How do you know when the Lev has lost potency?

I used to be able to judge my insulin potency easily because if more than one cat was getting bad numbers, it was the insulin.


Now with only one on insulin I'm not sure. Tucker's numbers are acting more like PZI, increased preshots with big drops mid day. Sorry, spreadsheet not up to date, I need to add a few weeks. But, AM around 250 with +6 in the 90s and Tucker feeling cruddy.

Is the insulin pooped since he's not getting flat curves or is Tucker's pancreatitis acting up? The lev cartridge is halfway done, he gets a fat .5U BID, so it's slow going on using up the cartridge.

How do you folks judge when it's time to start a fresh vial/pen?

 

Hi Jennifer,

I have been able to use Lev cart to the very last drop ( 2.5 months ish) without a problem. My lev cart is wrapped in dark paper to keep light out and bubble wrap taped to cart cuz I drop it from time to time and kept in fridge in door inside pill bottle for best preservation.

Can you update SS and when you get time do a curve ( spots every 2-3 hrs) to give us a whole day picture? IMO, we need more data to give informed dosing response.

Thanks!

 

Thanks Melissa. I'm not really looking for dosing advice, just wondering how folks know when their insulin is expired.

Considering Tucker's advanced age, IBD, chronic pancreatitis, many allergies and now the neuro problem with his circling, I'm pretty happy getting numbers that are mainly in the blues all the time.

I guess I could just open a fresh vial and see if that does the trick. Was trying decide if I should do that or a dose of Buperenix.

I was hoping others might be able to tell me that either the numbers didn't move or they might have experienced something else that told them the insulin was expired. Without Misty and Sadie who were on insulin, I can't tell if it's just the insulin or if Tucker's CP is acting up.

 

My bad...when you wrote:

I thought you were asking us to help you decide if it was the lev or the pancreatits effecting the BG values.

Several here have experience with Ptitis that will stop by after work or on thier lunch breaks and thought it would get us ahead of the game for you to have the numbers available to them. I know I would have needed recent BG values and some spot checks to help answer that question.

As you said, changing vials will likely allow you to answer your own question. ;-)

 

I'll update the SS tonight, he goes to the vet tomorrow for his monthly weight loss check so the vet will want it e-mailed anyway.

Today, however, he was AMPS~240 and +6~56 then I rechecked the +6 and got a 60.

He never has those kind of drops on Lev, so that's why I'm thinking the Lev is pooping out.

Normally during a CP flare I can't get his numbers down at all.

However, with whatever is going on with Tucker's losing so much weight and the circling episodes, I have no idea what his common CP looks like anymore.

With age he's changing.

 

I hardly think the insulin is pooping out if it's giving him nadirs of 60!

How is he eating? That may very well be the missing factor here which is causing him the lower numbers after the mid-200s.

As for the cartridges, honestly, I've been using Lev for over 2 1/2 years now and each time I thought the cartridge was pooping out and I opened a new one, the same problem continued until I figured out that it was dose or schedule issues affecting his numbers.

I suppose there's a possibility if the insulin is affected by an external factor that its action would change such that you might see later or earlier nadir, not sure. We speak of "poop out," meaning the insulin acts like it's NOT working at all anymore. Yours seems to be working better than fine!

CP is going to affect numbers, especially if their eating habits change, not necessarily not eating but perhaps not eating until 6 or so hours after shot, for example. And eating less when they do eat.

Halfway done - pen been open about 3 months now? Just for curiosity sake, why not open a new pen and see what happens?

 

It's best not to put Lev in the frig door

You meant door right, not drawer? It's being moved every time you open the door, Melissa! And it's a jerking movement too because of the door suction. Tuck it to the side (not too close to the back) if you don't have a drawer, that's probably better. Good that you keep it in another container, that way you can find them!

 

Hi Jennifer...I agree with what Vicky is saying - doesn't sound like it is the insulin since he is getting a lot action from it even though it is steep and not what you want.

Just a thought, maybe he just needs LESS insulin now that he has lost more weight? It almost looks like he is rebounding from what numbers you have given.

 

I've updated my spreadsheet and tomorrow's weigh in will tell us if he's lost even more weight.

There's some yellows in AM numbers recently.

I am not sure if Tucker's IBD or CP is acting up. I think it's his IBD. We are back on B12 injections weekly (as long as I remember each week). There's no gluten that he could have gotten into. He had another *cough* yesterday so he got hairball remedy.

Just as an FYI, we use the flex pens, stored on a shelf in the fridge. Since it's in the pen, I don't store it in anything else, the pen seems to keep it well insulated.

