Trouble getting out of pinks and reds

Link to introduction thread:
http://www.felinediabetes.com/FDMB/threads/jack-joins-the-group.156834/

Thanks to the great group here I am learning more then I ever wanted to about FD, but I am very grateful that this group exists as it has allowed me to work with the vet and and not just accept their advice but to also question certain aspects of their recommendations.

Quick recap: Jack was diagnosed Apr 5th and started on 1U in the AM once a day of Pro Zinc. This has been increased and today was the first day of 3U twice a day. He only eats wet low carb food now and even at this dose his numbers just aren't dropping much. He is a big cat so probably needs more insulin, I read that 5U is getting to be a lot, is that 5U total in a day or 5U at each shot?

I've been increasing his dose a little faster then the sticky, but given his numbers felt comfortable and look forward to being able to fine tune his dosing once he gets out of the pinks and reds. I've been filling out the spreadsheet and both of us are getting better at home testing using the Relion Micro meter.

Any insight or comments on his spreadsheet / labs would be appreciated. I think I need to keep on the same track I am currently on but it has been quite a rollercoaster over the last few weeks and any advice is welcomed.

 

Welcome to Jack and his bean (can we get your name too?). Okay, the first thing I have to say is...I LOVE THAT PICTURE! Jack goes boating with you? How cool!!!

Yep, once daily insulin doesn't cut it with Prozinc. We start to think about high dose conditions at 5 units per shot. So I wouldn't worry about it too much just yet.

I see you notated the Alphatrak in your SS a few times. Are you using it exclusively or are you using a human meter other times?

Honestly, I'm not sure here. The numbers on 4/8..are they from the vet's office or home? Vet stress raises the glucose which is why I ask. It's hard to tell you what to do here since you don't have much data from other doses and it looks like you increased fairly fast...and eventually switched to twice a day dosing.

I know you said you're doing the testing slowly, but is there any chance of a curve soon? I feel like maybe that data would help. If we could see that he's surfing along all day, which is what it looks like, that might help.

I'll say this. It looks like 2 and 2.5 don't do much for those pinks. I'd be interested to see what that 3 dose brings you to for tonight. If you're still in pinks and reds tomorrow, maybe up the dose to 3.5? Could you monitor tomorrow if you did?

 

Hi handsome Jack and his bean. My cat's been diabetic since August and it truly takes awhile to for their bodies to get used to the exogenous insulin - so it takes some patience. You're off to a great start. How much are you feeding him and how are you feeding (2 meals a day vs more frequent smaller meals)? Also, you should get some urine ketone strips (at any drug store) and check his urine for ketones. Is he healthy otherwise (teeth and everything else ok?).

 

Jack had two curves done at the vet's office(4/8 and 4/18), those were done with the Alphatrak and commented in the spreadsheet, I'll try to make that a little clearer on the SS. At home we are using the Relion Micro meter. Now that he is getting into the home testing routine I can definitely get some more consistent tests posted in the SS. I work from home a decent amount so kitty will get an at home curve this week to see how his numbers look without the vet stress.

Right now I am torn between high numbers and waiting the recommended amount of cycles before upping his dose. I will start testing more to get some good data to base the next move on.

Thanks for the comments.

Wes (humble feeder and scritch giver for Jack)

 

He has always been "food motivated" so he is used to 2 meals a day, no free-feeding. Before Dx he got 50/50 dry and wet, since Dx he is on low carb wet only and is eating better in the last week or so. When he left food in the bowl my alarms went off, he usually licks the plate clean and then licks it again to be sure . He lost 2 lbs this month so he has gotten a few inbetween meals to try to get some extra calories in him. Right now he gets 3/4 can twice a day, roughly 300kcals which is what he was getting pre-dx.

Vet said his teeth looked very good, and other then the FD he is healthy. I did pick up some ketone strips when I got the meter, the next challenge is getting him to not be so modest in the litter box with me hovering behind him. He did test negative for ketones on 4/5 when he had labwork done.

