9.5.18 Merlin PMPS 369; +1 369; +2 363; +3 359

http://www.felinediabetes.com/FDMB/threads/using-r.202058/#post-2248239

Dosed! He’s fine; I’m shaking. The hardest part is getting the .25 in the syringe. Of course the first needle was bent at the plunger and I couldn’t understand why I was looking at it like I was. I had it over the sink and was expressing drops and counting. When I finally figured it out, I got a new syringe and was good. I even used a magnifying glass ;-)

 

Those tiny doses can be hard to measure. Do you have someone checking in on your condo today? When starting R we like to have an experienced member checking in to make sure everything looks good. LOTS of data the first few R shots is critical to make sure the reaction isn't too strong. It also gives you a chance to start getting used to how R will effect Merlin's numbers. Not sure what time zone you are in but I would get hourly tests in for the first few hours. I was a poke-a-holic while I learned how to use R. This way you can see how much .25R effected your boy.

I'm not sure how much info you have gotten on R(not around as much these days), but R is good at lowering numbers and then the lantus/levemir can keep the numbers steady with the time release action of them.

Keep in mind too that IAA can be interesting to deal with. My guy was also acro/IAA and I noticed a bit of a delay in onset compared to the more typical cats on the board. I could shoot R and not see a drop for a few hours. I'll try to pop in today to check up on you and Merlin unless another R experienced member pops in.

 

@Marje and Gracie has been extremely helpful and has
provided me with a ton of info and guidelines. She’ll be checking in for sure. This is the only way forward for Merlin. I’m committed.

Thank you very much.

 

Now the data collection begins

One housekeeping item/- please edit your post header to start with today’s date, kittys name and AMPS followed by R info. Thanks

So now you will test each hour for the next 4-5 hours.

See you in one hour

 

Sorry Sandy. I do not know how to edit the post header. Clues?

Never mind! I found it

 

Beautiful! You can add the BG values as your R trial progresses. This way folks can know what’s going on at a glance.

 

I’m up now, too and waiting to see how the +1 is.

One thing I forgot to put on the list yesterday, which I will modify and you can add to what you printed, is that we usually shoot R only in the scruff because the absorption is slower there. It likely won’t matter for him at this number but as he comes down in subsequent R shots, it could.

 

Ahhh. I will start the next R dose in the scruff. Thank you.

 

I will need to fire up my computer to keep adding his #’s. My phone doesn’t scroll to the end of the thread name.

 

Sorry about that. Who knows whar happened to that brain cell that had that little bit of info

Another thing that might help you a lot is if you aren’t using calipers to dose, I’d do it with at least the R. That will make a big difference in consistency and accuracy of the small doses. I actually had a separate set of calipers just for the R so I didn’t have to change my L calipers when I was dosing both.

Edited to add: just saw the +1. Don’t worry...as I said, it’s not unusual to see little or no response as you start out. We might be below the dose that will get him to move. I actually believe it is a little helpful to calm the nerves if you don’t see a big drop the first time you use it.

 

Sorry, I do not know what calipers are (I’ll go look it up) and what is college siste day?

 

Dosing with calipers ....it made a huge difference for Gracie as she was sensitive to small dose changes. Lots of members now use them.

Sorry...I fixed it...it is “consistency”. I proofread too fast as I had two big eyes looking at me wondering where breffis is.

 

Just watched the videos. Really well done and good info. Something I’ve not come across. Thank you for the link!

 

You’re welcome. With the calipers, I could dose down to 0.05u of R consistently.

 

Just saw the +2..... not unexpected. Once we get the dose tweaked and it’s working better, you’d expect to see onset +1/+2 with R.

Are you feeling calmer?

 

Yes Marje, just a bit. I want him to feel better so badly. He’s been through the ringer and is just an innocent little boy. Hard to see them suffer so.

I will say it’s a pretty good morning for him all things aside. He still feels crummy, but has been keeping close. He also poo’d nicely and he ate two bowls of food so there’s that.

Thank you so much!

