Leoberry (aka Leo)

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Noon - the vet had called multiple other vets in town. No one carries it or had extra. The order is put in, and will arrive via FedEx on Friday. Totally my fault.

At the dosage being used, PZI is more expensive.
$260 Lantus = ~2.5 months worth = ~$100/month
$130 PZI = 1 month exactly = $130/month

PZI doesn't seem any more effective than Lantus on Leo. So after this next vial, I may switch back. Also, Leo is being slowly ramped on PZI. With luck, we'll achieve another day of 60-200 nadir.

Thanks to everybody who has helped me. High dose kitties are such a challenge. We are being extra diligent on food regulation and food type. I also baked a brisket for the cats on Tuesday ($2.00/pound). Leo and Chinus were having conniption fits waiting for the first bite :)
 
So just a thought......if you are considering going back to Lantus and you have some available now, you could cancel the order for the PZI and just switch now. Lantus is a good insulin and if per chance Leo is an IAA kitty, as much as I'd like to think the PZI was the magic wand that got him down that one cycle, that is pure speculation and may have just been Leo's system having a good day.

ETA I can just picture those kitties sitting at your feet while you carve off some brisket for them!:D:woot::D:woot:
 
Leo and Chine went bonkers for 2 hours waiting for those brisket slices. I liked it too!

That is a good suggestion to switch to Lantus. I'm so close with PZI now to regulating him. PZI was not the magic sauce. And I don't feel that I took the Lantus high enough - that was because of the vet's suggestion. But I really like your suggestion.

I can't cancel the PZI order. The vet, the vet admin, and a vet tech all got involved in this last minute PZI because of me. The admin called over 10 other vets for me looking for spare PZI. I didn't know she was going to do that. So a box of chocolates is going with me tomorrow to pick up the PZI.

Menace' curve is PZI, and I've reviewed it a bunch. the regulation is amazing now. Maybe that could be Leo in 2-3 weeks. Leo had 2 mid-cycle yellows in the last two days. So maybe I could get Leo regulated on PZI, then switch to the Lantus, which is cheaper and more readily available.

Thank you Linda for the help and suggestions.
 
Too bad about the PZI but I agree with the hoops they jumped through to get it for you, cancelling wouldn't be an option. If it's arriving tomorrow, that's not too bad and you have some flexibility with the PZI such that you can maybe give his shot earlier and work your way back to your normal over a few days. Don't be surprised though if it takes a few days to get Leo's numbers down again.

Menace isn't on PZI Jeff. She is on another long acting depot insulin called Levemir. She started on Lantus but it is acidic and she was one of those kitties that was having discomfort from the injections once we got to about 6 or 8u (can't remember exactly now). So I switched to Levemir for no other reason than to avoid having her indicate she was unhappy every time I gave her shot. I don't think the difference between the action of Lantus and Levemir had anything to do with the progress we have made. I am over the moon at the reduction we have managed to do so far but as you can see there are still days where her numbers are a bit higher and so her dose goes down and then up and then down. It's sometimes one step forward and three steps back and it does take loads of patience not to increase too quickly when you see those higher numbers. :)
 
When you were buying Lantus I take it you were getting it from a local pharmacy and buying the 10ml vial based on the price and shelf life you provided. We can save you even more money on the Lantus. Many folks here buy their insulin from Canada from Mark's Marine Pharmacy and I believe it's under $200 for a pack of 5 - 3ml Solostar pens. Inside the pens, are small vials that folks use with syringes so they can fine tune doses by 0.25u at a time. So for less than what you paid, you'd get 1500 units of insulin vs. 1000 units for less money and the real saving is that the Solostar pens usually have an expiry nearly two years out so even those with kitties on small doses, can often use up all the insulin rather than ending up with all sorts of waste. Here's a link to some info re: Canadian Pharmacies. I believe Mark's is somewhere further down the list.
 
Thanks for these details Linda. I somehow forgot that Menace was not a PZI kitty. But that progress should be a locked thread to show people that regulation can be achieved. It is amazing. Now I understand why Menace is on Levemir. The main thing I do not like about Lantus is the stinky smell. PZI doesn't have that.

