Elmo PMPS 155.....

Good morning! After a +11 of 144 last night, Elmo has produced a AMPS of 153......go with.25 minus 1full drop as last night PMPS of 152....he did a nice slow slide last nite on that dose

 

Morning, Beth.

If you're up for it perhaps it might be an idea to try the same dose as last night because the drop was smooth and the nadir was a little lower.

With Elmo's current numbers his pancreatic insulin must be doing some of the work. It can get a bit tricky sometimes when BG levels get into a lower and healthier range and only a tiny dose of injected insulin is needed: if it's more than the body actually requires at any given point then the situation may arise where the body starts to release stored glucose to counter the excess and that may result in slightly elevated numbers (e.g. producing a tick-mark curve as discussed earlier). Sometimes shaving the dose can help improve numbers because the body won't be fighting against that little bit too much insulin active in the system and overcompensating somewhat. Another possible reason for the lower night time nadir might be due to Elmo running lower during the PM cycle; many cats do.

Sending some scritches for your darling boy. It was lovely to hear about him being playful yesterday evening.


Mogs
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Good morning Beth. I think I'd go with the same dose this AM. Oh I see Mogs beat me to the task! So I'll just say Ditto to Mogs' comments!

 

Thank you, dear Mogs !!! I have a very good feeling about that cycle last night. It was joyous each time I took his BG to see the low slow descent.Hope this finds you much restored this day !!!

 

Thank you, Linda ! Two of Elmo's godmothers heard from and in agreement ...doesn't get any better than that !!

 

Still banjaxed. With the CFS, etc., it takes very little to leave me bedridden for days.

You did great again on the PM cycle last night.

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Mogs! Hopefully things will be quiet around here today and you'll be able to grab a siesta or two!

 

I do need to ease off, Linda. My mind and body just can't cope with any level of sustained activity. It's so different to the person I used to be.

 

Question: monitor every hour ? Or every 30 minutes?

 

Linda, could you send the link to the u40 to u 100 chart please for vet visit today .

 

I understand chronic health issues, Mogs. Take care of yourself.

 

The others beat me to it. Good advice from them. He's doing really well, Beth. Here's the conversion chart link:
conversion chart

 

Mogs, you put your heart and soul into your own and everyone else's kitties and their Beans but sometimes in your passion to help I think you forget about yourself. So while I know you have heard this a million times over, look after yourself first, the Noodler next and then when you have the energy, all the kitties here that you vicariously adopt along with their parents each and every day. We'd all rather see you take a break for day or two than to see you do yourself in and be gone longer!

Now having said that....Elmo behave yourself today so your Mama and Mogs can take it a bit easier today.

Here is the conversion chart Beth. CONVERSION CHART Let us know how the appt. goes.

I have to pop off for a few minutes and go check on my little menace (yes I meant that to be lower case this time!) because she is making Mama scratch her head and do happy dances all at once AGAIN this morning. Why do our cats pick the wrong time to do what we've been trying to get them to do for ages!?

 

I'm sorry to hear that, Kris.

In all truth I wouldn't wish such insight on anyone. Really saps all pleasure out of the business of being alive. Once upon a time I used to be a real powerhouse of a woman ...

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(((Linda)))

It's a family thing.

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Oh, another Elmo godmother heard from.....thank you, Kris, for the link

 

Check at +1.5 and do your usual steering. If numbers similar to recent cycles then I'd suggest next test at +3. If +1.5 is showing a steeper drop do the steering and check a little sooner; and if on the low side intervene as necessary and then post for help.

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I like being one of Elmo's faerie godmothers!

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The up side is that I've developed an excess of grit and determination to keep going when I feel like !%$@! That's why I've referred to my "pit bull" mentality on other threads here ...

 

In my eyes you ARE a powerhouse, a force to be reckoned with, a strong spirit....but even powerhouse forces have to take care of themselves . I pray for you to allow yourself to get full rest....as Linda said, for yourself and your critters first and all others after that

 

Atta girl, Kris!

This 'ere Moglet used to be powered by sheer Corkonian bloodymindedness.

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((((Beth))))



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Behave, you little Menace !!! Give ur Momma a break !!! I can't be too strong cos she is wayyyy too cute !

 

Oh, believe me, I understand bloodymindedness!

 

Bloodymindedness: preserving the sanity of women everywhere since the year dot.



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Got it !!

 

Thank you Beth! I think she heard you and listened! She was JUST high enough to shoot and got another reduction this morning. She had me biting my nails earlier when she didn't finish her last snack before AMPS. Very uncharacteristic for her and a call to action for me especially when I expected a bounce after yesterday's cycle. At least she didn't throw me a terrifying 40 again! This is me dealing with her lately......

 

Aw ...c'mon ... we all need a challenge, don't we?? Keeps the "mature" brain firing on all pistons!

