Leoberry (aka Leo)

Discussion in 'Prozinc / PZI' started by JeffJ, Jul 28, 2016.

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  1. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I've posted about Leo before. This will be his new thread for awhile. Current summary:

    "old" History:
    • Leo is 10 years old, and he was the cutest black tabby kitty ever - a true heart melter
    • Inside-only kitty
    • Leo is a high-dose kitty
    • Insulin started August 2015 , after he dropped to skin and bones weight (and he had acid ketosis)
    • Insulin was low dose (3 units/day) initially, with 150-200 nadirs
    • Started on 1.0 Lantus/day then over 8 months ramped to 9 units twice daily - without low nadirs.
    • Kept him at 18 units/Lantus for too long - his nadirs ramped to 250/300
    • Our vet has never had a high-dose kitty, but she is a very experienced vet
    • Never a single hypo incident
    • Low carb, wet food only
    New History:
    • PZI started 7/7/2016 - at 1.0 unit/twice daily
    • Nadirs >400 until 8 units/day
    • Ramped 1/2 to 1.0 unit additional over 20 days
    • 22 units/day current PZI
    • Preshots are 500-540
    • Nadirs now 320-380
    • Neuropathy in hind legs getting worse
    • 7/15/2015 started - 3mg B12 cobalamine daily, and weekly B12 shots
    I didn't test him for high dosage conditions yet. He has no external signs of Acro. But even if I test him, the treatments are effectively very expensive (ie. radiation for Acro). The alternative is high dosages of insulin. I'll type his numbers over the weekend.

    My sweet kitty now lives in the kitchen always waiting for more food. And still using the litter box with substantial urine. I've read a lot of similar posts. I've read the high dosage literature (acro, IAA, Cushings). It's hard to remember that Leo used to just be a regular fun loving kitty. His brother Duma (aka Scoobs) recently died - thread here. Leo misses Scoobs too.

    JeffJ
     

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    Last edited: Jul 28, 2016
  2. Ruby&Baco

    Ruby&Baco Well-Known Member

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    Apr 21, 2016
    Hi and welcome, love that picture!
     
  3. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Thanks. Our cats are basically our furry kids...like many on this forum.
     
  4. Ruby&Baco

    Ruby&Baco Well-Known Member

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    Apr 21, 2016
  5. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Hi Jeff! You're totally right to start a new thread...I'm REAL bad about hijacking others!

    I don't have experience with high dose conditions other than just reading about them some. Honestly, it sounds like you're doing everything right. So, to clarify, preshots went UP after you moved beyond 8 units? His numbers for the last bit will help. Have you ever run a curve?

    It's possible Sue will have more suggestions. I need to do a bit of research on high dose conditions before I can make any suggestions.

    I'm sorry to hear about Scoobs. The cats are our kids here in this forum!
     
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  6. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hey there and sorry about your kitty. There are several people over in the Lantus and Levemir forum with cats with IAA. Maybe post there for help.
     
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  7. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hey there and sorry about your kitty. There are several people over in the Lantus and Levemir forum with cats with IAA. Maybe post there for help.
     
  8. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I am sad to read about sweet Leo, Jeff and losing Scoobs. It does sound like Leo is a high dose kitty. @Sharon14 has a high dose kitty on Levemir and may have some ideas for you, and know some others who may have suggestions. It sounds like you started him on a low enough dose and raised the dose slowly and carefully. Other than continuing to up the dose, I don't have any ideas, never having dealt with this myself. Many people with kitties who have high dose conditions use Levemir as it is thought to sting less at the higher doses.
     
  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hi Jeff. Leo is indeed a very handsome fellow.

    I'm the proud Mom of a high dose girl with IAA.

    Unfortunately cats with acromegaly usually don't have any physical symptoms until later on as the disease progresses. Yes the condition is very expensive to treat but because there can be other medical problems as a result of acromegaly, it could be helpful to know if he has the condition so symptoms of other associated problems can be identified and treated promptly and appropriately. The only caveat is that unfortunately a negative test is not necessarily conclusive because aromegaly is a pulsative condition with the blood factor being measured going up and down.

    IAA often goes hand in hand with acromegaly but can also occur on its own. With IAA, the condition usually burns itself out after about a year and then out of the blue, suddenly the BG numbers start dropping and kitty starts down the dosing ladder. Knowing this abrupt change in circumstances was likely to occur made it much easier for me to figure out how vigilant I needed to be as far as monitoring to keep my girl safe and to take precautions when I knew monitoring would not be possible.

    Cushings is the rarest of the high dose conditions and rare enough that I'd be inclined to rule out Acro and IAA before pursuing that testing.

    The testing for Acro and IAA are not expensive. The biggest part of the expense is the blood draw at the vet's and possibly shipping costs as the tests are only done at the University of Michigan.

    I'm guessing you switched insulin in the hopes of getting Leo better regulated. Most folks with high dose kitties use Lantus or Levemir because of the gentler curves they produce. Levemir seem to be a little more common in this population due to the discomfort some kitties experience with the injecting of large doses of Lantus.

    Some folks use regular insulin along with a basal long term insulin to keep the BG more regulated but this is something that should only be done with the guidance of people experienced in it's use. If you are interested in considering that option, there are some wonderful people here who can help you but as Bobbie indicated, most of the high dose helpers are over on the Lantus/Levemir board.

    I'm so sorry to hear of Scoobs' passing. Your poem was a wonderful tribute to a special kitty and Scoobs and Leo lucked out having you for their pet parent!
     
