1/4...Elmo update

Hello to all..miss our daily posts and wanted to update u all on Mr Elmo( aka Buddah Kitthe) ...Still waiting on Lantus. It is now in the hands of US customs but is scheduled for arrival Friday. My buddies at our post office are watching for it and will put in frig and call me immediately. Love my small town Post Office . I purchased a FS freedom lite ( cos of AT familiarity) and have been practicing with it, taking backup BGs to get at ease with the lower numbers. I know you all told me there is greater difference at high numbers and get closer as BGs go lower...today his AT BG at +3 was 112 and FS was 72. Am getting ready to call vet to see if they carry ulticare 100 with half unit markings and have them show me where the .25 mark is. My old eyes need all the help they can get( thats from too much reading and cross stitching, so says my sage 94 year old momma, Millie).
Wanted to ask you all if there is anything you believe important?relevant ab Elmo to date that I would need to point out to folks on LL forum. You have been with us thru these last few months and know him very well so I would love to hear if there is anything I need to be passing along . I have poured over the LL Stickies, taken notes and am getting ready to post my questions there later today. Can feel your support and love all the way down here in the Ozarks hills and hollers(Kris) ...means more than i could ever express. You are in this with Elmo and I and no kitty could ask for better godmommas. Praying you and yours are fit and well . ANd a btw, if Canada would quit hogging the snow we might get more than a forecast of flurries( flurrieS??!!! Flurries!?!). Also am so blessed to know Chris and China are there for us on LL ...this could all not be any better.
Again, please keep an eye on Elmo's SS and let me know of any insight ab him u might have to pass along.
@Critter Mom
@Kris & Teasel
@MrWorfMen's Mom

 

Was that 66 on the Alphatrak, Beth? If yes, that signals a dose reduction is needed.

Sorry I can't write more; I'm really unwell.




Mogs
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Sorry about the run on paragraph...did indentions and felt so techy....will do better next time...

oh , Mogs....please take care of yourself ! And no , it was AT. 112 and FS 72.....Elmo is doing well and we r praying for u to be well and restored ASAP

 

Also, what syringes do you all use...got some Relion u 100 but not liking the movement after using the ulticare vet Rx so ordered some from ADW and waiting on them as well. Even my new good vet doesn't carry them ,even after agreeing that Elmo needed to start Lantus with same .25 as Vetsulin. Ah well, it will all come together as planned. So please tell me which syringes u prefer and where to get them . Thanks and hugs

 

There isn't any .25U mark.....the best we can do is half unit....after that we either have to eyeball it or use calipers to get those "in between" doses

 

Are you "priming" the syringe first? There's lubricant inside the syringe so you should pull the plunger in/out a few times before you use it to spread it around and help with the "stickiness"

 

Re syringes: I doubt whether most vets even think of dosing between the lines on the U100 syringes and that's what you'll have to do to get 0.25 u. I have had 3 different kinds of syringes - Monoject (from vet), Ulticare (from human pharmacy) and now am using Elimedical brand from my vet. I have no strong opinions on syringes. All three of these cost me the same - $25 CAD for a box of 100. I was fine using all of them.

I'm sure I've told you that I use Freestyle Lite strips in my AT meter. They give a reading much closer (generally only 3 - 7% difference) to what the AT strips give using them that way as opposed to putting the FS strips in the FS Lite meter.

Yes, we're hogging the snow here, Beth.

 

Thanks Chris....soooooo looking forward to you walking me thru this. Went to Bradford Park Vet in Spgfld last week and they don't carry half marking syringes. Prescribe .25, yep....have syringes with half marking, nope. Got some Relion but am so use to ulticare I feel awkward with any other but will hang onto them for now. Have been eyeballing .25 on u40 for weeks now so it's no biggie but it would be if not for half marking. Btw, how is your momma? Gotta go up to St Louis and take mine for doc appointment later this month . She still drives(not much) but is very hard of hearing ....she is a hot mess !!! Thanks for checking in on us....I have a million questions from reading the Lantus Stickies that I will post, few at a time, on LL forum. So glad you are a Lantus Lady !!! Makes me feel so much more at peace at this switch

 

Yep, I primed...just bit stiffer movement than ulticare which at times can be too sensitive to movement...I'll experiment with both ....have old bottle of vetsulin I'm messing around with...such is my exciting life here in Big Buffalo

 

Thanks,Kris....as usual my overthinking MO concerning syringes is in full play as I wait for Lantus...I am pondering the attributes of syringes WAY too much as I run out my back door periodically screaming at a sparrow hawk trying to get my songbirds ! What must the neighbors think ???? Ha, they are sadly use to it

 

My personal approach is always what I call the "middle way". There are SO many variables in the FD dance - insulin absorption location to location and day to day, minor variations in injection technique, invisible fluctuations in kitty's physiology moment by moment, etc., etc., etc. Against that backdrop I try not to get fussed by slight variations in syringes, syringe mechanics and so on. I do my best to be as consistent as I can in measuring out doses but beyond that I don't worry too much. I can't possibly control every variable so I don't try.

