead of R, and he knew what N does for Chip. I believe Shelly has used it once based on her vet's recommendation but we would normally recommend R over N because it is in and out in four hours.

However, using R takes a lot of attention. Using R requires:

--laying an R curve over an L curve to see the effects and ensure the nadirs don't overlap
--testing every hour for 4-5 hours PLUS watching closely the next one or two cycles because sometimes R opens the door for the L insulins to really work
--using a tiny dose which is hard to measure and, as Suzanne said, hard to know whether you got it in or not
--understanding how both insulins actually work
--using it as the bounce first starts and numbers quickly rise; if a kitty has been in the bounce several hours, it's not wise to use it; sometimes you get a high before a break and you have to recognize it and not shoot r
--avoiding use of R as the bounce clears
--understanding that you won't always get the same response every time
---avoiding use when the kitty is clearing bounces quickly

R can be very dangerous to use. It can drop numbers like a rock and the CG must be there to catch it if that happens.

I think it would have been just fine to keep this subject matter in Rockys condo

 

[BJM]

This is very much a 'know your cat' situation.

I've used both R and N layered on Lantus when I had Spitzer. Due to the IBD, with its intermittent vomiting, diarrhea, and inappetance (alternating or rotating, sometimes in the same day), I couldn't reliably increase the Lantus dose for concern he'd then hypo. And if he was vomiting, I couldn't manage a hypo with food.

I was very, very cautious, starting with just a drop of the R. Have you seen the drop method explained? You practice first. Take a syringe, fill it to 0.5 units with colored water, then slowly, carefully, squeeze out 1 drop at a time. Some folks find twisting the plunger gives more control. Repeat until you can get equal sized drops of about the same size every time.

Now you're ready to experiment - and let's be clear it is an experiment. Given that R peaks roughly 2 hours after administration, you want the timing of its use to cover that period around a shot, when Lantus is at its weakest. This is about +10 to +2, overlapping the end of one cycle and the beginning of the next. You must be home to monior this until you have data showing what happens. Be prepared with higher carb food in case you need to steer numbers.