I am trying to be patient but it can be tough seeing such high numbers, but his behavior has improved even if his numbers are still high. He is drinking a little less and eating a little more and being a little more himself, all of which point to him at least starting to feel better.

Thanks for the advice, it is a big learning curve, but with my growing knowledge and the great group here Jack is in good hands.

Wes

 

Just looked at your spreadsheet and happened to look at the labs. There appears to be some liver issues going on, possibly from fat breakdown for calories. The Ast, Alt, and triglyceride are elevated. Is he at all jaundiced/yellowish in the skin or whites of the eyes?
There are some supportive measures for the liver such as milk thistle (ex Marin, Denmarin) which help it work. Maybe discuss that with the vet?
Also, the neutrophils are elevated. Is he being treated for any kind of infection or allergy?

 

I would give the new dose twice daily a few cycles before increasing. It may prove to be too much insulin if you went from 2 units once daily to a total of 4.5 when dosed twice. We usually suggesting halving the dose when you go from once to twice daily - so 2 units once daily becomes one unit twice daily.

I'd watch carefully 5-7 hours after the shot to be sure he doesn't drop low midcycle. When you have some more data, we can help with maybe modifying the dose. Hard to tell yet - sometimes too much insulin looks the same as too little.

 

BJM,
Thanks for looking over his SS and labs. I agree that those ALT and AST's are a concern. They were taken before he started insulin, so hopefully they will drop in time as his condition improves and reduces pressure on the liver. Thank you for the tip on milk thistle(adding to the research list). The labs were when he first went into the vet, he did have a low grade UTI which was treated with a 10 day course of antibiotics(zeniquin 25mg). The vet mentioned the sugar he is dumping probably contributed to the UTI. From what I am reading I need to have another lab done to make sure the meds cleared up the UTI. He does not show any signs of jaundice, I think the levels might be partly due to his weight loss(2lb in under a month), he has since stabilized since getting on insulin so hopefully the liver was not damaged severely. The vet mentioned a fructosamine test in 6ish weeks, will be a good time to discuss another liver and urine test.

Sue & Oliver, thank you for the insight. Yes, I agree it was a pretty big jump. I kind of went middle of the road between recommendations here and the vets recommendation. She had recommended a single big jump to 3U twice a day which I was concerned with. I definitely agree with holding at 3U twice a day for the 6 cycles too see how his body adjusts. He is a big cat and his lowest ever recorded number was 294 so I was not too concerned about dipping too low(please correct me if I'm wrong, still learning about all the weird things cat's bodies can do).

I am doing an at home curve today to try to get a full day's worth of data to help better see what his numbers do over the course of a full day. Anecdotally he seems to be surfing through the day, dipping less then 100 pts, just always at a higher number then I would think is good.

Hopefully the curve will provide some useful data.

As always, thank you for the comments and opinions, there is a lot to absorb and I am doing my best to make sure Jack gets the best care I can provide.

 

I got some good data yesterday, went ahead and did an hourly curve to better see when the nadir was and how he responded overall to the insulin. Unfortunately his numbers are stubbornly high, but consistent. He is continuing to lose weight even with eating as much as I can stuff in him.

I have him on an ultra low carb diet, the more I read I wonder if getting something in the 5% carb range might be good to try, his food now is only about 1.2%.

I've noticed some slight neuropathy in the back legs(didn't realize what it was at first) and will be getting some B12(zobaline) in addition to some milk thistle for his high AST numbers. Any recommendations on a good milk thistle brand is appreciated. I found the zobaline on ilifelink.com, not sure if that is the best place and if I should order the milk thistle from them as well. Reading about the extract, different brands vary in potency/consistency.

Any advice on dosing would be appreciated, I am worried sick about my little love and getting him stabilized is my number one priority. I am considering going to 3.5U, but would appreciate any insight from some more experienced members as I am still new to this.

Jack and his bean say Thanks!

 

Yes, he is pretty high. I still wonder if he is getting too much insulin, but couldn't argue with a increase. Maybe 3.25 or 3.5 on a daytime cycle you can monitor.