 

Vet tech just called, seeing if I had started my two week OTJ trial yet ... I said no but would get back with them soon.... they restated they would much rather have me remove Elmo from insulin for two weeks then do a curve and go from there....not supportive of what I'm getting ready to do but didn't discuss it with them. Are they afraid of people letting their cats hypo ??? Elmo is very sensitive to meds ....still planning on going with .25 ( maybe minus a drop like vetsulin??) ....thots ????

 

Amen...gotta shoot ur best and go ...

 

Hmmmm .... I don't think I'd want my kitty off insulin for 2 weeks especially since there's been a DKA episode. Having said that, Elmo's numbers have been good. Maybe you could experiment with taking him off for a few cycles to see what happens and if there's the slightest trend upwards in his numbers put him right back on.

 

What about the 66 at PM+2 on 3 January in the spreadsheet, Beth?

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Hmmmm....just read over my notes from vet visit and what he advised was :
1. Stop insulin for two weeks
2. Do an every 2 hour curve
3. If ( after two week trial) BG above 350,restart insulin with 1/2 u 2x a day Lantus ..if below 350, 1/4 u 2x a day
Not so sure about this dude now

 

Yep, that was a shocker...came back up very easily...may have given full .25 without minus a small drop...

 

Actually, this is a decent methodical plan: 2 weeks off to see if Elmo holds his good numbers then two different restart doses depending on the BG drift. You could still try leaving him without insulin for 2 or 3 cycles to assess step 1 of the plan.

 

The dose needs to be reduced, Beth. 66 is under the limit on an Alphatrak.

Be extra cautious; Elmo's BGs are improving very quickly now. Double digit BGs on Vetsulin - especially when measured on an Alphatrak - are uncomfortably low.

Can't type the positive thoughts I have - don't want to jinx anything ...

(((Beth and the Buddha Kitteh)))


Mogs
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If starting on Lantus I wouldn't give any more than 0.25IU as a starting dose; you need to take into account the Vetsulin history.


Mogs
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Also, if numbers started to drift up during the OTJ trial I would not wait for 2 weeks to restart insulin treatment.


Mogs
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I see where I got vet endorsement of .25 unit...it was from what would need to be done after trial OTJ and referring to possible BGs at that time

 

I'm not a fan of that 2 week idea of his....Mogs, ur thots on trying him off insulin for a few days? Or go straight to Lantus at .25 when it arrives ???

 

What about the yellows ???

 

Not sure what Mogs would say, Beth, but I think you could try 2 or 3 cycles off insulin to see how he responds.

 

The odd yellow during a no insulin trial wouldn't be any different than what you see now. If you start seeing more yellows then you know that he still needs a small dose.

 

Bless his heart, he doesn't stay low for long...careens right back up...just got a +7...179 after a + 3 of 110.... feel ya'll what, Ole Buddha Kitteh is aging me quick and it ain't pretty

 

Whatever the BGs were, I still would not start Lantus any higher than 0.25IU (based on Elmo's spreadsheet data and response to Vetsulin).

Slight rebound from the quick drops early in the cycle on the Vetsulin. Look at how easily the current dose will pull down a yellow preshot as well as a blue one.

BTW - if your vet starts saying that Lantus should be dosed on the preshot BG that is categorically incorrect; Lantus dose adjustments are based on the nadir BG.


Mogs
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Yep, I think Mogs had gone thru similar with Saoirse...and I believe in ECID but Elmo and Saoirse's journeys are similar in so many ways ....

 

God bless vets for the knowledge they have and I am proud of his prescribing Lantus but he sure is not a fan of micro doses...thinks at that point let an OTJ trial rip and see what happens

 

With Lantus the curve should get much, much smoother.

Re skipping a day or two you might lose momentum - or Elmo may coast down into lower numbers without insulin assistance. Ask for input on this from the experienced members on L&L.

