Using R to give Levemir a jumpstart (pt2)

[Bronx's dad (GA)]

The typical R onset is around +2 and and nadir round +4. Neko was not a "typical" cat. She did things in her own time. First time I used R with her I tested every hours for four hours and saw no change, went to bed with her in high numbers and woke up to green. Her R onset was late compared to most. It also meant I didn't like giving R later than +1 because the big R drop could coincide with her Lev onset where she sometimes did a big drop. I preferred giving R at preshots or before. ECID. I have a math background, and used to think of laying the L and R curves on top of each other, and trying to time things to avoid combined big drops.

As for the karo question, I have rarely seen someone have to resort to it in a syringe. I did once, at Neko's parting PJ party. With acros, you can usually put a bit of it on food and the cat will inhale it. I didn't dilute it and just filled the syringe when I found she wouldn't eat it.

Do I need to feed Bronx with R like I do with Lev?

today's continuation of this thread http://www.felinediabetes.com/FDMB/threads/using-r-to-give-levemir-a-jumpstart.170628/

 

[Wendy&Neko]

You do want to make sure he has food on board when the R onsets. If you are giving R initially around preshot, you don't have to do anything different.

 

[Bronx's dad (GA)]

You do want to make sure he has food on board when the R onsets. If you are giving R initially around preshot, you don't have to do anything different.

Wendy, has anybody done a study here on how high the IGF-1 number relates to how much insulin a cat needs to regulate? Also, did you do another IGF-1 test after the SRT?

 

[Bobbie And Bubba]

Good luck with the R. We used it too last year in December to break through and it really helped .

 

[Wendy&Neko]

I don't think the IGF-1 correlates to much of anything. It is no indication of tumour size. Neko's IgF-1 was very close to Bronx's and she topped out at 8.75 units but started giving me green a little over three units. Punkin, whose IGF-1 was about half of Neko's ended up on about twice as much insulin. Grayson who also has a lower IGF-1 went over 50 units, but he also had IAA, which punkin did not.

I did not retest the IGF-1 after SRT. They told me not to bother. Julie did and punkin's went higher. SRT has more of an impact on the growth hormone than the IGF-1. Other retest results I have seen are all over the place. And the data wouldn't have changed anything I did, plus the test are more expensive in Canada.

 

[julie & punkin (ga)]

Julie did and punkin's went higher.

Yeah, and that was about as discouraging as you can imagine it being! Go to all the trouble of getting the SRT done, then the excitement of going down the dosing scale, only to retest and have the number be bigger than when you started. Way to wreck one's day!

I also think it's not just about the IGF-1, it's about other things going on in the cat's body, whether or not there is iaa in the mix.

Let's look at what his cycles are looking like on Friday and make a date for Saturday to try the R. We can look and see if there is any curve going on at that point, or any visible nadir, and figure out a time. I'm basically around, although not going to get up at 4:30am. @Dyana has said she could do it - she's also east coast - but it's her only day of the week off and since you're available later, I don't think she needs to give up her day to sleep in.

There's not really anything more you need to do to prepare, although one thing that I did that was helpful was to take a used syringe and practice drawing up 0.25u. It's a bit tricky for those of us used to doing big doses! You can use colored water (tea, coffee) to help see it. With any dose, the important thing is not that your 0.25u looks like mine, but that what you call 0.25u is a dose you can replicate again. We'll start with 0.25u and then try 0.5u another time. Markings are notoriously inconsistent in how they are printed from one syringe to the next. Some people use calipers to measure doses accurately. I never used them and just did the best I could. With larger doses slight differences are less important than in tiny doses. But if you are interested in investigating calipers, Marje did a tutorial on them. Look on the "Where Can I Find?" thread, scroll down to the second half of the first post and look under "Starting out with a diabetic cat" to Testing and Shooting Tips for the dosing with calipers link.

 

[Bronx's dad (GA)]

We'll start with 0.25u and then try 0.5u another time.

Hi Julie. I actually started today with .25R this am. Since Bronx is still so flat and high, I do not foresee any big drop and wanted to get a starting point sooner rather than later since he has not even been close to a yellow yet and I will be home all day to monitor. Got some great info from you, Jill, Marje, Wendy & all others who chimed in. I feel confident starting today with a very small amount of R, will test every hour.

 

[Jill & Alex (GA)]

Happy to see you're testing every hour.

Just a note for going forward...
*usually* we don't recommend increasing the basal dose and giving R on the same cycle. It's easier to see the affects of one change at a time. Too many variables can sometimes cloud the picture. That said, it'll be interesting to see what Bronx does with this small dose of R.

Looking forward to seeing the +3...

 

[LizzieInTexas]

Hey! Just took a peek at Bronx's SS. Nice solid pinks! Much better than the reds and blacks. Slow going but it is progress.

How is Bronx doing with the Lev? Is the sting reaction better? How is he acting? Have the rivers and lakes in the LB diminished a little?

Just wanted to say hi. Give Mr. Bronx a scratch from me.

 

[Bronx's dad (GA)]

Hey! Just took a peek at Bronx's SS. Nice solid pinks! Much better than the reds and blacks. Slow going but it is progress.

How is Bronx doing with the Lev? Is the sting reaction better? How is he acting? Have the rivers and lakes in the LB diminished a little?

Just wanted to say hi. Give Mr. Bronx a scratch from me.

Hi Lizzie, thanks for checking in on Bronx! Yes, happy to see mostly pinks and just a few reds and no blacks in a while... knock on wood! I think we are finally getting a little closer to the right dose but have a feeling that will be in the double-digits. Bronx is still eating like mad, hopefully that will slow down when we get to the yellows. Will try 0.5u R next time I am home all day to monitor, probably Friday. No sting with the Lev, he doesn't seem to mind it one bit. LB? not sure what that stands for? Gave him a scratch from you, he says purrrrr!

 

[Wendy&Neko]

LB = litter box.

 

[Bronx's dad (GA)]

LB = litter box.

Ahhh, thx. the LB is getting a little better but not by much. I should buy stock in the Precious Litter Company! Get the 40lb bag delivered via Amazon, seems like every week now, UPS guy must hate me LOL.

 

[LizzieInTexas]

I should buy stock in the Precious Litter Company! Get the 40lb bag delivered via Amazon, seems like every week now, UPS guy must hate me LOL.

That will get better too (eventually).

makin the UPS guy earn his wages!

FD - making online purchasing a success! I live and die with Amazon, Chewy and ADW - so does my bank account