Dusty's AMPS "HI"
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rhiannon and shadow (GA)
Member Since 2012
bowel issues with Dusty condo
update on dusty condo
rx for lantus from May 30
new to lantus condo
Hoping for a real number .... later today....
linked all your previous condos for others who want to read what's up.....
update on dusty condo
rx for lantus from May 30
new to lantus condo
Hoping for a real number .... later today....
linked all your previous condos for others who want to read what's up.....
dustyboy4
Member Since 2010
PMPS 547
Rhiannon, thank you so much for linking my condos. You had to have read my mind. I had looked at Shaddow's condo's and thought to myself, "that is so cool, I wonder how I can do that for Dusty". I've even been on here earlier today for to see if I can find directions on how to manage this software better and found some directions that I haven't tried yet, then here I get back on tonight to update Dusty's SS and walla, it has been done for me. I know it makes it so much easier to find out about a kitty when one can read all about it at one time instead of trying to piecing the info together.
Again, thank you,
Elaine
Rhiannon, thank you so much for linking my condos. You had to have read my mind. I had looked at Shaddow's condo's and thought to myself, "that is so cool, I wonder how I can do that for Dusty". I've even been on here earlier today for to see if I can find directions on how to manage this software better and found some directions that I haven't tried yet, then here I get back on tonight to update Dusty's SS and walla, it has been done for me. I know it makes it so much easier to find out about a kitty when one can read all about it at one time instead of trying to piecing the info together.
Again, thank you,
Elaine
dustyboy4
Member Since 2010
Kathie, I had a similar experience with a cat I had several years ago. His name was Gateway. After he and Dusty were playing one day, his eye started weeping. Gateway was my seizure kitty (long sad story) anyway he was already seeing the only board certified cat Dr. (at the time) in Atlanta, GA. The weep had become pinkish in color soon after it occurred. I too thought his eye was bleeding. The Dr. also suspected herpes but in his case the test was negative. He tested that eye on at least 2 occasions and even put a contrast color in it which was supposed to make an ulcer glow if one existed. The ulcer never lit up but I continued to put the prescribed antibiotic ointment in his eye and finally it healed and quit weeping. I bet it took 2 to 3 months to heal if I remember correctly. When it did finally heal I could see a little, tiny white spot on the colored part of that eye. It didn’t seem to bother him, but it left a scar. Very glad that Zeus’ eye has healed.
Hope Zeus is able to regulate on the Levemir. Thank you for the encouragement for Dusty.
Elaine
Hope Zeus is able to regulate on the Levemir. Thank you for the encouragement for Dusty.
Elaine
Elaine:
How available are you to monitor? Are you around at all during the day? I'm asking because it may be worth getting more aggressive with Dusty's dose but if you want to be aggressive, you have to be able to monitor.
How available are you to monitor? Are you around at all during the day? I'm asking because it may be worth getting more aggressive with Dusty's dose but if you want to be aggressive, you have to be able to monitor.
dustyboy4
Member Since 2010
Sienne,
Unfortunately, I'm not available to test during the week day. I leave for work at 8:00 a.m. and don't return home until right before 6:00 p.m.
I am available to aggressively test on any weekend. How many days do you think it would take to aggressively treat? I have some vacation I could schedule.
Unfortunately, I'm not available to test during the week day. I leave for work at 8:00 a.m. and don't return home until right before 6:00 p.m.
I am available to aggressively test on any weekend. How many days do you think it would take to aggressively treat? I have some vacation I could schedule.
dustyboy4
Member Since 2010
Right now, I know Dusty still isn't feeling real well. Better, but not well. I contacted his vets this past Saturday 06/08/13 and spoke with one of the receptionists who, while I was on the phone, told Vet C that I felt Dusty, after 8 days on Convenia, still didn’t seem to be feeling well and that he is still urinating outside of his boxes. At my request, she asked Vet C whether Dusty could try a different antibiotic. I was told that they couldn’t give another antibiotic, that he had to wait until the 2 week period had ended and if still sick then a different antibiotic could be administered. It was suggested for me to try to catch pee in a container and bring it in to see if it still had blood in it. I understand looking to see if there is still blood in his urine but if they aren’t going to treat him? I still haven’t tried to capture his urine. He doesn’t seem to be in pain, just not 100%.
I figure I will just wait until the 14 days are up (which will be this Saturday) and take him back for a vet visit and kindly demand that they take a sterile sample of his urine and culture it.
Does anyone have an opinion on this?
I have a feeling that this UTI has been coming and going for some time. In March I suspected a UTI and when I had him in to his Vets they told me they couldn’t check for a UTI because his bladder was empty. He had emptied it about 45min prior to his visit. Instead of giving him a bolus of fluid and letting him wait a few minutes to see if his bladder would feel full, he was given Convenia (for just in case) and shipped out of the office. I’m pretty fed up right now. Something has to give. I figure for me to be able to treat his diabetes appropriately any infection needs to be cured or his stress and if he has pain (even though he’s not crying) will give high numbers and skew any results I get out of his insulin.
What do you all think?
On another note, I am up every 2 hours at night when I'm supposed to be sleeping (between 10:00 p.m. & 6:00 a.m.) because Dusty gets me up wanting to eat.
