Elmo PMPS 133.....

Good morning from the Ozarks....just took Elmo's BG...141 after no insulin last night...fed him small amount before bed last night( about 6 hours ago).... please advise .....

 

Will be feeding in15 minutes and shot 30 minutes after that...he is more alert and yeowing to be fed...will be watching behavior as vetsulin has made him sleepy and lethargic most days...

 

Morning, Beth!

Good plan.

Just looking at Elmo's spreadsheet. Are you able to monitor BG through the whole cycle?


Mogs
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Yes

 

Elmo held his numbers very well overnight. Do you feel comfortable with the same drill as yesterday's AM cycle?


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Just updated SS from yesterday..

 

Yes if that is what he needs....yesterday summary was : give 0.25 minus one drop...test at +1.5 , +2, +2.5, +3, +3.5, + 4 , + 6.5 and +11.... monitor and feed at each as necessary

 

Oh and goal is to keep BG above 100, correct ??

 

So it's 0.25 minus one drop ???

 

Yes, same plan as yesterday. And monitor often. The cavalry is around.

 

Your boy's pancreas is definitely doing something. It's his best AMPS for a good while - and it's down from last night's PM+2.

It's great that you got the PM+2 test; it shows a food rise from the PMPS test and gives us more info about what may be happening with Elmo's pancreas function.

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Sorry for delay replying, Beth; my friend just popped in with some groceries for me.

@Kris & Teasel - are you around today to help Beth should she need assistance?

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Thank you, Mogs, for " holding my hand" thru all of this....so I am to give him 0.25 minus one drop and monitor thru out as yesterday???

 

Both a pleasure and privilege, Beth.

As long as you're able to test and feed then based on Elmo's numbers I think you should be OK with the same dose as yesterday morning.

Be sure to do the first test at +1.5 to make sure Elmo's safe and to see where the cycle's heading UNLESS he starts asking for food earlier (in which case test straight away in case he needs some carbs).


Mogs
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A million thank you's.....going to ask a silly question...when I minus the one drop do I do it when drop first shows or wait til bigger?

 

Yes, I'm at home and will check here frequently. We have a lovely snow storm going on here today.

 

That's a good question, Beth, because the size of drop can significantly affect the dose at these micro levels. Do you recall what you did yesterday? Try to mimic that as well as you can.

 

You're a star, Kris!

I need to try to get some more rest; still desperately tired and very sore.


Mogs
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I am jealous

 

What??!! Jealous of a snow storm?? Winter here has its charms and can be beautiful but it can get SO cold (-20 F) and it lasts SO long (Nov/Dec to March/April).

 

... but those charms can wear off pretty darn pronto when one ends up snowed-in with no food in the house.

My love affair with snow ended when I had to do a lot of driving in the course of my work. We're not geared up for it properly on this side of the pond and it makes road travel a complete mare.


Mogs
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Yes I do LOVE snow , although ours does not come often or stay for very long....going to call vet in a bit to at least get the u100s approved and hopefully gotten today..hoping he will consider changing insulins without seeing Elmo. Oh, how he ate the hour long round trip and not fond of the visit itself..has taken to biting if gets the chance.

 

Keep warm, Kris!

 

I can well imagine. Mogs. At least here it's in our DNA and we put snow tires on our cars and there are huge fleets of vehicles out to plough/salt roads.

 

Be sure to let us know how things go with the vetty bean, Beth. Sending wishes for a productive and helpful consult.



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What? Biting? Not Elmo, the Buddha!

 

Definitely not very Zen!

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Great. Now I've got a rather irksome snippet of the soundtrack to The King and I rattling round in my noggin.


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......go rest, Mogs....

 

Oh I will...probably won't place that call til after they've gotten thru their Monday morning rush and lunch...get them when bellies full and surroundings quieted....oh yes, I have a plan

 

Yep. And I am more concerned about his upset than their bloody finger....when he was sick early on was very doscile but now that better he is back to his old self of " do not mess with me"

 

Kris, when u have a minute, please explain U100s to me and how if there r no extra markings it is easier to give these micro doses..I want to call vet well armed and sound like I know what I am talking about. I figure if I take baby steps, today requesting u 100 and then the request to change insulins I can ease vet into my brave, new world

 

Also, if u were me, what would need to be said to let vet know why I want first the needles and then the insulin change.Wanting to go in armed and informed.

