5/11 CRYSTAL AMPS 331 Gave R + 4 279, +6 259 +10 230 PMPS 243 gave R +2 234 | Feline Diabetes Message Board - FDMB

5/11 CRYSTAL AMPS 331 Gave R + 4 279, +6 259 +10 230 PMPS 243 gave R +2 234

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suki & crystal (GA)

suki & crystal (GA)

Member since 2014
yesterday

Crystal was pink at AMPS so upped her R and gave her 3u. Has come down at +6, hope she continues to slide, would love to see some blue on her SS. Was feeling fed up and confused but Marje's post in yesterday's condo makes me realise it's all part of the never ending saga of finding that elusive dose, and is by no means unique to Crystal. Just gotta hang in there I guess, could be a lot worse.

Vines to all kitties in need, and their long suffering beans too.
 
Hi Suki,
You are doing such a good job managing Crystal's numbers. I am sorry you were feeling fed up and confused with it all, I can empathise completely. I hope Crystal comes down well for you with this dose. She is a lucky girl to have you.
 
Thanks for your kind words Bron, seems like both our little girls are being rather uncooperative at the moment.

Recap on Crystal's numbers
331 AMPS
279 +4
259 +6
250 +8
229 +9
230 + 10

So, she's come down a 100 points since AMPS with the 3uR so going in the right direction, even if we haven't made it to blue. She what number she is at for PS whether she gets some more R.
 
Suki

I had an idea and it might be crazy....I don't know if it will work and others might have some knowledge or input as to why it will or won't work but I'm brainstorming so other thoughts and input very welcome.

The levemir flex touch pens allow for you, using the pen and the pen needles, to inject up to 80u at one time. The pen needles come in as small a size as 32g. I know that some new members have come in here using the pen needles. i haven't looked at my pen but I'm thinking the doses are by 1u. What I'm getting at is that using the pen with pen needle would allow you to at least inject 50u with a smaller gauge pen needle so you'd only have to inject her basal insulin dose once. But the downside would be you'd probably have to increase the R dose to account for the reduction in the L dose. While a 2u reduction in L dose might be huge for a non-acro cat, it would be a small reduction for Crystal.

Again, I'm just brainstorming and it might be a horrible idea because Crystal might need more levemir but as we've discussed, the cost is getting prohibitive and when it got thst way for Suzanne, she leveled off the L dose and shot more R. We don't know if Cobb had acro or just IAA and thsts the big difference between the two kitties. It might have worked for Cobb because he potentially just had IAA.

I'm just trying to think of a way to get the insulin in her but keep you from shooting four shots of L a day to reduce the number of shots she gets. The other thing is, I shoot Gracie right behind her front paws, then midway between thst spot and her flank, and then her flank. Do you think Crystal would let you shoot L in that midway point? If she would, then maybe eventually, she'd let you shoot the flank with L?

@julie & punkin (ga), @Wendy&Neko ....do either of you ladies have some thoughts about my suggestion? Again...I could be way off base with it but doesn't hurt to throw it out and get some eyes on the idea.

Edited to add: glad she's coming down...paws crossed.
 
Hi Suki! (((hugs))) I totally understand where you are with the L getting to be cost-prohibitive. It is frustrating, isn't it? We really just go to the point where we couldn't afford more than what we were shooting. We were doing 62uLantus a day. I just had to draw the line at a syringe full of insulin. We were able to come down with the Lev, but Marje is right -- I decided to just stop upping the L because it was so expensive, and I tried to offset with the R. I can't imagine the cost you're going through right now. We never had Cobb tested for acro, but it is likely he had it. We KNOW he had IAA so at some point that insulin resistance was going to break. I personally think overwhelming the body with the different insulins was key to breaking through his IAA - but it's only a theory of mine -- and NOT one I would encourage anyone lurking to try!!

@Sgans , R insulin is a fast-acting in and out insulin. Levemir and Lantus are a bolus insulin. They are longer acting. Kitties can be very sensitive to R insulin. For some a drop of it can make their numbers come crashing down very quickly. With a high dose cat, sometimes you need to add a R insulin into the toolbox to bring down high preshot numbers so that the L insulins can work more efficiently. Lantus and Levemir work better when the BG isn't sky high.
 
