Merlin’s just pitiful

http://www.felinediabetes.com/FDMB/threads/merlin-amps-361.201500/#post-2241058

My little boy has been so sick for so long during this journey. He’s had some better days, but more really bad ones. He’s just suffering and I’m beyond worried. His test for acromegaly and IAA are due back next week. His GI panel and labs are on the spreadsheet and if we can break these high numbers, that will be addressed due to his ultrasound showing a thickening in his intestines. He hasn’t vomited his food or had diarrhea (or soft poo) once I took him off of beef over a month ago so I don’t want to upset that apple cart. I’m taking him in to see his vet on Tuesday to see if there are some blood chemistry issues we could address (phosphorus is on my radar and I have aluminum hydroxide being delivered, along with omega 3 fish oil and a refractometer to keep an eye on his USG). I also want her to look at his teeth as he has had to have them cleaned (sometimes with extractions) ever since I adopted him 10 years ago. His ketones are checked regularly. I also have a phone consultation with his holistic vet that I occasionally consult with for a fresh set of eyes on his labs and disposition. I had to post here because I cannot keep seeing him like this. He’s not a cat anymore, just a sick little boy.

 

love light and healing

 

I can't access the spreadsheet. It opens in what looks like a preview view of the BG numbers and says "protected document"

I am trying on my tablet so may not be an issue on a computer.

 

Has anyone used Novolin R? An admin on one of the FB support groups wants me to get a bottle so she can walk me through lowering his bg’s. She’s adept at dm.

 

Hugs to you and love to Merlin. I am wishing him well.

 

There are some here that use it and some experts that will assist here also. You might put it in your title to get eyes on the question.

 

I certainly understand wanting to break through those higher numbers while you're waiting for the other things to happen. However, I urge you to seek help on the FDMB, an open and peer-reviewed message board, rather behind closed doors in a FB group.

That said, we do have experienced caregivers in the use of R as a bolus insulin. I'd help you myself , but I was just diagnosed with a nasty case of shingles. I don't think I'm able to commit the time needed to help right now, but let's see if we can find one or more members to help.

@Marje and Gracie

@Wendy&Neko

@Dyana

@Bobbie And Bubba

@Sandy and Black Kitty

Members, feel free to tag other experienced R users on this thread.
Thank you!

 

Hello, I've been here for nearly 7 months & I'm still learning. Have you read the Information about Lantus? There's a lot to learn. Once you understand how this insulin works it will get easier. You need to get advice on this forum on how to increase the insulin. I've discovered that most Vets are not familiar with Lantus .
The people here are. They can help you. Everyone here loves their Kitties & want to help you ,help your kitty. They have a lot of experience dealing with Diabetes, Insulin & a whole lot more.
Have you read about the 2 methods of using Lantus Insulin? Either SLGS (Start Low go Slow) or TR (Tight Regulation) It will help people to advise you once you choose a method.

You need to read as much as you can to understand how the insulin works & what to expect. It takes time. But eventually it will get easier.

You've come to the right place for help!

Best of luck to you & your Kitty. It will get better! (what is your cats name? I can't pronounce Itlpnksk)

 

Hope it is a short lived flare. I can sympathize.

 

Except for a single anomaly in June, I only see a single blue number on his chart. He is not getting enough insulin. I would strongly suggest you to select one of the protocols on this forum and pursue it. Even if you are conservative, Merlin is not getting enough insulin. He needs to achieve some blue nadirs on a daily basis to get healthy.

Once you have achieved some BG regulation with him, he will start feeling a lot better. Kudo's to you for maintaining his spreadsheet. Let's get some insulin increases into him and get him healthy again.

 

According to Merlin's ss, it appears the current plan is to hold a dose for 6 cycles and then increase in increments of 0.5 unit... in addition to the possibility of incorporating the use of R as a bolus insulin.

 

Vines for Merlin.

 

"the current plan is to hold a dose for 6 cycles and then increase in increments of 0.5 unit"
That is a good and a standard plan to follow. Let's hope Merlin responds well.

I would urge you to continue the protocol until you see some blue nadirs. The reduction on 8/14/2018 probably should not have been done.

 

I am finding it difficult to reply to each reply. Anyway, Jill I’m so sorry for the shingles! I really hope you are not too uncomfortable. I had a mild case of them 18 years ago. I never want to see them again! Best wishes.

Joy and Jeff - I am following the TRP so I’m on board with the protocol.

Novolin tags - using it makes me completely nervous even thinking about it. As far as getting guidance, I’d come here that is why I asked the question. I get his acro and IAA results back this coming week so that will tell me a lot so I don’t want to do anything with Novolin just yet.

Right now I’m feeling heard, cared for, and supported. It’s been sooooo difficult. My husband an I talk about this all day/every day, but I’m doing the research. So thank you all very much.

 

Most of us have been in your shoes. It is hard to get a kitteh regulated, especially as the dosage increases. I had lots of help here initially too.

Persistence pays off. Diabetes is not a sprint, it takes awhile sometimes. Leo just celebrated his third year as a diabetic. If FDMB wasn't here, he probably would not have made it.
Leo's 3rd diabetes anniversary <<--link

 

Jeff - there was a reason to fall back to 1.5U. I felt that maybe I had missed a dose. On ProZinc, I started seeing a few yellows and a blue and then his Internist switched him to Lantus. skipping from 1U to 2U. He was feeling awful at the 3.5u of Lantus when he got that far. She always wanted to go up in 1U increments until I refused and told her I wasn’t comfortable with that. I showed her the protocol on TRP but she is not on board with that and just said she wouldn’t advise it. I did it anyway but she always wanted to hold the dose longer. At 3.5U Lantus I had to reevaluate and look back to see where he was getting better numbers. I had other eyes on it as well. I didn’t do it blindly and I was terrified. It’s done now and This is where I am. I just have to keep moving forward.