 

Linda, I continue to be amazed that as you all deal with your own personal and kitty issues , you are on this board pouring out of yourselves to others . This is the most extraordinary group . Really defies words to describe.

 

"Mature brain" ......like I tell my sister in law, we aren't getting older we're getting wiser !

 

I'm ducking away now; need to rest. Will check back later.

Slán go fóill!




Mogs
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It sure does!

Great plan Mogs! Rest well!

 

@Kris & Teasel @MrWorfMen's Mom .......+1.5...124..no snack........+2..104.. no snack.....+2.5...99..no snack....thots ????? Checking every 30 minutes and monitoring behavior...instead of laying down he is roaming around, checking out stuff in the basement....at what number should I steer with 1 1/2 hours til nadir

 

What the heck??? +3 just now was 138....up from +2.5 of 99.... have not intervened with any food....what is this ???

 

Elmo's liver, possibly.

No snack at +1.5.

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Sounds like he might possibly be feeling happier with less Vetsulin.

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Mr. Elmo is playing with your head. Could be that he's bounced a smidge with that 99? No worries. See where he goes at +4.

 

Have given no snacks....is doing much better behavior wise...way less lethargic

 

Did your Menace text him and suggest these head games , perhaps

 

Tick-shaped curve, perhaps because the Vetsulin hits so hard in the early part of the cycle. As well as problems with safety, Vetsulin really is a pain in the fundament trying to work with at lower BG levels. That said, one could see similar with Lantus in a cat close to remission but because it's gentler in effect it doesn't drop BG as fast as Vetsulin and therefore can make the process of nudging the whole curve down into more healing numbers more straightforward.


Mogs
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Could be because he has had less Vetsulin.

Whatever the reason, it is very good to hear Elmo's feeling better in himself: that's what this whole palaver is meant to achieve, after all.

ETA:

Beth - be sure to record the improvements you're seeing in behaviour, mood and energy levels in the Remarks column of Elmo's spreadsheet: it will help you in discussions with your vet.

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Welcome to the Vetsulin Dosing Wall, Beth.



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Testing every 30 minutes...also vet appointment had to be rescheduled to later this week....will give me time to collect data from latest dose drop....sending BG SS and conversion chart along to them today...

 

Ugh

 

Once an hour to +4 would probably be OK, Beth, unless any test showed him dipping unexpectedly.

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BTW what was the carb value of the food you gave Elmo for his brekkie?

 

5carb

 

+3.5 was 115....taking +4 in a few minutes

 

Oh yes , I record every little nuance I observe...have a notebook with a page for each day ....vet probably thinks me a bit goofy but with age/wisdom also comes a " who gives a rat's patoot" about what others think....quite freeing, actually

 

+3.5....115......+4...128........behavior: quite different... instead of up in his man cave is here in kitchen, laying in the sun...

 

Suggestion: try feeding him 8% carbs tomorrow morning.

I am sooooooooooo glad to hear he's feeling and acting better. Bet seeing him like this is making his mama feel better, too.

Might I suggest that you keep a brief note of clinical signs in his spreadsheet too, Beth? It really helps to see both the clinical signs and the BG data side by side - can make it easier to spot patterns. (It's the way I managed to work out that C/V insulin was making Saoirse feel icky; at that stage I'd not read anything here about the possibility that a particular insulin might make a kitty feel crummy despite BG levels having improved.)


Mogs
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Will do, oh Great Yoda of all things kitty....i have more notes on him than squirrels have nuts ! Was encouraged in that habit by my wonderful holistic vet I consult with by phone from time to time...you all would love her..she is definitely one of us !

 

"An excess of grit and determination" ... I love that quote and totally relate !!!

 

She's the Yoda!

One thing about this Sugar Dance is that it teaches us to get much better at 'listening' to our beloved fur babies. Keeping a journal for Saoirse helped me to care for her better (especially when there were setbacks). Indeed, through her spreadsheets Saoirse is still able to help kitties here now. I love my girl so very much - and I always will. I am beyond blessed that I'm the one who got to be her Person ... (((Saoirse)))

Mogs
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Yes, Mogs, Saoirse continues to love and give ....and I know they truly have " gone ahead" and wait for us there!!!What a legacy !!! Thank you, sweet Saoirse

 

I work on the principle that she's still right here beside me all the time. (I'd be sat in a padded room somewhere were it not for that ... )

Here's her spreadsheet from last year:

https://docs.google.com/spreadsheets/d/1v0bhNxuX_2npXIFlDVDS821F1_Y2K-0KsvIJXmmcjME/edit#gid=5


Mogs
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Oh , I believe that without doubt... I believe they are more waiting for us far more than gone....we have had to release our two oldest in the last year and a half......Socks lived to be 21 and went ahead May 2015...then almost to the day our sweet 19 year old Chloe left this May....

