Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Juliet, Jan 2, 2018.
Hope Silver comes down and stays in some nice blues today.
Sorry things have been so crazy the last couple of days. Silver is lucky to have you.
Thank you both of you.
Catching up on your condo from yesterday. I truly understand your frustration with Silvers numbers being higher than you want and being limited with what you can do about it. I tested Asia a lot in the beginning, I could monitor and do curves and it was still hard to watch all those pinks and reds and wait for the days where it was safe to increase.
I was able to treat Asia as aggressively as the TR protocol allows and it was still a good 3 months before I started getting somewhere and she was seeing numbers regularly that didn’t make me cringe.
I know it can be discouraging and your schedule and health are limiting factors for you, and it’s obvious how much you love and care for Silver and that you are doing the most you can do for him at this moment. I also know when you’re already feeling run down, discouraged and overwhelmed, it is easier to take things said personally or in a manner of which they were not intended.
From my perspective all opinions and advice are good in that I so appreciate people trying to help and many heads coming together to help me sort through a problem. If I don’t like something suggested, I don’t apply it and I move on. If someone is terse, I don’t take it personally and I try to see if what they have to say is useful in spite of how I feel about their delivery of the information. It really helps to think of it that way.
I hear you when you say you feel like what you’re doing is perceived as “not good enough” by others. What you are doing is good enough for you to continue on treating Silver at this pace. I think the miscommunication lies in that you are asking if someone agrees for you to be a bit more aggressive with dose increases and the answer to that is “only if you can fill in a few more blanks” followed by lots of suggestions and brainstorming on how you might do that. If you can’t, you can’t, and you’ve stated it and that is fine, but know that they are not judgements or attacks, they are suggestions and I think all anyone is trying to do is help you help Silver.
Putting the shoe on the other foot, would you feel comfortable agreeing with someone to increase a dose when you don’t have all of the information that would make you relatively confident that it is a safe choice? If something unfortunately happened to someone else’s cat based on something you condoned or advised as a perceived wise, experienced and trusted member of the community, what would that feel like? That’s where others are coming from. I think people genuinely only want to help you but this board is all about safety first.
You have some bounces that unfortunately coincide with the days you are able to do curves and that certainly muddies the waters and puts you in a position of waiting even longer to see what a dose is doing. How long does it take Silver to clear a bounce? Asia is a pretty solid 2-3 cycle bounce clearer and I’ve been told that is quick!
All that being said, it is your cat and your call, you hold the syringe. I know it’s comforting to get a blessing on decisions that give you pause, but the only way scrupulous people can do that as outsiders looking in, is if the data is there that mitigates the risk. That doesn’t mean you won’t get support in the decisions you make (nor does it mean your decisions won’t be questioned, it’s a peer board after all and we are all here to bounce ideas off of each other), it only means, most times, you won’t get a blessing in advance to make those decisions.
Keep trucking along, Juliet, I’m confident Silver will be in some nicer numbers soon, but it’s so hard to wait for it.
Jones is in the same boat...I am having a hard time holding the dose as he keeps bouncing. It really muddied the picture. He seems to be holding his bounces way longer now.
We do what we can with what we have. You are doing your best by Silver. I will be with you offering patience support and maybe some pattern talk if I see one with Silver.
Thanks @Stacy & Asia and @Tracey&Jones. I seem to have communications going in yesterday’s condo and today’s abc I’m not getting notifications about comments in today’s condo so apologies for the delayed response.
I’m not in a hurry to increase Silver’s dose but I am worried holding too long will cause glucose toxicity and I was told that was what happened when I was gone for a week to UK. He was giving me blues and a couple greens at 0.25 and I was also told you can’t look too far back but only what is happening now. So will holding a dose too long cause glucose toxicity to happen?
I am not sure on the glucose toxicity. I think that is what happened to Jones but then it doesn't look like. Heck I think with FD half the time we are guessing as the cat is not telling us their secrets.
Here is a link to what I read up on it...link. Not really sure/endorse all the methods mentioned but you will see that one method mentioned is to slowly increase the dose until you "break" the glass ceiling. Which is what you are doing!
Silver is getting better. That cycle yesterday looked like a normal cycle even if all yellow. Last night looked like it could of been a high flat pink (guessing here as I think his nadir is around +6/+7). Which may mean a high flat cycle before a drop. We will see how long he want's to hold the high flat pink cycle. Hopefully, he drops down further on that next normal looking cycle.