I've tried and tried to get him to stop doing this. Everyone asks me what happens if I just don’t feed him during the night? This is what happens, Dusty begins waking me up by making a grunting noise. If I ignore him it progresses to scraping his face on whatever is available that will make noise to get me up. If I ignore that sometimes he will jump onto the bed and start licking me or if I shut him out of the bedroom by shutting the bedroom door he will use his clawless paws and bump the door so it will make noise. The only thing I haven’t tried is crating him which probably wouldn’t be a good idea because he doesn’t like his large carrier. (He will just about rub his mouth raw rubbing it on the wire door and because of this now I don’t use it, I just let him sit in the seat of the car when taking him to see the vets.) Also, when I totally refuse him food, he gets mad at me and will urinate outside of his boxes in the middle of the floor –or- wherever. In January or February of 2012 I even tried using a timed feeder. He conveniently found a way to break into this $80 feeder. He used his face to lift the entire feeder and banging it on the ground, waking the entire house up. Somehow he could get the lid to move over just enough to get the tip of his paw into the next segment and dip food out with it. As you can see, the action of him waking me up all night long (for food) has been going on for over a year now. Although I’m glad he knows to get me up when something is wrong, like his BG is actually low, I wish I could correct his bad habits.
Getting up feeding him every couple of hours during the night seems to only be a pacifier. [He has me trained well]. You can see by his SS that sometimes I even test his BG in the middle of the night just to make sure he hasn’t gone low. When his numbers are down, Dusty doesn't get me up as often. I guess his hunger isn’t as predominant.
Because I break down and get up and give him a teaspoonful when he won’t leave me alone, his numbers are always high at the AMPS due to the eating. In the mornings when I feed him his regular 1 can of food, I save some of that can to put down right before I go to work at 8:00 a.m. in the hopes that he will save it and eat it during the day if he needs it. He usually gobbles it up right away but on occasion he will leave it. I know this because when my husband gets home at 4:00 p.m. he informs me when Dusty has left it and hasn’t eaten it until he gets home.
I truly think if I could get Dusty to quit eating all night long his numbers would go down for his AMPS. He gets plenty of food during his main feedings at 6:00 a.m. & 6:00 p.m. by receiving 1 entire can at each. Dusty just gobbles it up in one sitting and if I put it all down at once would try to eat just as much as he could stuff in. I sure wish I could free feed him. HUMPH.
I would also welcome any suggestion on a different way to feed Dusty.
I figure I will just wait until the 14 days are up (which will be this Saturday) and take him back for a vet visit and kindly demand that they take a sterile sample of his urine and culture it.
Does anyone have an opinion on this?
I have a feeling that this UTI has been coming and going for some time. In March I suspected a UTI and when I had him in to his Vets they told me they couldn’t check for a UTI because his bladder was empty. He had emptied it about 45min prior to his visit. Instead of giving him a bolus of fluid and letting him wait a few minutes to see if his bladder would feel full, he was given Convenia (for just in case) and shipped out of the office. I’m pretty fed up right now. Something has to give. I figure for me to be able to treat his diabetes appropriately any infection needs to be cured or his stress and if he has pain (even though he’s not crying) will give high numbers and skew any results I get out of his insulin.
What do you all think?
On another note, I am up every 2 hours at night when I'm supposed to be sleeping (between 10:00 p.m. & 6:00 a.m.) because Dusty gets me up wanting to eat.
I've tried and tried to get him to stop doing this. Everyone asks me what happens if I just don’t feed him during the night? This is what happens, Dusty begins waking me up by making a grunting noise. If I ignore him it progresses to scraping his face on whatever is available that will make noise to get me up. If I ignore that sometimes he will jump onto the bed and start licking me or if I shut him out of the bedroom by shutting the bedroom door he will use his clawless paws and bump the door so it will make noise. The only thing I haven’t tried is crating him which probably wouldn’t be a good idea because he doesn’t like his large carrier. (He will just about rub his mouth raw rubbing it on the wire door and because of this now I don’t use it, I just let him sit in the seat of the car when taking him to see the vets.) Also, when I totally refuse him food, he gets mad at me and will urinate outside of his boxes in the middle of the floor –or- wherever. In January or February of 2012 I even tried using a timed feeder. He conveniently found a way to break into this $80 feeder. He used his face to lift the entire feeder and banging it on the ground, waking the entire house up. Somehow he could get the lid to move over just enough to get the tip of his paw into the next segment and dip food out with it. As you can see, the action of him waking me up all night long (for food) has been going on for over a year now. Although I’m glad he knows to get me up when something is wrong, like his BG is actually low, I wish I could correct his bad habits.
Getting up feeding him every couple of hours during the night seems to only be a pacifier. [He has me trained well]. You can see by his SS that sometimes I even test his BG in the middle of the night just to make sure he hasn’t gone low. When his numbers are down, Dusty doesn't get me up as often. I guess his hunger isn’t as predominant.
Because I break down and get up and give him a teaspoonful when he won’t leave me alone, his numbers are always high at the AMPS due to the eating. In the mornings when I feed him his regular 1 can of food, I save some of that can to put down right before I go to work at 8:00 a.m. in the hopes that he will save it and eat it during the day if he needs it. He usually gobbles it up right away but on occasion he will leave it. I know this because when my husband gets home at 4:00 p.m. he informs me when Dusty has left it and hasn’t eaten it until he gets home.