ETA - spending a little longer on insulin may promote further healing of the beta cells.

Empirical evidence here shows a slow taper off insulin makes for a more solid remission. (Some OTJ trials fail if the dose is dropped from 0.25 straight to zero. With Vetsulin the taper's nigh on impossible but it's fairly straightforward on Lantus. Technically after that 66 yesterday the dose of Vetsulin should have been reduced to zero.)

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Saoirse's first OTJ trial didn't hold because I didn't do the taper on that occasion.

I tapered the dose down to 1 drop and then did the second OTJ trial (successful).

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With adequate monitoring Lantus doses can be ramped up fairly quickly under TRP if the starting dose is insufficient for a cat's needs.

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I don't think Elmo is ready for an OTJ trial just yet

We like to see at least a week in mostly normal numbers (50-120 or 68-about 150 on AT) before starting an OTJ trial

Our goal is a strong remission.....not a fast one, so we want to keep them on insulin as long as possible to give their pancreas the extra support time

 

Chris, you have seen Elmo's sensitivity to slight insulin variations ( like last night I possibly gave a .25 without minusing a small drop and he dropped like a rock at Lake of the Ozarks...in a quiet cove , of course)...with that in mind and ur extensive experience with Lantus, what would u think his starting L dose would be ??? I'm gathering all info now so ready for when it gets here .

 

AND he is now on a full 2.5 mg methimazole for thyroid 2x daily, up from 3/4 of a pill twice daily last week.....may be kicking in and starting to affect BG values ....

 

Agree.

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......once again, to you all, I shudder to think where Elmo and I would be if not for those of you who care for him as if he were your own...makes my heart about burst

 

I'm wary of the dips you're seeing in BG now, Beth - especially with another hormonal treatment in the mix. Safety is everything. If it becomes unsafe to give any Vetsulin (and I think it is very much getting that way) if it were my cat I would stop it and wait for the Lantus to arrive before giving any more insulin.

Other members may have a different view.


Mogs
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Maybe go with .25 minus large drop tonight and see where we go ??? And you know me, monitoring is my life as well as middle name

 

Messages crossed mid pond !!

 

If I were to give anything at all it would be a single drop.

 

Mogs, right now that would be for at least two days...Lantus has gotten hung up cos, like a doofus, I ordered during the holidays...tracking says is in US customs and here on Friday the 6th....if it doesn't come I may have to bite the bullet and go buy one pen to get me by til it arrives...

 

I think starting at .25 is a good place ....you have to remember that lantus is a gentler insulin for most cats......we're all hoping it helps to stop those fast, steep drops

If that worries you, there's no reason you can't start lower....let Elmo's numbers be our guide

His BG tells us what to do

 

Oppps.....just checked and tracking says it's been delivered to my Post Office...going to run there and check !!! Be right back !!!

 

I'd rather have a safe cat running a little higher for a day or two.

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Yeah!!!! Yippeee!!! Yahoooo!!!!! Just picked Lantus up from post office and put in our frig !!!

 

Ha ! As an aside...just stuck the spoon under Elmo's bum for urine sample and when I poured spoon out behind him in litter box he literally looked over his shoulder at it then looked up at me as if to say " what , in the world are you doing , Mom ???"

 

Chris, going to need ur guidance as to how to draw the .25 on the Relion syringe...going to watch the video on Sticky...I will probably wait til tomorrow morning to start rather than overnight...have many questions I will,post on LL .... will need to get new SS set up and get signature changed too....btw, my son helped me with the coloring in of the squares and texts on SS....haven't had to stack yet but showed me how to do that as well....a real computer whiz , that's what I'm becoming

 

Mogs, Kris, Linda...will keep you posted . Chris , I will start a thread on LL forum with some of my first questions after doing errands tonight....my plan is to skip vetsulin all together tonight and start Lantus tomorrow A.M.....is that a good plan ??? Skipping the vetsulin???

 

Elmo has gone low on the last 2 PM cycles. Skipping gets my vote.

 

Oh Wow! All this excitement! Lantus has arrived and you and Elmo get to start on the next part of your journey. YEAH! Your little darling is definitely on a mission Beth and I am looking forward to seeing his progress from here. I'm with Mogs about Vetsulin tonight. I'd be careful after that 66 last night. I'd be inclined to skip and see what he does. I don't think it's worth/safe trying to skinny up the dose anymore. Missing one shot isn't going to hurt and he is obviously effected by tiny dose changes.

Oh this is sooooo exciting! I will be keeping an eye on you!