Notice all the qualifiers in those statements. It isn't black and white.
Thanks for the link. Will check it out!
Yeah. I figured that out already.
Gonna hold his dose until next curve and take a break from the board. If I’m holding dose then there’s no real reason for me to post daily. I’ll come back for dosing advise after a couple curves give more info and hopefully someone will have an idea at that point.
Thanks to all for the advice but I need to bow out for a bit. I am not thick skinned despite people telling me here that I should be.
just wanted to share something I have done to help with feeding. My George is a bit like your guy, he will eat everything you put down straight away. In a way it's a blessing knowing that they will eat when you need them too, but it did get tricky when I had to go out, I couldn't leave food out for him to graze.
Anyways an autofeeder was a lifesaver, especially when he started getting lower numbers, it gave me some freedom and peace of mind.
I know you have other kitties in the house so an auto feeder can be tricky, you can't be sure the right kitty is going to get the food, it wasn't an issue when George was on insulin because I only had one cat, but since his remission, George now has a little brother and a little sister, I want them to graze when they want but with George that wasn't possible, so what I have done is put a microchip cat door into a utility room, they have access to that and can eat when they need/want to, and George has his auto feeder dispensing his reglar 3 hourly meals (the kittens don't get a look in, George always makes it to the food bowl first).
If having a seperate feeding room for Silver is not an option have a look at this thread,
I Loved how Jane made Boo his own little restaurant, take a look at it in this post, it meant she could leave food in an autofeeder for Boo and her other kitties wouldn't get it, you wouldn't need to do anything as fancy, I've seen folk rig similar things up using a dog crate and a cat flap.
Hope to see you back soon.
Thank you for the suggestions.
You're welcome, don't be a stranger.
We'll miss you Juliet, but I can totally get how frustrating this is. I almost left for a while at the beginning when Neko was bouncing all over the place and it seemed like there was nothing I could do to get her in good numbers. Feline diabetes is harder on the caregiver than the cats I think.
Give Silver's cute face a few scritches from me. I hope he's otherwise doing well.
Ah there you are. I've been hanging about . Here's to Silver's numbers giving you both a good day. All paws crossed this end.
Don't be away too long missus.
Thank you for the encouragement. Maybe I’ll still post his numbers then. I needed this yesterday. I think I’d just had too much advice and just needed some understanding.
Thanks I like watching out for your posts too.
That would be kind. I would miss you and Silver otherwise.
Info overload is no fun at all. It gives a person mind ache , especially when under duress or over tired.
All that stuff will still be there for you to dip in and out of as needs be, so I suppose look on it all as a bit of a repository . Meanwhile. Do your thing your way , the best you can for the both of you.
I will see you when you post again. I will be looking.
I don't post much, but read lots to continue educating myself about current treatments. I just wanted to say that sometimes a dose can be adjusted by less than a full unit - half or even quarter.
My other thought about food - perhaps it could be placed in different areas of the house so it is harder for the cat/s to hoover it all at once. Also, adding water to wet food makes thm feel more full.
Back to my cave now!
Thanks - yes, on SLGS the increases are 0.25u at a time.
Sorry this made me giggle, my boy is lazy, but when I tried that he managed to sniff out the food in five minutes flat
Adding the water is a great suggestion, aside from making them fuller it helps keep our FD kitties hydrated.
I like this too and will try to remember this. Ty has turned into a vacuum hoover monster despite getting enough for his needs. He even tried to eat the duck's scraps and a knob on the side of the dishwasher door. Blimmin' diabetes.
He's losing so much weight no matter how much I feed him. He needs regulated so badly. I know I seem in a rush but he is wasting away before my eyes . Four day bounce by the looks of it...
Juliet, when I changed Bubba to more than 2 feedings a day, he started gaining back weight. Smaller frequent feedings are best for diabetic kitties. I know your work day is long so it would really help if you could use an auto feeder. I had to get 2 since I have another cat and I just started feeding my civvie cat the same schedule. I calculated what was the amount of calories needed by both cats and divide it into 6 times a day as that is what I feed them.
The smaller more frequent feedings would help you to be able to get more insulin into him while you are working. For instance, before you leave for work and you have a lower than normal number, instead of skipping the shot, you could give a little higher carb food and leave snacks in the feeder to open up every 3-4 hours or however often the preshot number warranted.
I'm sorry, Juliette, I know it's difficult to wait and watch.