I truly think if I could get Dusty to quit eating all night long his numbers would go down for his AMPS. He gets plenty of food during his main feedings at 6:00 a.m. & 6:00 p.m. by receiving 1 entire can at each. Dusty just gobbles it up in one sitting and if I put it all down at once would try to eat just as much as he could stuff in. I sure wish I could free feed him. HUMPH.
I would also welcome any suggestion on a different way to feed Dusty.
Waiting until the Convenia is out of his system does make sense.
Your thoughts about giving Dusty fluids while at the vet are good. The downside is that it take hours, not minutes for the bladder to fill. If most of us drank a glass of water, we wouldn't have to use the facilities immediately, either!
Would a timed feeder be a possibility for Dusty so he could eat and you could sleep? There are 2-chamber and 5-chamber models that you can find on Amazon or at a pet store.
As for being aggressive, you could either raise Dusty's dose by 1.0u every 6 cycles/3 days or increase the dose by 0.5u every 4 cycles/2 days. You could try either strategy until you see a break in these numbers and then back off and follow the protocol. The only issue with this is that if it's the UTI that's causing the high numbers, once Dusty is on an appropriate antibiotic, his numbers could drop quickly.
Your thoughts about giving Dusty fluids while at the vet are good. The downside is that it take hours, not minutes for the bladder to fill. If most of us drank a glass of water, we wouldn't have to use the facilities immediately, either!
Would a timed feeder be a possibility for Dusty so he could eat and you could sleep? There are 2-chamber and 5-chamber models that you can find on Amazon or at a pet store.
As for being aggressive, you could either raise Dusty's dose by 1.0u every 6 cycles/3 days or increase the dose by 0.5u every 4 cycles/2 days. You could try either strategy until you see a break in these numbers and then back off and follow the protocol. The only issue with this is that if it's the UTI that's causing the high numbers, once Dusty is on an appropriate antibiotic, his numbers could drop quickly.
You should schedule a vet visit early in the morning for the urine sample. If he's just used the LB, it can take a good part of the day, even with fluids, before they need to go again. I've had a couple of my boy cats that have had to stay most of the day at the vet to get a sample. Getting a culture on the sterile sample is the way to go to figure out what's happening and which antibiotic to use.
What brand of automatic feeder are you using? Some seem to be a bit more cat proof than others. Have you tried freezing tablespoon size chunks of food and leaving them out before you go to bed? It will take a while to thaw and become edible, unless you have a cat who will lick it frozen until it's gone. :roll:
What brand of automatic feeder are you using? Some seem to be a bit more cat proof than others. Have you tried freezing tablespoon size chunks of food and leaving them out before you go to bed? It will take a while to thaw and become edible, unless you have a cat who will lick it frozen until it's gone. :roll:
rhiannon and shadow (GA)
Member Since 2012
Maybe making Dusty some catsicles will help for night time....
With diabetes, his body is starving so he's not trying to fool you at night..... He really is starving/hungry.
Even though he is eating a lot, the nutrition isn't getting where it is supposed to in his body which keeps him hungry all the time.
This will get better when his numbers get back in a normal range.
With diabetes, his body is starving so he's not trying to fool you at night..... He really is starving/hungry.
Even though he is eating a lot, the nutrition isn't getting where it is supposed to in his body which keeps him hungry all the time.
This will get better when his numbers get back in a normal range.
dustyboy4
Member Since 2010
dustyboy4 said:
Sienne read the above. Dusty had the feeder figured out in under 2 weeks. :lol: My sister is the one that thought of it and purchased it.
Our family was in the mix of moving to another house and we were living with my sister for a few months. (Our family being myself, Dusty & my husband) My sister told me after she sent off for the feeder that she did it because she hated knowing I was getting up during the night and not resting.
That feeder, well lets just say, before the feeder Dusty only woke me up occasionally at the midnight hour and always at 3:30 when my husband arose to go to his job. Now, every 2 hours. He's like an alarm clock ringing. He loved the feeder, LOVVVED it. I would come home after work and the last couple of days before I took it away, Dusty would have food all over the floor, his front paws and his face. I wish now I would have taken photos. It was like seeing a baby eat with its hands and messing it all over the high chair tray. It was funny but also I really hated seeing him like this because it was such a desperate act all for the love of food, glorious food.
Wendy, I can't remember the brand of the feeder. I'll try to remember to ask my sister. I remember reading in the instructions for use that it was supposed to be made so that a kitty couldn't get into food before the timer opened the door. This feeder looked like a flying saucer and it had several wedged areas to it. I can't remember if it was 6 or 8 feedings you could set it on. I tried to get my sister to send it back to the company and let them know that it wasn't as good of a product as they claimed but she kept it.
Sienne - I'm seriously thinking about raising Dusty 1.0 u since the 5.0 u isn't doing the trick. I will be able to watch him closely this weekend so maybe (maybe) if he drops it won't be too significant.
Wendy, I think I will try to find my ice trays and try freezing some of his food. I don't know why I haven't thought of that myself. I've read all the articles about making raw food and freezing it but have never thought about freezing his canned cat food. Brilliant idea, thank you. I'll see how that will work.
Elaine,
I sent you a message to explain about R and how it interacts.
About the feeders, the most popular one is the Petsafe 5 compartment one. You can easily clamp it so that Dusty and all his neighborhood buddies would not be able to open it. It's a great feeder and godsend for overnite!
