1/26 Autumn amps -133

Okay for those that don't know us, Autumn and I have been doing this tango for coming on 3 years this coming March. But Autumn isn't a PZI kitty she is a Levemir kitty.

Now you are probably wondering why a Lev Kitty would be posting in PZI ISG? Well because after years and years of testing I've come to the conclusion that someone forgot to give Autumn the manual on how she is suppose to use a depot insulin..She believes that it is an In and Out like PZI. And that is how she dances.

So since she uses it like an In and Out and no matter how I try to spin depot insulin protocol rules, she refuses to obey the rules I got to thinking that maybe over here is actually where we need to be.

Here is what I know about Autumn, she is impossible to shoot low to stay low, if I shoot her below 250 she crashes, doesn't matter the dose, under 250 we are going to be having a pajama party.

She gives me an immediate response to dose changes, she just doesn't seem to develop a shed, and she has erratic cycle durations which also makes her impossible to consistently shoot the same dose every 12/12 of a standard depot insulin protocol.

She is approx. 18 years old and was adopted as a diabetic after being left completely untreated for 10+ months after she was diagnosed by her previous person. Which has made her a brittle diabetic and more than likely insulin dependent for life. Prior to coming to live with me, she has been shot in the face/neck/and shoulder and one of those B.B's pierced her thyroid causing her to have a sputtering thyroid which also effects how she uses insulin. Some days her thyroid is working and she uses it fine, other days it is low so she extends her cycle to almost 16 hours. So we kind of have the opposite problem to most In and Out's in that we don't run up against too short of a cycle but too long of one.

Because she doesn't seem to develop a the normal shed of a depot insulin and responses immediately to dose changes I'm thinking that she might benefit from me working with a protocol more fitting PZI than the standard Lantus/Levermir so that we can start eliminating the steep drops and sky high bounces.

Anyone up for the challenge?

Mel and The Fur Gang.

 

I'm always game; I finagle.

Have you tried Prozinc or PZI with her? Both come in a U-40 concentration, which could make micro-dosing easier.

And I have a feeling the erratic thyroid may be the culprit in the erratic responses.

 

Have tried BCP PZI and she went straight 500's and didn't move at all, haven't tried a U40 Prozinc, mainly because I just haven't felt like the fight with the vet's yet. Plus I have a pretty good supply line of free Lev thorough a human diabetic friend that saves me his leftovers for her. So that helps stretch what I buy for her from Canada. Three choices here with the Vet's are Vetsulin, NPH, and Lantus. Only reason I have a script for Lev is because I went rogue, switched her myself and then lied and told them when I adopted her that was the insulin she came with. But on Lantus she is a nightmare and vicious. She actually didn't do too bad on NPH just have to shoot T.I.D until she got down to where even a drop would take her from 300+ to lo.

And I'm pretty sure that her erratic thyroid is the culprit to the erratic responses. Because it does sputter on and off, they don't want her on thyroid meds, we tried them for awhile and she started swinging between hypo-T and Hyper-T and was one sick little girl. So since when she is low she is so borderline low, that treating the thyroid issue was doing more harm that good.

And well she is just plain ancient for a kitty. Like all of us as we advance in age, some stuff just doesn't function like it did when we were younger.

Mel and The Fur Gang

 

I-131 could knock the erratic thyroid out of the way, but I doubt I'd do it at her age, plus being diabetic. Had you looked into the possibility of diluting the Levemir?

 

We're game if you are, Mel. Interesting that BCP didn't budge her. Wonder why? Maybe because like NPH, it would need TID……. I am not sure ProZinc will be much better than PZI in terms of how it works. In "most" of the cats I have see BCP and ProZinc act a lot a like…even when cats switch.

Looks like the advantage of an in/out insulin would be, if she does drop low, you only have a few hours of panic before she should start up. At least that it is the why it works in most cats. I am thinking, like you, the thyroid is always going to be the stealth player in the mix and it may always make things messy.

 

I-131 is for HYPER-T, Autumn is naturally HYPO-T she only swings to HYPER-T if we give her thyroid meds to increase her thyroid production.

I have thought about diluting the Levemir but so far can't find a vet or a compounding pharmacy that is willing to try it. Not exactly working with the most up-to-date veterinary care here in the back waters of Nebraska. Heck it is a 200 mile drive just to find one with an ultrasound or dental x-ray machine.

Mel and The Fur Gang

 

Here is what I've been working with and so far it seems to be helping just need eyes to refine...Sliding scale with her since she responses instantly to dose changes and just chasing her numbers. She's easy to bring up but impossible to steer to keep the bounce at bay. But if I can catch her before she takes off, and shoot again I can drop her back down into normal range. Just so isn't how Lev is suppose to work I'm out of my depth.

