10/29 Cupcake - opinions needed, +3 - 79

Discussion in 'Lantus / Levemir / Biosimilars' started by Cupcake, Oct 29, 2013.

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  1. Cupcake

    Cupcake Member

    Joined:
    Oct 8, 2013
    Good day,

    we had 79 after three hours of AM shot. And now we are rising a little.
    I need suggestions and opinions regarding my boy's numbers, please. My tonight's plan is:
    if PMPS > 252: 3,5 U
    if PMPS < 252 but > 198: 3,25 U or 3 U (?)

    I need your estimations.
     
  2. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Well Cupcake just told you that 4 u is too high of a dose so you definitely don't want to give that much again.

    More importantly right now is that you are going to keep testing every hour to make sure he doesn't start dropping again once any food he just ate starts wearing off. You still have several hours to go before he hits his nadir or the lowest point in his cycle.

    This is officially a HYPO WATCH!!!

    I need to run briefly and get my crew's breakfast but as soon as everyone is fed I'll be back to discuss how to go forward from here.

    Be Right Back

    Mel, Maxwell, Autumn and The Fur Gang
     
  3. Cupcake

    Cupcake Member

    Joined:
    Oct 8, 2013
    Dear Mel, there is no hurry, my guardian angel :)
     

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  4. nckitties3

    nckitties3 Well-Known Member

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    Jan 12, 2013
    Morning Hon. You need to test again. Anytime they are running that low early in the cycle, you need to be testing at least every hour, if not more.

    Dose is not determined by the preshot readings, it's determined by the nadir, the lowest point in the cycle. At the rate he's going, you may need to reduce his dose anyway.

    Mel will be back soon to help you out, until then, get another test. Do you have a higher carb food in case Cupcake goes too low? You need to be keeping a closer watch on him today.
     
  5. Cupcake

    Cupcake Member

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    Oct 8, 2013
    Debbie, thank you for your support! I'm armed with lots of weapons in case of hypo: high carb dry food, maple syrup, just in case.
    Will be back in an hour, thanks a lot!!!
     
  6. Cupcake

    Cupcake Member

    Joined:
    Oct 8, 2013
    Ok, let's discuss the issue, my dear supportive team.
    I do think Cupcake is able to go into remission. I kept him on smaller doses for a pretty long time. He showed me that 3,5U is not enough. Yes, he went low very quickly today and I'm watching him. But is 79 a hypo? I want to keep him in blues and greens for as long as I can. I start to think that maybe his pancreas has started healing and I do not want to reduce his dose a lot. He was 245 @+6. I think I should stick to 3,5 - 4U for now. I may be in the wrong... But I will not help him to go OTJ if I reduce his dose and start playing with little doses again. Could you please have a look at his whole spreadsheet? I palyed with 1U, 2U, 3U... My heart feels that this is enough. I see his activity while he is in greens. He helps me, I help him and I think we shall stay where we are right now :roll: What do you think?

    And here is some information too:
    "Because continual high blood glucose perpetuates the pancreatic suppression/toxicity that has caused the diabetes in the first place, cure can only happen if insulin is used to effectively bring the diabetic cat into the normal range for glucose in this species. Most normal cats operate when relaxed between 60-100. As long as you feed low carbohydrate wet foods, you will not cause seizures in your pet. In hundreds of cats that I have put through this protocol using low carbohydrate foods, I have never caused a single one to seizure, despite taking many well below 100 mg/dl. Clearly, the liver in the diabetic cat that is no longer eating dry cat foods becomes capable of producing glucose again in response to falling blood glucose. This may be because the recovering pancreas can now secret gluagon to trigger the liver’s glucose releasing capabilities, or because of some other direct effect of diabetic regulation on the liver itself. Whatever the cause, the liver’s reawakened capabilities make clinical hypo a worry of the past and diabetic cat owners can give up the fear they have been taught about taking a diabetic cat into the normal blood glucose range where recovery can occur."
    Source: http://www.yourdiabeticcat.com/protocol.html
     
  7. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Okay back again.

    Now to go over some of the basics of working with Lantus and insulin in general.

    The very first concept to grasp is that insulin is NOT a drug like say a pain killer, it IS a hormone, and a very powerful one. A tiny drop can make a huge difference.

    Because it is a hormone using it too shove down BGs too fast and hard can cause a pendulum effect to start where the cat drops hard and fast then because of that fast drop the body tries to stop it because it is uncomfortable by throwing out counterregulatory hormones and stored sugars and the cat jumps right back to high numbers.

    Now with Lantus the only thing the preshot readings tell you is that it is safe to give insulin in the first place, where you and Cupcake are right now your NO SHOOT number is 150 You just don't have the data to support shooting lower than that right now.

    To adjust doses you need the nadir reading or the lowest point that a given dose takes him. You pretty much ignore the numbers in between except to make sure he is staying above 50.

    Yesterday was a prime example of a bounce for Autumn. If I would have reacted to that one day of high readings and upped her dose I could have thrown her into hypo and possible killed her over night or at least had a night of no sleep and a lot of ear pokes. Now Autumn clears bounces pretty quickly because her body knows what it feels like to be down in normal numbers again, but a 33 will still cause her to bounce because it is still too low so it triggers her self-protection mode to set off.

    With Cupcake I would roll back to a flat 3u and hold for at least 5-7 days. Then run a curve where you test every two hours between a set of shots. Once we know where his nadir is then we can help you decide if you need to increase or not.

    It is very possible that a perfect dose can still have preshots in the 200s if the nadir is at the right point.