I do have the Canada link, and read about it a bunch. That price is the clincher, and a great argument for Lantus or Levemir. I can't do it now because this is Austin TX and it's 100 everyday. Using your numbers, and assuming 20 units/day for Leo:

$260 Local - 1,000 units = $0.26/unit x 20 = $5.20/day
$200 Canada - 1,500 units = $0.1333/unit x 20 = $2.67/day

So that is half price. Wow.
1,500 / 20 units per day
= 75 days worth
vs 50 days of the 1,000-unit vial

Leo just had 2 mid-point yellows in the last 2 days. He seems to feel better then. When he is in the black, I think he gets crankier.
 
Successful 9.5u dose given.
There may be one more dose. Picking up the PZI insulin after 9am tomorrow.
First use of U100 5/16" syringe for PZI using 2.5x conversion chart. Much thinner needle, and no poke thru tent.
 
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I don't even want to imagine how hot it is in Texas. We are sizzling up north too with temps around the 90s but it feels more like 104 with the humidity! I can't remember the last time we've had so many heat warning days or that I have spent so little time outside enjoying the summer because of the heat!

Those are really nice drops Leo's has had the last couple of days. I notice a big difference with Menace when her numbers go up too. It's heartbreaking when all they want to do is eat and sleep and don't seem very engaged but it does get so much better and it looks like you are on the right path with Leo.

I used those 40u 1/2 inch needles while helping with another cat and I remember thinking they looked like daggers compared to my skinny short ones. Makes it easier to fine tune the doses too.:D Sounds like Leo won't have to miss a shot.....you could always shoot a lower dose (whatever is left) if need be to tie him over till Friday night shot and shoot a bit earlier Friday night. Whatever works for you.
 
Thanks, really hoping to replicate Leo's BG drops. For the PZI, there is a little bit left in the vial. I'll know in a couple hours when I extract it. It's is silly that they provide those huge U-40 horse needles. Poor kitties.

The vet confirmed the insulin will be here today. Good thing I work from home (mostly). ...Yes, there are no heat warning days here until it gets over 105. I don't know why they bother, it is always toasty here in the summer.

On July 7 we adopted a stray. He will come within 3 feet of us now. We trapped him before. Got him snipped, and treated for ear mites, fleas, shots, and expensive dental work. His urethra may be infected, and his ear mites are back. Tried to trap yesterday. Trying again this morning. He is warming up to us, and just darned cute.

I am going to buy some FreeStyle Lite strips for the AlphaTrak2 today. Besides expensive insulin, $5-6/day of strips is $150/month on AlphaTrak2.
 

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Actually if you read a lot of veterinary documents, they recommend a 1/2 inch needle. What's not clear is if this has anything to do with the depth of the skin on our cats or just because that is the standard size available in vet syringes. I have tried the 6mm (about 1/4 inch) human needles but found them a little too short and more prone to fur shots especially if kitty moves at all. There are folks who do use them though. Perhaps their kitty's fur isn't as thick or their kitty isn't quite as plump!:woot:

I think we are a little wimpy up here when it comes to too cold or too hot compared to you folks. As soon as the temperature hits 90 given it gets very humid here, they usually start issuing heat warnings. I've never had the pleasure of visiting Texas (on my bucket list!) but I have been in Nevada and Arizona in May and I just can't imagine what it must be like in the summer months. I am a heat lover but 104 is just a bit too hot for me.

Little Dude is adorable! Love those copper eyes! He's a lucky kitty to have you looking after him.

I understand completely about the cost of the AT2 strips. Not sure if you have read up on using the FS strips or not but in case you haven't here is a message I put together for someone else who wanted to use the FS strips because it's important to clearly understand the implications and how to use them as safely as possible.