As I said in my message to you, you need to get cracking on the dosing.... don't hold any dose longer than 6 shots; you need to get those numbers down because these HIs are very hard on Dusty's body and organs.
For testing.... the weekends is a great time because lots of other people are also around to give you a hand..... once you have the R insulin, just post and you will be able to test on a weekend. If you can swing it, see if you can get the R by this weekend... I don't think you need a prescription.
Gayle
I sent you a message to explain about R and how it interacts.
About the feeders, the most popular one is the Petsafe 5 compartment one. You can easily clamp it so that Dusty and all his neighborhood buddies would not be able to open it. It's a great feeder and godsend for overnite!
As I said in my message to you, you need to get cracking on the dosing.... don't hold any dose longer than 6 shots; you need to get those numbers down because these HIs are very hard on Dusty's body and organs.
For testing.... the weekends is a great time because lots of other people are also around to give you a hand..... once you have the R insulin, just post and you will be able to test on a weekend. If you can swing it, see if you can get the R by this weekend... I don't think you need a prescription.
Gayle
Jill & Alex (GA)
Member Since 2009
hi gayle. how about posting your explanation about R and how it interacts here in the thread? not only will others learn, but there's less chance of misinterpretation by either/both advice givers and those on the receiving end when public explanations are available for peer review. :mrgreen:Blue said:
fwiw:
i agree with gayle about becoming more aggressive with dosing if you can manage it, elaine. a few days ago sienne asked me for dosing suggestions for dusty. my response was if i were in your shoes (and given dusty's history), i'd increase the dose by 1u after every 6 cycles until i saw some movement OR by 0.5u after every 24 - 48 hours until i saw some movement. my recommendation is for dusty (not other kitties) and based solely on the data you've collected thus far.
just my thoughts...
EDITED TO ADD:
the dosing suggestions i've made are aggressive and do not include incorporating the use of R as a bolus insulin.
i'd have to rethink dosing suggestions if R is brought into the picture.
Hi Michelle
A few of us, including Sienne, Wendy, Jill (one of our most experienced members), and I were discussing Dusty's SS.
Jill thought you could choose to either raise the dose 1u every six cycles or .5u every 24-48 hours. She thought the latter might be the better way to go provided you can grab spot checks because taking smaller increases would allow you to catch any lows. If you raise by 1u, you do take the chance of bypassing a good dose. However, increasing .5u every 24-48 hours would still be aggressive.
R can be a great tool to have in your toolbox but you need to be cautious with it. All advising regarding the use of R needs to be on the board in your condo and not in a PM. I also would not use R without someone to walk me through it several times. I use R and I use it with great caution. There are very specific times that you can and can't use it.
I would also opt to start at a low dose of R and try it first....see how much movement you get from it before you use a larger dose. ECID and Dusty is definitely different than Gracie but I see a huge drop just from .1u. That might definitely be too low of a dose to start him on but I would just use caution.
A few of us, including Sienne, Wendy, Jill (one of our most experienced members), and I were discussing Dusty's SS.
Jill thought you could choose to either raise the dose 1u every six cycles or .5u every 24-48 hours. She thought the latter might be the better way to go provided you can grab spot checks because taking smaller increases would allow you to catch any lows. If you raise by 1u, you do take the chance of bypassing a good dose. However, increasing .5u every 24-48 hours would still be aggressive.
R can be a great tool to have in your toolbox but you need to be cautious with it. All advising regarding the use of R needs to be on the board in your condo and not in a PM. I also would not use R without someone to walk me through it several times. I use R and I use it with great caution. There are very specific times that you can and can't use it.
I would also opt to start at a low dose of R and try it first....see how much movement you get from it before you use a larger dose. ECID and Dusty is definitely different than Gracie but I see a huge drop just from .1u. That might definitely be too low of a dose to start him on but I would just use caution.
Elaine is getting pulled this way and that. She's getting all sorts of suggestions, and one that says to increase dose by 0.5u every 24hrs is dangerous. I don't know who thought that one up but it's wrong.... no cat will adjust to an increase in 2 shots, and making it even more vague by saying every 24-48hrs compounds the confusion. This situation calls for the bigger of the increases, but never 24hrs only. Take a look at the ss and you will see there are no lows to catch. None.
Stick to the protocol that states you hold a dose for 3 days/ 6 shots-cycles.
The fast track is 5 shots-cycles. At a 5u dose, and all the solid HI test numbers, I suppose you can go with 1u increases, BUT hold for 5 shots.
Normal increases are 0.5u or 0.25u depending on the BG up to the 10u dose mark, then your increases would be 1u or 0.5u up to the 20u dose mark. After that point, we make our own acro protocol which is whatever works.... often it's 2u increases, but holding for the 5 shots.
To go faster is not safe; rather, you want to inject some R into the picture to bring down those HIs where the Lantus will be able to work. A cat registering all HIs is not going to be phased by a 0.1u shot of R.... hey, I bet the 0.25u won't do a single thing either..... I don't think Dusty will respond to any R dose under 1u. You can't compare the use of R on a diabetic cat to a highly resistant cat.
My message was no diff than my usual ... just an illustration of a train.
I can share it for sure.... maybe you could share your behind the scenes discussion of Dusty's situation so that others, peers, can benefit from your brainstorming out a possible approach.