I know you can't feed him more frequently, but can you feed him more at his meal times? It may help a bit until he can use the food better to increase his calories.
Ok, I have been reading and re-reading the posts in Silver's condo the past couple days and I want to throw something out there. I think Stephanie may have mentioned it but I am wondering something:
In October - Silver was on just 0.25u and I caught two nadir's below 90 and immediately reduced as per the SLGS method. So he was down to one drop. Then I got a whole bunch of reds and presumed this was a failed reduction but could that have been bouncing? I also have read on this forum that too much insulin can look the same as too little. Do you think he is getting too much. Based on what Jill said, I did not know where each dose was taking him and was basing it on a once a week curve, so perhaps he should not have got all those increases to our current 2u?
I am asking this because he is losing a lot of weight and appearance wise is worse than when he was in Oct. What, hypothetically, may be the result if I were to drop back to 0.5 and begin again? He hasn't had a blue now in almost a week and I am getting worried about him seeing no progress yet I was getting blues and greens on a much lower dose. If am totally wrong, I am quite prepared to hear that. I am also okay with holding the dose longer until I know more - but I am getting scared.
I have been doing just that - doubled his food, put water in it, I have taken the advice from the forum despite everyone thinking otherwise. But as I have also read on here, the more he eats it makes no difference - he is constantly hungry until regulated.
I think you missed the conversations we had about this. I can't use a feeder as I have two cats and the other is on a strict diet. I have only one open plan room so no-where to shut them in and I cannot afford microchipping feeders. I do give him an extra meal at bedtime so he gets three meals but I cannot leave food out. I know I know someone will be upset at me for this comment. I cant afford to buy different types of food, auto feeders etc...I have no money. I can barely afford to feed myself right now with Silver's supplies.
That's great that you're doing that. I don't think it makes no difference, it certainly has a bigger impact with lower numbers, but I'm sure it helps better than nothing. Asia packed on her lost weight since diagnosis in short order, she gained a little each month and even gained some of it when she was in mostly pinks, FWIW.
What was giving your greens on a lower dose was then and this is now. Their needs for insulin does change as insulin is a hormone and not a medication and their needs are constantly fluctuating.
As far as the feeders, I probably did miss the one about your special diet kitty. Is the special diet for calories or medical needs? .
I could be wrong here, recall I joined in September, but from what I understand going backwards like that rarely works out and will guarantee you see higher numbers for a lot longer while you inch back up the dosing ladder slowly. Regardless of if you skipped over a good dose back then or not, it's ancient history and you have been increasing in small increments, Silver will respond in time.
Ok I think I understand that. So ignore what was going Oct?
The other cat gets the same food - just I have to monitor how much she gets.
The issue is I cant afford to buy feeders that are microchipped.
I can't afford to have different types of food in the house - my budget is so tight there is no wiggle room whatsover for anything different. Even buying more food for him than usual is stretching me beyond my limits. Someone said on here that I needed to curtail social activities so I could get more testing in. LOL what social activities. There is no $ for that.
Ok.. I wont go back - but you know - if you look at his ss from the first time around - vet put him at 2u and he was at that for a few weeks before board here told
me to drop to 0.50 and when I did, he was OTJ in ten days so I guess sometimes it does work which is why I asked.
The immediates for right now are:
Dose wise - okay I will leave as is for a while, I have heard all the messages that I don't know enough to increase, but what about decreasing?
Food wise - I will increase his am and two pm feedings a bit further to TRY and get some more weight on him.
He is looking unwell - thin, fur in bad condition although he still plays and acts normally. That is the main worry. Seeing him wasting away, hence me pushing for regulation.
Could you put one cat in the bathroom so you know that the cat on the restrictive calories is only getting his/hers?
I dont have a bathroom - I have a tiny toilet that only has room for me to turn around in. I share the upstairs shower room with my landlady who is terrified of cats.
That does make it hard for you.
What’s the importance of several feedings? If I increase to three is that better? I doubled his food but still he’s losing.
The smaller frequent feedings help the pancreas to process the food better. And, it helps to feed the curve to help flatten out the cycle and keep them from going to low too fast. Have you seen the thread about feeding the curve? Lots of great info there. Scroll down to post # 15 where Jill gives a great example of manipulating the curve.
It doesn’t spike the next test if they’ve had food? I can do more frequent meals at the weekend but I thought it would taint the curve. From the tests I’ve caught so far I don’t think he’s going very low. Even when he’s hit blue and I’ve been able to test he’s been flat blue for 8 hrs.
