Smokey 4/24 AMPS-461| +5 399| PMPS-363|+2 369
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linda and guinness
Member Since 2009
Re: Smokey 4/24 AMPS - 461| +5 399
Hi Denne',
Sorry to hear Smokey's not grooming himself. They seem to get so lazy when their numbers are so high. How's he doing on the thyroid medication? Is he tolerating it well? Hope you guys have a lower number soon.
Hi Denne',
Sorry to hear Smokey's not grooming himself. They seem to get so lazy when their numbers are so high. How's he doing on the thyroid medication? Is he tolerating it well? Hope you guys have a lower number soon.
Ella & Rusty & Stu(GA)
Member Since 2010
Re: Smokey 4/24 AMPS - 461| +5 399
Hi Denne',
I'm sorry that you are going through such a struggle. I think that once your insulin dosing is more consistent again you will begin to see progressively lower numbers. As I mentioned in my reply to your post of a couple of days ago (http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=41771), I don't recall any instructions being given by my vet to decrease insulin because of Hyper T.
What is Smokey's dose of methimazole? As in diabetes, the idea with the thyroid medicine is to start low and go slow with increasing. (My vet--who believes in one size fits all-- started Stu off on a very large dose: 5mg twice a day. I was told here on the board (by a number of alarmed people) that that dose was way too high.) In any event, I believe that it takes a while for the thyroid medication to begin to work.
Good luck, and I hope that Smokey will begin to feel better soon. Hang in there!
Ella & Rusty
Hi Denne',
I'm sorry that you are going through such a struggle. I think that once your insulin dosing is more consistent again you will begin to see progressively lower numbers. As I mentioned in my reply to your post of a couple of days ago (http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=41771), I don't recall any instructions being given by my vet to decrease insulin because of Hyper T.
What is Smokey's dose of methimazole? As in diabetes, the idea with the thyroid medicine is to start low and go slow with increasing. (My vet--who believes in one size fits all-- started Stu off on a very large dose: 5mg twice a day. I was told here on the board (by a number of alarmed people) that that dose was way too high.) In any event, I believe that it takes a while for the thyroid medication to begin to work.
Good luck, and I hope that Smokey will begin to feel better soon. Hang in there!
Ella & Rusty
Smokey
Member Since 2010
Re: Smokey 4/24 AMPS - 461| +5 399
Smokeys dose is 2.5 once a day for a month before a recheck. What we were concerned with was smokey being on 2 units and almost crashing a week ago. My vets other cats that were OTJ then were brought out of remission by hyper-t had high BG like smokey does and their BG came down.
With the tapazole which slows down everything in his body, the numbers generally and usually come down and start to even out. We did not want to chance smokey crashing again especially with my husband working 75 hours a week and me working 50 hours a week. We all would rather be too high than too low. I've spoken to others on this board who's numbers also came down when starting this medication. I do what I know and when I know better I do better...no one knew how he would respond initially.
We are now back up to 2 units ONLY due to smokers behavior (which is still bad) and I have seen no signs of improvement with almost 1 week of medication.
Denne'
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Smokeys dose is 2.5 once a day for a month before a recheck. What we were concerned with was smokey being on 2 units and almost crashing a week ago. My vets other cats that were OTJ then were brought out of remission by hyper-t had high BG like smokey does and their BG came down.
With the tapazole which slows down everything in his body, the numbers generally and usually come down and start to even out. We did not want to chance smokey crashing again especially with my husband working 75 hours a week and me working 50 hours a week. We all would rather be too high than too low. I've spoken to others on this board who's numbers also came down when starting this medication. I do what I know and when I know better I do better...no one knew how he would respond initially.
We are now back up to 2 units ONLY due to smokers behavior (which is still bad) and I have seen no signs of improvement with almost 1 week of medication.
Denne'
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Laurie and Mr Tinkles
Member Since 2010
Re: Smokey 4/24 AMPS - 461| +5 399
Denee', about a week ago, Smokey had a low PMPS, and you skipped the shot. It was suggested then that you reduce the dose from 2.0u to 1.75u, because the low preshot was an indication that the dose was too high. You shot a 43 last night, which was also too low to shoot, so, again, the dose should have been reduced to 1.75u.
