Dose Settling -- Revisited

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Lana & Yoyo

Member Since 2010
Seems to be a lot of people on this board right now suffering angst over whether to raise, lower, or hold a dose. Add one more 'cause I've joined them!

Yoyo has had a good downward progression but I am at a point where I am not sure what to do. He is on the 4th day at fat 0.5 and I am not seeing the response I would like to see. Yes, he had 134 last night.... but this morning he was at 387. I am wondering... if this dose is too low, will it stress out his pancreas and we will lose some of the ground we've gained, where, if I raised it a little, it might allow his pancreas more time to catch up? Should I try to hold for a 10 day cycle or just accept the 5 day cycle and increase his dose a bit?

Comments?

Lana
 
Welcome to the club Lana! :lol:
I just looked at your ss and IMO it looks like he might need .75. Hopefully others will chime in.
I forget, have you tried L-lysine for Yoyo's scratching? It's helped Klinger with his latest round of allergies.

Marcy & Klinger
 
I see poor Yoyo just had 3 teeth extracted on top of the constant stress of his flea allergies. Poor guy!

Is he still on antibiotics from the extractions?

I see you got the yard sprayed. Good thing you are keeping him indoors until you get a good rain. But you are also keeping him indoors because of some complications of his teeth extractions? Is he on pain medication too? The stress from being kept indoors and his teeth could also contribute to his higher bg levels.

I looked on the Capster site and they recommend using it along with PROGRAM Flavor Tabs. Have you ever tried this? Maybe then you could cut back on using the Capster so often?:

http://www.medi-vet.com/Capstar.html

With all these stressful factors and since you are already at a fat .5, I wouldn't think an increase to .75 would be unreasonable either.
 
Marcy wrote, "have you tried L-lysine for Yoyo's scratching?"

No, I did not know it was used for itching. Yoyo is not doing a lot of scratching anymore. But if he does scratch, even if is only for a moment, I note it and I also note where he is scratching. If it continues, and I get to the point that I don't think it can be flea-related, I will try to track down what is causing it. Right now, he is taking an herb that the acupuncturist is giving him, but, when I finish the herb, if he is still itching, I will give the L-lysine a try.

Pamela wrote, "I looked on the Capster site and they recommend using it along with PROGRAM Flavor Tabs. Have you ever tried this? Maybe then you could cut back on using the Capster so often?

With Program, the flea must bite the cat in order to get the ingredient that eventually kills it. Allergic cats are allergic to flea saliva.

"PROGRAM® is a once a month flea treatment that you give in your pet's food. It comes in tablet form for dogs and in liquid form for cats. How does Program Plus work: All fleas must have a blood meal before they are physically able to lay eggs and start an infestation. This is why PROGRAM® is such a cunning method of flea control. After an animal is treated, a tiny amount of PROGRAM® circulates in their blood. If a female flea now bites the animal, it will 'swallow' some of the active ingredient and pass it on to her eggs. Inside the eggs, PROGRAM® goes to work, preventing the developing flea from growing a tooth that it needs to be able to hatch. Since all fleas must bite in order to continue their life cycle, all will be affected, and none of their eggs will be able to develop into adults."

Pamela wrote, "I see poor Yoyo just had 3 teeth extracted."

The diagnosis the dentist gave me was that "two teeth had resorptive lesions and the third one was broken, the pulp tissue was exposed and necrotic." I have not looked up definitions for these terms yet but it sounds pretty bad. He said he had a hard time getting the third tooth out, the problem went all the way into the bone --- it had eaten into the jaw bone and he had very little jaw bone left. For two weeks, Yoyo is to get soft foods and is not to go outside unsupervised. No pain meds or antibiotics... at least none that he gave me to bring home. He has recovered. He is driving me crazy. On Thursday, I am going to call the vet dentist and ask if it absolutely must be 2 weeks that he has to stay inside! The dentist wants him inside because his jaw bone is so fragile that he could break it if he were to bite down on something hard and two weeks should provide healing time. I don't think Yoyo is going to bite down on anything outside. He's not an explorer.... he just lies under the house, in the sand with the fleas, no doubt, just in case he needs to defend his house.

Also, Pamela, the pest control company is "green," and they are telling me I have to get the yard sprayed every month, $85 per treatment. I told them to go ahead and spray for this month, but I need to find another option.

As to the dosage, I think you are both right. I will continue with the fat 0.5 through tomorrow which will be 5 full days and go back to 0.75 day after tomorrow. Maybe I can start dropping him again after his teeth settle down. Today, it looked to me like the swelling I had seen in his mouth was greatly reduced.