Here's my pm on using R; I look forward to reading your group discussion to learn from your logic.
So, as I said in my post to you, Dusty needs to have you hold a dose for 5 shots ONLY. that's just 2 1/2 days... if you don't see an improvement, increase the dose by 1unit. On your spreadsheet, you have just till the 11th posted, and you held the 5u dose for 10 shots, 5days. When you are dealing with high numbers and insulin resistance, you need to sort of 'get in front of the speeding locomotive like Superman and push on it to stop the train'. By staying on a dose for too long, all you are doing is running beside the train.
Now, you are using a good insulin, Lantus, but both Lantus and Levemir work better if the cat's numbers are lower, so what helps is to use another insulin, a fast acting insulin which pulls down that HI number to maybe 400 or something, then when the R wears off, the Lantus starts to work.... think of a relay race where R is the fast guy and gets a head start, then R hands off the baton to the Lantus to run the rest of the race. They work as a team.
At shot time, you will test Dusty. Then you will give the shot of Lantus, 6u, and you would give another shot of R, but a very small amount.... R is very powerful so you would give a shot of R at a dose of maybe 0.25u. yes, that's right, it will be just 2 drops of R and you measure halfway between nothing and the 0.5u line on the syringe.
You will need to test Dusty every hour for the first 4 hours.... you want to know how sensitive Dusty is to R and how quickly it begins to work, so when you start using R, be sure you have time for the testing, and post so that someone can be around to help you and answer all your questions. OK?
Gayle
Stick to the protocol that states you hold a dose for 3 days/ 6 shots-cycles.
The fast track is 5 shots-cycles. At a 5u dose, and all the solid HI test numbers, I suppose you can go with 1u increases, BUT hold for 5 shots.
Normal increases are 0.5u or 0.25u depending on the BG up to the 10u dose mark, then your increases would be 1u or 0.5u up to the 20u dose mark. After that point, we make our own acro protocol which is whatever works.... often it's 2u increases, but holding for the 5 shots.
To go faster is not safe; rather, you want to inject some R into the picture to bring down those HIs where the Lantus will be able to work. A cat registering all HIs is not going to be phased by a 0.1u shot of R.... hey, I bet the 0.25u won't do a single thing either..... I don't think Dusty will respond to any R dose under 1u. You can't compare the use of R on a diabetic cat to a highly resistant cat.
My message was no diff than my usual ... just an illustration of a train.
I can share it for sure.... maybe you could share your behind the scenes discussion of Dusty's situation so that others, peers, can benefit from your brainstorming out a possible approach.
Here's my pm on using R; I look forward to reading your group discussion to learn from your logic.
So, as I said in my post to you, Dusty needs to have you hold a dose for 5 shots ONLY. that's just 2 1/2 days... if you don't see an improvement, increase the dose by 1unit. On your spreadsheet, you have just till the 11th posted, and you held the 5u dose for 10 shots, 5days. When you are dealing with high numbers and insulin resistance, you need to sort of 'get in front of the speeding locomotive like Superman and push on it to stop the train'. By staying on a dose for too long, all you are doing is running beside the train.
Now, you are using a good insulin, Lantus, but both Lantus and Levemir work better if the cat's numbers are lower, so what helps is to use another insulin, a fast acting insulin which pulls down that HI number to maybe 400 or something, then when the R wears off, the Lantus starts to work.... think of a relay race where R is the fast guy and gets a head start, then R hands off the baton to the Lantus to run the rest of the race. They work as a team.
At shot time, you will test Dusty. Then you will give the shot of Lantus, 6u, and you would give another shot of R, but a very small amount.... R is very powerful so you would give a shot of R at a dose of maybe 0.25u. yes, that's right, it will be just 2 drops of R and you measure halfway between nothing and the 0.5u line on the syringe.
You will need to test Dusty every hour for the first 4 hours.... you want to know how sensitive Dusty is to R and how quickly it begins to work, so when you start using R, be sure you have time for the testing, and post so that someone can be around to help you and answer all your questions. OK?
Gayle
Jill & Alex (GA)
Member Since 2009
gayle, dusty is grossly under dose and his numbers need to come down sooner than later. i think we can agree on that.
there is a provision in the TR protocol to raise the initial starting dose after 24 hours: "Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours)." yes, i'm "borrowing" the after 24 hours part (not the 48 hours part (see below) for subsequent increases for two reasons: 1. dusty is grossly under dose (BGs are extremely high and are not moving) and 2. there are more aggressive approaches out there to cause a break through when using lantus.
for example, Rhett Marshall's (Rand's old partner at University of Quensland and co-author of the original Rand Protocol) method of increasing the lantus dose by 0.5u at each injection until the pre-insulin glucose is under 252 and then reduce the dose by 0.5 unit (VIN 05/2008). the latter is not a method i feel comfortable with nor would recommend for internet purposes. i am only using it to illustrate there are more aggressive approaches out there than the TR protocol we use... which have been used successfully.
fast tracking:
for years we've been fast-tracking kitties after holding a dose for only 4 cycles (48 hours). not sure when it changed to 5 cycles???
