PLEASE-HELP FOR MAX

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MK + Max

Member Since 2013
I'm posting on behalf of my friend who is trying her darndest to help her recently dx'd sugarbaby Max. Vet prescribed Lantus, but neither of us know whether it's the tight reg or other.

Unfortunately she has a young toddler and so i have the time to post for her. Hope you understand.

but his numbers are all over the place. He's running dangerously high BGs, and am worried. Any advice? Sorry, but the google docs really not working for me at the moment. We upped the dose to 1.5 but this AM was 476 pre-shot. Any helpful advice is greatly appreciated.

Date AMPS U + 1 + 2 + 3 + 4 + 5 + 6 + 7 + 8 + 9 +10 +11 PMPS U
04/09/13 1.00 249 1.00
04/10/13 281 BG a.m. 1.00 1.00
04/11/13 270 BG a.m. 1.00 1.00
04/12/13 310 BG a.m. 1.00 1.00
04/13/13 383 BG (7:30am) 216 BG 180 357 1.50
04/14/13 325 BG 1.25 1.25
04/15/13 314 BG 1.25 318 1.50
04/16/13 336 BG 1.50 295 280 1.50
04/17/13 334 BG 1.50 498 1.50
04/18/13 316 BG 1.50 421 1.50
04/19/13 368 BG 1.00 233 267 1.00
04/20/13 300 BG 1.00 1.00
04/21/13 241 BG 0.50 217 334 1.00
04/22/13 392 BG 1.25 365 1.25
04/23/13 352 BG 1.25 243 1.25
04/24/13 535 (1.25 units) 1.25 488 315 1.25
04/25/13 395 BG 1.50 287 311 1.50
04/26/13 331 BG 1.50 225 272 1.50
04/27/13 High 1.50 405 351 1.50
04/28/13 476 BG 1.50
 
Max's food intake, fed before shot, and mid shot gets small amount of gerber chicken.
Weruva chicken or chicken and egg. Also Wellness turkey. He has that uti thing – problems with crystals in the past. Nothing since we avoided certain ph foods…
Low sodium no gluten chicken broth and freezedried turkey for treats
 
Morning and welcome to Lantus Land!

I'm assuming she is shooting about every 12 hours?

One thing I see is that she's hopping the dose around too much. Lantus likes consistency and we dose on the nadir (lowest BG in the cycle) and not the preshot. We hold doses for a certain number of cycles based on the numbers.

The other thing....and I know this has to be tough with a toddler...but it's possible that Max is going low midcycle and then bouncing way back up.

When Max was first diagnosed, his BG had probably been high for a bit. Once the insulin starts to work and the BG comes down, the liver panics at lower numbers or fast drops and it then releases counterregulatory hormones and glucagon to bring the BG back up into what the body believes is a safe number. We call this bouncing. Just about all diabetic cats on I soul in do this for some period of time. It can take up to 72 hours for a bounce to clear.

So in one cycle, Max might start at 300, be at 50 midcycle, and then be at 400 by the next PS. Without that midcycle test, one would assume he's just high and continue to raise the dose.

If you can PM me, I can get a spreadsheet set up and you all can fill in these numbers. We use the SSs to look at waves of action more than just one or two numbers or a cycle.

Hopefully we can help your friend help Max. We have a pretty good track record :-D
 
It's very generous of you to help your friend!! In this case, here's hoping that two people working at this will be doubly effective. If you or Max's mom haven't yet had a chance, please take a look at the starred sticky notes at the top of the Board. They will help you get oriented. In addition to the information on the Tight Regulation (TR) protocol, some of the members here use the Start Low Go Slow (SLGS) approach. SLGS is less aggressive with respect to dosing and doesn't have the research support that the TR protocol does. Either approach can work.

Unfortunately, this message board system loses the column formatting so it's hard to decipher the testing information you've provided. Let me see if there's someone around who can help you get the spreadsheet up and working.

My best guess is that what you're seeing is that Max is bouncing. For example, on 4/13, Max dropped to 180. Since his body has been sitting in diabetic numbers for a while, he's not used to seeing lower numbers. As a result, his liver and pancreas overreact and start pumping out a stored form of glucose (i.e., glucagon) and counterregulatory hormones. It can take roughly 72 hours for a bounce like this to clear.