 

Good morning all! Glad to see Elmo is holding great numbers despite no shot last night. I too will be around today between snow shoveling sojourns so I'll keep an eye on Elmo too. I love snow and prefer it over rain but I do wish Mother Nature had seen fit not to bless us with this huge dump all at once. Already did one clean up of what looked to be 3 to 4 inches last night and I'm guessing there is another 4-6 inches of it out there now.
Here's a picture for you Beth so you can enjoy it vicariously!


This is my front window view this AM! Not sure what's up with the sidewalk plow leavings. Looks like some ancient art site out there right now! And the neighbourhood dog walker with her 3 tiny charges is having a hard time getting them onto the road from the sidewalk at the corner. Poor babies!

 

Ohhhhhhhhh.....makes my heart glad !! Thank u , Linda, for sharing that snowy photo! How absolutely gorgeous! What can I say, I'm an autumn and winter girl !!!

 

As for explaining the need for 100U syringes to the vet, I'd take a copy of the conversion chart with you to show how you'd be able to draw up 0.2u of Vetsulin using the first line on the syringe barrel and point out that you'd be able to draw up even less if need be, by drawing up between the top (needle end) of the barrel and the first marking. Elmo definitely needs very small doses now and this is the only way to be able to do it with Vetsulin.

On the long acting insulin side, I'd simply point out how quickly Elmo's BG is dropping and how much in the cycle and mention all the sleep derivation that has ensued because of the monitoring/steering that requires. The treatment plan has to work for both you and Elmo and right now using the Vetsulin even at tiny doses is time intensive and can be downright scary (don't be afraid to be dramatic to get your point across if there is any pushback!). It's also making it necessary to skip shots from time to time which you prefer not to do with a ketone prone cat. Longer acting insulins take longer to start working and will give Elmo a smoother cycle with a slower drop, easier to catch and steer if need be and will last through the 12 hour cycle which Vetsulin does not.

 

Not sure what this means, Beth, so I'll proceed:

• U40 insulin has 40 units (active amounts) of insulin in each mL of insulin solution. U100 insulin is more concentrated and has 100 units (active units) of insulin in each mL of insulin solution. So - U100 insulin is 100 ÷ 40 = 2.5 times more concentrated than U40 insulin.
• Regardless of how concentrated the insulin solution is, a unit of insulin is a unit of insulin. It just takes more (a larger volume) of the U40 solution to get a dose than it takes of U100 solution. So if the dose you want is, say, 1 unit you'll have more insulin solution liquid in your U40 dose than the amount of liquid in your U100 dose. Make sense?
• U40 syringes and U100 syringes are made to accommodate the difference in concentration. U40s are wider in diameter with a little more distance between the marks. U100s are smaller in diameter and there's less space between marks. The distance between full unit marks is still one unit on each type of syringe. It just takes LESS of the U100 insulin to get that unit.
• One drawback of U100 insulin and the accompanying syringes is that it's harder to give tiny fractions of doses because the stuff is so concentrated. You can measure out full and half units using the marks and can learn to eyeball 0.25 u but that's it. The marks on the barrel are so close together that you can't dose any finer than that.
• Here's where using U100s to dose U40 insulin comes in: U4o insulin is more dilute so it takes more liquid insulin solution to have 1 unit of insulin, as a matter of fact, 2.5 times more. Recall that U100 insulin is 2.5 times more concentrated. Said another way, U40 insulin is 2.5 times more dilute.
• If you want to draw up 1 unit of insulin in a U40 syringe, you fill it to the 1 unit mark. That volume has 1 unit of active insulin floating around in it. If you could transfer this amount of liquid magically into a U100 syringe, lo and behold, it would fill that skinnier syringe with its closer markings up to the 2.5 unit mark.
• The conversion chart we use here was made up so you don't even need to think of all this but just follow the numbers: conversion chart.

Here's why using U100 syringes for U40 insulin works to your advantage:
2.5 on the U1oo syringe = 1 unit of U40 insulin
2.0 " " = 0.8 u
1.5 " " = 0.6 u
1.0 " " = 0.4 u
0.5 " " = 0.2 u
0.0 " " = 0.0 u.
You can also eyeball half way between the half unit marks on the U100 syringes to dose even finer - eg. 0.1, 0.3, 0.7 u.

