Maggie's perplexing progress

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Kelly Howard

Kelly Howard

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New thread for a new week. Really happy with her numbers since last night's shot. She must have had a late nadir last night that left her in relatively good numbers for AMPS (and that was a +13 number at that!). Seems to have cleared that bounce and coming down nice and slow today. I won't be able to get many more tests as we'll be gone for the afternoon. I'm anxious to see how next week goes! I hope this pattern of low numbers continues.

I was just looking at her spreadsheet... isn't it colorful? Lol! All the colors of the FD rainbow :p
 
Kelly Howard said:
New thread for a new week. Really happy with her numbers since last night's shot. She must have had a late nadir last night that left her in relatively good numbers for AMPS (and that was a +13 number at that!). Seems to have cleared that bounce and coming down nice and slow today. I won't be able to get many more tests as we'll be gone for the afternoon. I'm anxious to see how next week goes! I hope this pattern of low numbers continues.

I was just looking at her spreadsheet... isn't it colorful? Lol! All the colors of the FD rainbow :p
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Kinda like Teasel's except for the blacks! ;)
 
High AMPS, I'm thinking she may have bounced overnight. She was already in blue at +3. Yesterday she stayed a little too high with the 2.25 dose so I went back to 2.5. Of course will have to wait til Wednesday again to get mid cycle numbers. And I really really need to order those U100's! Do they sell them in stores anywhere?
 
Kelly Howard said:
High AMPS, I'm thinking she may have bounced overnight. She was already in blue at +3. Yesterday she stayed a little too high with the 2.25 dose so I went back to 2.5. Of course will have to wait til Wednesday again to get mid cycle numbers. And I really really need to order those U100's! Do they sell them in stores anywhere?
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U100s are the syringes that humans who are on Lantus use. You should be able to find them in any pharmacy. Make sure they have the half unit markings - sometimes pharmacy staff aren't aware of this. If your vet prescribes Lantus, they should be able to sell you the U100s, although probably at a higher price. I buy mine from my vet because of the half unit issue. Many people on FDMB buy them at the Walmart pharmacy for dirt cheap.
 
Kelly Howard said:
Darn. Prescription only. Just ordered some from ADW.
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Really? Different rules in the USA. I can buy U100s at a human pharmacy without a prescription. Would your vet write you a prescription (with repeats) so you could buy them at Walmart - or would he/she be aghast that you want to use U100 syringes with a U40 insulin?
 
Yeah, I don't know if it's everywhere -- I just stopped by CVS, and they said they require one. I didn't want to run around too much since I had to get back to work.

I'm not sure what the vet's reaction is to all of this yet. Last week I was trying to get a refill of the Prozinc and they said that was fine, but before the next refill, they wanted her back in for another curve. Well, I can buy 100 FS strips for the cost of 4 tests at the vet's, so I'm hoping I don't have to do that. In response I gave the whole spiel about finding this forum and all the great advice and experienced people who were helping me here. I sent a link to my spreadsheet and explained the logic around adjusting her doses. That was Wednesday and I haven't heard a peep from them since. That was also before her two blue preshots, so if they give me any flack about it, now I can point to those and say, what do you think would have happened if I gave her the prescribed 3U on those two mornings? He is a younger guy so I'm hoping he will be open minded about me taking control of her treatment. We'll see what he says if I ever hear back!
 
Kelly Howard said:
Yeah, I don't know if it's everywhere -- I just stopped by CVS, and they said they require one. I didn't want to run around too much since I had to get back to work.

I'm not sure what the vet's reaction is to all of this yet. Last week I was trying to get a refill of the Prozinc and they said that was fine, but before the next refill, they wanted her back in for another curve. Well, I can buy 100 FS strips for the cost of 4 tests at the vet's, so I'm hoping I don't have to do that. In response I gave the whole spiel about finding this forum and all the great advice and experienced people who were helping me here. I sent a link to my spreadsheet and explained the logic around adjusting her doses. That was Wednesday and I haven't heard a peep from them since. That was also before her two blue preshots, so if they give me any flack about it, now I can point to those and say, what do you think would have happened if I gave her the prescribed 3U on those two mornings? He is a younger guy so I'm hoping he will be open minded about me taking control of her treatment. We'll see what he says if I ever hear back!
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My vet, who's great, has trusted me to be quite autonomous in handling Teasel's diabetes but I hadn't been in contact with her since I started doing things the FDMB way. I decided last week - because I wanted a ProZinc refill BTW - that I'd email her the ProZinc "Advanced Dosing" sticky and Teasel's SS with a preamble about why I'd adopted this protocol. We spoke on the phone after she'd had a chance to review it all and she's totally on board. She thought it was logical and that I was making progress with Teasel who had defied all attempts at getting him regulated the usual way (assign dose, give for a week, do a curve, assess dose, repeat ...). She said she views the client-vet relationship as a collaboration. I was relieved at her response because I do need her in my corner.