Would it be possible for Max's mom to get a "before bed" test every evening? Getting at least 4 tests per day will help to sort out if, in fact, Max is bouncing. If, in addition to the pre-shot tests, Max's mom can get at least one test during both the AM and PM cycles, it will help to see if there are any points in the 12-hour cycle that Max's numbers are dropping lower.
 
Hi, Marge ~

Thank you so much for the advice.

Yes, she's shooting every 12 hrs, 8AM + 8PM.

I did d/l the .xls sheet from the forum instructions and i just emailed it to her for her record keeping. But Google docs creeps me out, and i didn't like giving permission to the drive on my system. I do a lot of financial work on my computer and absolutely can't compromise my system.

So if it's all the same to you guys, I'd prefer to keep the .xls sheet on the desktop and paste into the body of the post.

Understand wanting to look at waves. I was an FDMB member for years with my sugarbaby Timmy who passed away in late 90s. I owed those last 5.5 years to all the fantastic people on the board.

But i'm not used to the "new" board, it's dizzying for new members, and so am navigating my way through this.

Thank you sooooo much, Marge.

Best,
MK + Max
 
Re: PLEASE-HELP FOR MAX-UPLOADED PDF WITH NUMBERS

here is a PDF from the .xls sheet, which works for me, i can bypass google docs.

thank you, folks!
 

Attachments

Welcome back to FDMB then and I'm sorry Timmy crossed but glad you were able to have the extra time with him.

I understand about your concern with google docs, but we have to be able to scroll up and down and look at patterns. Is it possible to put it on your friend's computer? It would really help us help you all ....we've tried with the PDF SSs before but it isn't as effective. We want to be able to help as much as we can.

Can you tell us your names please? You are MK but how about Maxs mom? We are a very friendly bunch ....like a family here...and I really like to address members by their names. If you don't mind.
 
Thanks to Siene as well.

I've just spoken to Max's mom, and she's going to try and get mid-shot numbers to see if we can solve this riddle.

i used PZI back when i was a FDMB member and cared for my sugarbaby. I understand Lantus is supposed to be a good insulin, so far, i'm not a fan!

sawreee!

cheers,
MK + Max
 
Hi ! Welcome to LantusLand!

Take time to breathe and maybe a cup of coffee. We've got a lot of studying for you to do. I'll give the basics in a nutshell and then you need to go to the permanent posts at the top of the list (we call them Stickies) and read them.

Lantus is dosed on the lowest point in the cycle, usually about6 to 8 hours after the shot. If a cat goes low during a cycle, the liver can respond to what it sees as a dangerously low number and release gulcagon to raise BG back up. In a diabetic the liver is unused to normal numbers and "panics."

Lantus is a depot insulin and builds up a shed (reserve) in the body which releases slowly. kind of like a timed release pill. when starting out it can take a week for the shed to build up and you need to hold the dose that long. THEN start adjusting the dose, holding for 3 days before adjusting again.

Your friend needs to be more consistent w/ the dose, hold it when she does increase and most importantly start getting some mid-cycle checks.

the difference between tight regulation or not is how aggressively we control and adjust the insulin. With TR we tend to give a higher dose of insulin, but that requires more monitoring and more adjustments. It also, we feel here, give a better chance of remission. The vet is probably not used to these terms. Just how much info was your friend given? Also what meter is she using? If it is a pet meter they tend to read higher and are really expensive for both the meter and the strips. Most of us use human meters and make the adjustment. We have lots of ways to save money and keep Max safe.

Whether you go w/ TR or not you are very welcome to post here for advice. This is the most active board and there is nearly always someone here to respond.
 
When you attach a PDF it has to be downloaded to the viewers computer. That means a new file is added to all our computers every time you update. Perhaps you could save it as a jpeg. Do you have an online photo sharing site? A link to the jpeg there would be easiest.