@Grayson & Lu, Lu-Ann has just posted this on an old Crystal condo here in reply to one of Suzanne's queries but I've copied it over to today's condo for ease of reference:

I gave Grayson R at preshots - rarely mid-cycle. Most of the time he nadired late - +9 or +10; so anything mid-cycle might have wound up w/ simultaneous nadirs instead of a jumpstart at his base line.

He was resistant to responding to it until we reached 3u. Even at CSU - they gave him 1uR (no effect) and gave Tracy's Leo a glucose drip! Our boys couldn't have been more different if they tried!

I see she's playing with your sleep patterns. Those are the nights when I didn't give R, and took an Excedrin PM so I could try to get a solid block of sleep. Sometimes, that's the price to pay for all their slumber parties!

Thanks for confirming your dosing strategy Lu-Ann, I usually stick to preshots too as I find it quite difficult to work out the nadir for Crystal, changes nearly every day. Better to be safe although I have given her small doses of R at +10 before.

How wonderful everyone is chipping in with some ideas, I really appreciate it guys.

@Marje and Gracie, thanks for your idea Marje. I did try using the flexpen with it's needles when I started using Lantus, the vet let me borrow one to practice with. Unfortunately, I didn't get on with it at all, although it was a much lower dose it was difficult to know whether the insulin had actually gone it, and Crystal didn't cooperate with it at all. It certainly would be a good idea with just having the one injection and cuts down the injections by 50%. I might ask to borrow some needles again and have another go with it, worth a try.

@Suzanne & Cobb(GA) Crystal sounds the opposite of Cobb, confirmed acro with possible IAA and Cobb was confirmed IAA with possible acro, but I think the outcome is the same, very high doses of Lev together with aggressive use of R. I think that it the protocol that I will have to follow. I am prepared to up the Lev if necessary but there does have to be some sort of limit, I certainly couldn't afford to double my usage. So let's try the R for a couple of days, with both cycles and see how she reacts to that. I did try to give her a flank shot tonight, growls and hissing while I was trying to manipulate the skin, but as she has the acro "potbelly" the skin is fairly tight there and it was too difficult, then she got really fed up so I went for the shoulder site as usual. Thanks for answering Stephanie's (?) query re the R for me.
 
@Suzanne & Cobb(GA) - thank you SO MUCH for that explanation. When I first got my Px, doc was going to use NPH, which sounds like it was going to be like that "R" insulin you discuss. It was this site that got me on Lantus.

@suki & crystal , I can't IMAGINE the expense of the volume you have to use! It's good for me to see there're alternatives if, by any chance, I have to increase to large doses. Best to you!
BTW - yes, it's Stephanie... :)
 
Suki. No advice, experiences, wisdom from me. Just huge, monstrously huge, admiration for all your doing. And vines galore.

Marilyn and Polly
 
Sorry I forgot you used the pen needles. It's not uncommon for new members to come in using them and so I don't retain who has and who hasn't. I'm also sorry she did no better with the flank shot.

So we are back to square one really and my best advice is what we've already discussed. If I think of anything else once I'm back home, you will be the first to know.
 
@Sgans , Hi Stephanie, thanks for looking in, I really hope you don't turn out to have a high dose kitty, paws crossed for you and Eegie.

@pollydoodle , Marilyn, thanks for your support, as ever. Keep the vines coming!

@Marje and Gracie, yep looks like back to Plan A but thanks for coming up with an alternative, just think it might not work for Crystal, but I won't right it off completely, especially if I do have to increase the Lev in future.

Recap on Crystal's numbers

331 AMPS + 3.0uR
279 +4
259 +6
250 +8
229 +9
230 + 10
243 PMPS + 2.0uR
234 +2
239 +4

Crystal is snoozing, unaware of all the head scratching she is causing, typical cat:cat:

@BJM , just saw your post, does that mean one syringe holds in excess of 50u? that would be great if that's the case.
 