Many vets don't want their clients using U100s for U40 insulin because they're afraid of dosing mistakes being made. If you're careful this isn't an issue. Even if the math is confusing, the chart does the work for you.

Sorry if this is too long ...

 

If you request a U100 insulin the only option is U1oo syringes so that shouldn't be an issue. It's requesting a prescription for U100 syringes to use with U40 insulin like your Vetsulin that might cause some head-scratching. Maybe go armed with the conversion chart and say you want to be able to try smaller doses than you can manage with the U40s.

If you're not quite ready to give up on the Vetsulin, you could try using U100s for a bit to see how he gets on with tiny doses. If that doesn't work and you want to go to a U100 insulin you'd already have the proper syringes,

 

Mr.WorfMens Mom said it more succinctly. I was trying to explain the concentration factor and got long winded.

 

BG numbers update Beth?

 

Thank you, thank you

Thank you, thank you, Linda !!

 

Hurrah for the Post-lunch Dip!

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Snowhenge!

Beautiful scene, Linda.


Mogs
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If it were me I wouldn't fanny around with the Vetsulin/U100 + conversion chart stuff; I'd move straight to the request for the new insulin. (Ask me some time about when I reached this stage with Saoirse and forked out nearly £100(!!) for a Vetpen which only got used twice. )


Mogs
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BG update : + 2.5...126....gave 1/2 t 5 carb....

 

Very similar numbers to yesterday's, Beth.

 

Yes the snow is beautiful to look at! I've been using that beauty as my excuse for procrastinating at cleaning it up this morning but alas I really need to go get my butt in gear! Right now I'd probably have a hard time getting out of my driveway even with four wheel drive and snow tires!

 

Story of my life ...

Somewhere in my DNA there's a 'Why Use One Word When You Can Use Fifty!' gene.

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Nice start to the day for Elmo.

Good point Mogs! Maybe reverse the order and make the U100 insulin request first. If you get any pushback, then you have the request for the U100 syringes as a fallback position in the negotiation.

 

Totally with you...been at this vet practice for +15 years but mostly saw his associate, a lovely younger vet who was easy to communicate with...sadly she left this summer not long after she diagnosed Elmo..was there for his DKA hospital stay in a grand way. He is a caring vet who goes the extra mile but is next to impossible to communicate with...a very highly intelligent man with zero communication skills. I am preparing on how to finagle him into agreeing to this. I may be overthinking nothing but want to be prepared. Happily his wife, an RN, manages the office and is easy to talk to. I have already moved my tabby brothers to another vet but didn't want to disrupt Elmo's care at this time.

 

Yes, almost exact. My tabby brothers keep watching me, wondering why big brother Elmo is getting snacks and not them. Ah, I do love my furry boys !

 

Maybe if you threaten the vet with dropping Elmo off the next time he requires a PJ party so he can get a taste of what you've been going through!

 

And still, I'm green with jealousy

 

Ohhhhh, now that's good. Bless his heart tho,probably all I'd get is a blank stare. A real flat liner ! But great especially with cats. Does not overcharge but will not give up on an animal. Has kept kitties brought in for euthanasia for insane reasons and he takes the money and the cat, care for them and then keeps or adopts them out. Huge heart but small mouth

 

Maybe he's on the spectrum?

 

Maybe print out some of the posts on this thread and the previous one which cover the reasons why a gentle, longer-acting insulin would benefit Elmo. Maybe use a yellow highlighter to emphasis the key reasons and use that for yourself as an aide-mémoire to help you keep on point during your discussion with the vet?

I've also attached a PDF of the Roomp-Rand published, peer-reviewed study on the management of feline diabetics with long-acting insulins. It covers the use of Lantus and Levemir to achieve better regulation of blood glucose levels. (about as legitimate a reference as one could hope for.)


Mogs
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Remind me never to fall out with you, Linda!



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Thank you to you all, the awesome Royal Mounted Kitty Cavalry...u can see I've upgraded ur title ......btw BG update: at + 3. 128.....gave 1 t 5 carb just to keep it headed north until +4 usual nadir....

 

Mogs, I can get a bit carried away when dealing with unreasonable people who think everything is black and white and they know it all.