Lana
 
Yoyo's BG yesterday was a flat curve:

AMPS Tues through AMPS Wed: 387. . .378. . .326. . .337. . .341. . .341. . .338

Seems to me that I remember something to the effect that a flat curve appears at the maximum effectiveness of a dose??? I am going to up Yoyo to 0.75 this morning. I had wanted to give the 0.5 five full days, but I don't think there is any point.

Lana
 
Sheila wrote, "I am confused, is he on lev or lantus?

Yoyo went back on Lantus Apr 28th. On Levemir, unless Yoyo stayed in greens, blues, and low yellows all through his cycle, he had severe diabetic symptoms, walking around crying frantically, drinking massive amounts of water. Even though he is indoor/outdoor, I kept a litter box so he did not have to go out if he felt bad. I use Fresh Step. I would scoop out urine balls the size of two large navel oranges. I would not have believed his bladder could hold that much. I returned to Lantus because Yoyo did not do that on Lantus. He could start in the low reds, go down into lower numbers and finish back up in the low reds without the side effects. His urine balls are the size of golf balls to tennis balls now. I have read posts from members of this group for a long time now and never seen anyone with a similar problem on Levemir, so I think this is something specific to Yoyo.

Yoyo is doing better now that I have gotten a handle on the flea allergy and I imagine he would be successful on Lev or Lantus now. However, the vet called in a prescription for a vial of the Lantus, so we will have to use that up before changing.

Lana
 
Lana & Yoyo said:
No, I did not know it was used for itching. Yoyo is not doing a lot of scratching anymore. But if he does scratch, even if is only for a moment, I note it and I also note where he is scratching. If it continues, and I get to the point that I don't think it can be flea-related, I will try to track down what is causing it.

Thanks for the clarification on the Program flea stuff. So does he itch after getting the Capster? I thought that was what was supposed to happen because the fleas are scrambling and biting for a short time after. Sorry for all the questions. confused_cat

Lana & Yoyo said:
The diagnosis the dentist gave me was that "two teeth had resorptive lesions and the third one was broken, the pulp tissue was exposed and necrotic." I have not looked up definitions for these terms yet but it sounds pretty bad. He said he had a hard time getting the third tooth out, the problem went all the way into the bone --- it had eaten into the jaw bone and he had very little jaw bone left. For two weeks, Yoyo is to get soft foods and is not to go outside unsupervised. No pain meds or antibiotics... at least none that he gave me to bring home. He has recovered.

Poor Yoyo going through all that! I am glad he is better now though. I don't have any experience with FORLS in cats but I know a lot of people here do. Tigger has so far only needed one dental cleaning and that is all (hopefully - he needs to be rechecked). If you do a search on Health for resorptive lesions I am sure you will get lots of personal experiences and some good info.

Lana & Yoyo said:
As to the dosage, I think you are both right. I will continue with the fat 0.5 through tomorrow which will be 5 full days and go back to 0.75 day after tomorrow. Maybe I can start dropping him again after his teeth settle down. Today, it looked to me like the swelling I had seen in his mouth was greatly reduced.

I agree, hopefully that is what will happen. Paws crossed! :)
 
Pamela asked, "So does he itch after getting the Capster? I thought that was what was supposed to happen because the fleas are scrambling and biting for a short time after"

I think the "Capstar Dance" is common with cats who have a lot of fleas. Yoyo usually doesn't have many fleas, so no, I have not seen Yoyo having any reaction to the Capstar. Even when I took him to the cat groomer, complaining of his huge flea problem, they told me later, with puzzlement, that they didn't see all that many fleas on him. His scratching is mild now and doesn't last long at all. He does not pull out any hair anymore and all his bald spots are filling in since I started Capstar.

Yoyo still hates the flea combing and has a fit when I try to do it. So, when I say that I haven't seen a flea this week until tonight, you can take that with a grain of salt because I could have easily missed them with the quick flea combing I am able to do. Plus, I am only flea combing once per day where I was doing it multiple times per day until I started Capstar.

Since Yoyo has not been out for the past week, his coat has been very, very clean and free of dirt. Previously, I would find a lot of debris and have to figure out if any of it was bloody (flea poop), the poop being food for the fleas eggs when they hatched. I guess I will have to start that process again when I let him back outside ---- putting all the dirt into a cup of water and examining it for any blood.