Wanting Maggie back in before your next ProZinc refill might come from a place of veterinary liability concerns but I suspect there's a strong financial component as well. Right from the get-go I was told to do Teasel's curves at home but I did have to pay an "interpretation" fee for the vet's feedback and further instructions. This was fine at the beginning when I was in the "deer-in-the-headlights" phase of reacting to the diagnosis. Before long I was talking over how to proceed with my vet and then going longer periods without close contact.

To give them their due, though, vets also deal with clients who won't/can't take a hands on approach. I think they're surprised when an owner wants this sort of control. :cat:
 
I remember seeing your update about the vet in your thread. That's awesome that she is willing to work with you! My gut says this vet will be the same way, but I just don't know him well at all so hard to say. Yeah, it is understandable for them to be cautious with clients who want to be making decisions like this. Even in my line of work, if we have an end user who wants to do something really technical, they have to prove themselves to us before we will hand over the reins. And the worst thing they can do is mess up a website! Of course you'll want to be much more cautious when there are furry little lives at stake. But I think now, after these last few days, I can make a data-supported argument that testing her at home and making small adjustments is much safer for her. He did mention home testing at our very first appt so I know he isn't completely opposed. And hey, worst case scenario we switch vets. We've been going here for all of 3 months so I really don't have anything invested. This is a big city and I'm certain I can find a vet who is willing to work this way, if this one isn't.
 
Not sure what to make of the last few days. She's falling back into the typical Maggie pattern -- really nice mid cycle numbers, really high preshots. I was thinking bouncing, but last night I dragged my butt out of bed at 2am and got a +7 number. It did look like a nice gradual cycle; really, the nicest PM cycle I have on record. I'm thinking the right dose right now may be somewhere between 2.5 and 2.75. Hopefully those U100 syringes ship quickly!

I'm interested to see what tomorrow's curve reveals! (Wow, add that to the list of things I never thought I would get excited about...)
 
Maggie did give me a laugh last night. Here she is hiding in the baby's room trying to avoid her +3 test! :D
 

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So I'm still very very inexperienced with the low preshot game. I'm curious, what made you skip the shot completely today but give a normal dose on the days when he was only a few points higher? Is it because he wasn't rising today? One day I hope to be making these decisions too... :)
 
To clarify, I was specifically wondering about why NS vs just a lower dose since the numbers are fairly close (within the same range at least).
 
Kelly Howard said:
To clarify, I was specifically wondering about why NS vs just a lower dose since the numbers are fairly close (within the same range at least).
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My no shot number for Teasel is around 10 mmol/L, or 180 mg/dL. This is based on a general FDMB recommendation as well as what I've learned by studying his SS. If his AMPS is in the 8+ range, I try stalling for 20 min and retesting. This usually gets me to 10 or very close with no more than an hour's stalling. There's no way he would have risen from today's AMPS of 6.8 to 10 in an hour so I opted for no shot. All three get antsy if they're not fed according to schedule.

Why 10 (180)? Because I think it's a safe number to shoot based on all the data I have on Teasel. I'll usually opt to reduce his dose a bit (guesswork/experimentation). Anything lower than 10 puts him in danger of going too low and I don't have any experience shooting in low numbers. Some people get there as kitty nears remission. Not where I want to be yet - still learning.

One thing I don't do with Teasel is switch up his dose often (ie., in response to one number) or by very much. I've learned that he's very reactive so I do a lot of "tip toeing", as I like to think of my approach.

