Elmo + 11 141...PMPS 152..

Good morning from Elmo and I...AMPS was 169....ketone check negative....alert and yeowing to be fed..proceed with .25 today minus one drop or go back to full .25??? And i am available to monitor today, as usual( hey, maybe I'll even get Christmas tree decorated.....or not...)

 

Time to shoot in 15 minutes

 

@Kris & Teasel

 

Stayed at .25 minus one drop....when I fed him earlier , I heard him quietly purr....hasn't done that in forever..about made me cry

 

Will monitor/ feed as yesterday unless instructed otherwise....starting at +1.5 taking BGs as necessary.

 

So sorry, Beth - just seeing this now. You did the right thing this AM. I'm sure you'll be watching/testing today.
I know what you mean when you see their "normal" behaviour show up.

 

Oh no biggie. You all have taught me well. Are there any negatives to him going with no shot 3 nights in a row? Does it put him at risk for ketones? ( which he has never had since I shoved a ton of syrup down him pre July DKA ??)

 

If his BGs are good he won't likely develop ketones. I'd keep testing him for your own peace of mind and because he makes it so easy for you.

 

As my little niece says " you are my best, Kris "

 

Btw, how is Teasel and how is the snow up there in the White Cold North ???

 

Teasel is being Teasel - never being predictable in this FD sugar dance but he's OK. All three of them have a long snooze on my bed after breakfast. Lots of snow out there but they're quite efficient at clearing roads in the aftermath. As you can imagine there's a huge chunk of the city budget devoted to road salting and ploughing in winter.

 

Opppssssss..... got my adjectives flipped, I think....it's Cold White North, correct ? Got tickled when u called it that the other day

 

Hi Beth,

Just saw this now. I think you did the right thing giving the 0.25-1 drop dose. (Remember: the same dose may yank down numbers from a higher preshot value to the same sort of nadir range, as you saw a few days ago with that yellow PMPS a few evenings ago.)

When your vet is reviewing Elmo's numbers be sure to point out to him that when you skip a dose Elmo's numbers drift upwards again; if it were my cat I would take that as an indication that insulin treatment is still needed.

As you can probably imagine I am absolutely shattered today (and very, very agitated with PTSD symptoms really flaring) so I really need to take a bit of a timeout; I need bed rest. I see Kris is here looking after you (hi, Kris!). I'm also going tag Linda (@MrWorfMen's Mom) to ask if she will also keep an eye on you when she's online. (Hi, Linda!)

It warmed my heart to hear about Elmo purring this morning.

(((Beth & Elmo)))




Mogs
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Actually, it should be "The Great White North". I misnamed it myself, although Cold White North works too. Lots of cold and white, except when it's 90F+ and humid in the summer ...

 

I'll be around most of the day off and on.

 

I'll be around most of today so will help keep an eye on things too. Mogs, you stayed up way past your planned bedtime last night! Be careful or you'll end up on Santa's naughty list. PLEASE get some rest today and look after yourself! I stayed up late last night and ended up sleeping late this morning much to my furry kids' dismay!

Yep Cold White North works too! I still have to go chop through some road plow leavings at the end of the driveway. I ran out of steam yesterday. I don't mind the light fluffy snow but this snowfall was so heavy and sticky! Now that we've had our first storm, I'm ready for those humid 90F days again! My love for winter is very short-lived!

 

That's the problem with the PTSD. I actually passed out whilst still sitting up after Sashi's BG levels started showing signs of recovery and I knew you were all around to help. The Noodlebug woke me to feed her. My body can't handle any stress so after I woke up I was still shattered and desperate for rest but the PTSD leaves me in this awful 'tired and wired' state; I then can't sleep without taking meds but I need to come down a bit from the ceiling before they stand any chance of working. I'm still really jittery today and I had to take a dose of diazepam a little while ago.

I have tenure.

Kris and Linda, glad you're around to keep an eye on dear Beth and Elmo. I'm going back to bed now.




Mogs
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Elmo and I are great !!! YOU, on the other hand, need to rest your mind and body today !!! Don't make us have to jump in a plane and come man handle you into taking care of yourself . As I was reading this A.M., " who will take care of you if not YOU?"......so rest, rest, rest and if an emergency arises I'm sure you will be notified. Keeping you in thots and prayers for rest...but now you must choose it

 

@Kris & Teasel and @MrWorfMen's Mom ......Elmo is doing great....had AMPS of 169 and + 1.5 of 129....gave 1 t 5 carb and will test every 30 minutes til satisfied no longer falling. All of you have taught me well...I have your fantastic plan of action to follow and if there's a problem I will send up a flare! To both of you, please rest today...after the Sashi ordeal you have WELL earned it

 

Nice start to the day for Elmo. I'll check in periodically to see how things are going!