 

Sorry to be gone when advice was requested, Beth. I have a very large furry critter who lives out at a stable and he needed a visit and a grooming today. Beautiful winter wonderland out there!

 

Just catching up. Was on the phone FOREVER!

Hugs to you both for the ones who have passed on. I've been through it myself and firmly believe they never leave us and are always watching over us. We learn so much from each one of our furkids. Because they are all so very unique and special, they continue to influence our choices and actions even when they aren't right under foot.

Elmo is looking so good! Glad you stuck with the lower dose.

 

I'm sorry to hear that you lost them, Beth - and so close to one another - but glad to hear that you had them in this realm for as long as you did. Oh, but that they might be longer-lived ...

I've just been telling another member a story about when I first adopted Saoirse and Amadán: here's a link to the post in case you'd like to read it:

http://www.felinediabetes.com/FDMB/threads/introducing-scooter.169382/#post-1842592

(I'm unable to write a proper FMDB tribute for them because remembering the joy of the wonderful times is just too painful; makes the missing so much worse ...).


Mogs
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Hugs to you too, Linda.



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Another thing about the longer acting insulins is that you can shoot lower pre-shot numbers (once you have enough data) to keep kitty surfing in good numbers because of that gentler curve.

 

Oh Kris, never apologize for living ur life ....I bet ur stable critter is gorgeous and needs his Momma too.....and yes, I still have snowy envy

 

[Emphasis mine]

That's the key to it all; the L insulins are great for holding down good BG levels because you can administer them at lower PS levels (safety and data volume permitting). The likes of Vetsulin are better at yanking down high numbers but not really suitable for tightly regulating a kitty in the optimum, healing range. I think that Vetsulin can be sufficient to help cats who only need a diet change and a bit of a nudge to go into remission but in situations where a kitty's pancreas needs to rest for a longer period in order to recover more beta cell function then the L insulins are, in my considered opinion, the best treatment choice (provided they agree with the cat).

The opportunity to tightly regulate a home-monitored cat safely provided by these insulins can make such a difference. Having seen real-world examples of how the different insulins work in cats it's no surprise to me now that such superior remission rates were observed in the Roomp-Rand study of newly-diagnosed cats who receive early treatment with L insulins. Indeed, I think there may be many cats who could be good candidates for remission but who will never achieve it - either through being put on the Caninsulin 'doggy protocol' (feed the cat kitty cornflakes and throw lots of insulin at it to try to keep it under the renal threshold) or else getting close to remission and then hitting the C/V 'dosing wall' where for safety reasons it's not possible to get the cat into the tightly-regulated BG levels which offer the best chance of the pancreas recovering enough beta cell function. It makes me sad because there must be a lot of kitties and caregivers out there who might have been able to live life free of the pokes and prods and the worries if only they'd been able to access a better treatment option.

Saoirse is a case in point: she got close to remission BG levels with Caninsulin and closely controlled feeding but her pancreas still wasn't getting proper rest because even a 0.2IU dose was too harsh and her body ended up fighting against the insulin for a good part of each cycle. After I had to stop Caninsulin for safety reasons she couldn't hold in the normal range without support (and within a week she had a severe pancreatitis flare). I don't think she would have achieved remission without being tighly regulated on Lantus.


Mogs
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Any news, Beth?

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Oh, Mogs, thank you for checking on us....Elmo was up, bopping around until about 2:00 when he retreated to his man cave for the first time in the day....sending his SS along to the vet tomorrow and reschedule for Friday....I got the impression from his wife who works with him that normally at this point where Elmo is that they do a trial OTJ ....I said I believed Elmo needed more time on a more gentle insulin to give his pancreas optimum healing time.....I know that is what is best for him but I am a bit scared in learning how to use a new insulin when he is doing so well...I know I have no choice and that we have hit the vetsulin wall( perfect description from you) but I'm dealing with apprehension about the switch....after a good night's sleep tonight I will tackle the Lantus stickies tomorrow...glad you gave walked almost this same path with sweet Saoires so that calms my heart muchly

 

If you could tomorrow, very briefly tell me about Saoires's transition....since my vet has never used Lantus I will be totally dependent on FDMB for direction and protocol.

 

AND, Mogs, please explain how I am to try feeding 8 carb food tomorrow morning....give it to him til he walks away and not feed more when he returns? Can I feed other 5carb after the 8 carb at the same meal??? Or just put 8 down,when he walks away that is it for that meal ???? As u can see, my overthinking self has barged in

 

Kris, also forgot to thank you for the excellent tip to " play with water" to practice drawing up this minuscule dose. Have also been practicing with an orange to understand how it feels to administer the dose. My sweet husband usually does the shooting while I pet Elmo but he is gone til tomorrow and then will be gone again this Sunday thru Thursday to ski with our son....so it's time to put on my big girl pants and give Elmo his dose....