As you know my little sugar is a diehard kibble addict that I have been trying to convert to wet food since I adopted her a 10 weeks old. Needless to say, I have kicked myself often enough for not being more assertive about the change in her younger days, but the last straw was when I felt beat up here with every one telling me ALL cats can be converted over. I seriously thought about offering to pay her travel costs to any sugar Mamma who thought she could convert my girl with instructions not to return her until she was TOTALLY converted. The one caveat to that plan was that I couldn't live without my sugar for any length of time so I thought better of making the offer for fear someone might take me up on it and I might never get her back knowing how stubborn she is!

You, my friend, could never fit the profile of anyone deserving of my wrath so no worries!

 

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Morning summary: AMPS 141...+1.5..123( gave 1t 5 snack plus thyroid meds).......,+2....119( 1/2 5 carb1/2 8 carb snack).....+2.5..126( gave 1/2 t 5 carb).......+3....128( 1t 5 carb snack).....+3.5..131( tried no snack).....+ 4...125( 1 t 1/2 5 carb 1/2 8 carb........will check again within the hour then test again at + 7.5 and +10....

 

Nice 'n' steady; you're looking after Elmo so well, Beth!

Maybe skip the +10 and do the +11 instead so that you'll have a guide as to whether Elmo's rising at PMPS (same as yesterday). No food after +10 (unless something weird happens and food is needed).


Mogs
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Looks good!

 

I would not be doing what I'm doing and he would not be doing well if not for all of you...

 

Oh, btw, his +4.5 was 137

 

Elmo is having a very nice & peaceful cycle today. Yeah ELMO!

For your pleasure ladies, I invite you all to join me by my Lagoon of Tranquility! Almost as beautiful in the winter as it is in summer! The waterfall isn't showing well in the picture due to winter configuration to keep my fishies safe but the sound of it in the silence of the snow is just short of heaven to me!

 

This is beautiful, Linda! Remind me: where are you in Canada?

 

ohhhhhh, snow !!!!!!!!!

 

Praying for you , Kris and Mogs, as you help Sasha's Momma....mercy .....also FYI vet appointment set for Wednesday ...wants to research the L insulins ( had only used vetsulin, prozinc and novolin)....used the word "crashed" multiple times....again, praying success and rising BGs over Sashi....I know the situation all too well

 

It's been a busy few days for the Royal Mounted Kitty Cavalry!

 

Bless your hearts.....amazing kindred spirits

 

How is Elmo? Have you called your vet? Just thought I'd dash over here to check in in the midst of Sashi's crisis. Whew!

 

Kris, I'm in Etobicoke, a western suburb of Toronto. A tad warmer here than in your neck of the woods so we often get that heavy wet snow rather than the fluffy fun stuff and the clean up today is proving to be brutal! I need to go tackle the pile up left by the road plow! It was hard knocking down those little statues. They were so cute but also rather heavy!

 

Yes, I know Etobicoke. I agree that Ottawa is a tad colder. Isn't it the coldest nation's capital in the world or is that Moscow? Still snowing relentlessly here.

 

How much of this white crap do you have? They say we got 17cm but I'm sure I cleaned up more than that. Which reminds me...the bottom of my driveway and road access still need clearing. I'd better get at it before dark!

 

Elmo is great, thanks to all your great coaching, time and wisdom...I go to vet on Wednesday..told them Elmo's story and they r going to research the L insulins ( which they have never heard of) but open to it. Going to fax BG records tomorrow so vet has day to digest it all. Sounds promising .....and as far as Sashi...oh...my...goodness....you all r amazing....I know her panic and living far from ER clinic...keeping Sashi,his mama and all of u in my heart, thots and prayers....mercy

 

Not sure how much we have so far. Just glanced out my window and saw a guy riding a bicycle down the unplowed road beside me. Not the best transportation today methinks ...

 

Perhaps download the file attached to this post and email it you your vets.

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Good idea !!! Will do ! Got good feel from his wife when I called. Giving him time to research and sending him Elmo SS tomorrow.

 

Thank heavens Elmo is OK today! I've just eaten dinner in front of my computer to keep track of Sashi's progress.

 

Seconded; and ditto.