Yes. U-100 means 100 units per mL, so a 1 mL U-100 syringe will hold all the Levemir you'd need. It may not have half unit markings, but I don't think you need these. They may or may not have 1 unit markings.
 
Just found them on Amazon, but will check with my local pharmacy first but if not I can order them tomorrow, thanks BJ, very helpful and will save Crystal 2 injections per day, she will be very happy.
 
Coming late to the party - looks like Crystal was flat yellow. Sometimes that means something, sometimes not. :rolleyes:

Just something to watch out for if you switch to one syringe of Lev per cycle - some people with high dose cats have reported that splitting the dose in two gets better action and means less Lev needed per shot. If you go to one shot, then we'll just have to watch the numbers and see if it makes any difference for Crystal.

If R is a lot cheaper than Levemir, then a strategy of increasing the R might be worth trying. Especially since you use a lot less of it per day.

Come on down Crystal - I really want to see some blue on you!
 
Thank you, @suki & crystal - I do too. I'm sorry you have to deal with that. I'm sorry Crystal does, too...

I've been seeing people sending vines... which I interpret as good vibes and wishes (the lingo messes with me) ;) I'm sending you many many vines...
 
Wendy, yes she's a little flat yellow pancake at the moment

Wendy&Neko said:
Just something to watch out for if you switch to one syringe of Lev per cycle - some people with high dose cats have reported that splitting the dose in two gets better action and means less Lev needed per shot. If you go to one shot, then we'll just have to watch the numbers and see if it makes any difference for Crystal.
Click to expand...
Good point Wendy, I'll make sure I watch for any effect it may have on her numbers. I would LOVE to see blue again too.


Sgans said:
I've been seeing people sending vines... which I interpret as good vibes and wishes (the lingo messes with me) ;) I'm sending you many many vines...
Click to expand...

I know what you mean Stephanie, I have had to learn a whole new volcabulary. I think vines started with someone misspelling vibes and it sort of stuck, but we all understand the meaning and the sentiment behind it, thank you for sending us yours. By the way, how did you come by the name of Eegie, does it mean anything special? He is one handsome boy.

Just time for a +6 test for Crystal and then off to bed for me, still got the sore throat but now have a head cold to go with it ...... could do with a good night's sleep, at least I don't have to stay up for a PJ party!
 
I'm also late to the party - so late it's over! LOL. Good ideas brewing here. Out of need comes inventive solutions!

If I were in your shoes, Suki, I think I would consider increasing the R dose and holding the Lev steady for a while. I think it was the last time that Sandy posted that she said something about never having to worry about the depot for BK because she'd increased the R dose instead of the Lantus.

I've also heard that absorption can be better if the L dose is split in 2 once a cat passes 8u. I'm pretty sure I saw that in a post by Jojo quite a while ago. I never split Punkin's dose (although I was aware of that info) because I didn't want to poke him twice. It was bad enough to poke him with the additional R shots.

One thing you can consider is that people can and do figure out how to draw up one insulin and then use the same syringe to add the second insulin to it. I don't recall where I saw that discussed and I haven't personally done it. I think in your case if I wanted to try that, I'd draw up the R dose first - because of its size and the fact that it is relatively stronger, and a slight deviation from 2-3u would likely have more impact than a slight deviation on the 52u L dose.

In fact, if you can find larger 100u syringes that were still marked in 1u increments, you could try drawing up the R first, adding the Lev to it, and giving it all in one shot.

Again, these ideas are only for you, Suki - not for the many folks that read but might not ask questions. The dosing for a high dose cat is different than for others. No one else should copy Suki's dosing strategies for Crystal.
 
@julie & punkin (ga) , I'm still here, got waylaid reading condos and catching up with the news. Thanks for looking in Julie and offering some good suggestions. If I can get a few of the larger syringes to try out, I might well have a go at giving both the Lev and R at the same time. I seem to remember that comment from Sandy too. General consensus seems to be to increase the R and hold the Lev, which will be our way forward, certainly for the next couple of days and then review how she's doing.

Right, definately off to bed now, tomorrow is another exciting prospect!
 