Lantus likes consistency...it's nothing like Vetsulin, you will need to change your whole mindset. I know it's hard to do, we started with ProZinc and I had to "unlearn" what I knew in order to learn how to use Lantus.
The protocol we use here calls for increases of 0.25u in most cases....when you increased by a full unit all at once, you most likely missed his good dose. Please read the protocol and the other stickies at the top of the forum...there is a lot of good info there that will help you understand how to use Lantus.
I'm glad to see you say that you are concerned about him going too low when you are not there....I am too. The 2.0u dose is too high for him, and you are putting him at risk of exactly that....going too low when you are not there. The 43 last night was telling you that....please listen for Smokey's sake.
We want to help you, how can we do that? Please ask questions if something we say does not make sense, or the material we link is not clear.
Denee', about a week ago, Smokey had a low PMPS, and you skipped the shot. It was suggested then that you reduce the dose from 2.0u to 1.75u, because the low preshot was an indication that the dose was too high. You shot a 43 last night, which was also too low to shoot, so, again, the dose should have been reduced to 1.75u.
Lantus likes consistency...it's nothing like Vetsulin, you will need to change your whole mindset. I know it's hard to do, we started with ProZinc and I had to "unlearn" what I knew in order to learn how to use Lantus.
The protocol we use here calls for increases of 0.25u in most cases....when you increased by a full unit all at once, you most likely missed his good dose. Please read the protocol and the other stickies at the top of the forum...there is a lot of good info there that will help you understand how to use Lantus.
I'm glad to see you say that you are concerned about him going too low when you are not there....I am too. The 2.0u dose is too high for him, and you are putting him at risk of exactly that....going too low when you are not there. The 43 last night was telling you that....please listen for Smokey's sake.
We want to help you, how can we do that? Please ask questions if something we say does not make sense, or the material we link is not clear.
Smokey
Member Since 2010
Re: Smokey 4/24 AMPS - 461| +5 399
Laurie,
I understand the protocol and have read it several times however, with that said I feel that the BG is just 1 part of this process and that I need to take smokeys behavior into consideration and look at the whole situation.
I too want smokey on the lowest dose possible but according to how i understand it, when I get these high numbers consistently, I should increase..? My vet has also told me two different times to decrease the dose as he wants his pre shots between 300-350 (as this should be his highest of the day...I know, I know) and then when smokey continues to drink and drink a whole bowl every 12 hours, and his numbers are purple and yellow, we raise it back up. I know this is not exactly as the protocol states and I struggle with that every day. But, when I decrease and see worse behavior (than before) and high numbers, it makes me feel like i should increase again! @-)
Furthermore, when I read the renal value is 216 and I am always higher than that, it worries me that I'm damaging organs. It also worries me that smokey doesn't seem to have a nadir and that his highest readings come at +6...that alone throws me off. On 2 units he has days when he is still so high! If i was seeing some type of improvement in behavior like others do, it would at least give me hope! This is so challenging! Thanks for hanging in there with us!
Denne'
Sent from my ipad
Laurie,
I understand the protocol and have read it several times however, with that said I feel that the BG is just 1 part of this process and that I need to take smokeys behavior into consideration and look at the whole situation.
I too want smokey on the lowest dose possible but according to how i understand it, when I get these high numbers consistently, I should increase..? My vet has also told me two different times to decrease the dose as he wants his pre shots between 300-350 (as this should be his highest of the day...I know, I know) and then when smokey continues to drink and drink a whole bowl every 12 hours, and his numbers are purple and yellow, we raise it back up. I know this is not exactly as the protocol states and I struggle with that every day. But, when I decrease and see worse behavior (than before) and high numbers, it makes me feel like i should increase again! @-)
Furthermore, when I read the renal value is 216 and I am always higher than that, it worries me that I'm damaging organs. It also worries me that smokey doesn't seem to have a nadir and that his highest readings come at +6...that alone throws me off. On 2 units he has days when he is still so high! If i was seeing some type of improvement in behavior like others do, it would at least give me hope! This is so challenging! Thanks for hanging in there with us!
Denne'
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Laurie and Mr Tinkles
Member Since 2010
Re: Smokey 4/24 AMPS-461| +5 399| PMPS-363
Lantus is not dosed by preshot number. Please shoot 1.75u, not 2.0u.