Also we use a consistent color coding, the blacks there scared me (for us that is over 500!), but then I saw it didn't follow our format:
  • green 99 or less
    blue 100 to 199
    yellow 200 to 299
    pink 300 to 399
    red 400 to 499
    black 500 and up
 
Hi, Siene - that's not a spreadsheet, it's a PDF. Did you right click, or try to open from Excel? Simply right click on the file once you d/l.

You can d/l a PDF reader for free, most operating systems come equipped with one, at http://get.adobe.com/reader/

Hi, Ann! Welcome to LantusLand, the place you never wanted to be, eh? ;-O And the Sugarbaby Club, the club you never wanted to join.

Max's mom's name is Mary. Mine is Mary Kay, I used to be known as Mary Kay and Timmy, who was the most amazing spirit ever. I still miss him to this day, and I have 5 jazz kats! (I do rescue work, and sometimes they end up with me).

I will do my best to keep up with this, but most important is that Mary be able to focus on some of this info.

Lantus being a depot insulin is different from PZI, and I need to get used to that feature as well.

You guys rock, thanks so much!
 
Hi, Ann ~

I'll d/l from fdmb again, but i was using the file from the site.

Oh, and i'm a graphic artist, so of course can make a jpeg. does this work? (attached)

hope to get this right soon!

cheers,
MK
 

Attachments

  • max numbers.jpg
    max numbers.jpg
    150.2 KB · Views: 652
weirdness about the PDF. it was created on a Mac, in Photoshop. shouldn't be a problem. i put up a jpeg, may be better.
 
Sienne, I'm a MacHead too. I have mine set to open PDFs in Preview and it opened w/ no problem. Preview opens faster for me, if I need to use full Acrobat, I reset the individual file.
 
Ditto on the Mac. No problem opening even from my iPad.

I still don't think that is going to work as well. We can try but remember that we are helping lots of members. Quite often, we will just take a look at a SS from the google link and see something that we need to make suggestions about. We won't be able to do that here because we will have to rely on you constantly updating and attaching a new jpeg. With the google docs SS, it is set up to automatically update as you post numbers. So we can look at it at anytime and it's "real time".
 
But Google docs creeps me out, and i didn't like giving permission to the drive on my system.
Click to expand...

Actually, Google docs is all in the cloud, not on your computer at all. It is stored on their server and you access it only through the internet. I don't know of any reverse access that is possible.

See if Mary will let you get it set up from her computer (she needs to join Google), then she can give you permission to edit and "anyone w/ the link" to read. That way the link never changes and it can be put in your signature so it is always available and we don't need to search for the last time you posted it.
 
hi - welcome to Lantus Land !

I also work for a financial institution - you would not believe how strict our rules are - I can't even save to a USB or the internal DVD drive due to data security restrictions.
However, google.docs is fine - we use it a lot, including integration with some of our other cloud-based systems. I think you'll be fine but you could double check with your Security and Compliance teams.
 
thanks, everyone. all helpful.

will have to work out the google docs situation. I know about cloud computing, but your machine has to "talk" to the cloud and for that you need to establish a hiway for the traffic. And that means opening a port on your system through which info can travel, and it can be both ways.

Sorry, i studied internet security with Homeland Security. We regularly hacked into other systems just to know how it's done. So I'm more sensitive to the issue than most people. If it were not for the kind of information i save onto my system, wouldn't be a problem, but in my case it is. The cloud is simply where the docs are stored.

I'll talk to Mary. She's keeping the BG readings anyway, so it's best she learns to upload.

I appreciate all the help and input. Like I wrote, this board saved me and my sugarbaby Timmy. I don't know why I wrote he crossed in the 90s, it was 2006. Ach, my brain!

cheers,

MK + Max
 
Re: PLEASE-HELP FOR MAX - ONE MORE THING, SAWREe

just want to add to my post, so i don't scare anyone, that I studied internet security after 9/11 with a Homeland Security official, but we only hacked within the classroom. I've never done anything of the sort outside of class, and in fact, because I'm an "art" head, I don't retain coding. I studied php and other languages and still can't code. my brain doesn't retain it. So since no one here knows me, just want to assure you.

Thanks again,

MK + Max
 
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