"However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU."
just my thoughts...
there is a provision in the TR protocol to raise the initial starting dose after 24 hours: "Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours)." yes, i'm "borrowing" the after 24 hours part (not the 48 hours part (see below) for subsequent increases for two reasons: 1. dusty is grossly under dose (BGs are extremely high and are not moving) and 2. there are more aggressive approaches out there to cause a break through when using lantus.
for example, Rhett Marshall's (Rand's old partner at University of Quensland and co-author of the original Rand Protocol) method of increasing the lantus dose by 0.5u at each injection until the pre-insulin glucose is under 252 and then reduce the dose by 0.5 unit (VIN 05/2008). the latter is not a method i feel comfortable with nor would recommend for internet purposes. i am only using it to illustrate there are more aggressive approaches out there than the TR protocol we use... which have been used successfully.
fast tracking:
for years we've been fast-tracking kitties after holding a dose for only 4 cycles (48 hours). not sure when it changed to 5 cycles???
"However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU."
agreed, but what about this situation is "normal"?Blue said:
i can only speak for myself. i was asked for dosing suggestions. i simply gave them as i posted above. i also coupled dosing suggestions with "if i were in your shoes" and "until i saw some movement" as well as consideration given to the caregiver's ability/availability to manage an aggressive approach. after all, as you aptly noted, there hasn't been any movement to date. and the kicker here... there was very little movement at 10u BID.Blue said:
just my thoughts...
dustyboy4
Member Since 2010
tip toeing...... Just so you all know what my reply to Galye was so we are all out in the open here
Thank you all for your input. I am listening to all of your suggestions. Just as you all feel about Dusty's situation being quite unusual, his vets feel the same way. They've even told me they think he has lots more than 9 lives. Personally, I wouldn't go that far, he's just holding on by being loved and and feel I will know what to do shortly. If you all feel I don't need to wait on the urinalysis to treat more agressively please say so. I just don't want to overdose him and I'm scared.
Thank you all for your input. I am listening to all of your suggestions. Just as you all feel about Dusty's situation being quite unusual, his vets feel the same way. They've even told me they think he has lots more than 9 lives. Personally, I wouldn't go that far, he's just holding on by being loved and and feel I will know what to do shortly. If you all feel I don't need to wait on the urinalysis to treat more agressively please say so. I just don't want to overdose him and I'm scared.
Elaine,
If it took you 3yrs to get Lantus and your current vet will not prescribe R for you, it's time to look around for a real vet. Look at Dusty's sheet.... there is no way you are going to overdose him.
What's the insulin you were giving at the 10u dose? Dropping from 10u down to 1u has got to have been a huge shock on Dusty's system.
Fast tracking is what you need to be doing, but you can't be too hasty or you can very well pass your good dose for Dusty. Many cats take at least 3 shots to allow a new dose to settle, so that 24hr suggestion is out. Many cats take 6 shots or longer to settle, like my Oliver was, so that's the reason most people are told that holding a dose for 6 shots / 3 days is a good idea.
In your case, with such high numbers, you could likely be OK with 4 shots at a dose and up the dose by 1u until you are out of this HI range. It's not going to be easy because you have some strong looking resistance going on there, and you are going to need to be agressive.
I think if you like your vets for the most part, I would suggest that you give them one more try.
Go to the vet office, tell them that you want a prescription for R (I don't know if it's needed in your area), and you also want Dusty tested for acromegaly and IAA. Don't ask them; tell them. If they refuse, then find yourself a real vet .... YOU are the client; Dusty is YOUR cat; the money for the tests is coming out of YOUR pocket. YOU are the boss.
And don't ever feel that you have to tip toe around or feel scared about posting what you want and where you want. You are Dusty's advocate, so say what you like. I say what I like and my concern is for Dusty being so high for so long; it's hard on the body and the organs, and if he's acro, then his organs are more of a concern.
Look into getting some R and having Dusty tested.
Up his dose ever 4 or 5 shots by 1u until you are seeing some numbers in the 300s or even low 400s.
You really need to get that R because Lantus works better on lower numbers; right now, you are just tossing a bucket of water on a forest fire, and you need the planes full of R to dump on the fire so that your bucket of water may help.
Gayle
If it took you 3yrs to get Lantus and your current vet will not prescribe R for you, it's time to look around for a real vet. Look at Dusty's sheet.... there is no way you are going to overdose him.
What's the insulin you were giving at the 10u dose? Dropping from 10u down to 1u has got to have been a huge shock on Dusty's system.
Fast tracking is what you need to be doing, but you can't be too hasty or you can very well pass your good dose for Dusty. Many cats take at least 3 shots to allow a new dose to settle, so that 24hr suggestion is out. Many cats take 6 shots or longer to settle, like my Oliver was, so that's the reason most people are told that holding a dose for 6 shots / 3 days is a good idea.
In your case, with such high numbers, you could likely be OK with 4 shots at a dose and up the dose by 1u until you are out of this HI range. It's not going to be easy because you have some strong looking resistance going on there, and you are going to need to be agressive.
I think if you like your vets for the most part, I would suggest that you give them one more try.
Go to the vet office, tell them that you want a prescription for R (I don't know if it's needed in your area), and you also want Dusty tested for acromegaly and IAA. Don't ask them; tell them. If they refuse, then find yourself a real vet .... YOU are the client; Dusty is YOUR cat; the money for the tests is coming out of YOUR pocket. YOU are the boss.
