Cliff Notes, pt 1

Discussion in 'Prozinc / PZI' started by MiCo, Feb 11, 2017.

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  1. MiCo

    MiCo Member

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    new thread, switching to # system rather than dates b/c I was getting lazy abt creating new weekly threads.

    Amps=276
    A little bit of picky eating this am. Gonna keep an eye on that! Had to open a second can of something to get him to clean a plate. But in the end, he ate second offering heartily.
    7units
     
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  2. Sharon14

    Sharon14 Well-Known Member

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    Glad he ate!!!!
     
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  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes to yellow!! :)
     
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  4. Rachel

    Rachel Well-Known Member

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    What a nice preshot number!
     
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  5. MiCo

    MiCo Member

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    +2.5 370
    +4 443
    +7.5 489

    Blood ketones 0.2--which is very low/good (0.1 lowest next to "lo" reading)
     
  6. MiCo

    MiCo Member

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    Pmps=475
    7 units

    Just realized we may gave bought some hi carb sheba cans/pouches. We are still getting used to reading the sheba packages and I realized Cliff may have gotten 3 or fewer servings of this. :( oops. We caught our mistake and moved this food to the "in case of emergency" box.

    Also, got our relion prime meter in the mail. Going to switch over soon. However, new meter didn't come w control solution. I called manufacturer and will get some in the mail in 10 days. Is there any other way to test new meter/strips without? Can i use my AplhaTrak control solution?
     
  7. Rachel

    Rachel Well-Known Member

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    Welllll....I never used any control solution with the relion. To be honest, I didn't realize you were supposed to! I just used it straight out of the box.
     
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  8. MiCo

    MiCo Member

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    I'm sure that's fine and what most people do...:) I've just gotten in the habit of testing my strips w control. Also, user manual says to use... Which is why it confuses me that it's not included or available online!
     
  9. Rachel

    Rachel Well-Known Member

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    Haha well I learned something new today!
     
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  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Some people poke themselves to see if the meter is working properly. You could Google what normal human BG is and see if the meter gives you a number in that range.
     
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  11. BJM

    BJM Well-Known Member

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    Normal for humans is roughly 50-120 mg/dL.
    Per the Merck Veterinary Manual online:
    "The normal fasting value for blood glucose in dogs and cats is 75–120 mg/dL."

    and
    "The renal threshold for glucose is ~180 mg/dL in dogs and ~280 mg/dL in cats." (the tilde means approximately), This the level at which glucose is excreted through the kidneys.
     
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  12. MiCo

    MiCo Member

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    Thank you, All! I will self test tomorrow w the new meter.
     
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  13. MiCo

    MiCo Member

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    Doing a curve (w/AlphaTrak2) today:

    Amps=299
    fed
    7u

    +2 390
    +4 433--fed snack
    +6 468
    +8 372--gave cerenia, fed lunch
    +10 523
    +11/PMPS 513

    Need to email vet with a checkin, so I figured I would provide a curve-even though he's not really dipping much into a curve during day. He's staying High/flat.

    Started cerenia again, since he was picky eating yesterday (at one meal only) but I'm being extra cautious.

    Edited to add +10 & PMPS =513 ( shot early cuz he was so high)
     
    Last edited: Feb 12, 2017
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Those yellows that are starting to pop up are a good sign. :)
     
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  15. MiCo

    MiCo Member

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    Thanks for the encouragement. He ended the day/curve in black, but in looking back at all his curves, he usually ends high. I think the day starts to stress him. :(

    Shot early since he was black. Today was the easiest/most stress free curve for me. I guess it Does get easier!
     
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  16. MiCo

    MiCo Member

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    OK, email sent to vet. We will see what she comes back with.
     
  17. Pati

    Pati Member

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    Hey Michele. What did the vet say?
     
  18. MiCo

    MiCo Member

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    No word yet. She usually writes back end of day.
     
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  19. MiCo

    MiCo Member

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    Amps=413
    7u
    +3 399
    +6 367

    PMPS=404

    Nice to see lower #s during cycle. Lower than ps #s, that is.
    I truly believe the curve testing stressed him out yesterday, leading to blacks.