 

It is heartbreaking when they do not feel their normal selves and I really hope we can get him back to his old Merlin self. It probably helps him to be regular in the poo department and I’m glad he’s eating.

Let me know if you want to try the R again tonight. Although I already suspect what we will see the rest of this cycle, I’d like to let it play out and see if he gets response afterwards as Wes was indicating Jack did.

I can help you with the R again tonight if you like.

See you at +3. And could you p,Essex keep the subject title updated for us? Thank you!

 

Will update the title. Difficult to do on my phone.

About tonight - no need to walk me thru anything. Just following the same procedure, no? Test every 4 hrs?

What I will need your guidance on is tomorrow if anything needs changing. I’ll dose him in the scruff from now on and see if there is any change. Test again every 4 hours?

 

Yes for tonight but do you know what to do if his numbers drop suddenly? I’m available.

I can also check in to see how he does so we can see if the dose needs to change...likely it does.

The scruff typically has slower absorption rates....or so it is said. I rotated Gracie’s L shots daily and the scruff was one of the locations I used but I never saw a difference in absorption. Even so, with R, it wasn’t worth a chance so I always shot R in the scruff and I don’t know anyone using it who doesn’t.

 

Good Luck Cynthia and Merlin with the R. He is a lucky boy to have such a dedicated momma!

 

So if his numbers drop suddenly - not exactly in the know. I do have a hypo kit ready with Karo, high carb/gravy food, an extra glucose monitor (if mine decides it wants to freak me out). What else may you suggest?

Please feel free to chime in any time and give me your recommendation on dose change. I have no idea what I'm doing and completely relying on you and this amazing group.

As far as the scruff, consider it done. What I might mention is that we give Merlin fluids regularly. Backing off of every evening to every two days. It helps him stay hydrated and feel better. So, as for R, I'll dose in the scruff and avoid that area when I give fluids (move to the other side) so it doesn't dilute. I do rotate L every day so I'm in the know on that.

 

Thanks Bobbie!

 

Wes brings up an important point

Action can be very unpredictable with an IAA kitty so even though R is fast acting IAA can slow the action down.

Keep in mind also that IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation.

 

He's an enigma right now. It's a huge science project ;-)

 

Yes it is. I say we see how it goes tonight at 0.25u and then go from there.

Sandy is the best one on how to kick the IAA in the teeth! If you haven’t ever looked at BK’s SS, I would. What a wild ride and Sandy handled it seamlessly.

 

I just took a look at BK's SS. Amazing!

So for today, test at noon? Tonight, the same up until midnight?

 

It is an amazing SS because BK went OTJ and stayed there. Sandy did great.

A +5 is fine and then I’d give him a break unless you see a large downward shift. If not, I’d let him go to +8 unless @Sandy and Black Kitty chimes in differently and then I’d listen to her

 

Sounds good. Does anyone with a diabetic/acro/iaa kitty ever sleep ;-)

 

We didn’t. Even when the numbers would let us, I’d wake up in a panic that I’d forgotten to test her. That continued to happen to me for the first two years after my baby girl crossed.

We are headed out but will be back later and I’ll check in long before PMPS.

Great job today!

 

I agree with Marje that you can hold off testing until +8.

although at times it may seem like a shot of R didn’t really do much it must be evaluated in context with the recent BG activity. Always consider what BG might have been without R. A well timed shot of R can keep BG from skyrocketing if a bounce is in the making.

 

Thanks Sandy. I hope you can keep an eye on Merlin’s progress and chime in with your experience. I see a little of what you are talking about, but the bigger picture eludes all of us now.

 

I have a question to this group regarding feeding. I was under the assumption that before AMPS and PMPS, food was to be picked up 2 hrs prior to get a clean read. Is this what you all understand as well? Since I free feed Merlin, I’ve been getting up at 4:45 a.m. to make sure he isn’t eating during that time frame before testing. Same
for PMPS at 4:45 p.m. You guys operate that way as well?