 

You can do it, Beth. In my experience, there's very little resistance when the needle of the syringe pierces the skin, especially if you're holding the skin taut.

I'm glad the coloured water tip helped.

 

Have been readying to go to vet on Friday....wondering how much lower dose is available to Elmo as we r at 0.25 minus one drop??? How much smaller doses could be given with u100s ??? Just want to be ready to answer any questions he might have.....

 

@Kris & Teasel @MrWorfMen's Mom .......first off, should I start a new thread or rename a current one as I did here???...,Elmo had aPMPS of 155.... unless I hear different I will proceed with .25 minus full drop and take a +2 and + 4 unless I get chicken whereas I will take a + 3 as well .....sorry to be such a baby...just feel better checking with u all before proceeding....will be feeding in 20 minutes and shot 30 minutes after that....you all r my best...Elmo said to say thank you, thank you

 

No problem Beth. You are not being a baby. You are doing great and there is nothing wrong with wanting some backup of confirmation of dosing decisions. I think the same dose with tests at +2 and +4 is a good plan. As you said, you can always grab a +3 if you need or want to. I think Elmo will behave himself again tonight. He's had a couple of very nice cycle on this dose.

Man I just hit an unknown key and the type got HUGE. Please know I am not yelling!

 

Just seen this, Beth.

Glad Elmo didn't bounce at PMPS.

I like the plan for tonight. Don't worry about food carb % for now; just feed exactly the same tonight as you did on last night's PM cycle. Bearing in mind it's the night time cycle I'd suggest you keep to giving Elmo his +1.5 snack tonight.

In terms of giving the injection, in addition to making sure the skin tent is taut, make sure the bevelled side of the needle is facing you and that you insert the needle under the skin at a 45 degree angle to the cat's body. Practising on an orange really helps.


Mogs
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Anti-jinx!

(Ahem!!!)



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.....never would think that, Linda...a million thanks to you and sweet Menace

 

Thank u, thank u Mogs....he usually eats off and on til +1.5 but if he hasn't Ill give him a bit of a + 1.5 snack....sweet restful sleep to you !!!!

 

Well that is a bit of a tough question because we don't know exactly what the dose is when using the U40 0.25u minus a drop "method". You'd have to draw up 0.25u, count how many drops were in it and do the math. And of course the size of drop can differ slightly too. Using the U100 syringes, you'd be able to eyeball a dose of 0.1u and could technically use the drop method to decrease that further.

 

Start a new thread for Elmo tomorrow, Beth, and post a link to this one in the opening post. (One of us can post the link for you if you don't yet know how to do so. )

I'll reply to some of the questions above about transitioning to Lantus on this thread tomorrow (need to sort out the Noodlebug and take my sleep meds soon; I'm absolutely hanging).

If you fancy some light bedtime reading the "Management of Diabetic Cats" PDF contains the dose adjustment guidelines for cats following the Roomp-Rand Tight Regulation Protocol. If you go to the L&L support group board (link below) you'll find a sticky at the top of the board with the Start Low/Go Slow dosing guidelines.

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/


Mogs
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Fixed it! Now the anti-jinx is official!

 

But seriously Beth....if you switch to Lantus, you'll have lots of help learning how to use it....it's the most active forum here because so many of us use it. Generally we start the Lantus at about the same dose as Vetsulin/Caninsulin/ProZinc so Elmo would probably be started at .25

 

BTW - re injections, the insulin syringe needle's really fine and goes in easily. Injecting the orange will give you a fairly good idea of what it feels like.



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Thank you, fellow Ozarkian

 

No , no, no...tomorrow will be best for both of us...I feel a bit like trampled ground today so going to veg tonight....my 94 year old momma can turn me every which way but loose, bless her pointed little head ......

 

Ahhhhh....this be a crazy hot mess at times

 

@Chris & China - Visibility must be poor tonight. I guess you couldn't see just how deeply the tongue was implanted in the cheek from all the way over there!




Mogs
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I'd keep it simple for the vet Beth. You'd be able to give Elmo essentially half of what you are giving him now give or take a drop!

 

Sorry I missed your query AGAIN Beth! This time I was out at a little Christmas pot luck get-together. I usually don't go anywhere - it's just that busy season we're in.

 

Glad to hear you got out to the party Kris! A little seasonal cheer and good company is good for the soul!

 

Amen!!! And very well deserved

 

Kris, Kris, Kris..hush up and enjoy yourself..you deserve all the good things

 

Elmo, Benny , Chris(civvies) and I are all tucked in for the night...no snow but quite cold here which ( as Mogs says) cheeses me off...if its gonna be cold it needs to come with snow...just sayin'...BGs look great so you all are off duty

 

Wishes for a safe, peaceful and restorative night to you both.




Mogs
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Oh, Mogs, received and sent right back to you and yours