    We will increase by 0.25 tomorrow am.
     
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  20. MiCo

    MiCo Member

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    +3 at2=408; relion prime=321

    Wow, this relion meter is gonna take some getting used to! Hoping to switch fully to relion tomorrow.

    The vet wrote me back, and she wants me to test every hour for 4hrs after insulin for next curve to make sure we're not missing a low. (Somogyi) Otherwise, she says he might be reistant to Prozinc and suggests switching to glargine? I gotta admit, the idea of switching insulin makes me really nervous, I haven't even read much abt the other insulin options.
     
  21. Sharon14

    Sharon14 Well-Known Member

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    Glargine is Lantus, and it is very different. If you do switch, we will help you figure it out. Have you considered the tests for acro and IAA? I ask because if he has a high dose condition a switch to Levemir may be the better option.
     
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  22. MiCo

    MiCo Member

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    Thanks! I will ask the vet abt those tests.
     
  23. MiCo

    MiCo Member

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    +6.5 AT2=394|relion=324
     
  24. MiCo

    MiCo Member

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    Using relion prime today...

    Amps=296
    Ate good
    7.25 u
     
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  25. Rachel

    Rachel Well-Known Member

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    I agree with Sharon that you might want to look into acro or IAA...Cliff's on a fairly high dose and he got there methodically.

    I know switching to a new insulin is scary, but we have several who have done so, so if you do that, we can tag them to give you an intro into the L forum and to help you out.
     
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  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    As you know I'm one of those switchers, Michele, and I agonized over it for weeks and weeks. I'm calming down now that Teasel has completed his first week (back) on Lantus.

    I'd really think about getting Cliff tested for acro or insulin antibodies. Many cats on here have those issues and they're not necessarily treated for them but the insulin is dosed around them. The doses are very high in some cases although they can come down with careful management. Generally, U100 insulin is used, though, because the volume of a U40 insulin you'd have to inject would be huge.

    @MrWorfMen's Mom, Linda, has a lot of experience with this.
     
    Last edited: Feb 14, 2017
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  27. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Hi Michele. I had a look at Cliff's SS and I too would recommend getting the IGF-1 and IAA testing done. My girl has IAA only. With her, I often thought I was making progress with a dose increase on the day of or the day after only to have her numbers shoot back up to where they had been until we were up to 16u twice daily. Wendy & Neko coined the term "dose going stale". I never saw blue or green numbers at all.

    You've been dosing methodically and Cliff does seem to be stuck but he's had some blue and green readings so not quite the same pattern I experienced. You might want to try increasing doses by 0.5units now because when you get to higher doses, an increase of 0.25u is a drop in the bucket and the trick is to get ahead of his numbers and then keep him there.

    My vet was willing to test for Acro but tried to dissuade me from testing for IAA because it is thought to be so rare. I insisted and my vet was quite surprised when it came back positive. IAA seems to occur more often in Acro cats than on it's own.

    The U100 insulins Levemir and Lantus not only require less volume per shot but also provide a longer duration with a "depot" of insulin which can help to keep the numbers down. Because Cliff is on a higher dose of ProZinc, I would recommend Levemir over Lantus if you do decide to switch so that you don't find yourself having to switch insulin again if Cliff's dose remains high.

    Don't be surprised if your vet hasn't used Levemir or is totally unfamiliar with it. It is similar in action to Lantus and is dosed pretty much the same way. There are lots of folks here who can help you with it.
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Thanks for weighing in, Linda.
     
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  29. Pati

    Pati Member

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    Linda, what is considered "a higher dose" where this would apply? Does it apply to all types of insulin?
     
  30. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Generally any dose over 6u is considered high although I've seen some vets suggest not testing for high dose conditions until they reach 8u. I've never seen a reference to any particular insulin so I believe it applies to all insulins. I've also seen 1u per pound of body weight as a reference so if kitty is large, they may need more insulin without being suspect for an underlying condition.