Have you read about high dose conditions? Do any of the symptoms sound familiar?

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

 

It doesn't seem like it to me. He is losing weight, 2lb in 3 weeks, his face looks thinner not fatter, even with feeding him as much as he will eat. No circling, the changes in behavior are mostly sleeping in out of the way places, he normally sleeps near me, in the middle of a room or on "his" couch. This was one of the initial signs along with polyuria/polydipsia that led to the vet visit and diagnosis. He still likes to sun bathe on the porch so no avoidance of bright light, no sign of pain that i can see. He is lethergic, I chalked that up to the diabetes affecting metabolism. He normally is frisky and pesters the other cat in the house, he hasn't showed the slightest interest in chasing the other cat recently.

I'm not sure of the relationship between cat size / insulin repsonse, but he typically hovered around 17.5lb, any less and he cried, any more and I couldn't see hips... So we compromised and decided that was an acceptable weight for him.

Seeing a few tests igf-1, IIA, cushings, etc that I can look into and possibly have done at the next vet visit.

Very appreciative of the quick response!

 

Hmmm...it's just hard to be sure. As Sue said, too much insulin can often look like too little. I just don't know. I guess increase and see what happens. But be sure to monitor!

Are you checking for ketones? With those high numbers, it's important to keep an eye on that.

 

I gave it another day since I would not be around to test during the day. Today I increased his dose to 3.5U in the AM after a 426 preshot. I am testing every 3 hours today.

I have been trying to read up on the "too much looks like too little" and the best I can find mentions the bounce or rebound when BG drops low and the cat's body responds by releasing glucose. Please let me know if I am not understanding that correctly.

I have ketone strips but have been very unsuccessful at catching him in the box. With multiple cats I need to make sure I test the right cat. Today I am getting a separate box with some aquarium gravel and will segregate the cats to make sure Jack is the only one with access to the new ketone kitty litter box. He was negative on the urinalysis, but that has been almost a month.

Thank you for the help, I am learning and appreciate the support and guidance of the group. The wealth of experience here helps in not feeling so alone in trying to get kitties FD under control.

 

We don't have too much info on too much vs too little. It used to be, with the original PZI, which was a different insulin than ProZinc in a couple aspects, that too high of a dose would eventually cause a big drop - often unexpected and near hypo levels. But the present ProZinc doesn't seem to do that - or at least I haven't seen it. What I have seen is sometimes lowering a dose that has been raised too fast and by too much results in better numbers. But that makes us nervous to suggest - if he needs more insulin, lowering is the wrong thing to do and should be done with careful monitoring, for just a few cycles and watching for ketones and good appetite. @Sven is the only one in the past few years I remember who saw a dramatic improvement when he reduced, but I can't find him or his spreadsheet to give you. (He hasn't posted in a couple years and may no longer be registered. Can anyone else think of a more recent example?)

Usually when we see a cat who has systemically and carefully been raised from one unit to 5 over several months, and has seen little movement, we suggest looking at high dose conditions and/or changing insulin. Jack doesn't exactly fit that description.

 

Have a read of this and see if anything jumps out at you:
Acromegaly and Other High Dose Conditions: What We Know

 

I appreciate the explanation on the too much can look like too little. I'm leaning towards that not being the case with the anecdotal evidence so far. Things i have noticed in the past 1-2 weeks: His weight seems to be stabilizing, he is still drinking more then usual, but it has decreased. He does not wait for me in the tub to turn on the faucet for him. He is staying out in the open more and is more active, basically being a little more himself then he was a few weeks ago. So, while his numbers are not improving too much, his attitude and behavior are showing signs of heading in the right direction.

I don't see many obvious signs of acro yet, other then not responding well to the insulin. If the dose gets up to 5-6U it would probably be time to get some testing for igf and iaa.

I have figured out a good way to test for ketones, all have been negative so far which is encouraging. I also ordered some milk thistle and zobaline to help the back legs and liver with a little luck.