Make sense? :cat:
 
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Ok, I see. So, someone who has data on how their cat responds to a shot in the 120-180 range might be willing to shoot a low dose in that situation, but you've set a threshold of 10/180 for him based on the data you have plus a desire not to make drastic dose changes day to day. That makes sense. Man, figuring out what to do with those low numbers is stressful! But a good problem to have I suppose :)
 
Kelly Howard said:
Ok, I see. So, someone who has data on how their cat responds to a shot in the 120-180 range might be willing to shoot a low dose in that situation, but you've set a threshold of 10/180 for him based on the data you have plus a desire not to make drastic dose changes day to day. That makes sense. Man, figuring out what to do with those low numbers is stressful! But a good problem to have I suppose :)
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Yes, that's it exactly! I might in time get to the point of dosing in the 120 -180 range but I'm not there yet. I need more data and experience. And Teasel's volatility governs everything I do.

Darn right those low numbers are stressful!!! :eek:
 
Kelly Howard said:
I'm not sure what the vet's reaction is to all of this yet. Last week I was trying to get a refill of the Prozinc and they said that was fine, but before the next refill, they wanted her back in for another curve. Well, I can buy 100 FS strips for the cost of 4 tests at the vet's, so I'm hoping I don't have to do that.
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Well just read that comment you wrote and let me tell you this... you pay the vet, so you get to decide what you are and aren't going to do. They just want to get money out of your pocket with those curves they do at the vets... don't let them, they don't decide to make that curve for Maggie! And btw that curve will be a stressful one because the vets already causes kitties to stress and give higher numbers.
I hope your vet is willing to work with you and let you do your own thing. Mine was really willing to work with me as Prozinc was completely new in The Netherlands and I found the Dutch board and via that board I came here. She was really nice and called me every week and looked at my spreadsheet online. She was so amazed by the progress Baco was making because of the advise I got from this board! She even recommends to the new kitties on Prozinc to give low carb food (something they never have given as advise because they always recommended prescribted food which are high carb) Baco was the first kitty in her whole career she's has seen going OTJ. So great for her that she wanted to learn about Baco and of course the use of Prozinc.
So you do what's best for Maggie, and number one is not filling the pockets from the vets because you can test and make a curve yourself in a 0% stressful situation!
 
I love your attitude Ruby! And I totally agree, the only problem is... they have the insulin :p So if they want me to play their game in order to get a refill, I have to either suck it up or go somewhere else. And I don't want to give in, so I'm totally willing to do the second option. Hope it doesn't come to that.
 
Haha well thanks! I do think that it's your kitty just like Baco is mine and you as the kitty parent is the one that makes the choices and nobody else.

Well why would they refuse to give you insulin? They can't do that right that would be inhuman(cat)! ;) Hopefully this will not happen. If you explain the situation they can't refuse.
 
Hehe. Well, this morning's number was probably a combo of the lower dose, letting her have medium carb kibble after the 85 reading because I didn't want to stay up to monitor :rolleyes:, and maybe a bounce.

I'm conflicted, 2.75 gave her that beautiful curve but I did steer just a bit and I won't be able to do that today. I think 2.6 would be just right but no chance of eyeballing that! U 100's should be here tomorrow.
 
You could do a fat 2.5 (pull up a little more and let out a few drops) or a skinny 2.75. (Pull up 2.75 and let out a drop or two. ) Leave out some food so she can bring herself up if needed. Last two cycles were beautiful - BIG bounce this am.
 
Fat 2.5 is what I did (at least what I tried to do!).

She seems to drop in and out of the 70-90 range without much ado. Is that 68 number a hard limit for too low? Or can that be another ECID thing?
 
Since the first rule here is "do no harm" I think we set the hypo limit at a little higher range. Most cats at 50/68 don't exhibit any "symptoms" of a hypo. In general, we say you need to pay attention at those levels and feed a little regular low carb, to get them to perhaps surf in a nice range for a while. But also, to watch that they don't drop 10 points where they might be in trouble. For me, it is such a small drop to a number where they might have a seizure or something worse.

But, as always ECID, and you hold the syringe. Truthfully, I am more comfortable with lowering the no shoot number (after you have data and can monitor) because there is more room for error, than considering a lower number a hypo number.