"Having thoroughly investigated the FS vs. AT strips (checking patents, manufacturing location, assay used in the strips, calling both human and animal divisions of Abbott etc.) I am 99.9% sure the FS strips and AT strips are identical in their physical composition. The AT strips however have been batch tested to determine what code on the AT meter will produce a reading closest to animal lab values. Without the AT code for each vial of FS strips, your results will not be as accurate as those using AT strips with the meter set to the appropriate code. My own cross checking elicited results within 10% of the AT strips. Others have indicated their results were within 5%. The difference may depend on how high or low the reading being compared is.​

I am not advocating use of the FS strips in the AT meter, but they will work. If you choose to do so, it is imperative that you have your AT meter set on one of the cat codes (known codes are 08, 37, 38, and 93) to get a reasonably accurate result. Do NOT use the code on the FS strip vial as that is for use only with older FS human meters. By using one of the cat codes, you stand a 25% chance of getting accurate readings.​

It is also imperative that you keep some AT strips on hand to do baseline checks of your results with the same drop of blood, each time you open a new vial of FS strips or alternately, use AT meter control solution to ensure the strips are readings within the expected range. Also double check any unexpected or low FS strip readings using an AT strip.​

All meters have an allowed variance in their results of up to +/- 20% and using the FS strips in the AT meter adds another variance into the picture so your results, while in the ballpark, may not be as accurate as is possible."​

Last but not least, make sure your vet knows you are using FS strips so they understand that the readings are a little different than lab values/AT with AT strips.
 
Little Dude - that stinker got partways in the cage and I almost had him. Then he bolted. It's a shame because he didn't get fed (at least here) today. We paid to have his top canines (long ones) and one molar removed. They were busted off. Poor little guy, must have been in extreme pain. Expensive surgical extraction. So we are invested in him, and he is already healthier.

Thanks for the FS vs AT strip info. I'm going to keep a copy of that. AT strips are just too expensive. And overall, I bet all these strips are $.02 each to make. Now to find the best web deal for those FS strips.
 
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PMPS 484
Dose increased to 10.0 this morning.

Need to drive some decent nadirs soon. His neuropathy is pretty bad now. He tries to counteract it with lots of purrs. He is getting 3.0mg Zobaline (Cobalamine) daily, and a liquid B12 shot weekly.
 
One of these days you'll hit that sweet spot. You're doing great because our high dose kitties definitely test your stamina, endurance and patience. The saying around here is that this is a marathon not a race and no truer words were ever spoken with our furkids! I reduced my girl a week or so ago and now am having to increase again so it's a bit of roller coaster ride but it does get better so hang in there!

The neuropathy is definitely difficult to watch but the Zobaline and B12 should start helping soon as will getting him on the right dose of insulin to get his numbers down. The good news is that it's not painful for our kitties and they seem to cope pretty well.
 
Preshots 400-480 over past several days.
AMPS 400 today

Going to make 2 changes:
- 10.5 tomorrow evening if no drop
- Reduced food allowance
- We reduced food input today to 1 can Fancy Feast, 2 hours prior to AMPS. Previously it was 2 cans.
 
Based on Leo's weight, if the 15.5lbs is his ideal weight, then he would need about 280 calories per day which would equate to roughly 3 cans of Fancy Feast per day based on the average calories in a can of the different FF flavours. If he's particularly active or sedate, you can adjust accordingly. You don't want to pull back on the food too suddenly because not only could that effect the amount of insulin he needs but also could be hard on his liver. Cats should lose weight very slowly if that is the goal. And right now with Leo not yet regulated, he will be hungrier than usual and not able to get the nutrients he needs out of what he does consume. I would suggest you cut down by perhaps a 1/2 can to start with and weigh him to see if he is maintaining/losing/gaining according to what is appropriate for him at this time.

If he is particularly hungry all day, break his food allowance up over his two shot meals and a few snacks through the rest of the cycle. That helps keep food in the system for the insulin to work with and will keep him more satisfied and not so hungry at shot time.
 
Thanks Linda. Yes, 15.5 is his ideal weight and he is 16.5 now. He is getting overfed. So I'll start reducing and tracking that more closely. I had not realized she was giving him 2 cans for breakfast. He is starving all the time - typical of unregulated cats.