    Mel, Maxwell, Autumn and The Fur Gang
     
  8. MommaOfMuse

    MommaOfMuse Well-Known Member

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    May 26, 2010
    No 79 isn't hypo yet but he more than likely just ate which is bumping him up and he is already in free fall. Right now he should only be at or slightly below his preshot. all that fast drop is going to do is send him screaming back to a high again tonight. That's a bounce

    Plus with Lantus he still has another 3-9 hours to drop and right now he has no wiggle room

    Mel, Maxwell, Autumn and The Fur Gang
     
  9. Cupcake

    Cupcake Member

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    Oct 8, 2013
    Dear Mel,

    I'm sorry for so many questions. But don't you think that on the 26th of October his nadir was 65? And on the 27th - his nadir was 56. These numbers seem ok to me. I kept him on 3.5U from the 22th of October till the 26th. And then I saw the first red in my life. When I started 4U things got better. Now we have 265. Maybe I can stick to let's say 3.25 or 3.5 again but not 3?
    I know this is not a sprint. I do appreciate your valuable pieces of advice. However, I want to try a little bit more aggressive method because I do not want to play this game for too long. High numbers are no good at all.
     
  10. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Lantus is a depot insulin which means it has to build up a reserve under the skin or shed. Everytime you give a fur shot or change dose it has to adjust that reserve. That can take 3-5 days to happen. So those partial fur shots reset the clock on how long the dose was held. Plus he is working on clearing an infection. If you see an immediate reaction to a dose change it is too much insulin.

    Before remission can happen you need to get regulation. You want a flat curve even if the numbers are higher than you want then you raise SLOWLY at .25u to bring the overall curve down.

    Right now he is swinging wildly and that doesn't feel good it's like being on a roller coaster ride.

    Regulation is in the 200s at preshots and around 100 at nadir.

    Mel, Maxwell, Autumn and The Fur Gang
     
  11. Cupcake

    Cupcake Member

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    Oct 8, 2013
    I'm totally lost, Mel.
    My husband cried and said that we could go back to 3U over his dead body only ohmygod_smile ohmygod_smile ohmygod_smile
    What do you think about a steady 3,5U for now?
     
  12. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Okay let me see if I can find you. :)


    But first I just realized I have a couple questions that I don't know the answers to and might make a world of difference.

    I see that you believe Cupcake became a diabetic because of Pred use. Why was he on it? Is he still taking it? and if not how long ago was it stopped?

    but for now we will comprise and roll back to 3.5 although that may change depending on the answers to the above questions.

    I will also predict he will be high tonight because of the steep drop today..Do Not react just shoot the 3.5u

    Mel, Maxwell, Autumn and The Fur Gang
     
  13. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Now to try to explain how you get to regulation so you can work towards remission.

    Okay cats are diabetic long before they show any outward signs of being sick. Thus their bodies begin to think of those 200 &3
    300s as normal so when you introduce insulin and they drop from 300s to 200s if they are use to 300s as normal that 200s sends their bodies into panic mode as it reads it as a hypo setting in and it tries to save itself by releasing stored sugars from the liver, just like your body does if you skip a meal. So a bounce happens where they shoot right back up again. It has to relearn that those 200s are safe and it is not going into hypo when it feels them, before it can move on to learning that 100s are okay as well.

    With me so far?

    Mel, Maxwell, Autumn andThe Fur Gang
     
  14. Cupcake

    Cupcake Member

    Joined:
    Oct 8, 2013
    Oh, Mel :)
    My fluffy has been suffering from asthma since his early days. Our vet persuaded me to treat Cupcake with predni. Till then he was absolutely healthy (well, except the asthma issue) and has never shown any symptoms of FD. Vet injected some kind of long lasting predni in July, 2013. He said it would last for about a week. After this week I gave him predni tablets (10 more days according to the instructions of the vet). And "funny" things began then, after the course of predni: excessive drinking, excessive urinating, loss of weight... In the middle of August, 2013 Cupcake was diagnosed FD (blood test showed 324).
    The good thing is that I hear him coughing very seldom now :mrgreen:
    I've been trying to regulate his BG with the help of low-carb diet. Sadly, it did not help. As you can see, we started injecting insulin on the 1st of October.

    Here is our story. His weight was about 15 - 15,4 lbs till the start of predni treatment. He's about 11 now :(
     
  15. Cupcake

    Cupcake Member

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    Oct 8, 2013
    I'm here, dear! Can't find the words to say thanks...
    I'll do my best to keep him at 3,5U for at least 5 days and survive (my husband is going to kill me) :mrgreen:
     
  16. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Okay he's an asthmic as is my Maxwell. so does he now take anything for it? With my Maxwell he takes an inhaler just like a human except his is a little mask that goes over his face.

    If Cupcake is still having breathing problems from the Asthma it could cause his face BGs to rise as that is a form of stress.

    Any how back to explaining:

    Very early in the dance you want a dose that gently takes him from those 300s into the low 200s at nadir Right now you are shocking his body by sending it too low too quickly and it is fighting back. And it is sending him higher by the next shot back.

    Ideally you should see the pinks become yellows then those yellows become blues and the blues become greens consistantly not all in one day.

    Rainbows are pretty just not when they are on a spreadsheet.

    As long as he stays under renal threshold of 240 no more organ damage is happening and we are liver training.

    Just for your information weight plays very little part in this disease as long as they aren't obese. Most cats do very well on 2u or less

    Mel, Maxwell, Autumn and The Fur Gang
     
  17. MommaOfMuse

    MommaOfMuse Well-Known Member

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    May 26, 2010
    Ruta I started a new thread for you to help explain the reds you are seeing right now and your options on how to handle them.

    Mel, Maxwell, Autumn and The Fur Gang
     
  18. Cupcake

    Cupcake Member

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    Oct 8, 2013
    :YMHUG: :YMHUG: :YMHUG:
     
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