Green! 5/12 Rocky PMPS 283 +1 271 +3 183 +5 102 +75 +97

Status
Not open for further replies.
Tina & Rocky

Tina & Rocky

Member Since 2013
I am not going to pretend that it is a "good' morning for me or for Rocky.

I am not wearing "patience pants" anymore. This is crap.

Rocky continues to surf these shitty pink numbers..I wouldn't be surprised if he went to a red or a black today.

Yesterdays' condo:
viewtopic.php?f=9&t=118606

Yesterday's SS:
AMPS 293 +2 315 +5 396 +9 343
PMPS 410 +1 321 +4 365 +11 369

Suzanne & Cobb wrote:
Tina, I know you're frustrated. I'm sorry! The reason you can't just jump back up to those doses is because Rocky earned his reductions and proved that at that time those doses were too much insulin for him.
Click to expand...
I appreciate that you are trying to make me feel better, but you don't really understand how I feel or how frustrated I am. You get to give Cobb more insulin RIGHT AWAY anytime you don't like his BG number. I don't get to do that for Rocky.


Suzanne & Cobb wrote:
You had a nice streak of green between 4/23 and 4/29, except for that one day of red, which was directly related to the skipped shot that morning. All of those doses were under 2units.
Click to expand...
That was coming down from the dose of 2.0u and 2.50u. His depot was full. I don't believe that he will achieve blue or green numbers with only 1.75u of insulin this time. From Tilly's Diabetes Protocol: "Reducing the dose too quickly generally does not work: most cats do not go into remission with fast reductions." Based on this knowledge and what just happened to Rocky in April I know that we are NO WHERE close to remission.

If you examine Rocky's ENTIRE SS, you will see that his body does better on 2.0u to 2.50u of insulin. He is NOT bouncing right now. He is just not getting enough insulin.

Suzanne & Cobb wrote:
Unfortunately, searching around for the right dose is all part of this frustrating game. But the protocol is there to keep Rocky safe (and save you money so you don't feel you have to rush off to the emergency vet).
Click to expand...

I know that the correct dose for Rocky right now is nothing under 2.0u, and I think there are some folks here that believe this as well..

And yet on with the rules of this protocol--
ROCKY MUST ENDURE 13 DAYS and more (not cycles) IN PINK, RED, AND BLACK NUMBERS!!!​

Suzanne & Cobb wrote:
Try to be patient. I know (trust me), I know it is hard. Yesterday I was complaining about Cobb's numbers and had to be reminded of an adjustment in our schedule. Now he's back in better numbers. You may have to bounce around for a bit until you really find Rocky's optimal dose.
Click to expand...

Looking at Cobb's SS chart, it was 6 days and Cobb is back in BLUE numbers. Rocky, on the other hand, is still SURFING PINK NUMBERS AND IT HAS BEEN 13 DAYS!!! :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry:

You got to give Cobb "R" 17 times to get him back into better numbers, and everyone cheered you on. Giving Cobb that "extra shot" of insulin at least got him into the 200s. From Tilly's Diabetes Protocol: "200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. " That means AT LEAST Cobb is getting some healing time in there, AND, you get to do something to help Cobb heal.

I get to do nothing for Rocky. Instead, I am told to ♫sit on my hands and put on my patience pants♫ while I watch his BG surf pink, red, and black numbers for DAYS on end, which are slowly killing him.

I believe that rather than singing to me that ♫some cats are difficult to regulate♫ that the untold truth is closer to "our standard protocol doesn't work for every cat. :? " For example, in life there are different types of medication for the same illnesses in this world, for different people. Why would we believe that there is one--size-fits-all protocol for every cat? THERE ISN'T!!

I am DONE being patient with this protocol for Rocky. It DOESN'T WORK FOR HIM!! I've taken tons of blood tests that prove it. No one is listening to me.
:idea: :idea: :idea: We need to come up with a different protocol to help Rocky heal.. :idea: :idea: :idea:​

FYI: Tilly's Diabetes Protocol: http://www.tillydiabetes.net/en_6_protocol2.htm
 
Re: pls look 5/12 Rocky AMPS 295 +1 361

Tina

Rocky is not Cobb or vice versa. ECID. Remember? Suzanne was just trying to help and give you support. It doesn't matter what she does with Cobb.....he has IAA and likely acro and his dosing is going to be different so she can break through those antibodies.

It has been almost six months since Rocky was put on lantus. Maybe you want to try PZI (and I do mean PZI and not ProZinc). PZI is a fairly long-lasting insulin but when his numbers are up, you have more flexibility with changing the dose since you don't have a depot to contend with in lantus and levemir. It doesn't mean that Rocky won't still bounce. I've seen cats here go from lantus to levemir to PZI and they still bounce. There are cats that have been on insulin for four or more years and still bounce.

