1/18 Yum AMPS 566 +5 550 +8 562 +10 577 +11 578 PMPS 468/526 +1 505 +2 552 +3.5 437 +6 530

Yesterday's condo:
http://www.felinediabetes.com/FDMB/...500-6-552-8-540-10-5-453.189754/#post-2113339

Good morning.

I increased Yum to 8.5uLantus this morning.
I was going to do a tight curve from +3 to +6, but she snuck upstairs and ate a possibly large quantity of the civvies' food.
I don’t know if she gets a BG bump from the near 0 carb Radcat (+1t pumpkin) or not. She also snuck upstairs and ate their food an hour before AMPS.

Yum will have a blood draw for IAA and Acro testing on Monday. That way my vet can overnight it to MSU on ice and it will easily be there for the Wednesday lab run.

I haven’t decided when to next test R.
a. I could just watch to see what the Lantus increase does today.
b. If she's not doing much better than the (argh) 550 at AMPS+5, I will probably feel an urgent need to give her R again this afternoon [ @Marje and Gracie , @Wendy&Neko , @Jill & Alex (GA) ]
c. I don’t feel ready for a morning test yet, since most of the experts would be asleep when I started it.

I’ve been thinking about how .25uR could make a dent on 8uL. I realize I have to take the time release behavior into account. The Lantus releases over 16 hours, so maybe that’s like .5u insulin per hour.
The R releases over 4 hours, so that’s like .0625u insulin per hour—12.5% of the Lantus hourly dose. That of course ignores their cumulative effects and time lags.

I’ve tried finding curves comparing R and Lantus for cats with limited success. I found one showing insulin levels and blood glucose levels for Caninsulin, where the insulin peaks and runs out over 4 hours but the BG nadir comes much later. I have to think about that time lag.

 

I'm glad you are getting the tests done for IAA and IGF-1. With knowledge, you'll be able to answer more questions.

You won't find anything that's relevant for Yum. It truly is ECID. You have to learn Yum's curves. The answer to whether she has IAA or not will provide some clarity on the time lag. Antibodies can randomly take in or release injected insulin, which means some variability in R (as well as L) action. And means you have to be more cautious in case the antibodies choose exactly the wrong time.

 

Yay! However those tests turn out, I’m sure it will be a relief to have an answer either way.

Are they going to test for Cushings while they have her there? That test maybe doesn’t get sent to the same place, but if they are already doing a blood draw...

 

I’m glad they are going to test her finally.

If she’s still up at +10, you could give 0.25u R. If you gave it at +6 or +7, it might bring her BG down but it also might go right back up long before Lantus onset.

 

Okay. She is at 562 at +8. I plan on giving her .25uR at +10. What would change that? A number below 400?

 

We'll see if her bladder is full and she is calm.

 

If I were to shoot her in the morning too, would it be at PMPS+10? @Marje and Gracie @Wendy&Neko @Jill & Alex (GA)
The Lantus is giving a flat curve today so far. I wonder why that happens. Would I shoot her with R every 4 hours? I suppose I can never count on the curve being flat.

 

Not, not necessarily. Insulin is a hormone. One can't count on or even expect a given amount to be absorbed and utilized by the body at any given time. Thinking in terms as you mentioned above is a mistake. Instead, start thinking in "waves of action"... waves that generally last for around 3 days/6cycles in the beginning. Eventually the hope is to shorten and flatten those waves until kitty remains flat in normal numbers.

In this case... today... this particular cycle... if she's over 400, you're probably ok to shoot 0.25u R at +10... simply because there may be some NDW involved from the Lantus dose increase and 400 is still high. If she's dropped between the +8 and +10, post and ask for confirmation.

Numbers are important, but just as important is what the numbers are doing prior to giving R and how quickly they're doing it... rising or descending. If the numbers are dropping quickly, one wouldn't want to add R into the mix for fear of creating too much downward momentum. That's why we were concerned yesterday when you didn't test before giving R on a drop of almost 90 points. Luckily, it didn't matter, but it could have.

One also has to consider how many cycles it's been since the last increase or reduction (when the depot will be full/have diminished), if kitty is coming off a bounce, kitty's onset, nadir, and duration, etc. That's just off the top of my head. I'm sure others will chime in with what I've forgotten. That's why we can't always plan giving R ahead of ahead of time. It's also why we suggest posting the BG number and asking for guidance before shooting R. Those new to shooting R can't be expected to see or pick out all these things in the beginning.

No. It'll backfire on you quickly! Think of it this way... R disrupts the normal Lantus cycle. When you disrupt the normal cycle of anything you can't predict nor should you expect "what normally happens". Until you become extremely experienced with R use, your best bet is to wait to see how the R affects the next cycle. I hope someone has a better way of putting that. My brain is fried after attending a very emotional funeral this morning.


Edited to add:

Awesome! It'll help to know if you're dealing with a high dose condition.

 

I want to think of R as being a bit of insulin that is added on top of another.

You say it's not, because it "disrupts" the Lantus cycle. It's not a linear process.