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Dearest Mogs, please go to bed and rest. I worry about you and continue to pray for your restoration and rest. Elmo is doing wonderful...+ 11 he was 139 so it's a no shoot night again tonight...you and all Kitty Cavalry have well equipped me for which I am eternally grateful. Now put yourself first and rest your body AND your mind/emotions.You have earned it in spades

 

Elmo update: +11 was 139......PMPS was 133.....ketones negative....appetite great....litter box good( God bless this cat that his balancing on the edge of the box all these years has paid off in easy peepee collection)..... I'm guessing ( per Kris's former instruction) it's another no shoot night, let him eat when he wants, take a few BGs , leave little food out for overnight.....THE END .....

 

I'm so glad they gave you fair hearing, Beth.

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Another really smooth day for Elmo - and a very positive whole cat report! Long may ketones stay negative.

How were his energy levels today, Beth?

If he were mine I'd skip again tonight. If you get a chance try testing at PM+3 tonight.

Sorry I can't write much now; I'm completely and utterly exhausted; passed out a little while ago but thankfully woke again because I need to set out feeds for the Noodler. Once that's done I'm going to collapse again.

Great job looking after your boy. Thank you for coming to encourage Sashi and his mama, too.




Mogs
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Wow what a great start to the day! Elmo is doing great! Don't panic if numbers go into double digits... I always aimed for a low of around 85-90. As long as you're there to monitor it's good.

I have a feeling your off the juice trial will be soon.

 

I agree, no shot tonight.

 

Thank you, Janet. If not for all of u here on this board I shudder to think where Elmo would be. Many kindred spirits have been met here. What a blessing !!!

 

Elmo is looking good Beth. I'm hoping you are getting much more restful sleep on these "no shot" nights. Looks like the excitement with Sashi is under control (waiting for a last confirming test in an hour or two) so hopefully no PJ parties tonight.

Mogs, I hope you have now retired for the night. You may just be staring at a screen while doing these low number kitty watches, but we all know, the tension can be exhausting and you've had a number of these situations over the past few days which I am sure are taking their toll. Please do take care of yourself.

 

@MrWorfMen's Mom Thank you for that statement. I realize its been over a year since that comment was written but it fits my junior perfectly. He has been on Dry food for the last 10 years and now with his diabetes diagnosis changing his food from dry to wet has been impossible. I have spend so much on food just these last few weeks. Its only been 3 weeks since diagnosis and thank god he hasnt needed insulin since I started making sure he is eating low carb food, but let me tell you he is testing all my patience. I feel horrible but for right now I am going to give him just dry food to make sure he is getting all the calories he needs because in 3 weeks he has gone from 11.5 to 10 pounds. So once again thank you for your comment. Its helping cope with my situatin and it lets me know I am not alone in this journey of stubborn kitty food

luz and junior

 

@luz You are quite welcome. Rest assured I feel your pain and a little more because I am in Canada and I can't get the low carb dry food you can. EVO decided our market wasn't good enough for them and Young Again may or may not make it through customs and would frankly cost me an arm and a leg over time. So for now I have had to settle on a 15% carb food.....higher than ideal but the best I can do. They have to eat. There is no doubt it complicates things a bit more but it is doable. I still hold daily stand offs with my girl hoping one day her hunger will overide her brain and she will at least taste the wet food rather than trying to bury it as if it were her waste. My cat has a high dose condition to boot but we have made a lot of progress despite her fussy appetite, so chin up. You and Junior will be just fine! And if anybody tells you it's easy to transition them..... just let me know. I've got your back!

 

You are too kind. I am glad your fur baby is thriving on dry food. Will let you know if i need you to back us up.

 

When is 165 I would do the 0.25, but not lose the drop. You could get him just a tad lower closer to the 85-100 range.

 

Hi Janet,

In theory that might work but the issue with Vetsulin is that the same dose can yank down an unexpectedly higher, slightly 'bouncy' preshot to a similar nadir range as the cat would run in on the same dose but from a lower preshot BG level.

Upping the dose, even by a fraction, may result in a faster (and possibly earlier) drop followed by the cat spending the rest of the cycle in a higher range, not a lower one (a 'tick-mark' curve).

Because of its harsher style of action Vetsulin is not really appropriate (or safe) as a tool when trying to tightly regulate a cat. And aiming for a nadir in the 80s with Vetsulin is, in my considered opinion, putting a cat at greater risk of a hypo. If the pancreas decides to sputter or if, say, the cat doesn't eat enough/exercises a little more than usual there is little or no safety buffer.


Mogs
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