You have never needed permission from anyone to dose Rocky in a particular way. I have seen several cats whose SSs looked like Rocky's for this length of time and then they suddenly snapped and were all green. Maybe it will happen for Rocky; maybe it won't. And while we are a support group, keep in mind that we have all experienced your same frustration at one time or another but lashing out at those who want to help doesn't help you or Rocky.

If you think he does better at 2u or so, then take him back up. If he's got pink nadirs, you can raise him every four cycles by 0.25u but that is pretty aggressive. If it were me, I'd raise by 0.25u every six cycles until you hit blue again.
 
Re: pls look 5/12 Rocky AMPS 295 +1 361

Suzanne, I ADMIRE you and think you are a fantastic person. I am sorry if I've hurt your feelings in any way. Please, I'm just trying to say that we are not all suffering the same amount or in the same ways. I do super appreciate that you would commiserate with me, and try to make me feel better. But can you please just snap your fingers and bring Rocky's BG to the green numbers? :lol: :lol: I'd be very happy then. :mrgreen:

Sure Marje, Rocky is not Cobb, and vice-verse. What I pointed out is that Suzanne DOES get to try something to help her kitty get into better numbers again. (And it usually does work! :-D ) I get to do nothing to help Rocky. To be able to "try" and do something, I can imagine, is probably somewhat of a mental relief, even if it doesn't work. At least there was that option..

So, this is what I'm going to try with Rocky-- Rocky's Protocol:

First, I believe that Rocky is one of those cats that does BETTER surfing 40s. So, as long as his BG does not dip below 40 I am going to keep him at a dose where he is surfing 40. I will of course try to help him get his BG to the 50s again if he goes to 40. If his BG drops below 40 I will decrease immediately. From Tilly's Protocol: http://www.tillydiabetes.net/en_6_protocol2.htm
"Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way)."
Click to expand...
Second, I am going to increase an insulin dose when a recently increased dose not produce a blue or green number within 2 days, instead of 3 days.

If I cannot keep him in blue or green numbers, at the very least I can try to keep him in yellow numbers and minimize the amount of time his liver and pancreas have to deal with pink, red, and black numbers.

I am going to bump Rocky's insulin up to 2.0u tomorrow morning. I will keep him at the 1.50u tonight. I will be here all day and night tomorow to monitor him.
 
Re: pls look 5/12 Rocky AMPS 295 +1 361

Tina,

I don't "get" to give Cobb R. I HAVE to give Cobb R. Every time I shoot him with more than a few drops of R, which is an incredibly harsh insulin, I am taking a risk with his life. IAA can break at any time. I got ahead of the antibodies ONCE when he dipped to 39. That is the lowest I've ever seen him...ONCE.

And if you don't think I understand your frustration, look at the top of Cobb's spreadsheet. He saw consistent black, red and pink numbers from Thanksgiving to January. And what you don't see is the numbers he saw before I joined the board. We didn't see a curve with less than 500+ numbers in 7 months. I'm sure that did nothing for Cobb's health. Talk about slowly killing him!

Cobb was back in blue numbers for a matter of a few hours, and is now back in yellow ones. It may have been 6 days, but Cobb has a HUGE depot. I assure you, shooting 24 units of Lantus and between 0 and 6 units of R daily is incredibly frustrating, and exceedingly expensive. I have little hope that he will ever be on a dose as low as 2 units. I wish that were the case. I wish Cobb would earn reductions. He's earned 1 reduction...EVER. All I've seen is his dose go up and up and up. Talk about frustrating!

And despite getting more than 50 units of insulin daily, there are no signs of Cobb's pancreas healing. While I may "get" to give him more insulin, I am stuck with the fact that he probably has a tumor that will kill him within the next two years, given the time his diabetes was uncontrolled and his age.

Of course the standard protocol doesn't work for every cat. That is why people repeatedly say every cat is different. But the protocol has worked for hundreds of cats. If you don't think it is working with Rocky, no one is forcing you to stick with it. But then when you ask a dosing question, if you've strayed from it, no one can really answer it because they can't interpret your spreadsheet the way they usually would.

The people helping you understand how the Lantus depot works. They understand why there is a protocol. If you feel the protocol isn't working, then you can dose him accordingly. You hold the syringe. All anyone on here can do is offer their advice, support and commiserate with you when you have to increase his dose.