@suki & crystal , because he's a Russian blue, I wanted A Russian name. As big fans of young Frankenstein, my dad wanted me to name him Eyegore. I couldn't quite do that to my sweet boy, so it's actually Eegor which gets shortened to EEgie. I liked the "ee" better than the "I". Also, at the time, his things were loose so they stuck out really far, which reminded me of Dracula. Funny thing, my Vet's first name is Igor!

Bet you didn't expect such a long story, huh?:)
 
I have read also that giving the one insulin dose in 2 different places enhances the effect in a cat. I read it some time ago and I can't remember where but it was a research paper or a trial or something like that. I think the reason why it was more effective was because there was a bigger surface area around the deposits of insulin and that somehow helped with the take up of the insulin?
They did explain it but I can't remember the detail but it made sense. If you googled some specific words you might be able to find it. I think there was more than one article about the effect.
 
The info I received from Libby/Lucy was that two insulins, such as R and levemir, should not be put together in the same syringe.

eta: I believe many Europeans use BD syringes and they make a 1cc U100 insulin syringe so perhaps you can get it from the same place where you get your 0.3cc syringes.

1cc=1 ml = 100u
 
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Thanks Bron and Marje for all the good info above, I think I'll email the RVC and ask them about the pros and cons of using one syringe and also whether they recommend mixing the 2 insulins, can't hurt to throw their opinions into the pot!
 
Hi there :cool:

Regarding mixing R and one of the Ls, I don't have first hand experience with Lev however as I recall Lantus and R should never be mixed in the same syringe. I wish I could remember the exact reasons why.
What comes to mind is that Lantus is fragile and mixing R in the same syringe may contaminate the Lantus making it less effective.

From a safety standpoint, we know the importance of being fully present in the moments syringes are being prepared and shots are given.
I had a system which included stickie notes on the kitchen counter. Each note acted as a 'place holder, with the type and amount of insulin written on it.
As I completed filling each syringe I put it on it's placeholder. I could then easily crosscheck the doses were correct before shooting.
Although that may sound like a lot to do it ensured I had 13u L and 5u R rather than the other way around.


BBL :cool:
 
Hello Sandy, appreciate you looking in and sharing your experience. Marje has just sent me a document showing how to mix the 2 insulins but it states, quite categorically, that Lantus or Levemir cannot be mixed with R, but doesn't state why.

I'm very careful with the R, I do the Lev first, put the pen back in the fridge and then take out the R and fill that syringe, they are never on the table together. I also write down the BG and the dose I'm giving on a piece of paper, before transferring that info to my SS. Safety first, I've heard of one member giving 9u of R by mistake, luckily all turned out okay but it was a very nerveracking experience.
 
INTERESTING! About using the different injection sites!
I just recently changed my injection site, (using Lantus) because he gets sub-q at night near his neck/shoulders - so I started shooting insulin into his flank (at a friend's suggestion) so the fluids don't interfere... maybe THAT'S why my baby's numbers were better yesterday...
 
suki & crystal said:
Hello Sandy, appreciate you looking in and sharing your experience. Marje has just sent me a document showing how to mix the 2 insulins but it states, quite categorically, that Lantus or Levemir cannot be mixed with R, but doesn't state why.

I'm very careful with the R, I do the Lev first, put the pen back in the fridge and then take out the R and fill that syringe, they are never on the table together. I also write down the BG and the dose I'm giving on a piece of paper, before transferring that info to my SS. Safety first, I've heard of one member giving 9u of R by mistake, luckily all turned out okay but it was a very nerveracking experience.
Click to expand...
Yes, that happened with Ole. He was definitely a high dose kitty, but Rebekah got him to the vet quickly and he was fine. You may remember back in December when Matt was taking care of Cobb and was giving just R for a few days at a higher dose than need be. I, personally, think high dose kitties can typically stand a mistake like that -- NOT AT 50 units OF COURSE!!!! - our mistakes were at much much much smaller doses. I know after it happened Rebekah wrapped her R vial with a rubber band, and I removed it from our upstairs mini fridge so the mistake didn't happen again.
 
I remember that Suzanne at the time, slightly scary! My R comes in fairly small vials, no where as big as the Lev pen but you still have to be ultra cautious.
 
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