And don't ever feel that you have to tip toe around or feel scared about posting what you want and where you want. You are Dusty's advocate, so say what you like. I say what I like and my concern is for Dusty being so high for so long; it's hard on the body and the organs, and if he's acro, then his organs are more of a concern.
Look into getting some R and having Dusty tested.
Up his dose ever 4 or 5 shots by 1u until you are seeing some numbers in the 300s or even low 400s.
You really need to get that R because Lantus works better on lower numbers; right now, you are just tossing a bucket of water on a forest fire, and you need the planes full of R to dump on the fire so that your bucket of water may help.
Gayle
Jill & Alex (GA)
Member Since 2009
hi elaine. hope we haven't confused you! i think it's obvious gayle and i agree on the need for fast-tracking dusty up the dosing scale until some movement is seen. in an effort to avoid confusion here are the suggestions in a nut shell:
gayle is now suggesting increasing dusty's dose by 1u after every 4 - 5 cycles (48 - 60 hours) until you're seeing numbers in the 300s or low 400s... as well as incorporating the use of R as a bolus insulin.
i've suggested increasing dusty's lantus dose by 1u after every 6 cycles (72 hours) until you're seeing some movement OR increasing dusty's lantus dose by 0.5u after every 2 - 4 cycles (24 - 48 hours) until you're seeing some movement.
these suggestions are aggressive... no doubt about it. basically, they're simply different methods one can take to reach the same goal.
it's up to you to figure what makes the most sense for you and dusty. you have our support no matter what. :mrgreen:
gayle is now suggesting increasing dusty's dose by 1u after every 4 - 5 cycles (48 - 60 hours) until you're seeing numbers in the 300s or low 400s... as well as incorporating the use of R as a bolus insulin.
i've suggested increasing dusty's lantus dose by 1u after every 6 cycles (72 hours) until you're seeing some movement OR increasing dusty's lantus dose by 0.5u after every 2 - 4 cycles (24 - 48 hours) until you're seeing some movement.
these suggestions are aggressive... no doubt about it. basically, they're simply different methods one can take to reach the same goal.
it's up to you to figure what makes the most sense for you and dusty. you have our support no matter what. :mrgreen:
I'm just as thrilled as you are that you're beginning to see some movement with Dusty's numbers.
To be honest, I think you need to very carefully evaluate the use of R. It is an extremely potent form of insulin. Used incorrectly, Humulin R can be lethal. Used correctly, in some cats it can make bouncing back into high numbers worse. It is by no means an easy or quick fix. With a schedule like yours since you need to work, it may not be the best solution to getting Dusty's numbers into a better range. In order to use R effectively, you need to be home to closely monitor. Since you work, this isn't always going to be possible.
To provide a little more explanation, R is what is termed a "bolus" (or supplementary) insulin. It can help to pull numbers down quickly. It is often what vets use when a cat is hospitalized and critically ill to yank numbers down and it is being used in a situation where the kitty can be closely monitored. It works quickly -- within an hour -- and is out of the cat's system within 4 hours or so. Lantus, on the other hand, is considered a "basal" insulin. It is your base form of insulin. R can be used in combination with Lantus (a basal-bolus combination). There are people here who use R. It is a process of curving the dose and closely monitoring every single dose change to insure that Dusty's numbers don't go into too low of a range.
From what you've said, if Dusty were my cat, I would give the fast tracking of the Lantus dose a chance to see if you are continuing to get movement in Dusty's numbers. As Jill noted, the approach of increasing the dose every 48 hours is one that is very feasible and is used routinely with Tight Regulation, even if Gayle is not as familiar with this particular dosing strategy.
As for your vet, most of us have had issues with vets not being experts in every aspect of our cat's health. Many of the people here have vets they adore but who are less than expert at helping them to manage their cat's diabetes. Most of us have learned what we needed to about feline diabetes, kidney issues, etc. As you saw, Marje has had to learn about kidney issues. Jill is a huge resource on supplements and many aspects of kitty care, diabetes and otherwise, given her experience with Alex. There are others who know a great deal about assist feeding -- and the list goes on. We can help you to ask your vet the right questions so you can get the care you need for Dusty. You did great when it came to pushing to get the cystocentesis and the culture and sensitivity done. Information is power and we'll do our best to help you continue to be Dusty's voice.
Please let us know if you have questions. We'll do our best to provide you with information and help you get Dusty's numbers where you want them and help you to get Dusty the care that's needed.
To be honest, I think you need to very carefully evaluate the use of R. It is an extremely potent form of insulin. Used incorrectly, Humulin R can be lethal. Used correctly, in some cats it can make bouncing back into high numbers worse. It is by no means an easy or quick fix. With a schedule like yours since you need to work, it may not be the best solution to getting Dusty's numbers into a better range. In order to use R effectively, you need to be home to closely monitor. Since you work, this isn't always going to be possible.
To provide a little more explanation, R is what is termed a "bolus" (or supplementary) insulin. It can help to pull numbers down quickly. It is often what vets use when a cat is hospitalized and critically ill to yank numbers down and it is being used in a situation where the kitty can be closely monitored. It works quickly -- within an hour -- and is out of the cat's system within 4 hours or so. Lantus, on the other hand, is considered a "basal" insulin. It is your base form of insulin. R can be used in combination with Lantus (a basal-bolus combination). There are people here who use R. It is a process of curving the dose and closely monitoring every single dose change to insure that Dusty's numbers don't go into too low of a range.