    When kitty is on 1u of insulin we increase or decrease by 0.25u which is 25% of the dose. When they get to 5u of insulin an increase of 0.25u is only a 5% increase which is fine if you are finessing a good dose but not helpful in an unregulated kitty whose sitting in high numbers and not seeing much movement. The problem is that the longer they sit in high numbers, the more difficult it is to get them down so you need to be a bit more aggressive when dealing with the higher dose kitties. There are some cats on copious amounts of insulin so full unit or even larger increases are needed to get ahead of their numbers. There have been cats here on 50+units of insulin.

    Pati, Morris is getting some good numbers mid cycle and you seem to be honing in on a good dose so if I were you, I'd probably stick with 0.25u increases even if you do hit 5u or just above so you don't miss his "ideal" dose.
     
  31. Pati

    Pati Member

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    Thanks Linda. Yes Morris is doing great. Kris and Sue have been helping me. Thanks for looking at his spreadsheet. Ok to even if he gets to 5u. I was just curious. I read a lot on the forum to learn what I don't know. Thank you for your detailed reply!
     
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  32. MiCo

    MiCo Member

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    Oct 29, 2016
    PMPS=345
    7.25u
    +3.5 307
    +6 233

    *relion prime meter today. Need to update sig and SS. Rough day personally/chronic pain. Will try to update soon.
     
  33. MiCo

    MiCo Member

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    Oct 29, 2016
    +8 184 --relion

    So, I have always told Cliff, "wake me up if you need me."
    He came clomping up the stairs just now, so I tested him--human meter in the blues!

    Just realized, we will likely switch back the AT2 tomorrow, since vet asked for a mini curve. Sorry for the back and forth with meters!

    Also, she mentioned in a follow up email that based on his weight, 8u was the dose at which she would consider him Prozinc resistant. Is it possible he could break thru at 7.25? I hope so!
     
  34. MiCo

    MiCo Member

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    Oct 29, 2016
    +11=110 relion | 147 AT2

    What an interesting development! I meant to get a +9 or 10 in, but didn't set an alarm and fell asleep.

    We will see where he is at +12, but I anticipate having to stall, or maybe even feed and stall. Luckily, husband will be home today to test more, if needed. I may back down to 7u too. We will see where he is in an hour.
     
  35. MiCo

    MiCo Member

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    Oct 29, 2016
    +12 163 using AT2. Gonna use at2 moving forward, for today.

    Going to stall 20min and see where we are.
     
  36. MiCo

    MiCo Member

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    Stalled 20min and he's lower on at2--tested twice. 147 and 150.

    Ugh. What to do? I think I'm gonna feed and then test bg in 2hrs.
     
  37. MiCo

    MiCo Member

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    @StephG if you are around, can you help? I know you have a higher dose kittie. Not sure what to think of this too low ps.
     
  38. MiCo

    MiCo Member

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    Ok, fed the cats because they've been waiting /begging for 1.5hrs. I will wait 2hrs and test bg again.

    Question though--once i get a shootable bg (in 2hrs) does he need to eat again before i would shoot? Never used this feed then test in 2hrs method before.
     
  39. StephG

    StephG Well-Known Member

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    When I feed and wait 2 hours I usually give a lower dose. Not by much but I lower it because chuck won't get the "food spike" after eating. I don't feed him again besides his usual snack.
     
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  40. MiCo

    MiCo Member

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    Ok, I was thinking lower dose. He got 7.25 yesterday, so I was thinking 6.75 or 6.5. Is that abt how much you would decrease? And you don't feed again before shot in two hrs (assuming shoot able BG, ok, thanks!)
     
  41. StephG

    StephG Well-Known Member

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    Today might not be the best day to do a curve but just make sure you note that he was fed and injected 2 hours after.
    Dose reduction will depend on his BG reading at 2 hours after his meal.
    With Chuck I reduced his dose by 0.4 because he was in the 500s. (He didn't really respond like I expect but he never does!) If he was lower I would have reduced more.
    If you're going to be able to monitor 6.75 might be a good dose if his BG is near his usual preshot reading. Looking at his SS (the last 3 days on 7 units) if he's over 300 7 units might be OK too.
    If anyone has better suggestions before she gives dose, please jump in!
     