Lantus is not dosed by preshot number. Please shoot 1.75u, not 2.0u.
Caryl & Sebastian & Alex (GA)
Member Since 2009
Re: Smokey 4/24 AMPS-461| +5 399| PMPS-363
Denne,
You have to give the dose a chance to settle in. That takes more than a cycle or two. Unless you're decreasing because of a big drop in bg...just sit with it.
And, there is no reason to do anything with Smokey's dose because of 2.5 mgs of Tap once a day. It is a very small amount of Tapezole (which I agree is a good place to start...depending on his blood tests of course)...maybe it won't be the right dose for Smokey but you really won't see the effects of it for at least another week. (it's been a week now, right)? Usually closer to a month. That doesn't mean it's not working yet, it needs to build up before you will notice any results.
Constantly changing insulin doses is not a good idea with Lantus(no consistency)...you're not giving Smokey a chance to find out which dose is good for him...he could be bouncing from changing his dose so often. (and no I wouldn't have shot at 43...that was very brave ohmygod_smile )
As I had said, and I'm sure others will agree, diabetes and hyper-t is a balancing act but you need data before you can start balancing and you don't have that yet.
(I personally would be interested in knowing what Smokey's T4 reading was on his blood test.Did you ever say? After looking at his ss remarks just now I'm wondering because of the enormous amounts of water he drinks. Both of my kitties have hyper-t and drank a lot..but neither emptied out bowls on a daily basis. ECID but just sayin'.)....just me thinking out loud. Do you have the report? How much above normal was he?
It will all come together but it takes time....hyper-t and diabetes is not the easiest situation in the world to control but it is controllable. Most important is that Smokey gets correct dose of Tap...that's why I asked about his blood test as there ARE degrees of hyper-t.
Hang in there...
hugs :YMHUG:
Denne,
You have to give the dose a chance to settle in. That takes more than a cycle or two. Unless you're decreasing because of a big drop in bg...just sit with it.
And, there is no reason to do anything with Smokey's dose because of 2.5 mgs of Tap once a day. It is a very small amount of Tapezole (which I agree is a good place to start...depending on his blood tests of course)...maybe it won't be the right dose for Smokey but you really won't see the effects of it for at least another week. (it's been a week now, right)? Usually closer to a month. That doesn't mean it's not working yet, it needs to build up before you will notice any results.
Constantly changing insulin doses is not a good idea with Lantus(no consistency)...you're not giving Smokey a chance to find out which dose is good for him...he could be bouncing from changing his dose so often. (and no I wouldn't have shot at 43...that was very brave ohmygod_smile )
As I had said, and I'm sure others will agree, diabetes and hyper-t is a balancing act but you need data before you can start balancing and you don't have that yet.
(I personally would be interested in knowing what Smokey's T4 reading was on his blood test.Did you ever say? After looking at his ss remarks just now I'm wondering because of the enormous amounts of water he drinks. Both of my kitties have hyper-t and drank a lot..but neither emptied out bowls on a daily basis. ECID but just sayin'.)....just me thinking out loud. Do you have the report? How much above normal was he?
It will all come together but it takes time....hyper-t and diabetes is not the easiest situation in the world to control but it is controllable. Most important is that Smokey gets correct dose of Tap...that's why I asked about his blood test as there ARE degrees of hyper-t.
Hang in there...
hugs :YMHUG:
Smokey
Member Since 2010
Re: Smokey 4/24 AMPS-461| +5 399| PMPS-363
Hi Caryl!
Smokey's initial T-4 was 4.3 (gray area). This was on 3/29/11 and this is when we found out the Diabetes had returned. We wanted to get the Insulin started right away and then re-test in 1 month. After 3 weeks of seeing zero change in behavior, my vet suggested I come right in for another T-4. I did and the score was 4.9 which was the confirmation. And....here we are!! Loosing our minds :?
Hi Caryl!
Smokey's initial T-4 was 4.3 (gray area). This was on 3/29/11 and this is when we found out the Diabetes had returned. We wanted to get the Insulin started right away and then re-test in 1 month. After 3 weeks of seeing zero change in behavior, my vet suggested I come right in for another T-4. I did and the score was 4.9 which was the confirmation. And....here we are!! Loosing our minds :?
