Introducing ourselves "over here"

[Sheri & Spyder (GA)]

Hi all,

I wanted to get some eyes from this group, so I figured I say hello. We are currently over in the Levemir group, but think it's time for some TR. (basically started that yesterday)

SS is up to date (and I'm sure I did a few boo-boos)

But, in a nut shell, we pretty much have no history on Dante prior to July of this year. I'm thinking that Glucose Toxicity and Insulin Resistance is what we're dealing with.

(I have already somewhat been "in cahoots" with Steve (Steve & Jock))

We are on day 2 of 3, of holding @2u. He also has a yeast infection in both ears and unfortunately using Tresaderm (much to my disagreeing w/vettie bean) Other stressors include my civvie- she is not taking to him (short version)
I am not ruling out the possibility of using R for a booster.

Thank you all in advance, for any thoughts/comments/suggestions/lashings/hugs you wish to offer.

 

[PeterDevonMocha]

Hi guys and welcome to TR! Sorry to hear about the yeast infection going on in dante's ears .. we dealt with a bacteria infection in mocha's ears awhile back .. we though it was ear mites Anyways, I'm sure others will be along soon to help get you guys on the right path! Have a great weekend!

 

[Sienne and Gabby (GA)]

Welcome to Lantus Land!! Thank you for taking Dante into your home.

Our approach to TR is different than what you've found on the Lev board. I seriously doubt that we would have suggested reducing Dante's dose on 10/5. (We've had lots of discussions on this topic which I'm happy to link if you want to wade through them.) At this point, I don't know whether the issue is glucose toxicity or just not enough insulin. What we do often see when people are advised to reduce the dose is that the cat may require more insulin than where they were when the dose was reduced and, you've lost time with regard to getting your cat on a "good" dose of insulin. However, that's history and we're here to lend you a hand getting Dante into good numbers.

I would suggest that you routinely get at least one test during the PM cycle. Since Lantus and Lev dosing is based on the lowest point in the cycle, you don't want to miss a drop that could warrant a dose reduction. Many cats experience lower numbers at night so getting tests in the PM cycle is important. In addition, if you don't test at night, you're missing half of your data.

If you've not already done so, you'll want to read the starred sticky notes at the top of the board. There's an overwhelming amount of information there. We can all empathize if it seems like a lot to digest. Please ask questions. The people here are very generous with their time and information.

 

[Frosty]

Hi Sherry & Spider. I can't offer you any advise since I'm new to this but I did want to welcome you and say you're in good hands here. Have a great day and I hope Spider's ear infection clears up soon.

 

[Ella & Rusty & Stu(GA)]

Hi Sheri and Dante and welcome!

I'm not very good at interpreting other kitties' spreadsheets (have enough trouble with my own!!), but it does seem as if you may have reduced Dante's dose prematurely. The ear infection could also be a culprit with regard to the higher numbers. Stick with the TR protocol and you will always be comfortable in the knowledge that it is the safest way to work up to (or down to) the optimal dose.

Best of luck, and, again, Welcome!

Ella & Rusty

 

[Marje and Gracie]

Just wanted to drop in and welcome you all, Sherry and Dante. I hope you will like levemir.....it made a huge difference for Gracie. It's wonderful that you are giving Dante this chance and I hope he will settle into this insulin and do
really well.

Please let us know in any way that we can help!

 

[Anne & Zener GA]

Welcome to Lantus Land! You are doing a great thing for Dante. I hope Bonsai and he can make their peace. And can you post a picture when you get a chance? I'm sure Dante would like everyone to tell him how handsome he is.
Liz

 

[Libby and Lucy]

Hi Sheri and Dante! Welcome to LL! I don't post here as often as I used to, but I try to stop in occasionally if I think I have something to add.

My suggestion before you make any more changes is to spend the next couple of days getting as much data as you can. Then you will be able to make informed decisions. Slowing down for a few days won't hurt anything and it will give you a much better idea of how to proceed. The tresaderm probably isn't helping his numbers, but if he needs it he needs it. Just expect that he might need to come down in dose once he goes off it, and you might need to adjust quickly. Follow the numbers.

I've been studying your spreadsheet and I have a few thoughts.

One, I actually don't think it's bad that you reduced the dose last week. The increases from 1.75 to 2.0 to 2.25 to 2.5 were all done pretty quickly and without enough data to support the increases, so you're right, he *might* have been over dose then. I probably would have only reduced back to the 1.75 (because you did have data to support that dose), but that's ok. By going down to a lower dose and working up, at least when/if he gets back to 2.5u you will know that it is a good dose.

But..... you really, really, really have to get spot checks before doing any more dose increases. You need to get some PM spot checks too. I don't mean you have to test around the clock, but at least one spot check every night (most of us get a before bed test) and then whenever you are home during the day is needed. There will be times when you'll need to test more than that (especially when he starts changing), but plan on that to start. Dante's spreadsheet shows that he actually CAN drop from this dose - he came down from 400s to 200s on 1.5u on 10/10. Might he be coming down farther than that sometimes and bouncing? He might, and you don't want to increase the dose any more until you're sure. The TR protocol is based on making changes because you KNOW the current dose isn't working. Trying to guess makes it unsafe.

About using R, most of the time we find that Lev kitties using TR do not need R, but it is another tool in the tool box and it's doable if Dante needs it, with some caveats. ;-) Again, the first step is to get data. First you need to understand his Lev cycle (onset, nadir, duration, what makes him bounce and how long do his bounces last, how quickly does he come down from his bounces, how carb sensitive is he so you'll know how to control the cycles if you need to, things like that). Then you figure out the same things about his R cycle. Then you lay the R cycle on top of the Lev cycle to figure out the best times and circumstances to use R. Adding R to Lev will require more testing, but it's doable. Also know that if you add R now, you will probably find that everything you learn will change once he gets off the Tresaderm and the infection is gone. It is likely that those things are causing some insulin resistance right now.

I hope that helps!