Does it disrupt the Lantus cycle by affecting the way the Lantus depot dissolves and releases?
Or does it disrupt the hormonal reaction in a more mysterious less quantifiable way?
What if I stopped Lantus and just shot her with R every 4 hours? Would that be more predictable?
Yum's numbers are so high. Do you think the Lantus is doing anything? Do you think she would go higher if I just stopped it?
I suppose most of these questions don't have answers, but I thought I would ask them anyways.

 

Thank you for taking the time to post for my Yum on a difficult day.

 

Does it disrupt the Lantus cycle by affecting the way the Lantus depot dissolves and releases?
No. It simply disrupts what would have happened had you not given R.

Or does it disrupt the hormonal reaction in a more mysterious less quantifiable way?
Not that I'm aware of.

What if I stopped Lantus and just shot her with R every 4 hours? Would that be more predictable?
In a way, I suppose it *could be* more predictable, but only in that Lantus wouldn't be *running* in the background. However, I feel very strongly that discontinuing Lantus would be a huge mistake. We're looking for a long term... not short term solution here. Besides, you'd be putting yourself and Yum though hell. It's not worth it.

Yum's numbers are so high. Do you think the Lantus is doing anything? Do you think she would go higher if I just stopped it?
Yes, I think the Lantus is doing something. The thing is with Lantus, the numbers usually aren't that great until you get closer to an optimum dose. We can't safely increase the Lantus dose any faster than we are. All we can do is incorporate the use of R to help Lantus along until that breakthrough dose is found.

I know this is frustrating, but hang in there. I think you're expecting too much too soon. This is a process and we have to go about it safely. We won't put your cat in jeopardy. Stick with us. Trust that we know what we're suggesting and why... and that we've been successful doing it.

I suppose most of these questions don't have answers, but I thought I would ask them anyways.
Yes, always feel free to ask questions. And you're right. Sometimes there are no answers. You'll drive yourself crazy looking for answers all the time. I know because I've been there... done that.

You're welcome.

 

AMPS+10 577
I will shoot .25uR now and 8.5uL at AMPS+12
I will test every hour for 4 hours

 

I bent the needle pretty badly but I don't smell insulin on her. Fingers crossed.

 

Sounds good. There are several sets of eyes watching. If you don't mind, please keep your subject line updated with numbers. It helps to see what's going on at a glance.

Stuff happens! Alex moved and I did that once. Hopefully it's not a problem. Just make a note of it on her SS.

 

AMPS+10 577
AMPS+10 .25uR
AMPS+11 578

 

Good job today, MJW, under Jill’s guidance.

You may see, st some point, that the BG appears to be lower the cycle or day after you use R. I rarely shot R every cycle and so it was more evident to me but Julie also saw it with Punkin. It’s something to be aware of and which may or may not happen with Yum.

However, it’s one more reason why you have to be judicious in how you use R and don’t get too far ahead of yourself. As her curve gets lower, look for any clues as to what she might do that cycle. Please feel encouraged to ask if something looks “different” but you don’t know what it might mean in terms of whether you shoot R or not.

I’m headed out but I’ll check back in later. However, it will likely be much later in her cycle. If you keep posting her numbers in the subject line, other experienced members are also around if you need help.

Paws crossed for some nice gentle numbers.

 

AMPS+10 577
AMPS+10 .25uR
AMPS+11 578
PMPS 468 or 526
shot 8.5uL

I didn't have enough blood so I double dipped the first strip and got 468. I decided to do another poke and strip and got 526.
I think a double dip is allowed in the instructions, but I had a low once before when I did that.
I suppose there are error bars on these measurements too.
The second was also a new vial, same batch.

 

AMPS+10 577
AMPS+10 .25uR
AMPS+11 578
PMPS 468 or 526
shot 8.5uL
PMPS+1 505

 

Glad to hear you are getting the tests done, it will be good to know what you're dealing with. You are in good hands with the R recommendations here from the pros (I am not one!) but have had some experience shooting R more than once in a cycle...it was not a wise thing to do, caused Bronx to drop way too hard in the following cycle.

 

Thanks for the data point. So weird there is the time delay.

 

And even though R is an "in-and-out" insulin, it can have a cumulative effect.

 

AMPS+10 577
AMPS+10 .25uR
AMPS+11 578
PMPS 468 or 526
shot 8.5uL
PMPS+1 505
PMPS+2 552

Thanks everyone for your help today.
So far she didn't do as well today. Maybe there is food interference?
I will take one more measurement before I go to bed.

 

AMPS+10 577
AMPS+10 .25uR
AMPS+11 578
PMPS 468 or 526
shot 8.5uL
PMPS+1 505
PMPS+2 552
PMPS+3.5 437
Well, better late than never.

 

That’s her lowest number in 10 days, I know it’s still a red, but it’s progress!

 

Nice to see action, but quite the drop! I hope it doesn't set off a bounce. Slow and steady Yum.

 

Nice response today!

If she’s up in the clouds again in the morning, I’d suggest using 0.25u R again at AMPS. I’m suggesting AMPS because I assume you will be asleep at p.m. +10.

If you aren’t sure, please post and someone can help you. If you have doubts and no one responds, I’d skip the R.

 

She is back up to 530 at +6. Argh.