 

Skipping gets my vote tonight too

 

There's no big trick to it.....you just have to try to keep it as consistent as possible

Here's what .25 looks like


That first long line nearest the hub is the Zero line....the smallest line next is the .5 line.....You want the "top" of the plunger head in between the zero and the .5 line

 

I have noticed the U100 syringes from Relion have the same issue. Even with the lubrication in them, they just don't move as smoothly as the U-40s I had. It will just take some getting used to and a good hand. I figure I'm just going to be wasting insulin and maybe some syringes during the learning curve.

 

Hey Jo !!! So good to hear from u !!! You r amazing handling work and Ozzy, truly amazing !! We just have to do this a day at a time !!!

 

.....exciting and a tiny bit scary....can hear u all say" first, breathe !!!"

 

Chris, thank u so much for the guidance...the .25 is so close to nothing , at least as it appears to my old eyes...going to go watch the video and will have more questions i am sure

 

Mogs, please take care! I don't know what is wrong but please take care of yourself!

 

Oh boy, I hear you , Jo...I'm standing in my kitchen right now, practicing with u 100s and expired vetsulin...my life is way too exciting for me at this point.

 

Yes, excitement is over rated.

 

Chris, how the heck would I start lower than " top of plunger head in between zero and .5 ??? I know it's done...I know u know how to do it but for me, at this point, that sounds beyond imagining

 

Practice in U100 syringe with coloured water Beth.

 

Hey Kris and Linda ....we r under a winter storm advisory !!! Perfect way to top off my day....except it's only 1-3 inches but I shall be thankful !!!!

 

Enjoy, Beth! I'm sick of snow and winter already.

 

Thanks for reminder, Kris.....still it's a teeny weeny space...you all are rocket scientists crossed with chemists to know/understand this stuff

Kris, u know I'd take it off ur hands if I could...Even I can see how it could get monotonous.

 

Do you have a magnifying glass at home? I know Mogs mentioned a jeweller's loupe.

 

Same way you were doing it before...drawing up the dose and then carefully squeezing out a small drop!

What you can do when you're practicing is to draw up a "known dose" of something like water or colored fluid....then practice twisting gently to produce a drop at the end of the syringe....try to make the drops the same size.....then count the number of drops you get in 1U

If you get 12 drops, then .25 would be 4 drops....if you wanted a dose less, you'd expel one more drop for a 3 drop dose

 

I have a pair of reading glasses from WalMart that help (about $5)

 

Out of habit took PMPS BG with FS meter...BG ..128

 

Jewellers' loupes:

https://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias=aps&field-keywords=jeweller's loupe

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Ha! I have strong bifocals and ordered one of those jeweler magnifiers to help.... with u 40s it's not as small an area to eyeball...u100s make that look easy.

 

Better to stick with the Alphatrak tonight, Beth so you can compare how he does with the skipped dose compared to the 0.25-drop dose of Vetsulin. (If you change meters you won't get a valid comparison.)

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Mogs, at ur suggestion I ordered one..should be here in a few days

 

Thanks Mogs...will do next checks on AT...he has just eaten..should I grab a quick measure with AT ??

 

Just grabbed a post eat AT BG..197

 

Not much food influence there, Beth.

 

Ordered the loupe and is coming tomorrow , Kris. Your words on doing best u can and don't dwell on the small stuff is resonating in me....thank u for wisdom

 

Mogs, my plan is to test tonight as tho I've given insulin to have comparison ....he has been eating well and gaining weight...gotta watch that so he doesn't get chubby

 

The "middle way" promotes sanity, Beth.

 

Couldn't be anything else with the Buddha Kitteh!

 

@Chris & China .....hey Chris, I have several crazy switching questions...should I post them here or on Lantus ...don't want to clog things up over there with my overly detailed questioning when people r needing dose advice

 

I'd start posting on the Lantus forum

We post daily there with the subject line with the Date/Cats name/AMPS ##....then as the day goes on when you get new tests, you edit the subject line and add them. Use the ? prefix if your post contains a question (or 6) and when your question(s) are answered, remove the ? icon

Put the link to the prior post into the body and then give your "report" for the day and ask your questions!!

