1/14 Asia AMPS 280, +2 320, +5 222

http://www.felinediabetes.com/FDMB/threads/1-13-asia-pmps-164-2-145-6-161.189551/

AMPS 280. Increased to 1.25, I gave a fair shake to settle post vet visit freak out, but the overall numbers were looking to me like they were trending upwards even before that. I'm sure if this is not the case, she will let me know very shortly.

Hoping Darwin has eaten something and will turn a corner soon.

 

Oh Asia! Yellow isn't a good colour for you at all

 

Good luck with the dosecrease.

 

Come on Asia, work that juice!

Hope she comes down for you soon. Safely Asia!

 

Thanks! She's taking her sweet time with it, so far, so safe. I'm guessing she will save her daredevil moves for the PM cycle, as per usual.

 

I hope the new dose brings Asia's numbers down.

 

In an effort to maintain the FDMB's standards regarding peer review, my response to Stacy's PM:

Stacy,

I've been reading back through Asia's threads and have spent time studying her spreadsheet today. I was all prepared to post a detailed account of how I helped Alex achieve some awesome duration with Levemir. This will sound like a cop out, but I'm sincere when I say I think if I go into detail about the steps I took to achieve duration while Alex was on Lev, it will only serve to confuse you and cloud the issues you're experiencing with Asia on Lantus. That said, here's an overview:

Generally speaking, my ultimate goal was to push Alex into the range of a "healthy cat" (50-80mg/dL), not the "normal" BG range (50-120mg/dL). There is a difference. To do that I knew I would have to get enough insulin into her while preventing her from bottoming out. Reducing her dose every time she dropped low while the numbers on either side of the low were too high wouldn't achieve that goal... not with a cat who was extremely carb sensitive and whose pancreas was not in the condition of a cat who only needed a diet change and a short stint on insulin to achieve remission... pretty much no matter what a caregiver did or didn't do. I had to figure out how I could meet my goals while keeping Alex safe. You asked why I would increase her dose when her cycles had nadirs that were green, but blue bookends on either side... this was why. Not pushing for lower numbers would never get her BGs into the "healthy cat" range.

Getting to that point took a lot of experimenting, observing, learning, and then using what I learned about Alex (response to insulin and food). It took a lot of experimentation. Eventually, we were able to settle into a routine which included feeding LC prior to nadir and not afterwards whenever possible. Although, not feeding after nadir did change as other issues came into play. That's basically what kept her from dropping too low and increased her duration on Lev. It's really not that hard to maintain green cycles. It's the getting there that's the hard part. BTW, when a kitty is getting some great duration, shooting an hour or two early or late isn't much of a problem... one that worked well for me since I'm a night owl and not much of a morning person.

As time went by, Alex developed several other serious health issues. We almost lost her a couple of times. However, no matter what else was going on, it quickly became clear that she felt better when she was running in low BG numbers. Keeping her glucose levels under control was about the only thing I could attempt to control, so it became a priority.

I was also fortunate to be working from home which allowed monitoring almost 24/7. And... this wasn't my first rodeo. I wasn't afraid. My civvies regularly tested in the 40s when they were young. Now that they're 15, both of them have been testing in the low 50s (yes, they still get tested monthly). I also had almost 3 years of helping and observing others kitties in the L&L ISG in-between the first time Alex was on insulin and the second. When I started Levemir with Alex, I not only had a healthy respect for insulin, but I felt very confident in my ability to keep her safe.

You also asked why I switched to Levemir. At the time, I was advising others on it's use and didn't have hands on use with Lev. That didn't sit well with me. I believe, whenever possible, those offering advice should have hands on experience with the insulin prior to offering advice and/or suggestions. This was common practice on the FDMB at that time... so I tried it... and liked it! I have to say, after having used both Lantus and Levemir, I do think Levemir is easier and more flexible... just my opinion.

Getting back to Asia...
I think this time for experimentation is where you're currently at with Asia. Today's thread (oops 1/11 thread) alone has some great advice and observations made. Figuring out the differences in her cycles seems to be the goal at the moment. Once that's figured out, duration may fall into place. If not, it's back to the drawing board... the time to figure out how to get more insulin into her safely in order to flatten out every cycle.

I'm sure this isn't quite the response you were expecting, but hope it helps a little...

 

Thank you so much! That's a perfect response, the disappointing one would have been "I just got lucky and my cat had years of awesome duration that I didn't even have to think about". It looked very intentional on your SS, so I thought you may have some insight about it. I have seen cats that just get with the program and are green or nearly green all the time, right off the bat, obviously, that's not Asia, and it didn't seem like it was Alex either, but I had to ask.

That's where I am at, there is so little I can control with her age and organ decline, if I can at least manage to keep her BGs even, I know it helps.