Lana
 
It sounds like the one tooth was very decayed - would be a root canal on a human. Yowza! I have a 3 y.o. with resorptive lesions. She has already lost 4 teeth (well, one broke off/out and 3 were extracted). She was just 2 when that happened. Usually there are red, swollen gums all the time with these cats. I had a cat that had to have 8 teeth extracted - the vet blamed me for being a bad owner. This was before I knew anything about resorptive lesions - and apparently before they knew anything about them either. She did ok after the extractions. It's usually something you have to stay on top of the rest of their lives.

You can also just drop the debris on a wet paper towel - it will leave a rusty stain as it dissolves if it is flea poop.
 
Lana-I agree that Yoyo seems to do better on a higher dose, (but for that 64 on 6/10 which is a bit of an anomile).
I'm just curiuos-when did you chnage back to Lantus?
 
I called the vet dentist and asked if Yoyo absolutely had to stay inside for 2 full weeks. He said, "Yes, he might fall out of a tree and break his jaw." I said, "I don't think he is going to be climbing any trees. He can't even climb up onto the bed anymore." He said, "He might get into a cat fight and break his jaw." Yoyo is all bark and no bite but it was going to be a losing battle so I said I was going to make a recording of the fog horn marching around in my house and send it to him so he would be as miserable as I was.

I decided to offer Yoyo on ebay, but then I thought I should really offer him here first. So, bidding is open for one cat. He may have a compromised pancreas but it is completely offset by a pair of formidably healthy lungs. He has a strong character and knows what he wants.. . . . Marcy. . . you really need another white cat to keep Klinger company... and you're an old hand at White Cat Syndrome so you could deal with his allergies and occasional skin problems. Bidding starts at $1.25. Shipping is free!

Sheila, I misspoke when I said that on Lantus, Yoyo "could start in the low reds, go down into lower numbers and finish back up in the low reds without the side effects." He could start and finish in the low pinks -- spending much of his cycle in yellow and blue. If goes into the reds, he drinks and pees, drinks and pees, and walks around crying on either insulin. Yoyo had to stay yellow or lower on Levemir to avoid diabetic side effects.

Sheila wrote, "....resorptive lesions.... It's usually something you have to stay on top of the rest of their lives."

Did not realize that. Good info to know. The vet did say Yoyo needed to have his teeth cleaned annually.

Sheila wrote, "You can also just drop the debris on a wet paper towel - it will leave a rusty stain as it dissolves if it is flea poop"

Thanks --- that will make life easier!
Marci wrote, "I'm just curiuos-when did you chnage back to Lantus?"

April 28th. I used up the Levemir pen that I had and needed a new prescription for insulin.

Lana
 
Vicky, I've had that calipher that I ordered for awhile now and decided I need to figure out how to use it. I am totally perplexed. You said something about making marks on a 3 x 5 card... but the calipher "jaws" are elevated above the table surface which makes it very difficult to measure something on a tabletop. These caliphers seem to be designed more for the purpose of being using like a plumbers wrench to measure the width or diameter of physical objects. Also the size of the pen point does not lend itself to fine measuring. Help!

Also, you and Sheila talk about using the drop method. I have tried practicing that with the Relion micro syringes that I use and it is extremely difficult. The plunger takes a fair amount of force to move so I just do not seem to be able to move or twist it smoothly. Is there perhaps a difference among brands? Do I need to get a more expensive brand?

Lana
 
I have not used the Relion brand, so no help with those. I get mine from Hocks - or did. I may order from somewhere else as I understand the new owners at Hocks are requiring a script for syringes (at least for orders from IL). Pamela has a source so I will see if she can shed some light on it.

Do you pull out the plunger and push it all the way back up BEFORE drawing the dose? I do that and maybe that helps spread the lubricant so it moves more smoothy? Every once in a while I get a syringe that won't "move" by twisting or without applying a lot of force - and yes, that makes the drop method almost impossible.

FYI, most pharmacies will let you buy a pack of 10 syringes without a script (Walgreen's for instance). You could buy their house brand and see if those work better just to give you an idea.
 
I now get my BD syringes here:

http://www.americandiabeteswholesale.com/

I just saw on your spreadsheet that you found another flea. How in the world is he getting fleas now since he is inside the house? Those stupid little buggers are so hard to get rid of!

Sorry he is driving you so nuts, but at least you have a sense of humor over it! :lol:
 
Lana & Yoyo said:
Vicky, I've had that calipher that I ordered for awhile now and decided I need to figure out how to use it. I am totally perplexed. You said something about making marks on a 3 x 5 card... but the calipher "jaws" are elevated above the table surface which makes it very difficult to measure something on a tabletop. These caliphers seem to be designed more for the purpose of being using like a plumbers wrench to measure the width or diameter of physical objects. Also the size of the pen point does not lend itself to fine measuring. Help!