 

Morning summary : AMPS 169...0.25 minus one drop given........+1.5...129.(1 t 5 carb snack)........+2...113( 1 t 1/2 5 carb 1/2 8 carb).........+2.5...120 ( 1 t 5 carb) .......+3....137(no food).......+3.5....119( 1 t 5 carb)......+ 4......129( 1 t 5 carb).....+4.5. 139( no food)..........if you all have any thots / observations/wisdom to share, please do........will test again at +11 and of course PMPS.....thanks for keeping an eye on Elmo and I

 

Looks OK, Beth. You can see the effects of your food steering. With an AMPS of 169, a nadir of 80 or 90 would be ideal. He might have been headed there given his BG of 113 at +2. Your past data shows that he nadirs around +4. However, given what you've been through, you're wise to be cautious and control his descent with food. Good work!

 

One observation is that at +3.I didn't give snack cos in 130s and he wasn't ready to sustain that....same thing happened Tuesday when gave no snack after a 131..... will probably keep at a snack of 5 carb if we r still doing this tomorrow

 

Yes, I see that. If you find you have to steer with food this way going forward, that tells you he's dropping too fast and/or the dose is too much, especially for this fast acting insulin. Vet appointment tomorrow, right?

 

I agree with Kris that it would be ideal to get him down just a tad bit more and he may very well have been headed there but for the steering. If he were mine, I might be inclined to skip over the snack at +1.5 because you can always give a bit more higher carb at +2 or +3 if need be just to see if he will settle a little wee bit lower at nadir. We know what you've been going through and you have a good handle on his antics now. If you want to experiment a little, make a little change and see what happens and if it doesn't work, then you have the original plan as a fall back and of course we'll all be here to help out.

 

Thank you to you both. And yes, I am hyper aware of numbers headed south too quickly and so glad for your collective wisdom. I tend to want to rush in with too much intervention due to recent past history. And yes, vet tomorrow afternoon, 1:15 central time here. Sending SS today and he is checking on alternative insulin choices...has never used the L insulins and is researching those so glad they were open to that. Believing all will be well . Also a nadir should be roughly 50% of the AMPS ? Also at about what BG should I intervene with food? Again, thank you, thank you, thank you...

 

Yes, nadir roughly 50% of PS especially with insulin that gives a classic "smile shaped" BG curve. The L insulins can make them flatter in BG numbers so this guide might not apply.

Intervene with food if you sense he's dropping too fast based on +2 or +3 BG. You'll learn from experience. You already have, actually!

 

Kris, that is what kinda makes me a bit uneasy, that switching insulins means viewing what he's doing in a new way. Kinda like starting over? Wondering what effect will switching have on Elmo BGs at first, if any. As crappy as vetsulin is I at least know what to expect....

 

P.S. @Kris & Teasel @MrWorfMen's Mom ......can see even after the long day you both had yesterday your stepping up and being here on duty again today has given Mogs the peace of mind to get rest today.....bless you both for all your hard work and care. You are two extraordinary ladies

 

Ah shucks Beth, you've got me blushing! While I can understand the prospect of switching and learning the ropes with a new insulin may seem a bit daunting, many of the basics are exactly the same. The need for testing shifts a bit because nadir tends to happen later in the cycle but often a test at +3 or so will tell you if kitty is having an active cycle that needs a bit of watching or that they are just on their usual path and you can go about your business or get your beauty sleep without any concerns. The difference is that drops tend to be gentler and more predictable. You do have to be a little more regimented about keeping shot times consistent but otherwise it's a piece of cake. Once you get through that initial stage of finding the right dose for Elmo you'll be a pro.

 

Totally understandable and many have gone before you. One I suggestion I can make is for you to post on the Lantus/Levemir forum asking for guidance. Tell them you're thinking of doing this and why and ask for their input. I'm sure there are folks there who made the switch from Vetsulin to Lantus. I had similar trepidation starting Teasel on ProZinc but his DKA episode motivated me to go for it.

I spite of the hypo, Elmo is very calm and measured in his response to insulin. My guess is he'll settle into Lantus quite readily should you decide to try it.

 

It's better to feed at +1.5 to slow a drop on Vetsulin in kitties who metabolise it quickly like Elmo. Most of the drop will have occurred by +3 in fast metabolisers.

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We aim to help!

 

On aiming for a lower nadir, I think 80 on a pet meter is way too low - not enough of a safety buffer for this insulin.