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  42. StephG

    StephG Well-Known Member

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    Happy to see the breakthrough on 7.25u!
     
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  43. Rachel

    Rachel Well-Known Member

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    I like Steph's suggestion!
     
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  44. MiCo

    MiCo Member

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    He's 364 on the alphatrak 2hrs after getting fed. I'm thinking 6.75 because husband will be here today, not me.
     
  45. Rachel

    Rachel Well-Known Member

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    Sounds like a good plan to me!
     
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  46. MiCo

    MiCo Member

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    Ok, thanks for the help! Shot is in, & hubs should be able to test at +3. I will be home at +5.5 to test/feed. Hubs can test again in afternoon, if needed.

    This put us off schedule by abt 3hrs, but I'll make it work for next couple days until the weekend.
     
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  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Exciting, Michele! I'm glad that Steph, the dosing under weird circumstances guru, was here to help. I had success with Teasel using the feed, retest, then shoot a slightly lower dose method. It's a good tool when stalling a long time isn't workable. As for your three hours off schedule, I think you can shift back in 1 hour increments with Prozinc.

    I sure hope you're breaking through his resistance. It's scary but good. :)
     
    Last edited: Feb 15, 2017
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  48. MiCo

    MiCo Member

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    +3 is 422 using AT2
     
  49. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Food and/or bounce.
     
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  50. MiCo

    MiCo Member

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    Yeah--I did feed him before I left the house at 8AM, which was +1 from insulin, but had been 3 hours since they ate--my guys are serious grazers. (I think I did a test before feeding at +1, but I forgot to put in SS. Will do that when I get home.)

    BUT, I expected a little bounce from last night's BLUES! Just gotta see what the next couple of days bring us. I ended up ordering a new bottle of ProZinc today, because this current one is not going to last much longer with doses up around 6u and 7u. If we end up switching insulin, this might end up being an extra nearly full bottle, but he was going to run out before we made any decisions, so I had to order!
     
  51. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's what I would do for what it's worth. :)
     
  52. MiCo

    MiCo Member

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    :) Thanks!
     
  53. MiCo

    MiCo Member

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    Oct 29, 2016
    +5 was 424

    I will be home from work soon and will test and try to shoot at +11 (if he will allow) to help get him back on track closer to our normal 4a/4p schedule.

    The plumber came to the house today, and I heard from Dave that Cliff got frightened and has been hiding behind the futon most of the afternoon--but that he did eat an afternoon snack back behind there. I wonder if the stress will contribute to higher PMPS #?

    Also, thoughts on what to shoot? I know we need to see his BG # first, but is it ok to go back up to 7.25, or should I go to 7.0 units first on my way to 7.25 again? His evening cycles have been so different from his day cycles. In the evening is where we've been seeing yellows and blues towards the end at the +10 +11 and +12
     
  54. MiCo

    MiCo Member

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    Oct 29, 2016
    +11 469

    Thinking 7u or 7.25 again
     
  55. MiCo

    MiCo Member

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    Oct 29, 2016
    Shot 7u
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Should be OK.
     
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  57. Rachel

    Rachel Well-Known Member

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    The stress can cause a higher BG level, just depends on the cat. But if it wasn't right around shot time, I wouldn't think it would be causing anything. I like the 7u too!
     
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  58. MiCo

    MiCo Member

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    Oct 29, 2016
    Switching back to relion prime, bc we're running low on at2 strips and one of my at2 strip orders got canceled and another went mia during delivery.

    Anyways, +3 w relion prime is 337
     
  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's an expensive MIA. :(
     
  60. MiCo

    MiCo Member

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    Oct 29, 2016
    I contacted usps. I'm hopeful they will turn up. They were just supposed to be here today. :( And I got a confirmation that said they were left in my mailbox.
     
  61. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    I feel ya on the bottle not lasting long. I was ordering a new one every 4-5 weeks. Just picked up a new one tonight. Hard on the wallet!!
     