Laurie and Mr Tinkles
Member Since 2010
Re: Smokey 4/24 AMPS-461| +5 399| PMPS-363
I'm sorry, I got called away with a minor emergency (leaking washer)...I wanted to post a more detailed response to you.
Denee', I understand that you want Smokey to feel better...now! Lantus requires patience and consistency to work. You are not going to see instant results....but you won't see instant results from any insulin. It takes time, and you need to use the insulin properly to get the results you want. If you want to dose based on preshots, you will need to choose a different insulin....you can use ProZinc that way, but NOT Lantus.
Lantus is dosed based on BG, not behavior. The behavior will improve when you get the BG numbers to improve. The fact that what you are doing isn't helping his behavior just proves the point.....it's not working because you are not using it properly.
You are not seeing these high numbers consistently. You are seeing some high numbers, some lower numbers, and some numbers too low to shoot. There are nadirs, and they are not all high...some of them have been in the low blue numbers, which does not indicate a need for more insulin. When you see a 43 at PS time, that indicates a need for LESS insulin, not more.
But you are increasing again based on seeing higher numbers from a bounce. You don't want to do that, because when the bounce clears, his numbers drop too low because the dose is too high....like last night with the 43.
Do you think it would be more damaging to have him in some higher numbers temporarily, or having a full blown hypoglycemic episode when you are not there? :shock: As far as when the nadir is, and the highest readings at +6, the days when he is high on 2 units....he is bouncing some of the time, and you are looking at bounce cycles. Right now, 2 units is too much for him. Let's try 1.75u and see what happens, ok? You need to try to dose consistently, post as often as you can, and ask questions. It will get better...really it will! But you need to have patience.
If you get low PS numbers, please don't shoot! Post and ask for help, ok? Our top priority is Smokey's safety, and some of us were very concerned about him last night. I'm glad he's ok...but please let us help you...we care!
I'm sorry, I got called away with a minor emergency (leaking washer)...I wanted to post a more detailed response to you.
Denee', I understand that you want Smokey to feel better...now! Lantus requires patience and consistency to work. You are not going to see instant results....but you won't see instant results from any insulin. It takes time, and you need to use the insulin properly to get the results you want. If you want to dose based on preshots, you will need to choose a different insulin....you can use ProZinc that way, but NOT Lantus.
Smokey said:
Lantus is dosed based on BG, not behavior. The behavior will improve when you get the BG numbers to improve. The fact that what you are doing isn't helping his behavior just proves the point.....it's not working because you are not using it properly.
You are not seeing these high numbers consistently. You are seeing some high numbers, some lower numbers, and some numbers too low to shoot. There are nadirs, and they are not all high...some of them have been in the low blue numbers, which does not indicate a need for more insulin. When you see a 43 at PS time, that indicates a need for LESS insulin, not more.
But you are increasing again based on seeing higher numbers from a bounce. You don't want to do that, because when the bounce clears, his numbers drop too low because the dose is too high....like last night with the 43.
Do you think it would be more damaging to have him in some higher numbers temporarily, or having a full blown hypoglycemic episode when you are not there? :shock: As far as when the nadir is, and the highest readings at +6, the days when he is high on 2 units....he is bouncing some of the time, and you are looking at bounce cycles. Right now, 2 units is too much for him. Let's try 1.75u and see what happens, ok? You need to try to dose consistently, post as often as you can, and ask questions. It will get better...really it will! But you need to have patience.
If you get low PS numbers, please don't shoot! Post and ask for help, ok? Our top priority is Smokey's safety, and some of us were very concerned about him last night. I'm glad he's ok...but please let us help you...we care!
Caryl & Sebastian & Alex (GA)
Member Since 2009
Re: Smokey 4/24 AMPS-461| +5 399| PMPS-363
Hey there!
Wow that's practically borderline is right. 4.0 is high normal. 2.5 once a day is where any good vet should start. It could be that the thirst is just caused by the high numbers in combo with the hyper-t. Is Smokey still on Prozac? Does that cause thirst I wonder?
Like I said...don't lose your mind...you want to do what's best for Smokey. If he is going to stay on Lantus you have to keep the dosing consistent to get the best results. This is the truth. Thyroid can change from hour to hour especially when it's not at all regulated. Just keep consistent with the protocol for Lantus and keep giving Smokey his Tap and you will eventually see a change. Just please test for ketones when his numbers are high...like on a day like today I would definitely be testing. He's bouncing today and will probably be down by morning but please stick with one dose and let his poor body adjust..k? Try it?
hugs
Caryl, Alex and Jackson
Smokey said:
Hey there!