For now, I feel comfortable slowly raising the dose .5U every 3-5 days, if I don't see much improvement once hitting 5-6U per dose it may be time to run some tests for acro? He hasn't been on pro zinc too long so it seems a bit premature to think about switching to Lantus, but I am open to suggestions. How does that sound?

His chart shows he IS responding to the insulin, it just does not drop his BG very much, it looks like a pretty shallow curve compared to some of the sheets I have been looking at.

I'm still reading and learning and then reading a bunch more. The group and posts here have really increased my knowledge and I am slowly gaining confidence in how to treat Jack safely.

 

I think that's a good plan. Keeping it a slow, steady, monitored raising of the dose over time is the safest way to do it. As Sue said, we can look at other options when you hit those 5 or 6 units. It's still a new thing for you, so I don't think it's time to worry about acro yet. It could be that Jack just needs some time to get settled on the insulin!

 

Well, unfortunately, kitty is looking like one of those stubborn ones that just doesn't want to respond to the insulin. We are up to 6U twice a day and I'm yet to see even a single yellow on the sheet. He tends to drop around 100pts at most which just isn't enough given his AMPS and PMPS. I am really not sure what to do at this point and it has really taken the wind out of my sails. The vet seeing him is nice and has come around to home testing and seems willing to learn, however I fear we are getting out of her experience range with FD.

Jack is still sleeping in unusual places, his appetite has definitely grown(he cries for food rather persistently near food time), neuropathy in the back legs is more noticeable even giving zobaline at dinner meal. It kills me to see him not being himself and starting a slow decline.

It's only been a little over a month and a half on the insulin so I am hopeful that like some other cats he will have that breakthrough and start responding to insulin, but the wait is surely frustrating.

At this point I don't know if I should keep stepping up his dose either in .5 or 1 U increments or stop the increase. I think I read that prozinc was preferred over the depot insulin for high dose kitties, but I've read so much on the boards it sometime all just runs together.

Any thoughts or ideas would be appreciated and thank you, thank you, thank you for taking the time to help Jack and his bean. This would be 100 times harder without the group here.

 

I see no movement, which is discouraging. And you looked at the high dose conditions and don't think he has any of the symptoms, right?

I think I'd change insulin. It could be that another insulin would work better. With kitties on high doses, we usually suggest Levemir because it is supposed to sting less at high doses. If you switch, be sure to get advice from the people in the Lantus/Levemir forums on a starting dose.

 

Thanks Sue, I agree it has been a bit discouraging, but the journey will go on until we get Jack feeling better!

I've read over the acro link a few times and except for not responding to insulin, he does not meet most of the questions. no breathing or eyesight issues, still likes to lay on the porch in the sun. Cat has lost weight, but has stabilized and is gaining a bit back due to heavier feeding. He has not been retested since april but he did have a minor UTI show up which was treated with antibiotics, but not restested to make sure it cleared. He also has not been tested for IGF1 or IAA.

I have an appt with vet next week since I have already gone through almost a vial of prozinc, she was open to switching insulin so it sounds like trying Levamir would be a good idea at this point. I'll start reading up more on the depot insulin's and protocols now that it sounds like that is the next best step.

I really appreciate the help you provide on the forums here!

 

Hi Wes and Jack. My cat, Colin, was Dx with Acro, in January. The only physical sign he has is that I think his chin is somewhat enlarged. If you would like to look at his SS, Colin was on ProZinc until Sept 2015 when we started Levemir. He is up to 15.5u BID and is doing well. Hopefully Jack just needs a change in insulin. Let me know if you'd like me to tag a couple of the Levemir advice givers that have experience with high dose kitties. They can explain things better than I can.

 

Thanks Sharon, that would be great to know a few other high dose kitties in the lantus group to read up on. The lantus group is very active and a bit different from the pzi group with how they post and the etiquette, I'm already finding it akin to drinking from a firehose. Looking through Colin's spreadsheet now and trying to see how the change might affect the little guy. Looks like Colin's numbers got better on the levemir. My little guy looked very similiar to Colin in 9/15. BTW, good numbers the last few days.

