Mostly Yellow Cycles

[Ozzy Pawzbourne]

I havent been able to update my ss online last couple cycles but I have been keeping a log on paper. Will update the ss when I next can.

But for last 3 cycles Ozzy has been mostly yellow. His AMPS today was 306 and his nadir was around 216 today. He is at 284 at +6.5 now. I think he will be pink again at PMPS tonight.

I keep reading around here that you want kitty in 150-220 ranges but Ozzy is mostly always in higher yellows with a few blues here and there and a couple nose dives into greens where we steered him up with food.

Our issue right now is we can't give Ozzy too much insulin because he tanks quicky. How do we get him in the 150-220 range? Is this just a matter of timing? Meaning it will happen over time? I see other kitties on here who are getting there quicker than Ozzy. I know every kitty is different but just curious what you folks think about his progress and what would you suggest for next steps?

Last couple cycles he has been given 25-.75u (eyeballed so hard to be 100% sure).

Thanks!

 

[Kris & Teasel]

I havent been able to update my ss online last couple cycles but I have been keeping a log on paper. Will update the ss when I next can.

But for last 3 cycles Ozzy has been mostly yellow. His AMPS today was 306 and his nadir was around 216 today. He is at 284 at +6.5 now. I think he will be pink again at PMPS tonight.

I keep reading around here that you want kitty in 150-220 ranges but Ozzy is mostly always in higher yellows with a few blues here and there and a couple nose dives into greens where we steered him up with food.

Our issue right now is we can't give Ozzy too much insulin because he tanks quicky. How do we get him in the 150-220 range? Is this just a matter of timing? Meaning it will happen over time? I see other kitties on here who are getting there quicker than Ozzy. I know every kitty is different but just curious what you folks think about his progress and what would you suggest for next steps?

Last couple cycles he has been given 25-.75u (eyeballed so hard to be 100% sure).

Thanks!

Vetsulin is probably the culprit and Ozzy might be extra sensitive to it. Some kitties are more measured in their response to insulin. It's also hard to microdose with Vetsulin because of its hit fast and hard attributes.

 

[Ozzy Pawzbourne]

Should we be looking to switch insulins? What do you think? If so, which one do you recommend that has some flexibility dose wise? I know the Lantus one is talked about a lot but I understand it is $200-300/month or something crazy.

Our wlamart carries insulin that is really affordabl . I think it is called Novalin. Is that a good one to choose? We just spent over $5k to get Ozzy out of DKA so if we could find more affordable insulins, that would be preferred.

 

[Kris & Teasel]

Should we be looking to switch insulins? What do you think? If so, which one do you recommend that has some flexibility dose wise? I know the Lantus one is talked about a lot but I understand it is $2000-300/month or something crazy.

Our wlamart carries insulin that is really affordabl . I think it is called Novalin. Is that a good one to choose? We just spent over $5k to get Ozzy out of DKA so if we could find more affordable insulins, that would be preferred.

Many people in the US buy Lantus from a Canadian online pharmacy, Marks Marine Pharmacy. I don't know the exact price but it's much cheaper. You don't buy a 10 mL vial like you do with Vetsulin because Lantus is more concentrated (U100) and gets used up more slowly. Your vial would expire long before you use it up. It can be bought as cartridge refills of 3 mL each that are meant for an insulin injector pen but can be used like a vial to draw insulin into a syringe. You could post a thread asking about prices, etc.

 

[Nan & Amber (GA)]

Right-- there are cheaper ways to get Lantus. Mark's Marine is a favorite source, but I was able to buy individual pens (lasted months) for about $100 locally, too (depends on the pharmacy). Overall, I think it would be a better option to try for Ozzy given his response to Vetsulin. The Novalin N is convenient and cheap, but I believe it has the same kind of fast in-and-out action as the Vetsulin, and it sounds like Ozzy might be better with a depot insulin like Lantus.

 

[Jill & Alex (GA)]

Should we be looking to switch insulins? What do you think? If so, which one do you recommend that has some flexibility dose wise? I know the Lantus one is talked about a lot but I understand it is $2000-300/month or something crazy.

In my opinion (having used both Lantus and Levemir), Levemir affords more flexibility than Lantus. Although Lantus does have more flexibility than what you'll hear repeated by our members. A box of 5 pens will last about a year, maybe a little more at the low doses like Ozzy is on now. Some pharmacies *may* sell single cartridges or pens. Check with the individual pharmacy. Prices will vary.

Many of our members purchase insulin from Marks Marine Pharmacy in Canada. See THIS post for more information. Shop around for the best price!

A box of 5 Lantus or Levemir pens from Marks Marine will average less than $20 a month when kitty is on low doses.