In summary, we were not sure how much food he was getting. Now I'll tightly regulate that. I have been spreading the food out over the 16 hour day. Now there will be less of it. At least he likes the Fancy Feast. He has never been a picky eater, even as a little kitten.

AMPS = 400 today
+2 = 1/2 can food
+5 = 400 also
+5 = 1/3 can food
 
I'm reading all the post just now Jeff, i'm glad that you are testing and wow that must have been a scare that Leo was low all of a sudden! Glad you caught it by testing him.
Well, he did gave you a nice number, so maybe it is a sign for the future (anti-jinx) :rolleyes:
So happy that a lot of people can help you with the high dosing of Leo!
 
Thanks Ruby. Yes it was very scary. He didn't really hypo, but he got low real quick and I Karo'ed and tested him. He did like eating the Karo mixed with his food...but he pretty much likes eating everything.

I'm hoping we can get him into some yellow ranges this week. His neuropathy is pretty bad now. You and Baco must be having fun OTS now.
 
Leo summary:
Last 11 days - preshot tests 400+. And generally 300+ in between (except for Aug 3).
One more shot at 10.0, then increasing to 10.5. He is miserable for food, and especially cranky before the PMPS + dose. Poor kid.

Little Dude summary:
On a positive note, Little Dude, our orange stray recent adoption - got within 2 feet of Theresa during the evening meal tonight (outside). That is a huge gain of trust for us. Maybe another week and he'll give leg-lovin.
 
JeffJ said:
Preshots 400-480 over past several days.
AMPS 400 today

Going to make 2 changes:
- 10.5 tomorrow evening if no drop
- Reduced food allowance
- We reduced food input today to 1 can Fancy Feast, 2 hours prior to AMPS. Previously it was 2 cans.
Click to expand...
Try feeding just prior to the shots. Some of those high preshot numbers are food influenced. Take the preshot reading, then feed, then shoot.
 
Glad to hear about Little Dude! I've socialized several ferals, it takes patience, but it's worth it. Good luck!
Good luck with Leo's dose increase.
 
So glad to hear you are making some progress with Little Dude. Fingers crossed he will start trusting you both more and allow some physical contact in the very near future. :D

Jeff, if Leo is already miserable for food, don't try to reduce too much. He can't effectively use all the nutrients in what he consumes so he needs more right now. If you reduce too much, he may start losing weight and that could lead to ketones and you don't want either of those scenarios. It's a fine balancing act but sometimes you have to listen to what kitty is telling you rather than going by general formulas for calorie intake. I give my girl a set amount of food daily however if she is high and getting frantic for food, I don't hesitate to give her a little more those days despite the fact that she needs to lose a few pounds. Right now I am aiming for maintaining rather than losing.
 
Thanks all for the help and advice. We are looking forward to Little Dude getting closer to us. He hung out in our suburban front yard between 7:30-midnight last night.

I will be careful on Leo's food reduction. I am able to smell ketones as well. We had a small mistake this morning - Theresa fed Leo 2 cans before 7am. So now he's not hungry for the moment. AMPS will be off even when I wait until 9am. The small positive is he gets this small window of great contentment. It is real neat to see him in his old relaxed state for these small periods.

1:30am test = 330
For that (PMPS +5hr) test was not food influenced. He didn't get much food after PMPS shot, and he didn't get any food for 3 hrs before the (+5) test. Rest of today and tomorrow will be tighter food controls.
 
JeffJ said:
I am able to smell ketones as well.
Click to expand...
I'm assuming you just mean you're able to smell ketones.....not that you have already!?! I wouldn't rely on smell alone as they show up in urine a day or so after they start in the blood so there isn't always a strong enough odour for us to detect at low levels. If you can get Leo to pee on some plastic wrap in the litter box or set up a separate box with fish gravel, you can test that way using human ketone sticks from the pharmacy. Some folks can sneak up and put a strip or spoon under their kitty to get a sample but that doesn't happen in my world!
 