2 questions: Would getting an IGF-1 and IAA test help? It would help confirm being a high dose kitty, but it kind of seems like he is going to be high dose and not sure if the tests would change much. I fear my vet won't know much about high dose situations and want to come prepared!

I will be making a new post for dosing guidance in the levemir group, but for now I am not seeing anything about how a U-100 insulin differs from a U-40 regarding dosing amount (I know it is a concentration difference and would have thought it would be a lower U-100 dose compared to prozinc's U-40 concentration.)

In the words of Ralph Wiggum from the Simpsons "I'm learneding" and my personal favorite, "my cat's breath smells like cat food"

 

Yes the L&L forum is a bit crowded. Your post can easily get lost, so if you don't get answers, bump yourself up. I'll tag @Wendy&Neko And @julie & punkin (ga)
They have a lot of experience with lev and high dose cats and can explain things much better than I can.

 

I'm guessing they did not get my tags. I'll try again
@Wendy&Neko

@julie & punkin (ga)

 

Hey Wes, just a thought.....what kind of food are your feeding Jack? Let's just check to see if you could be feeding too high in carbs contributing to him staying high.

 

Thanks for the thought Bobbie And Bubba, hope the full moon party was good! Have been dipping my toe in the L&L group prepping for the Levemir transition.

I've been feeding Dave's pet food (can only), 1.2% carb in the 2 flavors he gets, he had a few days recently on 3.5% due to no store in the area having the right flavors. He was on Natural Balance prior to Dx and had a mix of dry and wet. Once diagnosed, the dry food was completely removed from the diet. He used to love to chase kibble around the kitchen with meals, but we had to give that up since kibble is now a no-no. Treats after testing are either a little bit of his normal wet or a fingernail piece size of turkey/chicken.

I accidentally gave him some old wet food(other cat likes it) which was over 10% and his numbers shot up over 500 the next day(5/9 noted on SS).

I can assume from the accident on 5/9 that the lower carb does help, I did not notice a significant difference between the 1 and 3% wet, have read where some cats have lower numbers on slightly higher carb food.

Thanks for taking a look!

 

I'll be making my way over to the L&L forum in several weeks, so I will also be watching for the advice you get
Never heard of Dave's pet food - where do you find it?

 

I found a local store from their website davespetfood.com. I liked the ingredients and they listed carbs on their website. Price is very reasonable as well, I pay about $1.20/ 5 oz can.

 

thanks I will check it out

 

Hello Wes and super sweet Jack. I'm responding to Sharon's tag. My Neko has both acromegaly and IAA. She had no visible symptoms at first, other than super hungry all the time and eating inappropriate foods (muffins, banana bread). Later on I learned that the tearing from one eye (which was a new thing), was also a symptom from the soft tissue grown blocking her eye ducts. And she still loved and loves her sunshine - but at one point she used to blink when she saw the bright light. That was it for symptoms, pretty subtle ones. The early signs can be hard to spot. Now many years later, Neko is showing more signs - arthritis, pot belly (enlarged liver), breathing a little noisier. She's had radiation therapy (SRT) on the benign pituitary that causes acromegaly, and it really slows down the progression of symptoms.

Recent studies have shown that one in four diabetic cats has acromegaly. And the most recent large study at the Royal Veterinary College showed they had doses from 1 unit twice a day to 35 units, although some need more. We call it a "high dose" condition, but it's not necesary for them to have a high dose. However, we suggest that cats with higher doses (we use 6 plus over on the Lantus/Lev forum) be tested for acromegaly (IGF-1 test) and IAA. We see the odd case of cats over 5 units that don't have either - often dry food is a culprit. And we've also seen cats with much lower doses test positive on the IGF-1 test. That same RVC study showed that only around 1/3 of cats had signs that "looked" like acromegaly.