Wow that's practically borderline is right. 4.0 is high normal. 2.5 once a day is where any good vet should start. It could be that the thirst is just caused by the high numbers in combo with the hyper-t. Is Smokey still on Prozac? Does that cause thirst I wonder?
Like I said...don't lose your mind...you want to do what's best for Smokey. If he is going to stay on Lantus you have to keep the dosing consistent to get the best results. This is the truth. Thyroid can change from hour to hour especially when it's not at all regulated. Just keep consistent with the protocol for Lantus and keep giving Smokey his Tap and you will eventually see a change. Just please test for ketones when his numbers are high...like on a day like today I would definitely be testing. He's bouncing today and will probably be down by morning but please stick with one dose and let his poor body adjust..k? Try it?
hugs
Caryl, Alex and Jackson
Smokey
Member Since 2010
Thank you Laurie, I gave him 1.75 tonight and will continue to ask questions when I have them. I appreciate your patience, your kind words and your big heart.
Are Nadir's the lowest number on any given cycle? Or, specifically a certain time frame after a shot is given. Maybe I'm misunderstanding what a nadir is. It seems as though he has his lowest number 4 hours post-shot at night but I can't seem to find any lower numbers during the day. Could a kitty have a nadir only at night and stay pretty even during the daytime?
Also, if Smokey has his lowest numbers pretty much at 12 hours, do I still dose on that number? Even though it is kind of reversed?
Thanks again!
Denne'
cat_pet_icon
Are Nadir's the lowest number on any given cycle? Or, specifically a certain time frame after a shot is given. Maybe I'm misunderstanding what a nadir is. It seems as though he has his lowest number 4 hours post-shot at night but I can't seem to find any lower numbers during the day. Could a kitty have a nadir only at night and stay pretty even during the daytime?
Also, if Smokey has his lowest numbers pretty much at 12 hours, do I still dose on that number? Even though it is kind of reversed?
Thanks again!
Denne'
cat_pet_icon
Libby and Lucy
Member Since 2009
I think you're thinking too hard. :lol: It's ok, it's natural, there's a lot to try to understand.
Most cats aren't going to have a nadir in every single cycle, especially when they are new. When he is bouncing, he won't have a nadir, and since bounces can last up to 72 hours, that's a lot of the time! That is the reason why we get spot checks as often as possible, trying to get at least one spot check on every cycle, so we can be sure we find those lower numbers (whenever they occur). If his lowest number is a 43, then it really doesn't matter if the 43 happened at +2 or +6 or +12, we just know that he got down to 43 and that is too low. It's normal for a low number to be followed by a bounce into higher numbers for up to 72 hours. If he is high for the next 3 days, you have to just put up with that and wait until the bounce clears to see if he goes low again. I know it can be frustrating! Don't worry too much about WHEN the nadir is, because it is really tough to figure that out at first. Right now you just have to play hide and seek and look for those lower numbers.
Once you know a particular dose can take him to 40s, even if most of the time he is higher, then you need to reduce because you don't want him going any lower than that. Does that make sense?
Most cats aren't going to have a nadir in every single cycle, especially when they are new. When he is bouncing, he won't have a nadir, and since bounces can last up to 72 hours, that's a lot of the time! That is the reason why we get spot checks as often as possible, trying to get at least one spot check on every cycle, so we can be sure we find those lower numbers (whenever they occur). If his lowest number is a 43, then it really doesn't matter if the 43 happened at +2 or +6 or +12, we just know that he got down to 43 and that is too low. It's normal for a low number to be followed by a bounce into higher numbers for up to 72 hours. If he is high for the next 3 days, you have to just put up with that and wait until the bounce clears to see if he goes low again. I know it can be frustrating! Don't worry too much about WHEN the nadir is, because it is really tough to figure that out at first. Right now you just have to play hide and seek and look for those lower numbers.
Once you know a particular dose can take him to 40s, even if most of the time he is higher, then you need to reduce because you don't want him going any lower than that. Does that make sense?
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