 

Ok. Ultimately you have to do what you feel comfortable with. We will help you move forward from here.

 

@Jill & Alex (GA) is 100% spot on with encouraging you to post here for help instead of FB. If you decide to use R, yes, we can help you and I would urge you to avoid any site where there is only one person versed in the use of R.

I’m happy to post some info about using R and while you are thinking about it, we can fast track Merlin as long as you are able to test him as you have been....if you wish to try it. We don’t do it often but with the way he feels and the numbers he’s at, you could raise his dose by 0.5u after every four cycles just until we see yellow or until you start R, if that’s what you decide. Then we can slow it back down.

Here is Chloe’s SS where you can see it didn’t take us but a couple dose increases to get her numbers looking better by fast tracking. This is an aggressive technique...more aggressive than TR and so you might not want to try it. That’s fine. Your other option is to increase by 0.25u every four cycles until we start to see better numbers or you use R.

Please note to other readers: this suggestion is for Merlin only. Please do not do this for your kitty without assistance from an experienced member.

I’d like to just give you a few bits of info about using R as a bolus and Lantus as the basal insulin. There is more to it than this but it’s a good place for you to start thinking about it.

• For a non high-dose cat, we typically start with 0.1u to see how cat reacts and increase, as necessary. The 0.1u to 0.25u usually works for non high dose cats.
• Aim for a dose that lowers the BG through the duration of R by about 100 mg/dL.
• Avoid overlap of the nadirs of the basal and bolus insulins
• Don’t give when a bounce is due to break
• Avoid giving R on a basal insulin increase cycle
• Monitor every hour for 4-5 hours to see onset, nadir, duration; once the cat’s patterns are very clear, monitoring every hour can be decreased to those times the cat is typically most active during the R cycle.
• Be aware that R can appear to have an effect on subsequent cycles. It is likely the effect of the L insulin grabbing onto the R and the BG lowering in response to the longer effects of the L.
• After initial uses, determine the curves of the two insulins so you can see other safe times to give.
• Developing an R dosing scale is handy for long-term use. As an example, if kitty’s PS is 300 and on the rise, 0.1u might be appropriate; if kitty’s PS is 400 and on the rise, 0.25u might be appropriate. This is ECID and should be done after full knowledge of kitty’s onset, nadir, duration of both the basal and bolus insulins.
• Be fully present and focused when preparing syringes and shooting. Develop a double check system.
• Patience is required. Activity from the R is often not seen every time it is given. Don’t increase the dose of R just based on one cycle. The amount of R given should be tied to the current dose and the BG.
• Knowing when not to use R is as important as knowing when to use it.
• There are also some cases where R might be used for a period of time and then, if the cat's situation changes, it might not be appropriate to use it anymore. One mustn't think that using R always is routine.

You can see that using R takes a lot of thought and attention. It can be very successful in getting numbers down but it must be used very cautiously or you can start a dive/bounce cycle that can be difficult to deal with.

I’ve got to get dinner started but will check back with you in a couple hours while you think about all I’ve thrown at you.

 

@Marje and Gracie
THANK YOU, Marje! Thank you for getting the ball rolling. I don't even have that much energy to type right now. However, I'll pop in whenever I can. Hopefully, this flare will be short-lived!

 

Thank you so much for all you have offered. It’s a lot to think about. I’m not so sure I want to use Novolin until I receive the acro/IAA results next week. All of this has me anxious. I am going to think about the dose increase more aggressively as well. I am grateful for all of this.

 

You guys are the best. My little man is everything to me.

 

Oh Chloe!

 

I second Jill's comment about listening to "advice" from non peer reviewed FB groups. Don't know if it's the same person or not, but we have had a couple cats arrive here using R on advice of FB and it took a while to sort out the mess. I'm glad you are here and hope we can help.

I was going to suggest that there are alternatives to trying to get to a good Lantus dose faster, but Marje beat me to it! Fast tracking by increasing every 4 cycles will get you there. It's an alternative technique for those following TR. I'm glad you've selected that dosing method, again, the faster you can get to a better dose, the better. If you are interested, I can find a few other spreadsheets of cats that fast tracked to get to a better dose faster, but still safely. You don't want to start fast tracking and start using R at the same time. Using R will slow down the fast track.

Could you help us out by putting TR in your signature. That way we'll quit asking you which dosing method you are using.

We totally get that. I would have and did practically everything for my little girl. I too remember being impatient and wanting her fixed NOW when I started. The good news is that there is a dose out there that will start to move Merlin.

 

You’re very welcome, Jill. Tons of healing vines....I know firsthand what a painful buggar shingles is. The gift that keeps on giving

You’re welcome.

Certainly if he comes back as acro and/or IAA, R is definitely something you’ll want in your toolbox. It can be very helpful in knocking back the antibodies with IAA and, if the basal dose gets high, it can help you keep the BG down without breaking the bank.

We are here to support and help you so please feel welcome to tag us.

 

Thanks for the reassurance. How do I put TR in my signature?

 

If you go to the top of the forum, top bar right hand side, you should see a couple of menu items, one of which is your member name, to the left of Inbox. Select the signature item from the drop down menu. Make any edits and save them.

 

Done!

 

Well done! You can use the signature to convey other useful information, such as date of diagnosis, any ongoing medical issues or medicines. Mine got a little busy over time.

 

It’s also good to put the date of diagnosis, his age, type of meter used, and, if you like, your name.

 

Sending you healing vines, Jill!!

 

Healing vibes to you Jill, I hope you get to feeling better very, very quickly. Shingles is absolutely no fun. Comfort!!!!