1/9 Buzz-PMPS 112-help please!

Discussion in 'Lantus / Levemir / Biosimilars' started by Sarah and Buzz, Jan 9, 2010.

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  1. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Buzz got her first dose of Lantus this morning (1u). We will see how she does today. :)

    ETA: link to Health post regarding Buzz's bloodwork results from yesterday (Friday 1/7):
    viewtopic.php?f=3&t=1929
     
  2. Pat+Raja+Shadow (GA)

    Pat+Raja+Shadow (GA) Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    Hoping all goes well on your first day of Lantus!!! Keep watch cause ya never know!
    Hope you enjoy Lantus... (kinda knowing you will... ;-) )
    Good girl Buzz....keep us posted, k? :D
     
  3. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Re: 1/9 Buzz-AMPS 367

    Glad you're starting Lantus, and I think you'll be glad too. :smile:

    I haven't been around as much as usual the last few days, so I apologize if you've already explained this. I see that Buzz had a vet appt. yesterday, did they find any reason yet for the numbers to have gone up like this?

    Wouldn't hurt to get a spot check or two today. Most cats take several days to respond well to Lantus, but some do like to surprise us by getting some action on the first shot.

    Welcome to LL!
     
  4. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    Yep, I was planning to get in a +5 and +7 if possible, in addition of course to the PSs. When does Lantus typically peak, do you know?
     
  5. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    Thanks for the welcome. :)

    They did not find any infection in either her urine or her blood, so there seems to be no reason for her high #s. I am planning on getting in a +5 and +7 to see how it's doing for her. :) I am a bit of a testaholic, it must be said.
     
  6. Ronnie & Luna

    Ronnie & Luna Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    I like testaholics :lol:

    Welcome Sarah and Buzz kitty!

    Glad you made it into your brand new first condo in Lantus Land!

    (I like everyone else too lol!)
     
  7. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    +4.5: 166

    I would say she got some action on that shot. :)

    Is this how I update her numbers throughout the day, or am I not supposed to do that? Or do I just put them in my SS?
     
  8. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    Hey Sarah! :smile:

    That's a good drop for the first shot. Sometimes you see action on the first dose and then nothing until the shed has been filled. Do not be alarmed if that happens.

    I would get a +6 to see where Buzz is headed. Updating both here and on SS is great.

    I just looked at the blood work. Did you talk to the vet about Chronic Kidney Disease? You may want to check out Tanya's CRF site: http://www.felinecrf.org/

    It can be possible for those numbers to be elevated due to infection, but a urinalysis and culture & sensitivity would have to be done to rule that out, with the urine drawn by cystocentesis (the only way to get a sterile specimen). Was urine drawn, and if so, was there a USG (urine specific gravity)?

    ETA: Just read the condo better and see the notes about urine..... ;-) Was there a USG then?
     
  9. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    I will definitely get a +6. Thanks for letting me know that I might not see another drop for a couple of days. I know I would have worried about that. ;)

    I don't know if there was a USG. She came back right away with the results (like within 5 minutes) so if that's something that takes awhile, then no. They sent the BW out but did the urinalysis in-office.
     
  10. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    USG is part of a urinalysis and can be done in-house.

    Was her potassium level okay? Calcium? HCT?

    I agree with Larry on your other thread about needing to talk to the vet about phos binders. Usually binders are started when the phos level reaches 6. It is also a good idea to start looking for lower phos food. What kind of food is she eating now?

    Has she had a dental done lately? Dental infections, or even just needing a cleaning, can cause BG elevations. Dental infections will not always show in blood work, and it is difficult to get a really good look into a mouth without sedation.

    Testaholics fit in around these parts just fine. ;-)

    Make sure you continue to test for ketones at home too when you can, especially until she gets to the right dose.
     
  11. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    I missed Larry's response on the other thread; I will go back and check. I would be totally lost if it weren't for the "view your posts" function on this new board! Way too much to keep track of. ;)

    Her potassium was 4.6 (ref: 3.4-5.6), Calcium was 9.3 (8.2-10.8) and HCT was 33 (29-48).

    She has never had a dental. I mentioned teeth to the vet while I was there, and she said that if there were an infection in her mouth, it would show on the BW. Apparently not necessarily true, huh?

    She is eating Wellness and has been since dx (5 months ago). We normally feed Beef and Chicken, but also feed Turkey flavor as well as Chicken. All 3 are grain-free. The 2 civvies get gluten-free FF (Liver and Chicken or Turkey and Giblets). Buzz does sometimes eat some of their food, but since it's all LC, I don't worry about it.

    Thank you for your help. :)
     
  12. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    Nice to see the potassium, calcium, and HCT all look good. :smile:

    No, dental infections will not always show on blood work. There doesn't even have to be an infection for bad teeth to elevate BGs. Inflammation will do it too, and also may not show up unless sedated.

    Great food choices already, which is nice. All of the Wellness are low in phos, so that's one thing you won't have to switch. The FF is much higher in phos than the Wellness. You may want to check out Tanya's Phosphorus Binders section before you speak to the vet about adding binders. Don't want to wait too long on them though if it is CKD causing these elevations, because phos levels are directly linked to renal disease progression.