 

[Lisa and Smoky]

I used vetsulin for Smoky for 2 and a half months and he did very poorly on it. He would hit his nadir about 3 or 4 hours after the shot was given. His vet suggested switching him to prozinc since it is an in and out insulin like vetsulin only milder and lasts longer in duration. Smoky is doing great on the prozinc even though only on it since 11/23/16. I will say that is is pricey, in my area around $120 for a 10 ml vial. If your kitty is on a low dose you may only use half the vial before it expires.

 

[StephG]

I used vetsulin for Smoky for 2 and a half months and he did very poorly on it. He would hit his nadir about 3 or 4 hours after the shot was given. His vet suggested switching him to prozinc since it is an in and out insulin like vetsulin only milder and lasts longer in duration. Smoky is doing great on the prozinc even though only on it since 11/23/16. I will say that is is pricey, in my area around $120 for a 10 ml vial. If your kitty is on a low dose you may only use half the vial before it expires.

Some vets will measure out a smaller vial of ProZinc insulin for you if your cat is on a smaller dose. That way you're not wasting half a vial or more. I know my vet does it for clients. Doesn't hurt to ask if you're thinking about switching to ProZinc.

 

[Jill & Alex (GA)]

Some vets will measure out a smaller vial of ProZinc insulin for you if your cat is on a smaller dose.

No matter the insulin, if you are buying repackaged insulin from your vet, even if it was transferred into a sterile container, its efficacy and longevity may be questionable.

 

[Ozzy Pawzbourne]

Got a return call from the vet last night that I missed. I have been trying to get ahold of him for 2 weeks. Apparantly they don't check email there. He left a voicemail and said he was impressed with our spreadsheet and wanted to talk with us about our options and maybe a dose increase. On vestulin? I am definitely nervous about a dose increase on this insulin especially since I am returning to work next week and won't be here to monitor Ozzy. I am going to ask about alternative insulins.

What other questions do you think might be appropriate for me to ask the vet? I think Ozzy is doing GREAT otherwise post-DKA THANKS TO SO MANY OF YOU!!

 

[Kris & Teasel]

Got a return call from the vet last night that I missed. I have been trying to get ahold of him for 2 weeks. Apparantly they don't check email there. He left a voicemail and said he was impressed with our spreadsheet and wanted to talk with us about our options and maybe a dose increase. On vestulin? I am definitely nervous about a dose increase on this insulin especially since I am returning to work next week and won't be here to monitor Ozzy. I am going to ask about alternative insulins.

What other questions do you think might be appropriate for me to ask the vet? I think Ozzy is doing GREAT otherwise post-DKA THANKS TO SO MANY OF YOU!!

Dose increase??!!

 

[Ozzy Pawzbourne]

Dose increase??!!

Maybe he sees that Ozzy is above the renal threshold most of the time. But you guys/gals know the problem with vestulin and Ozzy!

I am interested in the Tight Regulation protocol. We really want to see if we can get Ozzy in remission if possible and this seems to be the best route to do so. What insulins are appropriate for TR? Lantus only?

 

[Kris & Teasel]

Maybe he sees that Ozzy is above the renal threshold most of the time. But you guys/gals know the problem with vestulin and Ozzy!

I am interested in the Tight Regulation protocol. We really want to see if we can get Ozzy in remission if possible and this seems to be the best route to do so. What insulins are appropriate for TR? Lantus only?

Best asked on the Lantus forum. I don't have the knowledge.

 

[Jill & Alex (GA)]

What insulins are appropriate for TR? Lantus only?

The most commonly used insulins used when practicing TR are PZI, Prozinc, Lantus, and Levemir.

IMHO, our Lantus & Levemir ISG is one of the best when it comes to TR support with Lantus or Levemir... if either of those is your choice.

At one time on the FDMB, PZI was the choice insulin for those wishing to practice TR. However, I don't know if there's anyone around on the FDMB anymore who practices TR by using a sliding scale and shooting on the rise after nadir. If you can't find anyone here to help with TR with PZI/Prozinc, check out Diabetic Cat Help. I understand they offer a lot of help and have been successful when it comes to practicing TR with PZI or Prozinc.

 

[Ozzy Pawzbourne]

I am sorry for so many questions but how to I know which insulin I should switch Ozzy to? What factors are most important in making a switch and why?

Also, what is a sliding scale?

I want to talk with my vet about switching insulins but honestly I am a little concerned about how knowledgeable he is on this, especially considering he was making reference to maybe increasing Ozzy's dose of vestulin. We have already seen him nose dive in +2 a couple times on just a 1-1.5u dose.

 

[Kris & Teasel]

what is a sliding scale?

It's a dosing method whereby you vary the AM and PM dose depending on the BG number. Over time, data collection shows you how your cat reacts when a certain dose is given at a certain BG level. For example, you learn that BGs in high yellow generally need a dose of "x" to bring them down whereas if BG is high blue you learn that dose "y" is the way to go.

which insulin I should switch Ozzy to

Generally there's less of a nosedive issue with the depot insulins and there are lots of people on here with +++ experience using them for the FDMB version of TR. You could post over on the Lantus/Levemir forum for input/info.

