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manxcat419 said:
And that counts for a lot! :) We do talk about numbers a lot here, but how our cats are feeling and acting is also very, very important - they're so much more than just the number on the meter. Quality of life is extremely important too (in fact really when we talk numbers, we're talking a combination of safety plus getting to a range that's going to leave our cats feeling normal and happy). It's great that she's feeling happier - it's always lovely to see when they start feeling good again. :)
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I totally agree! I've seen Morrigan's trips to the water bowl lessen down to a more normal level most days now and her peeing constantly and huge clumps, down to 2 to 3 times per day and half the size of her previous many per day. I AM caught up in those numbers though. I am waiting for my vet to call me back (hopefully tomorrow), having sent him Morrigan's SS to look over as she's not due for another fructosamine level until July 7th but, I cannot get her out of the yellows yet! Last night, I had this LOVELY surprise of having gotten an 11.7 (211) at the +12 hr. mark and wanted to throw a party! This morning after that lovely number last night, at yet again, that nasty 16.4 (295). I know that it's likely largely due to kibble (DM and m/d) at night as she will leave the canned food and keep us up all night if we just leave that down but, at best, we pick up the kibble during the day (unless we're going to be out all day) and feed her solely canned foods during the day (she doesn't eat enough calories by just canned food though). And...I truly think that at worst, if we can't get her off of the kibble totally, she needs an upped dose now???

Any thoughts would be welcomed as I'm seeing this miracle here and thinking about Morrigan's situation too. But, back to Kate and Kloever and not just looking at the numbers but the overall picture! :)
 
manxcat419 said:
And that counts for a lot! :) We do talk about numbers a lot here, but how our cats are feeling and acting is also very, very important - they're so much more than just the number on the meter. Quality of life is extremely important too (in fact really when we talk numbers, we're talking a combination of safety plus getting to a range that's going to leave our cats feeling normal and happy). It's great that she's feeling happier - it's always lovely to see when they start feeling good again. :)
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Truly....like I said...she was laying on the floor just purring...no one was petting her either! :)
 
Louellen said:
I totally agree! I've seen Morrigan's trips to the water bowl lessen down to a more normal level most days now and her peeing constantly and huge clumps, down to 2 to 3 times per day and half the size of her previous many per day. I AM caught up in those numbers though. I am waiting for my vet to call me back (hopefully tomorrow), having sent him Morrigan's SS to look over as she's not due for another fructosamine level until July 7th but, I cannot get her out of the yellows yet! Last night, I had this LOVELY surprise of having gotten an 11.7 (211) at the +12 hr. mark and wanted to throw a party! This morning after that lovely number last night, at yet again, that nasty 16.4 (295). I know that it's likely largely due to kibble (DM and m/d) at night as she will leave the canned food and keep us up all night if we just leave that down but, at best, we pick up the kibble during the day (unless we're going to be out all day) and feed her solely canned foods during the day (she doesn't eat enough calories by just canned food though). And...I truly think that at worst, if we can't get her off of the kibble totally, she needs an upped dose now???
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You're doing a great job with Morrigan, Louellen. I know you've had problems with her both with testing and with persuading her to eat the wet food. Remember, those higher numbers at her AMPS are also going to be influenced by Dawn Phenomenon - seeing numbers a little higher first thing in the morning is normal! And yes, I agree, we all get caught up with the numbers - because Morrigan won't allow that for you, you're more aware of the other signs she's showing you that she's feeling better, which is great. :) That 211 is a good preshot number - it's below the renal threshold and is definitely something to celebrate. :) I really don't feel I've got enough experience to comment on her dosing since, with Morrigan, it's almost impossible for you to get tests at mid-cycle so I can't work out how much lower she might be at that point than she is at her preshots. She might do well with a slight increase, but the concern I would have in Morrigan's case is that if she did drop low, she wouldn't allow you to test every 30 minutes while you were getting her numbers back up which in itself would make me hesitant of trying to regulate her too tightly.