A potential problem with trying to nudge the nadir down - either by manipulating with food or tweaking the insulin dose a hair - is that, instead of easing Elmo into a slightly better range for the middle period and all else remaining pretty much as is now, the tweak could potentially just produce a tick-mark curve: steeper descent to lower nadir; numbers start climbing straight away after nadir; potentially higher preshot at end of cycle.

My two penn'orth.


Mogs
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I think 80 is too low too but I'd love to see him around the 100 to 110 mark at nadir and wonder if there is any way to just nudge him in that direction perhaps by changing up the food steering timing/carb load a bit? Thoughts?

 

@Kris & Teasel @MrWorfMen's Mom ..... what do you think ? +11 141.....PMPS. 152..... shoot or no shoot ?? Ketone check just now..negative......behavior : very playful an hour ago ...under tablecloth swatting at brothers...very frisky...

 

Will be shot time in 40 minutes

 

Thinking and looking at SS. How long can you monitor tonight?

 

Til +5 or whatever needed....

 

We don't want to create an all nighter again but also don't want to skip if not necessary and he's right at that "scratch your head" point readings wise. Is there any way you can squeeze two drops out of the 0.25u instead of one? I always worry at night because so many of our kitties tend to go lower at night and his AMPS despite missed shots have not been that high. I think if you can skinny up the dose a bit more or are going to stay up and steer him as you did today, you should be fine. Otherwise, I'd be probably skip again. Hopefully Kris or Mogs will pop by an offer their suggestion.
@Critter Mom .....any thoughts on what to do tonight?

 

I wondered about squeezing out a bigger drop...the drop I do now is when it first comes out....very tiny...thank goodness for bifocals

 

I could squeeze out the full drop instead of the tiny......goodness, this can get ridiculously tedious and tiny....don't know how you all have done it for so long ....amazing

 

Sunday night skipped on a 127... Monday night skipped on a 133... now tonight Elmo decides to throw on a 152, the little poop......Linda, please explain again why it's NOT good that he skip so many night doses. Still not clear...I was encouraged by them, saw as good sign.

 

Late to the party - I was out for dinner. I like Linda's suggestion to try squeezing a bigger drop out of 0.25 u. Monitoring to follow of course.

 

Sorry had to pop off and test my little stinker who is of course living up her name today when I am trying to move her shots ahead a tad for an event I must attend on the weekend. Her timing for these Mama challenges seems to always occur just at the wrong time!

The reasoning behind not skipping shots is because the longer you can keep Elmo in decent numbers the more chance his pancreas has to heal and hopefully sputter back into action. That's why you're into this microdosing phase. It seems likely his little pancreas is slowly waking up. The other reason is that with a history of DKA, skipping shots can be the wrong decision even at lower numbers. Now with Elmo, that isn't much of a concern because he's been doing so well and you are checking for ketones so not such a big deal right now.

If you can squeeze out a bigger drop, I think that would be ideal. I really think you'd be fine with what you've been doing but kitties sometimes call our bluff as you well know so I tend to try to be conservative about stuff.

 

One reason is that his BG fluctuates more in a 24 hour period. He'd spend half a day too high from no dose in one cycle rather than having 24 hour coverage with two insulin doses. The more hours in a day that they can have BG under control the better for healing of pancreas, etc.

 

What would I do without u, without u all ......sorry for my blubbering broken record....it just grabs at my heart, the gift u all r to Elmo and I......thank u, thank u, thank u....

 

Big drop it is... monitor every 30 minutes or every hour up to +5 ?????

 

AND, I'll proclaim it again...Canadians are my best favorite

 

I think hourly to +4 unless he looks like he's dropping fast.

Ahhh! You didn't know Elmo would have so many godparents! We virtually adopt them all around here.

That's sweet but there are a lot of mighty fine Americans, Brits and Aussies around here too as well as many other countries! We're just an all round great group of kitty crazy folks!

 

Beth, when you have a moment, can you update Elmo's SS with today's readings so they are readily available should you need help and one of us isn't available right away? Thx.

 

Yes right now !!!!

 

Wot! Paddies don't get a mention???



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Oh Man I knew I was gonna get in trouble making a list like that and quite frankly I was thinking you were in England. My Bad.
I hearby declare the bestest of all are the Paddies!

 

Yes!!! Here, here for the Paddies, the ancestral home of both my grandfathers !!!

 

Just checking in on Elmo. Looking good so far.

 

Going to bed now..thanks so much, Linda , for checking in.He has done remarkably well with a closing BG at plus 4 of 108 after a very gentle slide. Praying it portends of good things to come!!!!!!

 

Good night and sweet dreams!