Lana

Oh dear. Sorry I didn't see this until this evening. Let's see if I can describe how I use this contraption. The large "jaws" are what I use, not the small side, which is for measuring the inside diameter of something. Did you get a chance to look at my Photobucket album of pictures with it against a syringe? http://s5.photobucket.com/albums/y161/FindingNeo/Micrometer instructions/

You can't lay it down, you have to hold it up against the syringe barrel in good light, like at a window or computer/TV screen. So you're holding it up in the air. Not too hard really. I hold the micrometer in my right hand and syringe in my left. I look to see how off my plunger is, then I take the micrometer away and push out a drop, like in Sheila's drop method. It will probably take a little practice to learn what size of drop you need to squeeze out to get it more in line with the points of the jaws. Just squeeze a little at a time, remeasure and squeeze more out if you need to. The important thing is to go ahead and use the marks on the syringe to determine how many millimeters 1U is. Look at Sheila's pictures from here http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982 because the darn marks are so thick you have to begin your zero at the top of the line. 1U would be to the top of the 1U line, not the bottom of it. But make sure when you line up the jaw points to measure the insulin that you actually start with the beginning of the insulin barrel. Don't pay attention to the marks on the syringe when measuring the insulin, once you've determine how much 1U is in millimeters you use that measurement to base how much insulin you need in millimeters for a certain dose.

There is a little math involved. Say you measure 1U as 1.2mm and you want your dose to be .75U or 25% less than 1U. 1.2mm minus 25% = .90mm. So you set the micrometer jaws to .90mm. Not all syringes have their marks the same distance apart because some have bigger or smaller barrels. That's why you have to determine how much 1U is in millimeters first according to the marks on the syringe. If you use the GNP 3/10th cc syringes from Hocks 1U = 1mm. But they aren't all that easy. I also have Easy Touch syringes, which are longer than the GNP ones and on them 1U is about 1.3mm.

This makes it sound way more complicated than it is. I hope I've cleared some things up at least. Thanks for at least trying it. I've always loved tools, so that's probably why it's easy for me but hard to explain.
 
Sheila wrote, "Do you pull out the plunger and push it all the way back up BEFORE drawing the dose?
most pharmacies will let you buy a pack of 10 syringes without a script (Walgreen's for instance)."

Have not been sliding the plunger before I load the syringe. I will try that and also experiment with some other syringes. Someone said something about prescriptions for syringes ---I take the insulin box with the prescription label on it and I never have any trouble buying syringes.

Pamela wrote, "How in the world is he getting fleas now since he is inside the house?. . .Sorry he is driving you so nuts, but at least you have a sense of humor over it! "

I have another cat who goes in and out. He is a Wanderer and does not necessarily stay in my yard like Yoyo does. Although the acupuncturist recommended getting both the house and the yards sprayed, I only got the yard done. There could have been a flea or an egg in the house. Since fleas like to jump onto our clothing, I could have brought him in from anywhere that I have gone to.

Humor is my only defense against a cat with a masters degree in caterwauling. I don't know why the neighbors at the end of the block have not complained. . . maybe when I talked to the dentist, rather than saying his bark was worse than his bite, I should have said his spray is worse than his fight? . . . .

Vicky, thanks for the info on the caliper. I played around with it some more but I can tell right now that it is going to take some practice. The wheel on the caliper that moves the jaws open or closed is jerky. The suggestion to base the main measurement on one unit really helped (I was not doing that). One unit on the Relion is 1.10 so, if I divide by 10, each 1/10th of a unit will be .11mm. My concern is if I should need doses smaller than 0.5. I was thinking that was a real possibility but I'm not seeing that on Yoyo's horizon anytime soon anymore.

Lana
 
It's hard to get the exact millimeter - sometime I am .01 off, I don't worry about .01 difference. I have to move the wheel every so slightly, but it's very easy to go even .05 too far! I use both hands and kind of push against the direction I'm trying to move the points to keep from moving it too far. Sometimes I just roll it all the way back to 00 and start over 'cause sometimes it's easier to get it right on. Occasionally you should check if it still says 00 when you get the jaws together. That's what the "zero" button is for if it's not.

Humor is my only defense against a cat with a masters degree in caterwauling. I don't know why the neighbors at the end of the block have not complained. . . maybe when I talked to the dentist, rather than saying his bark was worse than his bite, I should have said his spray is worse than his fight? . . . .

:lol: :lol: :lol: :lol: :lol: :lol: :lol:
 
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