The R that I use is simply in addition to the protocol. You don't see me bouncing Cobb's Lantus dose around in fewer than 4 cycles. In fact, I've found he usually sees action on the 5th cycle. And he has seen two blue numbers in 8 days since then. There is absolutely NO protocol for using R. It is literally flying by the seat of your pants every time I shoot him with it. It could be WAY too much. I could accidently induce a hypo if I shoot too much. I could start a cycle of shoot R, drop too fast, bounce, shoot more R, and on and on.

It is just as frustrating trying to decide what to do with Cobb as you feel with Rocky. And most of the time, people can only pop into my condo and say hi or looking good today. There is less than a handful of people who can actually help, and oftentimes I feel completely alone in making dosing decisions.

I am sorry you are so frustrated. I know you want the best for Rocky. And I know it is frustrating seeing all these cats come on, stay on insulin for a week, two weeks, a month and then are OTJ. I fully admit I am incredibly jealous of those people! I'm jealous of the people that shoot 1 or 2 units a day. Not every cat goes OTJ. Rocky may need insulin for the rest of his life. He may not. I truly hope he doesn't. Cobb will.
 
Re: pls look 5/12 Rocky AMPS 295 +1 361

Aww Suzanne.. You made me cry... I'm so sorry..thanks for explaining all of your woes and frustrations to me about Cobb... it really helps.

I feel so bad for all of these kitties suffering from diabetes. And all of us CG's worrying all of the time and getting NO SLEEP. @-)

I didn't know that Cobb has a tumor. Is it anything that can be removed?

I didn't look at Cobb's SS very well, only the past 6 days. I had no idea that you have not been giving him a reduction but that his insulin needs keep going up. Now i feel like a real horse's ass. I feel so bad that all of this is happening for you and Cobb.. :cry:

I can honestly say that I don't feel jealous of the other cats that sail through the protocol and go OTJ. I feel SUPER HAPPY for those cats and CGs!! I want to celebrate with them because I'll probably never get to celebrate this for Rocky.

What bothers me is that this TR protocol isn't working for Rocky to help lower his BG numbers. He spends way too many days in pink numbers on this protocol.

I do understand that "the helpers" won't be able to advise me much with dosing instructions if I post a :?: in the topic once I start doing something different for Rocky. I will probably ask anyway!! :lol:

I've just got to try and see if a switch up in the protocol for Rocky, something more in tune with Tilly's Diabetes website, *will* work for him. (They only have the group website in German and I don't know any German.) I will keep posting "Rocky Condos" here on FDMB, of course, to show his improvement or decline. I just cannot sit back and keep doing the same-O' thing.
 
(increased carb load to 11%) Re: 5/12 Rocky PMPS 283

I just now fed Rocky 1/2 can of the FF Grilled Turkey and Giblets. It is suppose to be 11% carbs according to Dr. P's list. This is the amount of carbs that I usually give Rocky to raise him above 50.. I have been feeding him 0% carbs for about 4 and 1/2 days now.

Some cats do better on higher carbs, so I'm trying that plan of action. If his BG doesn't come down tonight to a blue or green number, tomorrow i will raise his insulin dose from 1.50u to 2.0u.

It will probably be too much insulin for him but I will work with it by feeding him HC. I bought a Science Diet food that is 33% carbs. I don't know how much gravy it has but it sure is high in carbs. :roll:
 
Re: (increased carb load to 11% 2nite) 5/12 Rocky PMPS 283

Tina

Just wanted to let you know I'm looking hard at Rockys SS to see if I can think of something to help you.

However, before I finish that and try to give you some ideas, just a couple things.

Tillys webpage has some great info and I use it frequently but it's not a protocol. The protocol is the TR protocol.

Personally, while there are some cats that might do better surfing in the 40s, it's not a place I like Gracie to be. There is just no cushion. A cats body does not know the difference between 50 or 90. So, for Gracie, I much prefer that she surf the 70-90 range. But then, I don't really get to choose. ;-) however, if she is trying to surf 40s, I try to bring her up. If I'm having to work at it, she needs a reduction. Yes, Rocky is different and you might find he can safely surf the 49s but if you are going to let him do that, you will have to be testing him a lot.

I liked Suzanne's comment about she doesn't "get" to use R, she has to. Using R is not a privilege or something a caregiver has to request to do. But using R, as Suzanne said, can be potentially dangerous and can also start a bounce/dive pattern. To use R, a CG must understand the action of the basal insulin (in this case, Lantus) and also understand how the depot works. The CGs must also know the kitty's onset, nadir, and duration so they can lay an R curve over the basal insulin curve so they can see when the safest time to give R is.