We are definitely at the experimentation point, especially with food. I'm throwing a handful of spaghetti at the wall and seeing what sticks regarding food experiments and writing everything down. Karo over honey has given me much more predictability and confidence I can get her numbers up, way up, if needed, that was huge by itself. Her response to carbs in am cycles is astoundingly different than her response in pm cycles, and I doubt is has as much, if anything, to do with am vs pm and more to do with momentum to onset and preshot numbers, but she gets that most often in the pm cycles. And I hope you're right, that once this is sorted, she will start getting duration.

My observation thus far (don't know how accurate it is, or if it applies to any cat) is that she got more duration at higher doses (and I can't say I had much to do with that, intentionally) and it seemed to fizzle out once I took the reduction to .75, I've been trying to get it back every since. I wasn't feeding any differently there, it just happened by itself. Since that reduction, her patterns have changed too, which I don't know if it's just a thing, or because of less insulin. She doesn't want to drop from high numbers at all (before she could be a bit dramatic about dropping from pink to green in 3-4ish hours), now she takes her time stepping down slowly, never getting where she needs to be and heading back up again. It's "surfing" but not the colors I want her to surf in.

What did you find easier about Levemir? I know ECID and your cat's experience on one insulin could be vastly different from another cat, but how would you compare and constrast Lantus vs Lev pertaining to Alex, specifically?

I'm quite hesitant to switch on one hand because a) Lantus seems to be working well enough b) I don't know how much of learning curve and schedule fiddling it would take if she had a late onset/nadir with Lev, but I also can't help but to wonder if she would respond better to a different insulin, specifically to be more even keel. All I have to go on are the many cats on the board that switch and seem to prefer Lev, and it seems to be in line with many reviews about the two insulins I've read with people. I'm jealous of the cats that surf with very little effort, surfing is a monumental effort over here.

Thanks for your time, I'll be back for more info once we sort out the cycle/food stuffs!

 

@MJW saw this on Thursday's condo, replying here so I don't bump up the old one.

Thank you for that, I will keep the SEB in mind, that might be worth trying out if the need arises... I don't usually have a problem with this, I figured out long before diabetes that the few times she would barf, it was because she went too long without food and it rarely ever happens because I make sure she has a little something often enough that it's pretty much a non issue.

I agree about Pepcid, I'm not a fan of acid reducers in general, in humans, so I would be hesitent to use it on my cat, and double that because she eats a raw diet.

How is Yum doing?

 

Come down from up there Asia!

 

Yum also eats Radcat to control her phosphorus. I couldn't get her phosphorus level down with binders until I put her exclusively on Radcat. The lamb gives her diarrhea so she gets the chicken. The introduction of the Radcat lamb last August coincided with her insulin shot dose gradually dropping from 3 units to 0.5 units. Something went terribly wrong though in November/December and now she is completely unregulated. I can't get her blood glucose down at the moment. Thanks for asking!
Lots of interesting stuff in this condo. I will bookmark it. I also bookmarked your earlier condo with the vitamin B information. Yum gets cyanocobalamin B-12 shots but I need to switch to the methylcobalamin.

 

Good luck with the dosecrease - I hope she shows some better numbers!!

So sorry for not seeing this earlier! I really appreciate it, and you always checking in!!! It's nice to have that support when you're feeling so stressed, worried and helpless. I have been a bit of a wreck this weekend, and trying to find ways to relax and not let myself get so emotional. It truly helps to have all the support!!

 

Radcat has been fabulous so far, we had to switch due to a recipe change of Stella & Chewies. I’ve stayed away from the red meats, they just eat chicken & turkey. I wish they had rabbit & phesant too, but oh well. Asia’s been a chicken only cat for a long time. Waiting on bloodwork to see if Phos numbers have gone done, went high for the first time in the last labs and she was eating radcat then, so it wasn’t good enough on its own, apparently.

I’m so worried about Yum. What is your vet’s most recent hypothesis of what’s going on? I really hope you figure what what is going on, did you ever convince them to get the acro/IAA testing?

 

Thanks, I hope so too, it’s sad seeing these higher numbers. No apologies needed, I didn’t tag you on purpose because I know you have a lot going on, just woke up thinking of Darwin and hoping he was doing better so I put that out in to the universe. Hope you’re taking care of you, which is near impossible with a sick cat, but I hope you’re finding moments to distract yourself. So glad Darwin is eating, even if not a lot, he’s eating. Hope those abx kick in real soon and beat the snot out of that pneumonia!

 

Erm. Wot's going on here missus ?

Me 'n Ty take our eyes off for just a minute ,whilst we enjoy a sunny weekend, and we come back to find you doing the yellows.

Stobbit.

 

I know I'm not sure what's going on yet, but her good number streaks started when her pain meds started in late December. I recently decreased her pain meds slightly to dose them every 8 hours instead of every 12. I'm going back to the dose she had before and see what happens.