I realize there aren't a lot of spot checks for a while but the foster kittens and I both had ringworm so I didn't want to handle my own cats too much until my ringworm went away. Foster kittens gift to me They still have it a little, but hopefully we'll get an adopt out day after they see their vet on Saturday. Tucker and all my own cats didn't get the ringworm.

So, Vicky, do you think I should lower the dose to .5 instead of the fat .5 (which I'm calling .6 on the spreadsheet)?

 

Not Vicky, but if you are asking that because of the weight loss, then yes, that would be what I would try. Of course, check with your vet since you are getting him weighed tomorrow anyway.

Interesting on your spreadsheet how his numbers went up for a short while right after starting the Tresaderm (steroid/AB) ear drops back in December. Do you think that was related?

 

I agree with Pamela about his weight and overall body condition affecting his insulin needs. So yeah a decrease is probably warranted. I don't know how long he's been at .5U dose, but if you're giving it as a fat .5U, decreasing to normal .5U might eliminate the swings, which is what you're seeing and usually due to a tad bit more insulin than they need. Remember that the smaller the dose, the greater the percentage decrease even if it's from a fat to regular or skinny. Say you decrease by .1U (from .6U to .5U) that is a 17% decrease! So it may not take much of a decrease to affect his numbers, (hoping my math isn't off!)

 

If it were me and my PK, I'd get a curve done BEFORE changing dose...get a bigger picture of what is going on.

From the BG checks available it does look a little like bounce, but again, I would get a curve first.

 

PMPS 157, I gave .5U.

Regarding Dec's higher numbers. I'm not sure if that was related to the ear infection, the steroid or the loss of Spunky, our senior alpha female.

Tucker's last and very long lasting CP flare occured after losing Henry, Lucy and Misty within four months, and now we have lost Spunky and Keesha and gained Mr. Darcy.

So, I do not know if he's not eating well from IBD, CP or emotions. Plus we have the strange circling he's doing now that the vet thinks is neuro-related, a type of slow growing tumor. He had a mast cell tumor removed about a year ago from his head. I know, rambling now, but Tucker's medical history is very complex, has been since I adopted him in '05.

This is why sometimes I'm reluctant to start pain meds if I'm not 100% sure it's pancreatitis flare. If it's IBD I worry the Buprenex could block him even more than his IBD does.

I was hoping this was just insulin going bad, but I can see your point that he wouldn't be getting such an extreme reaction if it was bad.

 

Tucker's gone through a lot! What a trooper! Gandalf had a parathyroid tumor removed a year ago last December, has nodules on his pancreas now with CP flares, so I understand what a hard time a person can have trying to decide what the right thing to do is in regards to medications. They want to give him ABS when he flares, but he doesn't tolerate them well and gets sicker than without them.

So you think Buprenex affects their bowel? I had not read that. Although our vet says Gandalf does not exhibit symptoms of IBD (no constipation or diarrhea) his ultrasounds always come back with small intestine IBD diagnosis. Thicker walls I think is the clinical description.

Tucker's in good hands. Hope his weight has stabilized. Let us know how he's doing.

 

Jennifer, just chiming in to say that I concur that given the response you are getting, the insulin seems ok. I have been using the same cart since last June with many months of not using it at all while one or both FDs were OTJ. (I store it in my fridge door, too, BTW).

Also, it does seem like maybe too much insulin. I got similar numbers with Beau but with a slightly higher nadir - it looked like he needed more, but after a few sudden, unpredictable drops to lows I tried lower the dose. And that worked well. I ended up lowering him right off insulin.

With Tucker's weight loss, it really makes sense that he may need less. Good luck tomorrow. I hope he hasn't lost any more weight. Paws crossed for him.

 

Good morning all.

We had a lower preshot this morning, 210, that was after the dose reduction last night. I'll be able to get a +6, then we go to the vet after work and hope we didn't lose more weight.

Thank you for all of the help yesterday.

 

It looks like he might be going in the right direction with a flatter curve - give it a few more cycles to settle and maybe the PS will come down some more.

Please let us know how the vet visit goes

 

Just got back from the vet.... drumroll please........


Tucker didn't lose or gain weight :mrgreen:

He weighs 15 pounds 4 oz, same as last month. Just four months ago he weighed 17.6, that's been pretty much his weight since adoption, he did go up to 17.9 at one point, but the losing weight so quickly was scaring me.

Maybe, just maybe, he's tapering off the weight loss and will hold steady for a while.

And my boy who had the I-131 treatment a month ago gained over a pound

We are very happy tonight. The vet also agreed that the dose reduction was the right thing to do. She doesn't give me dosing advice, but she likes to be in the loop.

 

dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat

 

LOL Carolynn, those are a lot of happy kitties!

