05/28 - Small Kitty amps 538 +2 365 +4 311 +5 380 +6 437 +7.5 470 +10 536 pmps (+.25U) +5 268 +6 336

First I'd like to say thanks to all of you who're helping in getting these numbers down.

Seems this morning, yet again, Small Kitty's system is not willing to cooperate. Neither Big Brother,
he left me a nice circular gift on the front door carpet. Start to wonder if I'll not accept the offer
my father made me when this thing started, to pick them up and go so I would not have to be involved in
the process.

Think I'll go back to bed so I don't think too much before next test at +2.

*Julie, thanks for you reply yesterday, I never saw the alert. I'll read it carefully when I wake up.


http://www.felinediabetes.com/FDMB/...229-5-382-whats-going-on.158473/#post-1687977

 

Sebastian I feel your frustration.

Sometimes it just takes more time with some kitties to start to see the light at the end of the tunnel.

As was discussed in your previous post, there is a chance that SK is bouncing again from a bigger drop between the PMPS and the +3 test last night. Some kitties are just more prone to bouncing and do it more than other kitties. When I started with my Tuxie it was 1 1/2 months before I saw ANY number that wasn't black or red. It may just be a matter of having to increase until you find the dose that seems to work best for SK.

Please don't be discouraged..I know how that feels. You have done so much so far in dealing with DKA on your own..a very difficult thing to do. But you did it and SK is still here because of you. Sometimes you have to learn not to be upset at what numbers you are seeing...SK is active and happy and that is what is important. Getting his numbers down is just going to take time.

If you are sure that it is BB that is peeing on the carpet, you could consider having him checked out with blood work and urine testing at the vet to make sure there is not some sort of infection. It could be that it is SK peeing on the carpet. With higher BG some kitties will do that,

I totally understand your frustration and disappointment, since I went through the same things as you when I started. I cried a lot and thought I was doing things all wrong and that I was just hurting my kitty by continuing to give shots that seemed to be doing nothing. But now 1 1/2 years later I am so glad that I didn't give up, even if Tuxie is not well regulated. I know how much you love both your kitties and I know they love you too.

Hang in there Sebastian.

 

Ah Sebastien, just hugs, and lots of hugs. So many of us have felt what you are going through as Mary Ann has shared her journey with you. We had a rough start too. 2 weeks after Bubba was DX with Diabetes, he was diagnosed with cancer of his left eye. Then he had two infected teeth that had to be removed and 6 weeks later the eye was removed. We couldn't get his numbers to budge and he developed ketones. So, a lot of us understand what you are going through. But, we just kept plodding along and doing the best we can and take each of the steps in the right direction as a victory, such as keeping SK's ketones in check. And everyday you will be stepping in a better direction the more data we get.

You are doing a great job and hopefully after today's curve some light will be shed on how to proceed with dosing. Hang tight, we are here with you.

 

I'm so glad you understand me because this is something I cannot talk to anybody and certainly not my father.
Even people around that are aware my kitty has diabetes don't know the level of investment in $$ time and ''emotions'' sort of speak.

 

Having an extra 4h. of sleep today was great, think I was pretty tired, witch doesn't help.

 

Yesterday Julie was very nice giving a flow chart of Lantus action (see below) What would be the most lucrative test time knowing the current results ?

0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar or lowerthan the preshot number. Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

I would be willing to bet that ALL of us here understand what you are going through. Most of my friends and family think I am nuts to deal with this Diabetic dance and sacrifice for Bubba. We all do what we have to do. Sleep definitely makes it better.

The flow chart you just posted is a good guide line. Good luck with the curve today, I see SK has already dropped 127 points. It will be interesting to see how much lower he goes. Keep up the good work!

 

I will finally pay myself the big luxury of a +5 AND +6

 

Good work on getting those mid cycle numbers. Have you done any more besides the +4 and +5.?

 

I know it's just going to be higher and higher in SL. Just did a 7.5 confirming this : +7.5 470.

amps 538 +2 365 +4 311 +5 380 +7.5 470

 

Strange coincidence :

After loosing a little bit of weight before and until Ketone was detected, Small Kitty is now back
to the same weight 20 days ago with similar numbers. Dose at that dime was 2.0 2X.
Could weight be as good indicator as GL ?

(See SS in comment section).

 

Thank you.

SK had a decent drop from AMPS to +2 and then just stayed fairly flat until your +7.5 reading. This is a normal curve for Lantus, since Lantus is supposed to keep the numbers flat and steady during a cycle. The +7.5 seems to show that the Lantus has reached its peak and is slowly started to wear off.

It looks like SK may need to have a higher dose, but I don't want to advise how much without others weighing in. I will tag a few people who have been following your thread and are familiar with SK's story.