Mel and The Fur Gang

 

I know what it is typically used for; I was thinking if you ablate the thyroid completely, it is removed from the equation, so no sputtering. And thryoidectomy surgery is too tricky on an elderly cat, even if it could get all the thyroid.

 

True but again finding someone capable of doing the I-131 and the having her radioactive around the rest of the Fur Gang might not be a good option either. Since she is a social eater and loses her mind if caged. She won't share a dish, but won't eat either if she is isolated from Hazy and Mariposa. When I had to cage her after her emergency dental surgery she flung herself at the bars and screamed like she was being killed until I released her. She becomes frantic when confined unless she has a buddy with her. (severe abandonment problems)

Mel and The Fur Gang

 

Hey Mel! Good to see you!! I don't know if I can add any wisdom here...I don't have any experience with thyroid issues. BUT...I'll chime in if I feel I have anything to add! Either way, it's nice to have you here!

 

Hi Mel,
I have been in PZI for 3 years however I've read post all over the board so I feel like I know you already. In fact, I loved reading your post so much that I'd swing over just to read them.
I hope that some of those wonderful coffee concoctions will be made for all your new friends in PZI???? (hint hint hint)
Welcome

 

Thanks Ladies,

I guess what I'm kind of suggesting since Autumn doesn't seem to know she is on a depot insulin is to just forget that she is in fact on Levemir and treat her and her spreadsheet when you look at it as if she was PZI girl, because that is what she seems to think she is using...lol

After the dismal failure of switching insulins with her, sticking to Levemir which agrees with her across the board is what I would like to do, but I have to learn how to forget the rules of a depot insulin and treat her like she is on an In and Out. Just with a very long duration, most of the time, although at times she will pull a short cycle as well.

This weekend even with the chaos mom was in, (God I hate tax season) she had a fantastic weekend but I am finding that I have to slide her dosing scale based on what she hands me for preshots, and I have to catch her and shoot when she starts making a run for the moon. That is further complicated because she is already a micro-dose girl.

Just for point of reference. What I'm calling a 0.10 is with the base of the plunger just kissing the top of the zero line, so it is just the insulin in the needle and the hub of the syringe. Now after much practice, I can get 5 drops out of the 0.10 before it is down to just depressing the plunger as hard as possible, inserting it in the cartridge and letting the plunger flex back into place to get a consistent 'drop' so if my math is correct that makes her 0.08 one drop twisted out after drawing to what I'm calling 0.10. What the actual dose is I have no clue put for sake of reference with you all and her vet I had to find something to name it. Because Dr. Linda just wasn't computing 1 drop, 2 drops, Fat Zero etc. lol

Right now if I'm understanding how to work a sliding scale correctly, and working with both preshot value and nadir, she looking really good, if below 200 I shoot 0.08, and 200+ the full 0.10 She's still giving some bouncing when she hits green but nothing like she was, where she would either crash into the 30's or lower and not rebounding clear up into the 400's +.

Mel and The Fur Gang

 

Well we'll do what we can to help you out Mel! Gotta do what the kitty needs after all!

I like your sliding scale. I think it's sensible. Those micro doses though...I'm impressed! I can imagine my vet's reaction if I told her "well I gave 2 drops less today..."

 

lol thanks Yeah, Autumn has taught me to be a Master of the Micro-dose. And she is still working on refining my skills as she threw me a new curve this morning by handing me an amps of 96! So adding another level to our sliding scale of 0.06u for under 100 preshots

I actually wish one of the U40 insulins would work for her as these itty bitty doses are hard on the eyes and the nerves.

But if anyone needs help learning to micro-dose just yell and I'll share what I did to learn to do it the best I can in a written medium. It takes a lot of practice, swear words and tears. But it is possible to consistently shoot teeny tiny doses if you are determined enough to put in the work.

Now for anyone wondering why not an OTJ trial, because we have tried and failed about 6 times over the last 8 months, if I take her completely off, she zooms right back into the 400's and stays there. So micro-dosing it is for now, until she just walks herself off.

Mel and The Fur Gang

 

Mel
I searched the forum for Levemir and dilution and found a few older posts. Apparently, because alev doesn't crystalize subcutaneously the way Lantus does, it has been successfully diluted in small quantities, with any excess tossed. Lev binds to proteins, so a diluent isn't likely to change that.
You can get sterile water or saline online, if you're inclined to test it.