If you do decide to think about changing insulins, I would do what Sharon did and switch to Levemir instead of Lantus. Some kitties find the acid base of Lantus stings at higher doses. Most of the kitties with high dose conditions do hang out on the Lantus/Levemir forums now. Feel free to stop by and ask questions. This post on acromegaly is one that is kept up to date. Most of the posts on the High Dose Forum are older now.

 

Hi Wes! I've been gone and just now getting your tag as well. There are actually a lot of high dose kitties around - mostly on the Lantus/Lev group. Punkin had acromegaly only, his iaa was negative. Jack's ss does look like he's likely got one of the high dose conditions.

The testing is valuable because the strategies for dealing with them are different. The most common is acromegaly, as Wendy said. While vets seem to think that it is rare and iaa is rarer, we actually see quite a few kitties with either or both conditions. I think the testing is worth doing - if Jack has iaa only, it is a self-limiting condition that typically runs its course in a year or less. Acromegaly doesn't go away without treatment, although the benign tumor that causes acro is called "pulsative" meaning that it can put out more or less of the growth hormones that prevent the cat's insulin from getting into the cells. Knowing which helps you target your strategy to be most effective for your own cat. And some cats, like Neko, have both.

The third high dose condition is Cushing's. It often is diagnosed because the cat's skin becomes fragile and tears, sometimes even from the cat licking it. We have one current kitty with Cushing's but I don't think he's got the fragile skin at this point.

I also want to add some encouragement. The initial diagnosis of diabetes overwhelms most people. Having your kitty not respond to the insulin like other cats do can become really discouraging. The good news is that you are not alone. Many other people have been in your shoes as well, and we get it. We can help you navigate through the next steps to help Jack. The link Wendy gave you has the info on how to get the testing done for the IGF-1 (acro) and the iaa (insulin autoantibodies). I'd start there and I'd also make the switch to Levemir at whatever point you are out of ProZinc. The longer lasting insulins are definitely helpful for high dose cats - and if a cat has iaa sometimes we see switching to Levemir can make a huge difference in blood sugar control. Not in every cat, but it happens often enough that it's noticeable.

Don't sweat about how busy the Lantus/Lev group is. Those of us who are "regulars" there watch for new people and try to make sure they don't get lost. We do have some strategies in place just to manage the volume of posters - probably the biggest difference from the rest of the FDMB is that we ask everyone to start one new thread every day for their cat, then update the thread title to ask questions or add information throughout the day. It's helps keep information current and helps people not get missed.

So ask questions - I had a zillion and I'm sure you do too. If you are curious, I've got a link in my signature block to Punkin's SRT, which was his treatment for the acromegaly. I tried to be good about documenting it so that it might help others later on. Lots of info there. Wendy & I typically post on the Lantus/Levemir support group, so if you are posting here and have questions, tag us.

Hang in there!!! One step at a time and you'll find your way through this new world you are in with your sweet Jack!

 

Wendy & Niko, Julie & Punkin, thank you so much for the information.

Sorry for the late response, had a bit of a scare and ended up at the vet this am. Jack was throwing up and barely eating yesterday and was very lethargic. He was drinking and tested negative for Ketones, but still got him into the vet first thing this AM. Sadly, the vet had not heard of IAA or IGF-1 tests, I left her with the printout's from the lab to look into and will be getting those done once she has a chance to look at them. She also was not familiar with Levemir, she recommended lantus, but I left her with more homework due to the recommendations here about levemir vs. lantus and should have a script on Thursday.

She was very receptive and appreciated the info I brought. The vet tech loved the spreadsheet. Jack got some sub-q fluids and appetite stimulant (cerenza, mirtazapine, b12complex, fomodamine), also a cbc and urine sample to check on liver(he had high #'s last time) and to check if UTI cleared up. I also talked them into getting a bag of sub-q fluids in case we have a similar issue, figured for the low cost it would be good to have in the toolkit.

Right now it looks like Thursday I will hear back on bloodwork and levemir script to get him switched. He is currently on 6U of prozinc twice daily. From what I am reading, I'll want to get U-100 syringes to match the levemir concentration. From there it seems like most who switch keep the same dose, so will probably start at 6U of levemir, but will confirm before doing so.