I am happy for you too Jennifer that he hasn't lost any additional weight. That is good news indeed! Glad the new dose seems to be making a difference too although it is still early yet. Please keep us posted.

 

Just hopping in to say cheers and congrats on the no weight loss and the great preshot this morning!! Seems like the slight reduction was effective drinking24

I am so sorry to hear of the loss of your other babies - it's truly amazing how they become our family members. I hope it gives you peace of mind to know that they led better lives because of you.

As for the ringworm,,,,all too familiar! When we took in one of the now civvies (my baby Lincoln who thinks i birthed him), he had ringworm on all four paws and we had no idea. I'm a teacher and we automatically blamed the kids i was working with at the time. My husband and i had it everywhere!!! (gee, and i wonder why i have never told this story before, ha!). It wasn't until we checked Lincoln with a Woods Lamp did we finally ascertain that it was him infecting us and not the kids (opps).

Anyway, long winded way to say hi, welcome and glad to hear your good news. I have read many of your posts on the old boards and you have always been so helpful to everyone - Welcome!!! Michele and Molly

 

Thank you everyone. Carolynn knows all too well how exciting it is when your cat does not lose weight :mrgreen:

I have to update his spreadsheet at lunch, I think this AM's PS was 187, it was almost the same as last night. I'll get some spot checks after work too. I'd like to get his PS numbers back under 150, but we'll work our way up to that. The vet and I are discussing steroid options for his IBD. That should add some nice wonky numbers.

Michele, sorry to hear you had ringworm too. At least it doesn't itch

 

Woohoo! What fantastic news for Tucker!!

My, he's a big boy and he maintained that 17 pounds through surgery and everything with diabetes? That's impressive. So I understand why his weight loss concerns you. What does the vet think caused it?

Want to share what I have seen with Gandalf as he's gotten older, as he is also a big boned cat (he measures almost 3 feet from nose tip to tail tip). I look at him and think he is so thin but he weighs over 14 pounds. He's lost muscle mass, which is obvious along his back and back legs. Muscle is denser than fat so when they begin to lose it, they start looking thinner, although they haven't lost as much weight as they do when they lose fat. He got down to 13 pounds from 18 during PZI overdosing/rebound in the beginning in '05 and didn't look as thin as he does now.

I also agree that holding steady is good, even if they have lost some weight.

 

Tucker is a very large cat, very long, very tall. I believe he's part Maine Coon.

With the recent weight loss I can now feel his spine and ribs, but what really concerns me is the sudden weight loss. In November '09 he weighed 17.6, when he went in January he had lost a full 2 pounds, then another few ounces end of January.

In '05 Tucker had many surgeries, dentals, repeat infections, impacted bowels, and BGs that were all over the place, but never lost weight. The fact that he is now losing weight for no reason has me worried. T4 was 1.something, very low, so he's not HyperT. Kidney/Liver values are all perfect. PLI is always high, last check was 26, should be under 9.

With his strange neuro thing going on, the circling a lot and for a while he seemed, well, dumb. I don't know how to explain it, he didn't seem to comprehend things. He knew to follow Ron downstairs for litter duty as he always does but he didn't remember to ask for his treat. He always demands his chicken treat at the last litter box. He also was letting Sam hit him. Sam is his best bud and my nicest most gentle cat. For Sam to hit Tucker was just weird and reminded me of how cats in the wild will attack a sick cat in the pride. Sam was also taking Tucker's food, Tucker would just sit there until I put Sam's bowl in front of him.

Tucker seems to have his mental facilities back. He now eats his food and doesn't let Sam take it. Sam and he are now buds again. So my weight loss concern is not knowing if his IBD is taking over and he needs to start steroids or if this strange neuro episode caused it. In any event, a two pound weight loss in two months in disconcerting especially since during that time his BGs were pretty well controlled.

 

Jennifer - good news on no weight loss.

The same thing happened with Beau. He went from 10 lbs 4 oz to 8 lbs from late Dec to end of January. He does have hyper-T and the vet adjusted his meds. He has stayed the same for 2 weeks, I have to constantly follow him around with his food dish and encourage him to eat. His BGs have been under control (OTJ) during this time, but he was back on insulin for 9 days at the beginning of the time period.

And I think I posted about a cat I had a long time ago that had a stroke and couldn't figure out how to eat. He circled, counter-clockwise at the outside edge of rooms. And he lost weight rapidly. He did not recover from it. It was heart-breaking. But it sounds like Tucker has recovered. Is he still circling?

If he is eating again, perhaps he will regain some weight. He looks like he has a lot of Maine Coon in him - a very handsome boy, Tucker is!