@Chris & China @Bobbie And Bubba @julie & punkin (ga)

 

I agree but how much? If it weren't for the 229 last night at +3 it would look like he needs a .50 unit increase but then there is the issue that Sebastien works and can't get any test in during the day. As of yet, he doesn't have his auto feeders he ordered. I guess if it were me, I'd go up to 1.75. Let's see what the others think.

During this cycle, what has SK eaten since his breakfast? And what time?

 

At about +3 he got 1/4 of a FF low carb can.

 

I'm not great at analyzing spreadsheets, but it looks to me like SK's nadir tends to be around +4 most cycles. Getting those tests last night was great. I agree that he needs a little more insulin. With Sébastian's schedule, I would keep the increase to .25, as Bobbie suggested.

 

Conclusion so far : it's at +10 that Lantus loose it's effectiveness (this 90 days old one). SL is at what,
I'm pretty sure, what it is going to be at pmps : 536.

That's for sure an increase in dose is needed. I don't have it fresh in mind but the ''start low go slow''
would recommend a .5 increment with nadir that high (311).

Does this make sens ?

 

No, SLGS increases are all at 0.25u increments. And with a test in the 200's on a pet glucometer I wouldn't increase by more than 0.25u anyway.

I would increase by 0.25u and stop testing for the rest of this cycle. Whenever it's clear that SK is in a bounce, ie, the numbers are rising from preshot on instead of declining, there isn't any point in continuing to test on a curve. Bounce numbers don't tell anything as far as making decisions on the dose. Go ahead with your preshot tonight and I'd skip getting another pm cycle tonight if you are still tight on strips, only because this bounce has just begun, and get a test at amps. Enjoy getting another good night's sleep.

Can I suggest you use something like a gray or brown to show the ketones test instead of the bright green? Using the colors that designate number ranges is kind of misleading, because glancing at the ss it looks like SK is getting into low numbers. Those of us who look a lot at spreadsheets rely on the colors to help us see the blood sugar flows up and down.

 

Forgot to put one test : +6 437

 

When Gabby crossed over the to the Rainbow Bridge a few months ago, one of the members put together a video and tribute condo for her. In that thread, I wrote the following:

The entire thread is linked in my signature.

 

Julie, you're kind a smart. Brown is also more consistent with color I started with for Ketone. Thanks.

 

I agree with Julie with doing a 1/4 unit increase. SK is very bouncy and with your schedule making it difficult to test in between that would seem to best way to go'

 

That was truly an amazing tribute to a very loved little girl.

ETA It still makes my cry every time I see it.

 

The bond you get from taking care of a special needs cat is unlike any other, it seems to me. You're so intimately involved in their care all day/night long and you know that you're saving your cat's life by your care. It is a gift, in a way, that gives you an incredible bond.

 

Sébastian, I agree with Julie about the increase. I know you are following SLGS, and it says to hold the dose for a week, but SK has DKA in his history, so we don't want him hanging in high numbers too long.

When Cinco was diagnosed with diabetes, my father-in-law thought we should have him euthanized. As my other kitties all were diagnosed with cancer over the next couple of years, he kept saying the same thing. Some people just don't get it. To many of us, these are not "just cats". They are family. We will do anything for our family. They need us. How could we let them down?

 

Wow, this is so nice, it's exactly what it is, a bond. Small Kitty is not fighting when on the ''operation
table'', he's patient and purr. He knows this is for good I'm picking and so. The break of 2 little brothers, born
the same day, the same kind of color pattern would be like a car missing it's rear wheels. Hope life will
not bring me against the wall with no other options.

 

Just stopping by to sypathize AND empathize. There are days when I am just a phone call away from begging for a spot in the witness protection program so I can wear a red wig and live in New Mexico as Frederica Carstairs or something. But hang in, hang in. It will get better!

 

Don't worry about what the future will bring. Just know that you are doing the absolute best for your beloved SK RIGHT NOW and you are giving him the best chance to get into a healthier area and stay there. You are an amazing care giver Sebastian

 

Thanks for catching that, Tricia. I think you should wait til tomorrow morning for that increase. That would give him 11 cycles at 1.5u, but still let you do the increase when you are home to monitor. I don't think we should rush it given that you can't get mid-cycle tests most of the time.

If he gets under 200 between now and then, that would change things. Then I would wait longer.

Would you remind me, do you have a method for him to get food during the days while you are at work? An autofeeder?

 

The 1/4 unit dose increase is a good starting point since Sebastian does not have a lot of mid cycle testing. But because of the DKA..which he is testing for with a meter on a regular basis....he may need to increase faster than the SLGS method calls for. Need SK to be safe from high numbers AND safe from low numbers especially when there is no way to test at mid cycle.

 

I think we have unanimity with 1.75 ? Or I am misunderstanding. Previous .5 increments proved
to be catastrophic.

I think I'll go with that unless one of you, precious helpers, say I should be more ''aggressive''.