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  62. MiCo

    MiCo Member

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    Yepp, it's been every 4 weeks right now! We love our kit-kats!! :)
     
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  63. MiCo

    MiCo Member

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    Oct 29, 2016
    +11 191-relion

    Amps=216 (relion) | 278-at2
    Ate very well
    7u

    A few things:
    • The combo of lower #s overnight and switching to using the relion meter is hard for me, so I've been using at2 to get (check) his pre-shot #.
    • Definitely still nadiring into blues during pm cycle, but also later. Seems like between +8 and +11
    • I will try to test more overnight tonight or tomorrow. In to weekend will be easier, since I have to work during week. :)
    • Not sure how to dose lately, especially since he's staying higher during day, and going lower at night.
     
  64. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Meter-wise, do whatever is most comfortable for you.

    He did have a nice preshot this morning. I think your dosing is fine. Have you thought more about getting those high dose condition tests?
     
  65. MiCo

    MiCo Member

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    Oct 29, 2016
    The tests are on my list to ask about.
     
  66. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Most vets think both conditions are rare, but new research is showing that they are not. My vet did not want to waste my money and I finally had to insist on the test. The only place that runs the test is Mich State Universty.
     
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  67. MiCo

    MiCo Member

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    Oct 29, 2016
    +2 was 377 on Relion
     
  68. MiCo

    MiCo Member

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    Oct 29, 2016
    Does anyone have recent articles on IGF-1 and IAA, to share with my vet?
    I found these links to MSU for the tests.
     
  69. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Maybe put up a post on the main health forum?
     
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  70. Sharon14

    Sharon14 Well-Known Member

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    Those are the links for the tests. I'll tag @Wendy&Neko to give you more info. She's one of the high dose gurus in the L&L forum.
     
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  71. MiCo

    MiCo Member

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    Thanks! I can also post to the Main Health Forum, per Kris' suggestion. Maybe I'll wait and see if Wendy can provide a link first? It would just help me greatly to have this information, and a quick google search and search of the site, I could only find really outdated info.
     
  72. Sharon14

    Sharon14 Well-Known Member

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  73. MiCo

    MiCo Member

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    +6 347 (Relion)
     
  74. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    My vet told me that based on Neko's weight, it didn't make sense to test for high dose conditions until we got to 10 units. We never did - maxed out at 8.75 units. I had to ask the vet to humour me for the tests. The clinic owner thought I was wasting my money on the "exotic tests". Guess who was most surprised when both the IAA and IGF-1 came back positivie. Not me. ;)

    The most recent research on acromegaly is done at the Royal Veterinary College in London, England. Their recent study found that one in four diabetic cats has acromegaly. They were trying to screen these cats out of another study, so weren't looking for acros. They also found that the average dose for these acrocats was 7 units, with a range from 1 unit to 35 units. This post here has a compilation of a bunch of articles on acromegaly. Post #7 by Julie contains the link to the article on the recent research on numbers of acrocats. There isn't a lot out there on IAA, but we do see it often enough that it's worth getting tested - and can change your dosing strategy. If you do get it tested and it comes back positive, let me know and I'll give you my collection of notes on it.
     
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  75. MiCo

    MiCo Member

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    Oct 29, 2016
    Do you mind me asking, do you remember about how much the tests cost? I see the test amounts listed on MSU's site, but I don't know how much my vet would charge to draw the blood and ship it. If you want to message me direct, that's OK too.
     
  76. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I am in Canada, west coast, so the majority of cost that I paid was shipping with an extra (get blood across the border) fee. If you've had a blood draw before done for Cliff, you should know what the charge for that is. And you can always call the clinic and ask first. I've seen recent quotes by people that it was $160-$220, but the shipping charge can be really variable. And some vets charge an extra fee on top for "interpretation". I got a full blood panel done at the same time, so it wasn't a separate fee just for the MSU tests. Summary, your mileage may vary on costs above the MSU fees.
     
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  77. Sharon14

    Sharon14 Well-Known Member

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    My vet charged $125, but only tested for Acro even though I requested both:mad: I printed off the info from the MSU website and brought it to him before my appointment so he could read up on what needed to be done with the blood.
     
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  78. MiCo

    MiCo Member

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    Thanks, both!
     
  79. MiCo

    MiCo Member

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    This is a great post, thanks for sharing the link!
     
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