 

[Beth 73]

Hey Jo !!! I truly feel ur pain and frustration over vetsulin....you know I know. I ordered Elmo's Lantus from Marks in Canada ....you have to have a script and have time to wait for it to be shipped. It is cheaper but with time being of the essence you could get ur script, buy just one pen locally and then place order with Marks. I'm not recommending Lantus cos I have not even begun it yet but if that's what u decide and u want to get started ASAP these are the details I know. Hoping ur vet will be willing to give u script for whatever insulin u decide. If you go to my lengthy threads where Mogs, Linda, Kris and Chris you can glean good info from them as I tortuously questioned them as I decided to switch. Hope this helps cos Elmo wants hos little brother well

 

[Ozzy Pawzbourne]

Betj- can you please send me a link to the thread you referenced? Thanks!

 

[Beth 73]

Betj- can you please send me a link to the thread you referenced? Thanks!

Jo, I am almost fully computer illiterate...depended too much on our techy son and when he moved out he took my abilities with him. I am getting ready to go thru old threads to collect up info shared and when I find which ones have the info I will let you know. My order of Lantus from Canada is not due til after New Year so I am making notes from L stickies and info shared by Mogs, Linda, Kris and Chris ....I know their insight will help you decide as it did me....question? Would it be possible to tell ur vet you r considering safer insulins for Ozzy and have him give scripts for several different ones ??? Living in S Cali as u do I cannot imagine a vet not being open and willing to do that. I'm off to search and will get back ASAP...

 

[Beth 73]

Hi Jo!!!... I am distracted right now and won't be back at going thru old posts for a while. I suggest u go down my old posts starting around 12/18 and earlier....they will all begin with "Elmo"....in the week preceding my 12/19 appointment is where the Kitty Cavalry gave me good info...especially when u see a long post , that's where much of info is. Hope this helps

 

[Jill & Alex (GA)]

I am sorry for so many questions but how to I know which insulin I should switch Ozzy to? What factors are most important in making a switch and why?

If I were making a decision to switch insulins, I'd have to carefully consider the support available to me for each of the insulins as well as what kind of support I'd receive for the method/technique I'd like to follow.

Also, what is a sliding scale?

Through data collection, eventually you'll know if I shoot "x" dose on a preshot number between this number and that number, I should be able to obtain favorable results. Although, sliding scales do change... one of the reasons I'd make sure I had experienced help and support available to me.

I want to talk with my vet about switching insulins but honestly I am a little concerned about how knowledgeable he is on this, especially considering he was making reference to maybe increasing Ozzy's dose of vestulin. We have already seen him nose dive in +2 a couple times on just a 1-1.5u dose.

I understand your vet's thinking. On 12/23 when Ozzy dropped to double digits, but you still had a bit of wiggle room. Oftentimes more insulin is needed to bring down the entire range of numbers. Feeding the curve will help keep Ozzy from bottoming out. In Ozzy's case, maybe your vet is looking for a way to get rid of those 300s?

When practicing TR, the goal is to drop kitty into normal numbers as quickly and as safely as possible... and eventually keep them there. If constantly handling low green numbers makes you uncomfortable, you may want to reconsider choosing TR. Practicing TR may not be a good fit for you. There's no one size fits all method for regulating kitties. You have to find what works for you. Just something to think about.

Good luck with whatever decision you make!

 

[Ozzy Pawzbourne]

my biggest concerns are not being able to monitor Ozzy once I start back to work on 1/3/17. I will only be able to do +2 and +4s on evening cycles and only AMPS on week day morning cycles. I can curve him on weekends and my every other Fridays off.

 

[Ozzy Pawzbourne]

Hope this helps cos Elmo wants hos little brother well

Thanks Beth! Ozzy and Figgie send kitty hugs their way to you and Elmo!

Been out Christmas shopping all day with my beautiful little niece so I have been reading everyone's replies but not able to really respond throughout the day. Thanks for all the feedback everyone.

Going to start a new thread here in a moment. Finally talked with Ozzy's vet and want to share his feedback and see your guys' thoughts.

 

[Beth 73]

Thanks Beth! Ozzy and Figgie send kitty hugs their way to you and Elmo!

Been out Christmas shopping all day with my beautiful little niece so I have been reading everyone's replies but not able to really respond throughout the day. Thanks for all the feedback everyone.

Going to start a new thread here in a moment. Finally talked with Ozzy's vet and want to share his feedback and see your guys' thoughts.

 

[Critter Mom]

I keep reading around here that you want kitty in 150-220 ranges

Recommendation for cats being treated for ketosis/DKA (human meter) so as to enable larger doses of insulin to be given in order to combat ketone production.

Mogs
.