Also, I'm going to take off and go to my favorite restaurant have a couple of beers and good meat leaving Small
Kitty and Big Brother doing their own business.

So here we go in an hour with .25 increase ?
.

 

I believe the suggestion is 1/4 unit increase for tonight but MAYBE another increase tomorrow depending on his numbers.

 

Next month one should arrive (2 actually). Will need help on how to split portions (quantity), that's gonna be for later.

 

Actually, Julie was suggesting waiting till the morning to increase, to give him another cycle at this dose and get closer to the SLGS guidelines.

 

Oups, think I didn't understand. Dose is 1.5 at the moment. Is next dose at 1.75 or 2.0 ? Like Julie and others said,
KDA is always next door.

 

I'd feel more comfortable with waiting til morning because you are following SLGS. Then a 0.25u increase.

 

By the way, whenever there is a lot being posted in your thread, it is a good idea to refresh and then look back up to see if you've missed anything. It's very common for people to miss posts whenever things are going fast and furious.

 

Sorry Julie I misunderstood your suggestion.

 

I've been sleeping for the entire day so if I go out I'll be able to perform a mid-cycle test.
Could that give a good indication on what a new dose has to say ?

 

No, you had it right. I changed my mind after Tricia pointed out that it hadn't been a week yet, but Sebastien is following SLGS and then was suggesting waiting til morning for the increase. That's still not a full week, but because he can't get mid-cycle tests easily, I was thinking that increasing tomorrow would let him have at least some time at the higher dose while he was home. It would also get him on a weekly schedule that lets him do a curve on Saturday for the SLGS.

Sienne is mentioning concerns about the recent DKA and ketones fairly recently as well. It looks like the ketone test yesterday was negative, thankfully. With that in mind, maybe increasing tonight isn't a bad idea.

Sebastien, I think this is up to you. You can see there are various factors to weigh, and as always, you hold the syringe. We can think out loud and try to give you pros and cons, but ultimately, you decide.

What do you think?

 

I'll go with 1.75 (.25 increase) tonight. Mid cycle are the most representative ones and I'll be awake (tonight).
If some purple can come up tomorrow morning that would be so nice. The 1.5 has been there for more then
5 cycles, it's now at cruise speed. Tomorrow his duty day (I've a second job) so testing will be amps then
possible again at mid cycle. If we want to know what this new dose has to say better do it now.

.

 

Any precautions, expectations I should have for next test ?

.

 

Just my 2 cents....since you ARE able to test on the PM cycle and can't do mid-cycles on the AM cycle (other than weekends) I think I'd go ahead with the increase to 1.75 tonight

It's totally possible SK will have some NDW, but if she doesn't, you're able to test tonight and when you can tomorrow/tomorrow night

You don't get Monday off like most of us here in the states right? So Monday you'll be back on only testing at AMPS, PMPS and a test or two after that? (I know you need your sleep too due to health issues)

 

In Canada the long weekend was last weekend. Also Sebastian said he has a second job he is working tomorrow but can still get a mid cycle test.

 

No Monday off, was this week (worked to have another day in vacation bank ). So you're right Christine, test will be flexible tomorrow but tighter next Monday until next week-end.

 

Small Kitty will be inaugurating his new 1.75 unit dose right now, shot/feed time has come.

Test break for now, will be in 6h.

I now know not to panic when new dose is coming in, so I'll deal with whatever will come up.

Thanks to all, enjoy your Saterday night because that's what I'm going to do.

Heading straight downtown Montreal after shot to have a good meal and fun time.

.

 

Thanks for coming in Christine, always appreciated to see you. Hope everything is as good as it can
be on your side. Been thinking about you lately.

 

Enjoy your "adult time" Sebastian..you have earned it. Please post when you get the mid cycle test for SK. There is sure to be someone here in case you need some advice.

 

Have a good time Sebastien!! It's good for the bean to get out once in awhile and leave the sugardance behind

See you when you get back from town and get the next test! Hopefully SK will be good while you're out!

 

That would be correct except for the fact that you cana'

I like that idea due to the DKA history and recent flirt with ketones. You will have tomorrow to monitor.

 

We can help with that.

 

YESS !!! Think we're getting somewhere. New pmps dose from 1.5 to 1.75 is giving good
results. Don't know if he's climbing or diving but that's a nice mid-cycle.

 

Slowly but surely wins the race!!

Don't be discouraged if he bounces around a bit...that first dose can do that!! (but hopefully the little extra will just keep getting better numbers)

 

New answer to this .25 increase : It starts to wear-out @ +6. Now +6.5 SL at 336.

SL will go up from there till tomorrow. Will see how far up.

Time for bed now.

 

Good to see the numbers coming down a bit. Hopefully the extra increase will keep the numbers in a lower range. But SK is a bouncy kitty so it may take a few days to see if this dose will be better.