    I know the renal issues can be slightly overwhelming (if that's what is causing these elevations - not sure if you have had a kitty with CKD before or not), but they are also very manageable. Lots of people here have kitties that are both diabetic and have CRI/CKD, and once you get used to the terminology and treatments everything will start falling into place.

    How is Buzz feeling overall? Did the vet mention starting fluid therapy?
     
  13. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    You are so helpful, thank you so much! :) I really appreciate, as always, the time everyone here puts into helping others. It really makes you feel good about humanity.

    I am so glad that Wellness is low in phos! I was already stressing over having to find another food, and I really don't have many issues compared to some people here. Sooo, yay! :) I was feeding all 3 kitties Wellness for a long time, but just recently (within the past month) I switched the civvies to FF because they weren't eating Wellness anymore. I do still try to mix some Wellness in there, just because I feel Wellness has better ingredients. Is a lower-phosphorous diet recommended for most kitties? In other words, do I need to worry about the other 2 eating the FF? I have not gotten recent BW on the 2 civvies because I haven't had a spare $200, unfortunately, so I do not know if they have any elevated values or not.

    I have not had a kitty with CKD before. In fact, these are my first kitties ever, and Buzz is the first pet with an illness that I've had to deal with (save Cassie's mast cell tumor a few years ago). I have been fortunate. I am the kind of person who is overwhelmed by most new (stressful) issues, but once I get a handle on them, I am fine. It's the not knowing, the feeling of powerlessness, that gets me stressed, not so much the thing itself (although that can certainly be a contributing factor ;) ).

    Because it is the weekend, we got a bag of subQ fluids (along with needles etc) to have on hand in case Buzz won't eat or drink. With the switch to canned food, she rarely drinks anymore. We have been giving her the water from canned chicken and she has been drinking that, and her appetite is back today. She is back to acting normally today, which is a relief. I have never done subQ fluids either, but the vet gave my fiance an explanation, and I know that there are people here who can advise me on the procedure, should it become necessary. The vet said not to give more than 50 mL at a time, no more than every 8 hours (so 3 times a day total, for 150 mL overall). Is this accurate?
     
  14. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    +6: 113

    Hmmm, apparently the new board does not let you do a *NM*. It told me my message contains too few characters.
     
  15. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Re: 1/9 Buzz-AMPS 367

    I wouldn't worry as much about phos values in a kitty that doesn't have renal disease. Yes, trying to stay lower in phos isn't a bad thing, but mainly because then if you do have a kitty that develops CKD you don't have to change the food out where there is already so much going on. My civvie Sweetie, who is 3 years old, eats a variety of food including FF, and I do not worry about phos levels with her. Sasha, on the other hand, who does have renal insufficiency, eats only low phos food. I've not had to add a binder in for her yet, but her phos level has never crossed the 6 threshold either.

    I am very much the same way. I more or less got a crash course over the last couple of years with Sasha being diagnosed with things left and right. Out of the possibilities, though, diabetes and renal disease are some of the better things to have to deal with, IMHO. The learning curves are steep, but once you read everything you'll be fine (Tanya's CRF site being one of the absolute most important and informative about every aspect). Plus, there are so many people here on FDMB to turn to also for tips, tricks, and advice.


    So happy to hear she is starting to act better today!

    Oral fluids are very important too. Does she have a drinking fountain? It's a good way to encourage more oral fluids, as well as adding as much water as she will tolerate to her food.

    Lots of people here to walk you through SQ fluids, as well as videos and this Fluid Therapy section of the Feline CRF site.

    First off, it is great that your vet even suggested giving in small amounts often rather than once or twice a week. She gets kudos for that! :D Many people that give 150ml per day split into BID dosing, so 75ml per session. Depends on what works for you.

    The Fluid Therapy section has lots of great suggestions for needle brands that are best (most people prefer Terumo) and how to Obtain Supplies Cheaply. Needle size and brand can make a big difference on how well the fluid therapy is received by Buzz. She's always sounded like a pretty laid back kitty to me, so just stay calm (first time is the hardest, but it gets much easier after that) and you'll both be fine.

    (((((((((((((((((Sarah))))))))))))))))))) <---Just because :mrgreen:
     
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Re: 1/9 Buzz-AMPS 367

    There are several folks here who give sub-Q fluids routinely. Carolyn & Latte immediately come to mind. You could PM her. Cassandra is a wealth of information and has been here longer than I and will be able to suggest the names of others who are pros at administering sub-Qs. I'd also suggest taking a look on YouTube -- there are videos of everything, these days!
     
  17. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Changed subject line of OP, not sure if that's right.

    PMPS is 112. Don't know what to shoot. Please advise. :)
     
  18. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Don't feed. Test again in 30 minutes. Sound good?
     
  19. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    We just want to establish a clear rise this time before you shoot, until you have collected more data with how Buzz responds.