I don't know where Leo's yellow numbers went - from 4 days ago. We're trying to do better feeding. Tonight doing 2.5 hour light feeding before PMPS. Then increasing dose +0.5 - to 10.5.
 
These high dose kitties can be challenging and very frustrating. Looks like Leo he had a bit of movement and then the dose went stale. You just need to keep going until you get to the dose that start bringing him down. I have patience pants but they're kind of in rough shape so I can't offer to loan them to you! ;):woot:

shredded.jpg
 
Thanks Linda. WHOA - I didn't know your cat had such sharp claws.:)

Leo is on the new vial of PZI. I am a bad end-of-vial insulin estimator. There were 4 more doses at the end of that last vial. Anyhow, the last dose was out of the new vial.
 
3-4 hours leading up to each shot, Leo seems to get frantically hungry. This may not get reflected in the testing. I think the insulin is wearing off and he is hitting a calorie deficit. Especially in the evening before preshot, he begs and cries persistently for food.
 
JeffJ said:
I didn't know your cat had such sharp claws
Click to expand...
Oh that's not her claws. She's very good about her manicures and super gentle. That's Momma rubbing her sweaty palms on her pants trying to figure Menace out! :p

That frantically hungry behaviour is why so many of us split food out over the course of 24 hours. I think that frantic behaviour serves to raise their BG to some degree too so I try to keep Menace relatively sated within reason. It's a trial and error proposition to find what works best for your cat because some cats will eat more at a meal and some like to graze.
 
No yellow today. He is acting more regulated. We are regulating food tightly within reason. He is not gaining or losing weight currently. Summary:
5am, 7am = 1/2 cans Fancy Feast
9am - 355
9:01am - 10.5u
9am, 11am, 12noon- 1/2 can or less each
2:30p - 380
2:30 - 1/2 can
TBD 9:00pm PMPS, 9pm, 11pm - food; then 1:30am test

Small victory of no red or black.
Sticking on 10.5 for 4 doses, then increasing to 11.0.
Fed fresh cooked similar portion of Tilapia (fish) on 2 feedings. Leo and Chinus love it. Little Dude (outside) did not touch it.
 
Tomorrow, may try same strategy as 8/3/2016.
No food between +2 to +6, then test at +6.
This assumes I can stand the persistent whining and crying. Currently have been giving 2 hour feedings of 1/2 cans or less. If I put out 2 or 3 cans, he will try to eat all of it.
 
I really think the hunger part of this situation is sometimes the hardest to deal with. I know I am the biggest sucker for those soft eyes peering at me and those meows that grow progressively louder the harder I try to ignore Menace. It's heart wrenching! Probably worse because like you apparently I am prone to catering to my kitties, sometimes too much. I have a furry senior citizen here whose appetite is very picky these days but he loves fried pork chops, poached chicken and steak so there is always a supply of one of these in my freezer for treats. Unfortunately (or maybe that should be fortunately) my little sugar isn't the least bit interested in any of my home cooking! :p

Maybe little Dude will come around in time or he may be like Menace who doesn't like fish.....but then it's soft and for her, if it doesn't crunch, it ain't edible except for grilled cheese and bacon or peanut butter sandwiches. :woot:
 
The persistent hunger is tough to deal with. Another high number (430) to end this day. Will stay on 10.5 for another 2 shots, then 11.0.

Looking at other traps for Little Dude, like drop traps. He has bad ear mites now. Theresa thinks his castration site is infected. So he needs a vet visit. He came within 2-3 feet of me tonight. Building trust takes awhile.
 
We are regulating Leo's food more closely. Summary status:
- 1/2 cans of Fancy Feast classic every 2-3 hours
- BG = 340 - 460 in last few days

Bumping him to 11.0 units on Aug 12.
Targeting a nadir in the 200's.

I'll probably move back to Lantus after this PZI vial, for cost reasons. The PZI is not any more effective on Leo. And the Lantus is at least 30% cheaper.
.
 