Kate and Kloever said:
144 at +4.5 :)
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That's great - she's staying in some nice numbers for you so far. :) I don't doubt she's feeling good today - she's looking beautiful in blue! :cool:
 
Thank you all for following her progress and paying attention to us!!! You're ALL gems!!! I'm excited for her!! Only 1 unit!!!! I'm sure I'll have to increase...but nowhere near where I was!!! :)
 
I also suspect she will need a touch more. The real question is does it last long enough that you can shoot every 12 hours, or if it wears off soon enough that a switch to the Lantus (since you have it) would be better than trying to schedule 3 shots a day at 8 hour intervals.
 
BJM said:
I also suspect she will need a touch more. The real question is does it last long enough that you can shoot every 12 hours, or if it wears off soon enough that a switch to the Lantus (since you have it) would be better than trying to schedule 3 shots a day at 8 hour intervals.
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Right...that's why I'm hoping to present my Vet with these numbers tomorrow and he'll let me switch. I think he will...especially if I present him with my knowledge..or in reality...all of the knowledge from you all...of the Novolin and that it actually wore off. The support in this group has been AMAZING!!! I'm also sure my Vet will be very interested in knowing that such a low dose kept her within range. My hopi is that it'll be a chain reaction. My experience may change/save the lives of many cats! :)
 
They do tend to do that, yes. If the dose is too high and drops them low, then the liver "panics" and produces glycogen...often too much, which sends them higher than they started out. If you miss the low and only ever see the higher numbers, then it looks as though the cat isn't getting enough insulin rather than getting too much...and every time the dose is raised, it makes the situation worse. It's fortunate for cats who are overdosed this way that they do have that defense mechanism built in to bring them back up, but of course it can't be completely relied on which is why we try to avoid having them go too low in the first place.
 
At some point, the glycogen in the liver is exhausted and the compensation fails. If Kloever could not eat enough to compensate for the insulin demand, she would have crashed and possibly died if not gotten treatment quickly.
 
Thanks @BJM - I knew there was a reason that the glycogen response couldn't be relied on long-term but I couldn't remember exactly why!
 
200...+6.5
So...it's going up pretty quick!! 5 or so hours until shot time...hope she doesn't get really high???
I'm so glad I came here!!!
 
Summary:
AMPS - 208, 1 unit of NPH
+2.5 - 138
+4.5 - 144
+6.5 - 200 as expected, the nadir for the N is around +4. It may start climbing higher than she started, but that is OK, as we're trying to establish an optimal dose on the N for now.
 
Lantus works very differently from N. It has a gentle onset and gentle wear off. It forms small crystals under the skin when injected, then gradually dissolves to work. There is a little residue left at the time of the next shot, which we call the depot or shed.
 
Yes. However, due to the depot build up, you have to keep the same dose for 5-7 days for the first level before curving, and then 3-5 days for every dose change after that.
The curve with the N is to determine how it is working in Kloever as well as getting her on a safer dose until you switch to a better insulin for cats, or she no longer needs it (that is a possibility - time and patience will determine that.)
 
She does need some insulin, so giving N in the morning and starting Lantus in the evening would be OK. Lantus needs a pretty consistent 12 hour shooting schedule, so you could pick a time to start that you could do most of the time, such as 7 am and 7 pm, etc.
 
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Summary:
AMPS - 208, 1 unit of NPH
+2.5 - 138
+4.5 - 144
+6.5 - 200
+8.5 - 198, so about the same (any 2 numbers within 20% of each other may be considered the same). That's good - she isn't skyrocketing up.
 
I find that very encouraging. It suggests that the lower dose works and is safe for her and does not leave her in exceptionally high numbers when it wears off.
You mentioned you're at home all day. One option to consider would be giving the insulin every 8 hours (TID in vet speak). This could keep her under 200 mg/dL much of the day, allowing her pancreas to heal more and preventing glucose toxicity where the glucose is high enough to cause organ damage. If that would be too much hassle, then switching to Lantus would allow every 12 hour dosing while keeping the numbers low enough.
These are options, not mandates. Whichever works best for you is fine.
 