    Was wondering how the rest of Buzz's cycle went. Looks like she is going to like Lantus. :mrgreen:
     
  20. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Ok, thank you. Testing now, will post in a few if you are still here. :)
     
  21. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    I'll be here. Lots of experienced eyes around tonight.

    Just out of curiosity, how long can you stay up tonight? Do you have HC canned in the house and a decent amount of strips just in case?
     
  22. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    121 at +13. I will be up for another 2 or 3 hours. Yes I have plenty of strips and HC food. :)
     
  23. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Let's stall until +13.5 and see what that is, unless you want to shoot now. You're not new to diabetes or testing, and you will test appropriately and know what to do, but there is no pressure if you want to wait a bit longer. Just want to try and get something in the shed by +14, as that's when the action usually really starts wearing off.
     
  24. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    ok will test now then. :)
     
  25. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    +13.5: 114. Doubtful it's lowering, probably meter fluctuation but not really rising. Worried about staying up testing all night after shot to watch for hypo but will if necessary. :)
     
  26. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    You can stall as long as you need to - want you to feel comfortable with what you do.

    Is the stalling going to really mess up your schedule as far as work/other obligations? We can help you come up with a plan for moving the shot time back to where you want it.
     
  27. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Luckily I am unemployed. ;) I don't mind shooting now, just don't know what to shhot. Her BG basically hasn't moved in 7 hours. She is also way overdue for dinner and she is mad. ;)
     
  28. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    We usually try to either stall or BCS dose (big chicken sh*t dose - the LL term for a reduced dose), but not both. However, it's your first day. So whatever you feel okay with is good. What do you think about 0.5u or 0.75u?
     
  29. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    I would rather do .50, given how she reacted to the 1st dose. Is that ok do you think?
     
  30. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Sounds good to me. :smile:
     
  31. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    What do you think about holding the 0.5u dose for a few days and seeing how it settles? The 1u may have been a bit much given Buzz's past history. Can reassess things after the shed has had a chance to build. Maybe give you a bit of breathing room.

    Also, after you shoot, can you get a +1? :mrgreen:
     
  32. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Hding at 0.5u sounds good. I don't mind shooting agressively, particularly during the day, and I am used to seeing #s in the 60s. If you think .75 would be agressive w/o being dangerous, I can do that but I have already shot 0.5 so I guess should stick with that?

    Yes I can get a +1 and maybe even +2. :)
     
  33. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    yes, stick with 0.5u for now. we can always take the dose up if necessary.
    consistency is important with the Ls...
     
  34. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Jill is right. Consistent dosing is one of the most important things with the L insulins - dose, time - the closer you stay to a 12/12 schedule and the more consistent you can be with a dose, the better response you will usually see.

    I like 0.5u because it is so much easier to measure consistently than 0.75u is. ;-) Sasha is on a fat 1.25u right now and it is a crappy dose to have to consistently measure every day!
     
  35. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Ok, I will stick with 0.5. Should I shoot at the new +12? in other words, 12 hours from the shot tonight, not 12 hours after the original shot was supposed to be?

    Thank you guys for your help! I am so glad you were here. :) I feel like my beginning days on insulin.
     
  36. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Yes, the shot in the AM has to be 12 hours past tonight's shot time. If you need to change the time back, just let us know and we can help you come up with a plan for moving it.

    I know it does kind of feel like starting over, but you will get the hang of it soon.

    Is it +1 yet? :lol:
     
  37. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    Testing now. :)
     
  38. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    +1: 157. :) Do I need to get any more tests? I can test in an hour or so and judge from there if necessary.
     
  39. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Test at +2 would be good. Want to see where the cycle is heading before you get tucked in. ;-)

    This is what a *typical* Lantus cycle will look like:

    +0 - PreShot number.
    +1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
    +2 - Often similar to the PreShot number.
    +3 - Lower than the PreShot number, onset has started.
    +4 - Lower.
    +5 - Lower.
    +6 - Nadir/Peak (the lowest number of cycle).
    +7 - Surf (hang around the nadir number).
    +8 - Slight rise.
    +9 - Slight rise.
    +10 - Rising.
    +11 - Rising (may dip around +10 or +11).
    +12 - PreShot number.

    Every cat will vary in onset and nadir, etc. It is very handy to know what kind of food spike is normally seen for Buzz and that the +1 or +2 is not far lower than the PS, as that shows it will be an early action cycle in many cases. If your +2 was 75, I'd tell you it wasn't time to head to bed quite yet, kwim?
     
  40. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    I do know what you mean. :) I will test again in about an hour. I will post here but please don't feel you have to wait up. I definitely have had my share of late nights worried about hypos. ;)

    Buzz has typically had a long food spike, 2 hours or so.
     
  41. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    I am usually up until about 5AM EST daily...if not later. No worries.
     
  42. Sarah and Buzz

    Sarah and Buzz Well-Known Member

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    +3.5: 178

    looks like bedtime for me. :) Again, thank you so so much for your help tonight. It means a lot. :)
     
  43. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Ni ni, Sarah. Great job today! :smile:
     
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