Thanks Rachel. I plotted Leo's AMPS and PMPS for 7/30 - 8/11. In Leo's google sheet, it is the second tab (see top tabs in the sheet).

The PMPS is trending down with the increased dosage. Also better food regulation. I'm hoping increased insulin will continue that trend.

Theresa and I were talking about our cats tonight. I'm spending all this time treating Leo, successfully since he is alive. Then Scoobs got that intestinal issue (June 29), with no symptoms and died 2 days later (July 1). We keep wishing we could go back in time and somehow see some small symptom earlier to save him. He just started throwing up, and we took him to the vet the next day (Thursday), then he died that Friday during surgery. Or we wish somehow the vet could have done some miracle and diagnosed necrotizing intestines on Thursday. But his major intestine was all dead. There was no blockage. Grief is a hard thing to deal with. I guess a lot of cat parents have the same guilt issues. All I know is I sure miss my sweet boy Scoobs.
 
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We totally get that Jeff. I still feel guilty about gypsy...I should have seen much earlier that something was wrong so I could have hopefully helped her. But we do what we can. I think our kitties know we love them and do whatever we can for them. Gypsy had a good life...and when it was time, I let her go rather than allowing her to suffer. Scoobs knows you loved him...and that you did whatever you could to help him.
 
Jeff, our kitties are all too capable of letting on nothing is wrong even when they are feeling quite ill.....the only common kitty trait I wish didn't exist. If we get them medical attention when we do see something off, that's all we can do. I think most folks here can relate to what you are going through but you got Scoobs to the vet as soon as you knew there was a problem. Many kitties wouldn't have had that care. Scoobs lived a good life with all of his needs more than met and was obviously adored, loved and very lucky to have you and Theresa as his pet parents. He knows that and he wouldn't want you beating yourselves up. :bighug::bighug::bighug::bighug:
 
Thanks Rachel and Linda. It has been 6 short weeks since Scoobs left. He just seemed so young at age 8 to leave us. We have his tribute shelf setup. We tried watching some videos of him, and I can't do that yet. He was a friend to all who met him (person, dog, or cat), and he was a kid to us.
 
Leo's numbers are not falling much. See his spreadsheet. We are strict on food now. Today:
AMPS = 330
then dose = 11.0 (increased from 10.5)
5am, 7am, 9am, 11:30am - 1/2 can food each time
+5 = 350

I might as well be injecting him with water. The injections are in his flank. Different spots to ensure effectiveness. I guess the main change is he is out of the 400-550 range from a few weeks ago.
 
Jeff, you've been hit with a double whammy between losing Scoobs and now dealing with the frustration of a high dose kitty. My heart goes out to you, but you are doing everything you can and the day will come when Leo will surprise you with another lovely lower number. You are making progress although not as quickly as you'd like. Unfortunately, baby steps are necessary to keep Leo safe.
 
Thanks Linda. It has been a tough month.

We went on vacation to Canada. When we came back:
- Leo had lost 1.0 pounds at the boarding facility, I think due to stress
- Scoobs was gone 5 days later, which devastated us
- Leo's neuropathy was pretty bad, and we were afraid of losing him too
- So no more real vacations for awhile

Leo's plan:
- keep increasing by 0.5u every 6 doses to drive BG reduction
- increase cobalamine to 2 x 3mg pills per day starting today

On a positive note:
Little Dude (orange outside guy) got within 18" of Theresa during one feeding, and same for me during another feeding. And he almost gave me leg-lovin. It is so rewarding. And he is doing air-dough, and he rolls over for food. I have no idea where he learned that.
 
Sounds like things are progressing nicely with Little Dude and he seems to be feeling good, so hopefully no infection from the neutering.
 
Theresa took pics, and had a vet tech evaluate the neuter site. They said he is okay. He doesn't mess with it. I would think if it hurt, he would be licking it or he would not be playful. Yet, no excessive licking there. And he looks real healthy, plus the rolling around on the ground for food.

Thanks for the post.
 
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