I think it's a "know thy cat" and ECID thing. Asia doesn't seem to do much of a spike without really HC, her regular LC food just helps her surf but won't bring her up. There are other cats like @KATIE&ovie that get a decent bump from LC food from lower numbers.
It would be a worthwhile experiment on a weekend to see how Silver responds, BG wise, to the food you normally feed him within his cycle. Some people don't feed past nadir because food can halt the action of Lantus on the decline, but again, ECID.
Silver does tend to spike quite a bit after food. His + 2 is significantly higher.
And that is good info to have, but when is his onset? The beginning of +2 for many cats is just before or perhaps at the start of onset, your results will vary depending on when the old shot wears off and when the newer one kicks in and still further on in the cycle when going down towards nadir.
From what I’ve seen he starts to go down (I guess that’s onset?) at +3 and his nadir is around +6 or 7. That varies. His + 2 is significantly higher than preshot.
Juliet, you are not alone in this. If you need to step back then do. But I recommend for both you and Silver you stay. I too am horribly burdened by my life circumstances and a true utter lack of financial resources. But (like you lest you forget) I am a fighter and I love my babies and will fight tooth and nail for them. When i get overwhelmed i cry a lot and post Myagi's numbers - that's it. Then when I feel stronger I add comments and ask questions. We can only do what we can do, but quitting isn't really on the table. Myagi went down to 1 drop and I thought he was going to be a miracle baby and otj. Then he skyrocketed and wouldn't come down and I had to increase not once but twice. Then the other day his bounce took him over 400 where he hasn't been since dx. Believe me when i say the distress i posted wasn't an eighth of what i was feeling! But you just have to keep pushing through for the benefit of the beloved sugar cat. This dance is tough but at least for me, it wouldn't be possible without the help of this forum and the amazing people here who love our kids almost as much as we do! It's not a straight line to regulation or remission - look how long Chris and China have been dancing to reach their beautiful trial. It's a long haul dance and remember like someone said earlier in this thread - it's a hormone not a medicine; Silver's needs will constantly change. As will Myagi's. I intend to take a lot of deep breaths and follow his lead, while here at the forum getting awesome support. Hope you and Silver do the same!
I wish Juliet and Silver to stay even if we get on her nerves with all the mithering . I like her and think Silver is a beauty.
Juliet, if anyone could be upset with you over this they are not your friend. Money doesn't just "appear" to people who are trying their hardest to do the right thing. I know you're in a hard place right now so this is all I've got for you. Any chance you could grab a used dog training crate? Ours is big enough for a 50 lb. dog to stand up and move around in. Throw in a basket and a small litter box and Silver could, if you wanted, free feed. Nigel was going straight downhill when our vet said "Screw it, this isn't working. Feed him whatever he wants whenever he wants it". That broke a lot of rules but it did not break Nigel or our hearts. Nigel was Noah's brother and my GA.
What I see, the first time around, is he was started on 2u, dropped to 1u, and then taken back up to 1.5u and then 2u. He then started earning reductions until he went OTJ.
I’ve looked at his SS many times and again tonight. When you started increasing the dose in the fall, you were rarely seeing blues but as you’ve continued to systematically increase, more blue has come back. I’m just not seeing “overdose”
on his SS.
If he’s eating well but he’s losing weight and his coat looks bad, have you had him checked for hyperthyroidism? That can put his diabetes out of whack as well. The symptoms you’ve described don’t sound like diabetes in a cat receiving insulin and getting into blues. I have to wonder if something else is at play.
I hope you will not stop posting daily. You are part of the family here.
BTW, his US SS is a bit goofed up. Pls PM me if you’d like me to fix it for you.
Part of our family.
Sorry all, I know Lantus is the fast lane so I'll be as brief as I can.
@Juliet By now you know I'm not a good communicator. Everyone knows. I know saying "Try an enormous dog crate" is right up there with "Why don't you just move?" Nothing is ever that simple. Sometimes what was meant as an act of compassion looks either like pity or implying the obvious, that was not my intent. I know you're doing your best and it's obvious from your posts that you know what you're doing medically. Some men get older and can either be condescending or over protective and sometimes the two sound the same. We all want you to stay.
Hehe that’s why I politely didn’t answer re your idea. Good intentions though I know . Think we are all just doing the best we can.
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