I was a little overwhelmed the first visit, but the knowledge here let me understand things quickly and not get too discouraged. Of course it would be great if he could be a *normal* diabetic and take .5 or 1U a day (so jealous of some of those SS's), but it is what it is and as others have said, he needs as much insulin as he needs.

Thank you so much for everyone's input, if I only followed the vet's advice we would be in a much worse situation so I can feel good knowing I am giving him great treatment and we are definitely huffing and puffing away on the marathon.

THANK YOU AGAIN EVERYONE FOR TAKING TIME TO HELP ME AND ESPECIALLY JACK, HE'LL SEND SOME PURR'S!

 

Glad Jacks ok and that your vet is open to learning! Levemir is expensive in the US. Many here order theirs from Canada https://rxcanada4less.com We usually use the pens instead of the vials but still draw the insulin into syringes instead of using the pen needles. When I started, I bought a single pen from the pharmacy to see how Colin reacted. Not all pharmacies will sell a single pen, so call around if you think you want to do that. Hopefully all Jack needs is a change in insulin to be back to old self. Thank him for the purrs and give him some chin scritches from me!

 

Sharon, there was definitely a little sticker shock on the levemir, especially factoring in a high dose kitty. Julie's SRT thread made a great point about ongoing costs with the meds. I will most likely need to buy my first dose in the US, I didn't know about getting a single pen, that would be ideal since it would not only give Jack a chance to "try it out" (like he has a choice ) but also to give some time for shipping from CA. I've seen Mark's marine mentioned as well as another common source for levemir.

He gave me a little scare but needed the vet visit anyways so not a big deal, I'm starting to think my salt water fish tanks are cheap after this ordeal! I'm not thrilled with the vet's knowledge, but had to suppress a chuckle when she called the FDMB "my specialist" and herself just the GP. As long as she is comfortable working with me and learning a bit, I am happy. I am even happier with the knowledge and support of the group here. Hope to be able to learn enough to give back a little once I can take my floaties off and swim with the more experienced folks!

scrtiches for the big boy it is... once he finishes his dinner! He needs some calories after the last 2 days(which is something I NEVER thought I would say), that's cats for ya!

 

Also ask at the pharmacy about any discount programs they have. Some have pretty good ones, but often don't mention it until you ask.

 

Thanks for the tip Sharon. I called a ton of pharmacies on Friday and all but one would not split the 5 pack box... One wanted to sell an old style flexpen that expired in a few weeks.

Of all places Walmart would sell a single pen and using my AAA card saved about $12. Now to order the 5pack from up north and save some real money.

 

I've been watching Jacks progress on Lev. He seems to like it! Here's hoping the insulin change is all that he needs!

 

Wow! Great looking numbers!

 

Thanks Sharon and Sue! He sure surprised me, my jaw was on the floor. I was hoping for a yellow, when we got into double digits I started getting worried since I did not expect that at all. Hope he continues to respond well to the new insulin. I appreciate all the help you both have given!

Here is a good pic of Jack currently:

 

That is possibly the best cat picture I've ever seen!

 

Wow, what a great start on the Levemir!! And such a cool picture of Jack! So glad the new insulin seems to have made a difference, keep up the good work Jack!

 

Thanks Sarah, yes I'm amazed at the difference with the new insulin. That pic was him sitting up for a treat, something he hasn't done in awhile so he is definitely feeling friskier as well. He is on Zobaline as well, and between that and some better BG numbers his back legs are looking a little better, fingers crossed it got caught early.

 

What a beautiful boy!

 

You guys had a busy day today! Hope Jack is doing good tonight and you can get some rest

 

Thanks Sarah, yes it was a whirlwind, getting text updates on bg#'s while discussing fun computer stuff. I feel a bit guilty, I swear I set my alarm to test and crashed pretty hard after the last few days of heavy testing and fretting as Jack gets used to his new juice.

Look at Cooter go, hope the OTJ trial keeps going smooth!