While some very experienced CGs with sick kitties or CGs like Suzanne with high dose kitties may use R to bring numbers down, for most of us, R is best as a tool to stop the ensuing bounce from going orbital. It's a fine line between knowing when the bounce starts, when it's safe to give R, and how fast the bounce will clear. The CG has to know how to recognize a high before a break to the extent possible. I can no longer use R for Gracie because she clears her bounces too fast.

Using R also means the CG must be there to test. Absolutely to test the four hours R is active but also for a few hours (or sometimes longer) after. R can knock down the counterregulatory hormones and open the door for the basal insulin to do its job. That means sometimes the cycles after the R cycle can be quite active.

Using R takes a lot of time studying the SS and understanding both the basal and bolus insulins. It's an added commitment to what the CG is already doing.

Ok...BBS.
 
nice suprise 5/12 Rocky PMPS 283 +1 271

Thank you Marje :YMHUG: I had thought I wanted to use the "R" with Rocky at the beginning of this but I actually gave up on the idea when I realized that so far Rocky is not a high dose cat. I don't want the added stress of figuring out all of those other curves layered on top of curves. It's too much work for me.

For Tilly's Diabetes, I thought it does say "Protocol" on the menu? :roll: The procedure, approach, protocol, suggestions, whatever one wants to call it, just seems to be a little bit different than on FDMB. http://www.tillydiabetes.net/en_6_protocol2.htm

Well, I didn't think I'd see that... Rocky's BG dropped ever so slightly tonight after eating those 11% carbs. I wonder how soon it will be before it climbs back up again, this time to hyper-outerspace? :roll:
 
Re: nice surprise 5/12 Rocky PMPS 283 +1 271

A kitty does not have to be high dose for the CG to use R. I've used it with Gracie a lot and her dose has never been higher than 1.4u and she's mostly been under 1u. But you are right that it takes diligence.

The LL protocol is a modification of the TR protocol published by Roomp and Rand. It was modified in LL based on observations of LL kitties and evaluation of data from LL kitty SSs.

It is semantics. Tillys is just the website which discusses the protocol but the protocol has never been called Tillys protocol. It's just the TR protocol :-D

Let's hope it doesn't climb.....
 
Re: nice surprise 5/12 Rocky PMPS 283 +1 271

Just wanted you to know I am still looking at his SS. It just takes me some time to read the remarks and compare the numbers and see if there is a pattern.

I won't forget you. Hoping I can finish it tomorrow.
 
Re: nice surprise 5/12 Rocky PMPS 283 +1 271

Paws crossed Rocky is heading towards bluer water tonight.

Just thought I'd pop in and answer your question to Suzanne about the tumor. She is talking about acromegaly, which is a tumor on the pituitary gland that sends out excess growth hormone, causes extra IGF-1 (insulin growth factor) which interferes with the cat's natural insulin. Kitties with acromegaly may in fact have a working pancreas but the IGF-1 overwhelms the insulin it produces. Neko has acromegaly and IAA (insulin auto antibodies), Cobb has confirmed IAA and possible acromegaly. Both conditions cause insulin resistance and require high doses to varying amounts.

The pituitary gland is very small and at the front part of the brain near the eyes. There have been some attempts at removing the tumor via surgery but it is a very tiny sensitive space in cats. Neko's tumor was measured at .146 cubic cm's. One more common treatment is radiation therapy (you may see it written as SRT, stereostatic radiation therapy). Actually, the most common treatment for cats with acromegaly is what Suzanne is doing, trying to manage the numbers and keep the kitty below renal threshold as much as possible. Other treatments (ie. SRT) are only performed at a few places in North America and not cheap. SRT neuters the tumor cells, it does not remove them. Finding a cheaper, more easily accessible form of treatment for acrokitties is very much an area of academic research.

Even the acrokitties that are here are following the LL protocol, because experience has shown it generally works for them. In spite of the fact that the original research by Roomp/Rand explicitly excluded acrocats from their study group.
 
Re: YIPEE! One blue number 5/12 Rocky PMPS 283 +1 271 +3 183

Hi Tina. I am as frustrated and worried as you are. Max cleared a bounce, dropped tonight and now is low again. I don't know what I am going to do either. I'm going to PM you something.
 
Re: YIPEE! Blues 5/12 Rocky PMPS 283 +1 271 +3 183 +5 102

Hi Tina,

You don't know me because I hardly ever post here anymore, for a variety of reasons. However, I saw this thread and just couldn't let it go.

I will admit off the bat that I am breaking some of my own rules - I haven't read every word in this thread, and I haven't studied your spreadsheet in great detail, but I have skimmed through yesterday's and today's threads and spent a little time with your spreadsheet. Normally I would not post until I had done a more thorough job of studying, but I am at work and can't do that right now.