Not sure that makes any sense
 
Thanks Sue. It's good to know that number is a bit on the cautious side. I will still take it very seriously, of course. Maggie seems to respond really well to just a bit of the MC kibble which I'm thankful for.

Well, she surprised me tonight! 242 PMPS. We saw over the weekend that 2u was too high for her in the low 200s. I'm thinking... 1.5? Skinny 1.5? I want to be a little conservative because I really don't want to be up at 1 or 2am monitoring.
 
Apparently I just didn't give it a chance to work last night. 269 this morning!

I guess I'll stick with what worked... wow! Now I wish I'd gotten a +6. I wonder if she just stayed in the 200s all night.
 
This little girl just keeps surprising me. She must be having really late nadirs all of a sudden. 214 AMPS!

It's early so I can wait a bit before giving a shot. Here's the thing though, we are going out of town this weekend and taking Maggie with us. She's going to be on a 90 minute drive starting in about 2 hours. Then she'll spend the whole weekend in an unfamiliar place with a bunch of people. I think it's safe to say she will have some stress numbers this weekend. Knowing that, do you think it's ok to shoot this yellow a little more aggressively? Maybe 1.6 or 1.8? Normally, I think I'd be doing 1.4ish based on our other yellow preshots this week.
 
Yes, I think shooting a little more if she has higher numbers would be fine. Hope the trip goes well. Nice amps! One of these days, you might lower your no shoot number a little- a day when you can monitor - and see if she is okay with that.
 
I haven't been around the board much this week. Maggie is, as always, full of surprises. When we went out of town this weekend, we were actually going to a cabin in the mountains that we just bought. We had to bring Maggie for obvious reasons, but left the rest of the cats at home (because who willingly travels with cats?? Not me!). I figured she would be hiding the whole weekend.

Well, she had the time of her life! I don't think I have ever seen her so happy. I think a lot of it was just from not having any other cats there. Maggie has always longed to be an "only child" again. She was talking a bunch, had her tail straight up all weekend, rubbing on everything, purring up a storm... she was in heaven. And when we came back home she was grumpy as hell! :p

I suspected she was bouncing again and today confirmed it. I'm going to drop to 2.4 and see if that's enough. Hate seeing those black preshots again!
 
Awww glad to hear that she had so much fun! Guess you know she'll always be willing to take vacations with you!
 
Well, the lower dose kept her from bouncing last night, but got us a (lovely!) tricky number this AM. I don't have much data on shooting yellows for her and I won't be home to monitor. On 10/22, a dose of 1.8 on an AMPS of 214 caused a bounce. The day before, a dose of 1.4 on 269 could have caused a bounce or could have just not been enough and left her high. So hard to say.

I'm thinking 1.6 or 1.8... I'd rather err on the side of caution since no one will be home until about +10.
 
It's their lack of consistency that's crazy-making! Sometimes Teasel will bounce and sometimes not. Erring on the side of caution is always best I think.
 
Maggie is having really bad numbers lately. I never did start using the new vial of insulin -- I wonder if this one is finally giving out. It's like I am not giving her shots at all. I need to update with today's numbers, but she's still in the 300s at +4 on a dose of 2.8. I did check for ketones on our new ketone meter and got 0.4, so all good there.

Last Friday she did get into some kitten kibble that we were feeding to a stray cat family that showed up outside (soooo cute! But we haven't seen them again since :( ). I thought that might leave her high for a couple days but no way it could still be affecting her after this long. Only thing I can think of is the insulin losing potency. Any other theories?
 
How long have you been using your old vial? It's possible that has lost some potency. You could try using your new vial to see if you get better numbers. I approach a new vial with caution - ie., be prepared to monitor. There might be no difference but better to be safe.
 
It's the original vial, so since her diagnosis on Aug 31. That would make it 9 weeks. I have a new vial that I got a couple of weeks ago, but then her numbers were looking really good so I hadn't started to use it yet.
 
Kelly Howard said:
It's the original vial, so since her diagnosis on Aug 31. That would make it 9 weeks. I have a new vial that I got a couple of weeks ago, but then her numbers were looking really good so I hadn't started to use it yet.
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Teasel's last vial lasted about 2 months. I changed it because I wondered if it was losing its oomph. No definite conclusion about that. There wasn't too much left in it. You won't know if it's the insulin until you try the new vial.
 
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