 

One thing I do need info on before tomorrow morning is feeding and when to test BGs ....Elmo's day begins with PMPS at 6:30 , eats for 30 minutes then gets his insulin at 7......does that change with Lantus as far as timing ? As far as BGs I read for first few days to take a +3, + 6 and +9.... is that correct ( Elmo's BG schedule has been at +1.5, +3 and maybe one later in cycle) ......also, Elmo tends to eat most of his meal in first 10-15 minutes, maybe comes back in 30 minutes or so then sleeps rest of afternoon. Read on Sticky that they need to eat several small meals thru out the day....is there flexibility to that ??? That was the stuff most wondered about for tomorrow a.m......thanks in advance for all your help, Chris. Hope ur momma is better...as a fellow daughter I totally relate.

 

@Chris & China

 

With Lantus, it's not as important that they eat before the shot....as long as they're willing to eat, it usually doesn't "kick in" for 2-3 hours, so most of us Test/Feed/Shoot, all in 5-10 minutes

You want to Test (to make sure he's high enough), Feed (to make sure he's not sick and at least willing to eat) and Shoot....most of us shoot while their head is in the food bowl

Now for the first 5-7 days, you're going to be "filling the depot", so you may not see the full impact of the dose until the depot is full (although some cats will respond on their 1st shot)...Think of the depot like a "timed release" medication.....out of each shot, a little goes to work now and the rest goes "in the depot" and is released slowly over the rest of the cycle....but until the depot is full, it won't release the amount of insulin equal to the dose (does that make sense?)

ECID, but we've seen a lot of times when the +2 can act like a crystal ball as to where they're going later.

If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....with a gradual decrease in numbers to the nadir and then gradually back up to the next PS

If the +2 is higher than the PS, that can be an indication that you're starting a bounce and those are the cycles where it's probably safe to take a pokey break

If the +2 is lower than the PS, that's your early warning that he might be going a lot lower later in the cycle, so those are the cycles you want to get more tests in

Now in some cats, the +3 is a better indicator.....testing will help to nail down which one Elmo is though

Plan on sprinkling tests in different point throughout the cycle....one day do +3,+6,+9, another day do +2,+5,+8....etc.....if you see a big blank white space on your spreadsheet, that's a good time to grab a test!!

Most of us feed mini-meals but this is another one of those ECID things.....some cats do fine getting small meals throughout the cycle (up to +10 anyway...you want to take food up after that) and some cats do better if they don't get much in the way of food after they nadir (it can "slam the brakes" on the insulin since it's already starting to wear off after nadir)....little pure protein snacks are OK if small meals cause problems after nadir (like baked chicken)

 

Beth- did you see Marge's advice on how to dose with calipers. Talk about scientific!! When I get on my laptop, I will send you the link.

 

Here's the Dosing with Calipers information

 

Ok Beth- I officially hate these new syringes! Stabbed myself in the finger after putting the cap back on after dosing Ozzy. Damn thing pierced straight through the lid and poked me in finger! Bleeding like crazy! And OUCH!!! Poor kitties!!

 

Thanks Chris!!

 

oh, Jo.. i am crying and laughing all at once........which syringe is it ??

 

Relion U100s with half unit markings. Little shiters!! Lol!!

 

i

......oh my gosh, u have me belly laughing ...it's so sad and wonderful all rolled into one that I share ur pain !!! Long as we keep our sense of humor we and our kitties are gonna make it

 

Those r what I have too...and I'm trying to draw a .25 dose.....Chris is so patient and explains so clearly...thanks Chris

 

Chris is wonderful!!!! We are SO lucky to have such amazing support and guidance here!! xoxo

 

Oh, Jo, where would we be without them ...I shudder to think...Chris is the first person I had contact with here(and Linda, Mr Worfmens mom) and she was up with me til wee hours of the morning getting Elmo thru his first and worse hypo...saved his life

Yah, my brain can officially NOT take that info in tonight

 

Just logged online on my laptop (been reading from my mobile) and saw THIS!!! Ya! So exciting! I can't wait to see little Elmo's progress on his new journey! So excited for you both!!!! Congrats!!

 

Wow!!!! I truly believe the advice I received here saved my kitty's life, too! We were told to start Ozzy on 2U and we never gave him that much due to folks here advising against us starting at such a high dose of VESTULIN. As you know with vestulin, it causes rapid drastic drops in BG. And I went back to work the first week where I could not monitor Ozzy......could you even imagine if I had been consistently giving him the 2u dose???!!! I shudder to think!!!

I hear you...I read that thread and it was a lot to take in....Not that I don't think I could do dosing with calipers if I decide to later on...but it's just a lot for that much precision.

My last day off before work, I literally spent the ENTIRE day reading Lantus stickies..... So sad, I need a life! Hahah!