My other comment (not specifically for you, but for everyone reading LL): this is the Internet. People can post whatever they want on the Internet, and they can sometimes say it with great authority. That doesn't mean that everyone giving advice (in any situation) actually SHOULD be giving advice. Anyone who is *receiving* advice on the Internet has the responsibility to think things through on their own, check the "credentials" of the person giving advice, gather multiple opinions, do their own research, etc. And yes, that includes me. Don't take what I say without thinking it through. :smile:

So... Tina, I actually think you are right, for the most part. Rocky's last good dose was f1.75u. Then he earned a reduction, got some more reductions and some BCS/skipped shots in there, and lost momentum. Too many reductions too fast - it happens. You can look at my Lucy's spreadsheet and see that she did that a few times. Lots of reductions, then back to high/flat. It was too much too soon. I think of it sort of like going to the pool - first you stick your toe in the water, then you go a little farther in, but it's too cold, so you back alllll the way back out and try again. Next time you'll go a little farther before it feels too cold, etc.

Per the protocol, you *could* have gone right back to the last good dose, which was f1.75, or more likely somewhere around 1.5u. You didn't (and I didn't either, when it was Lucy - I felt it was too risky to go back up that much all at once, perfectly understandable). When they lose momentum like that, you have to work your way back up. That doesn't mean you have to work your way back up slowly, though. I would say 4-6 cycles on a dose is plenty, in that situation (4 cycles if numbers are high/flat, 6 cycles if they are starting to get better). I also wouldn't mess witih increases smaller than 0.25u at this point either. You're testing enough that if an 0.25 increase is a bit too much, you'll catch it and keep Rocky's numbers up.

About the protocol, modifications, interpretations, etc., I wrote this a few months ago to address some of the common misconceptions about the protocol: Tight Regulation Protocol: Myths Debunked. I also talk a bit about bouncing and holding doses.
 
Re: YIPEE! Blues 5/12 Rocky PMPS 283 +1 271 +3 183 +5 102

adding a couple more thoughts after reading more of the thread: for one, it looks like Rocky got some lower blue last night. I would take the idea of increasing straight to 2u off the table. Depending on what he did after the 102, an increase to 1.75 might still be appropriate.

It looks like his breakthrough dose in the past has been in the neighborhood of 2.25 - 2.50. Lucy did have to climb all the way back up to her original breakthrough dose before getting another breakthrough. That happens fairly often, and Rocky might end up needing to go back to there, but I would give strong consideration to the fact that he was doing very well on 1.75u before he lost momentum. I think the 102 is enough of a clue that it's not the right time to do a 0.5u increase.

In my opinion (this is just observation, not science), there ARE indeed some cats who do well with slightly more carbs. My KK was one of them. I have mostly seen it with cats that are very insulin sensitive - they may drop like a rock, then bounce to the moon, even with small doses of insulin. You can't increase the insulin because they drop too low, but the small amount of insulin they are getting is not enough to help them overcome the bounces or doesn't give them enough duration. Rock, meet hard place. If you increase the carbs a bit, then that can help "prop up" the numbers a little, allowing you to give a little more insulin, which helps with bounces and/or with duration. I'm talking about feeding a higher low carb food (some would use 7-10% carbs, but I've even seen it make a difference for some cats switching from 0-1% to 3-4%). I'm not talking about feeding something that is actually high carb. Feeding TOO high carbs on a regular basis could backfire - if you increase the dose enough to counteract a ton of carbs, then if they don't eat one day or if they vomit, you can really be in trouble. I do think something higher carb than 0% might benefit Rocky, but that won't happen overnight.
 
Hi Libby,

Thank you so very much for sharing your years of knowledge and expertise to help guide me with Rocky. I was starting to lose my sanity, (what little I have), and I was feeling so sad. I really needed someone to agree with me that raising Rocky right back up to the last good dose is what I should have done. :roll: He just doesn't do those small incremental climbs of insulin very well.

You are right, the 2.0u would have been too much insulin.

I am going to continue feeding him a higher carb food, but one still considered a LC, by keeping it at 10% carbs. It's OK if I must raise his insulin dose to do this. This method might be the only way that I can get him to surf blue or green numbers. So far I've found that his pancreas and liver are not able to surf blue or green numbers on even a 4% carb food.

Rocky DID manage to get into some blue and green numbers on the 1.50u last night, but if he doesn't repeat it in the overnight hours tonight, I will raise his dose to 1.75u in the morning.

Thank you again for taking the time to write, even while at work. It means a lot to me.
 
Status
Not open for further replies.
Back
Top