From what you've said, if Dusty were my cat, I would give the fast tracking of the Lantus dose a chance to see if you are continuing to get movement in Dusty's numbers. As Jill noted, the approach of increasing the dose every 48 hours is one that is very feasible and is used routinely with Tight Regulation, even if Gayle is not as familiar with this particular dosing strategy.
As for your vet, most of us have had issues with vets not being experts in every aspect of our cat's health. Many of the people here have vets they adore but who are less than expert at helping them to manage their cat's diabetes. Most of us have learned what we needed to about feline diabetes, kidney issues, etc. As you saw, Marje has had to learn about kidney issues. Jill is a huge resource on supplements and many aspects of kitty care, diabetes and otherwise, given her experience with Alex. There are others who know a great deal about assist feeding -- and the list goes on. We can help you to ask your vet the right questions so you can get the care you need for Dusty. You did great when it came to pushing to get the cystocentesis and the culture and sensitivity done. Information is power and we'll do our best to help you continue to be Dusty's voice.
Please let us know if you have questions. We'll do our best to provide you with information and help you get Dusty's numbers where you want them and help you to get Dusty the care that's needed.
dustyboy4
Member Since 2010
Gayle,
The insulin I was using before Lantus was Prozinc. Prozinc is the insulin that he was on and receiving 10u twice a day.
It is supposed to be a long acting insulin. It worked somewhat for a time, but in the last month didn't work at all.
Just so you all know, one of his vets Vet C. Also made the statement that I probably couldn't overdose Dusty. She must be thinking
along the same lines as you Gayle regarding this. The other Vet H. is the one that believes he should go up the ladder in units very
slow. I've tried to take a middle of the road aproach since one Vet leans one way and the other leans the other way on dosing.
I'm caucious dosing because of Dusty's UTI, being previously confused about the protocol cycle and
in the past he has almost crashed with the Prozinc. The ladder being over 6 mo. ago now. I'm going to go up to 7u on his evening
dose today. Since he was registering in the upper 400's yesterday, maybe it will at least bring it down to the low 400's.
I guess we'll have to see.
Gayle, thank you for your vast knowledge and strong approach. I'm listening to you and will be putting it in action with Dusty.
The insulin I was using before Lantus was Prozinc. Prozinc is the insulin that he was on and receiving 10u twice a day.
It is supposed to be a long acting insulin. It worked somewhat for a time, but in the last month didn't work at all.
Just so you all know, one of his vets Vet C. Also made the statement that I probably couldn't overdose Dusty. She must be thinking
along the same lines as you Gayle regarding this. The other Vet H. is the one that believes he should go up the ladder in units very
slow. I've tried to take a middle of the road aproach since one Vet leans one way and the other leans the other way on dosing.
I'm caucious dosing because of Dusty's UTI, being previously confused about the protocol cycle and
in the past he has almost crashed with the Prozinc. The ladder being over 6 mo. ago now. I'm going to go up to 7u on his evening
dose today. Since he was registering in the upper 400's yesterday, maybe it will at least bring it down to the low 400's.
I guess we'll have to see.
Gayle, thank you for your vast knowledge and strong approach. I'm listening to you and will be putting it in action with Dusty.
dustyboy4
Member Since 2010
Sienne,
Thank you for your encouraging words. I talked with my sister this evening about the "R". She is a pediatric hematology/oncology nurse. They use short acting insulin with long acting insulin all the time. I have to agree with you about my inability to be available for close monitoring of Dusty since I do have to work. It does make more sense to me to increase the Lantus every 48 hours. Today I've used the 72 hour protocol but if 7u doesn't work in 48 hours I'll bump it up to 8u. I also think his BG was higher today than yesterday due to the angry(2)_cat sugar in the Clavamox. Maybe tomorrows numbers will be better since I've taken it away from him. In all, he's had 3 doses of the Clavamox. I know you aren't supposed to start and stop antibiotics but after tasting it, the sugar is really strong tasing in it and I really think it will either defeat the purpose of healing.
I'll just have to do some praying that the UTI is going away and won't come back. Monday the vets get an ear full and if he still shows positive for a UTI then they best be thinking about another antibiotic (without sugar). Dusty is easy to pill. I don't mind pilling him. I just wash it down with a syringe full of water. He usually has no problem with it.
Thank you for your encouraging words. I talked with my sister this evening about the "R". She is a pediatric hematology/oncology nurse. They use short acting insulin with long acting insulin all the time. I have to agree with you about my inability to be available for close monitoring of Dusty since I do have to work. It does make more sense to me to increase the Lantus every 48 hours. Today I've used the 72 hour protocol but if 7u doesn't work in 48 hours I'll bump it up to 8u. I also think his BG was higher today than yesterday due to the angry(2)_cat sugar in the Clavamox. Maybe tomorrows numbers will be better since I've taken it away from him. In all, he's had 3 doses of the Clavamox. I know you aren't supposed to start and stop antibiotics but after tasting it, the sugar is really strong tasing in it and I really think it will either defeat the purpose of healing.
I'll just have to do some praying that the UTI is going away and won't come back. Monday the vets get an ear full and if he still shows positive for a UTI then they best be thinking about another antibiotic (without sugar). Dusty is easy to pill. I don't mind pilling him. I just wash it down with a syringe full of water. He usually has no problem with it.
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