Based on today's data, you'd need to switch to Lantus to test and shoot every 12 hours. We generally prefer to get folks off N because of its short duration.
 
BJM said:
Summary:
AMPS - 208, 1 unit of NPH
+2.5 - 138
+4.5 - 144
+6.5 - 200 as expected, the nadir for the N is around +4. It may start climbing higher than she started, but that is OK, as we're trying to establish an optimal dose on the N for now.
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BJM, I'm learning as I watch and follow this thread too, hoping that I'll be able to help others as you do to some extent or another in time. :)
Members have said to me that I need to find Morrigan's Nadir still. I'm seeing you say here that Kloever's Nadir for N is around the +4 mark.
When I've done Morrigan's curve (according to my vet's instructions...and boy...what a day that is when I have to do those...I almost need to take up Valium or drinking! ;) )....I get these types of numbers (not meaning to hijack Kloever's thread by any means! Just trying to learn along with Kate)...I find that Morrigan has a rather "flat curve" while on Lantus and get numbers like this....

AMPS 252
+ 4 227
+6 245
+8 225
+12 246

So, in that example...does that mean that the nadir for Lantus in Morrigan is at the +8 ?
And, what ranges are we aiming to get to (besides the ultimate of being OTJ)? I was reading awhile ago on this site that the 100 to 300 range is to be aimed for but, I'm not sure, seeing that Kloever's levels are already there??? Sorry, I don't mean to make extra work but, I am so totally confused and would be useless in Kate and Kloever's situation.
 
I'm not sure Morrigan really had much of a nadir; she was pretty flat and above 200 mg/dL. If she has been at the same dose for a minimum of 3 full days on Lantus, following Tight Regulation, you would increase her 0.25 units. If you are following the Start Low, Go Slow protocol, she would need to be on that dose for a full week and a curve run, then if still above 90 mg/dL on a human glucometer, the dose could be increased 0.25 units.

Tight Reg aims for numbers between about 50 -150 mg/dL at the lowest on a human glucometer.
Start Low, Go Slow is more conservative and the glucose should go no lower than 90 mg/dL on a human glucometer.
 
Thanks BJM...that's what I thought...pretty flat curve. I see an increase needed then for Morrigan. I'm waiting for our vet to look at these numbers and get back to me (hopefully, tomorrow) as she is never below 200 mg/dl on the one unit. And, I find that the times I've been able to get +1 and +2 numbers, they've been higher than the AMPS numbers so....??? Not sure what is going on or why? Maybe, food related but, she generally doesn't eat for about 4 to 5 hours after shot as she's sleeping. Hmmm....more to learn!
 
Human diabetics are given guidelines on how to adjust their insulin doses to optimize their diabetes management. We use protocols to serve the same purpose in managing our feline's diabetes. In the case of the Tight Regulation protocol, it is actually based on research by Roomp and Rand. Rand is at the University of Queensland Centre for Companion Animal Studies.
 
BJM said:
Summary:
AMPS - 208, 1 unit of NPH
+2.5 - 138
+4.5 - 144
+6.5 - 200
+8.5 - 198
10.5 - 213
I think I'd go with 1.25 units of the N.
A note - Many cats go lower overnight.
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Sounds good!!! I could just do 1? Let me know at your leisure. You've been fabulous today! :)
 
Home glucometers are intended to provide general feedback, not lab equivalent values, and are sufficient for home monitoring per the FDA. Used with feline-specific reference numbers, they are adequate for that task. Noted international feline diabetes researcher Dr Rand of the University of Queensland provides feline specific reference numbers, which I have incorporated in my signature link Glucometer Notes.
 
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BJM, Manxcat and so many others did so much! I am learning as I go along too and your story with Kloever has helped me too! I hope to be able to have the knowledge to help others too as I go along. I'm trying to learn as well, not only to help my own kitty but, also to be able to help with other's as well. I owe a lot to the great members here and just seeing BJM having this "pick up" and do what she's done, has me in near tears of joy. What a difference! So happy to see this come out like this. :)
HUGS to everyone...and, now for some sleep. :)
 
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