 

There are a few potential scenarios when feeding the last couple of hours before the next shot:

• The carbs (even LC for carb sensitive cats) put the brakes on duration
• The carbs don’t necessarily put the brakes on duration but you get a resulting food spike that would make you believe kitty is coming up for PS, you shoot the higher number, then kitty immediately comes back down as the food wears off because it didn’t actually impact duration
• A combination of both of the above happens
• Nothing happens and it doesn’t affect duration or cause a food spike

We usually suggest new members don’t feed those two hours before PS until they have enough data on their cat to see what kind of duration the kitty has, what kitty’s carb sensitivity is, etc. For an experienced member who has data and knows their cat, they can feed whenever it’s appropriate for their cat. There were definitely times with Gracie that I fed her in the last hour before a shot because I needed to.

You’ll find experienced members doing different things. If you need to leave food out for Merlin at night, why not use an auto feeder so it offers him food at a certain time but you don’t have to get up and pick the food up (you can set it up so it moves around to an empty dish at a specific time).

 

Merlin likes me to sit with him while he eats. I’ve always been holding off the food before for two hours, except when I couldn’t stand it because he was either going to get a tummy upset and toss up bile (I’m the wee hours of the morning), or because he’s just so unregulated and so uncomfortable. It’s a decision I just need to make as I see fit. I’ve also been making sure he has something to eat just before the two hour window so he has an easier time waiting. I hope this extreme hunger wanes as he gets more and more regulated.

Thanks for the thoughtful suggestion.

 

Do I need to start another condo for tonight, or just continue on.

 

BKs SS gives us all hope for even the hardest kitties to regulate

 

Just continue on but edit the title after his name to start the numbers over again with PMPS.

We are headed to dinner but will be back by +1 so I’d suggest planning to shoot 0.25u at PMPS.

See you soon.

 

I’m back...paws crossed to see a better +1.

 

Ugggg. Nosiree!

 

Not up so that’s good!

 

I didn’t think of it that way. Ah. I’ll need to start thinking differently.

 

Normally I would go to bed and read a book for a bit before sleeping, but tonight I find this fascinating. I'm cheering for Merlin and so impressed with the amount of support.

 

I feel very cared for. Thank you Grandpa

 

That is correct

I just tuned in to the Merlin show. Tonights episode -F..L.. A..T

Are you home with him most days?

 

I would strongly suggest a dose increase of 0.5u in the morning for a new dose of 5.5u.

Sandy and I are discussing about whether this is a situation, because of such high numbers, to shoot R with the dose increase. It depends on whether you will be home tomorrow to monitor...as Sandy is asking.

 

Yes Sandy. I work around Merlin’s schedule

 

I’ll be home to monitor. He need some relief. What kind of monitoring are you thinking?

 

Same as today...PS, +1, +2, +3, +4 and then we decide on further.

 

OK. I’ll do up to a +4 on him tonight and restart tomorrow with 5.5L and .5R. Thanks for everything.

He’s not feeling well and all this poking and prodding isn’t helping. He’s just been through too much.

Pleasant dreams.

 

79% IAA is some serious insulin resistance and judging by the relentless reds and pinks ( nearly a month since the last yellow and approx. 2.5 months since the one and only blue) Merlin is in the thick of it.
If he were my kitty I'd go for it - 5.5uL and .5uR
(note to lurkers - the information here is specific to Merlin)

Does he have a good appetite?

 

I’m on board with Sandy’s idea, too. I’m still up for a while if you have questions.

I’ll check in in the morning, too.

 

He has an excellent appetite. And yes, it’s serious. He doesn’t feel well most days. He was just diagnosed last week. I wish I was able to be more aggressive earlier, but I’m new to diabetes. Internist is getting Gabapentin compounded for him tomorrow; I don’t like how bupe treats him. I feel awful for him and will not let him linger like this.

 

I kinda want to leave him alone for the rest of the night. Is a +4 really necessary?

 

It think it is OK to skip the +4 for tonight. He is looking just plain flat.
If you can manage a +10 or +11, it would be good data and help fill in the picture on that end.of the ss.

I'll look for you tomorrow.

 

I agree. That’s totally fine. get some rest and save some strips and we will see you in the morning.

 

Good luck with the R Cynthia Merlin is lucky to have you.