  10. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Hi Jeff, Leo sure is a handsome guy! I'm sorry you and he are having a tough time. It sounds like you've gone up in dose slowly so it's unlikely that you've passed his optimum dose. In your introductory thread, you said Leo was on OM food. Have you switched him to low carb wet food? if so and he's still high, it's possible that Leo has one or more of the high dose conditions. Do you plan to get the Acro and IAA tests done? I ask because if he were to test positive for IAA, there are things you can do to help him break through that resistance. Also, my cat, Colin, didn't show physical signs of Acro at the time of diagnosis either. The treatment for Acro is very expensive- out of my price range, so all I can do is treat him the best I can and aim for as high a quality of life for him as I can, for however long I have him. And really that's all any of us do for our kitties anyway. I knew that I wouldn't be able to afford the treatment if the test was positive, but I chose to have it run anyway, mostly to be sure there was a reason for his high dose and it wasn't something I was doing or not doing. I had racked my brain trying to figure out what I was doing wrong, why my cat wasn't responding to treatment like all the others on the board were. Once I knew, I was able to work out a plan that worked for me and my financial situation. If you choose to test, I hope he's negative, and if you choose not to test, just keep taking care of him the way you have, you are doing a great job! Remember Leo doesn't know he is a high dose cat.
     
  11. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thank you everyone for the Leo support, and for condolences about sweet kitty Scoobs. We sure miss Scoobs a lot. We still see his ghost all over the house and the backyard :-(

    Summary of answers for Leo:
    1. Preshots have not moved up recently, they are always 450-550 in recent months.
    2. I run 12 hour curves every couple weeks, like drawing blood from a wriggling worm. I test him every couple of days for nadir and preshot.
    3. PZI was started to see if it was more effective than Lantus. For Leo there is no change in effectiveness. And both seem equally expensive, mostly because of the high dosage insulin depletion.
    4. I do not like the high 27 gauge needles for the U-40 syringes. But at 11 units, I'll keep using those with the PZI because of the fluid volume. And what's with the 1/2" needle length - I'm not drilling for gold.
    5. Thanks for additional info on IAA, Acro, and Cushings.
    6. Leo's last vet visit was right after Scoobs died, I could barely drive to the vet much less think. It was a mistake for me to forget the blood work, since I had joined the forum prior to the visit. I may make another appointment just for that. The vet and staff are very capable and caring.
    7. Leo did get a complementary laser treatment on his back legs for neuropathy. I don't know if it helped, but the process was easy.
    8. Food is now Fancy Feast classic. He was on it before and the OM food was a temporary mistake.
    I have read dozens of threads. And lots of insulin online literature. The links from the forum are very good. I don't blame my vet, she doesn't have dozens of hours to become a high-dose expert for a single patient.

    Acro:
    Acro is a horrible disease. But I also read some of the side effects from the cures. Some of those are bad, and there are unknowns. I am not willing to spend $6k-$10k and then Leo ends up with another issue, or doesn't recovery from the procedure, or dies within a few months. Heck, one of the potential side effects is blindness. I'd rather him have Acro.

    Did any of you take blood yourself and send it to Univ of Michigan? I never drew blood before. And it's 100 degrees Fahr, everyday in Austin now, so maybe the vet should handle this.

    Food:
    I am going to spend some more time on food selection in the next 2 days. He also gets baked chicken, which is very good for cats (and people).
     
  12. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I just read thru some of the signatures. Wow, glad to have help from MrWorf'sMom and Sharon. You have some high-dose kitties too.
     
  13. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    @Wendy&Neko can tell you more about how to handle the Acro & IAA tests. My vet didn't know the procedure and the info Wendy provided was helpful.
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Jeff, the University of Michigan used to allow "civilians" to send samples directly to them but sadly they don't now so a vet visit to draw blood would be the only way to get the testing done.

    I hear you about the treatment for Acro. I am in Canada and despite being in the largest city here, would have had to travel great distance to get Menace treated had she been positive for Acro. While obviously the financial burden of treatment would have been a major deciding factor, even if it wasn't expensive, I know my girl does not travel well to my vet who is 8 minutes away by car. Knowing this as well as the potential side effects, probably would have had me taking the same stance as you....I'd rather deal with the acro.

    I don't know if anyone mentioned it to you, but many folks in the US order their Lantus and Levemir from Canada where it I considerably less expensive. If you wanted to switch back, that might make the associated costs a little easier on the pocket book.

    It would be helpful if you could set up a spreadsheet with Leo's BG numbers. There is a pattern of readings that suggests IAA. Someone here coined the phrase, "dose going stale". What that means is that when the dose is increased, there may be a slight bit of movement in the BG readings for a cycle or two and then the numbers just go back up. With my girl who is a kibble addict, I lowered her from a diet of about 35% carbs down to 8% and didn't see any change in her numbers whatsoever. These were my clues that something was up and made me pursue the testing for IAA which my vet told me was so rare it wasn't necessary to test. I insisted. My vet has plenty of experience with diabetes but like yours, has never had a cat with IAA before, so she can't help me much. The members here who have walked the path already, have been terrific about sharing their experience and knowledge and my girl has now gone from 16u to 7.5u twice daily and I'm hopefully she'll continue a little further down the dosing ladder.
     
  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hi Jeff - I am the one who coined the phrase "the dose going stale". Neko has both IAA and acromegaly. Your vet draws the blood, and the samples are send to Michigan State University. The two tests you want are the IGF-1 and IAA tests. Try to arrange the blood tests so that the samples arrive at MSU by Wednesday, as they only run the tests once a week. A fair percentage of acrocats (cats with acromegaly) have both conditions - Neko did. I say past tense because IAA is a condition that can be self correcting, after around a year. A cat having just IAA (like Menace), is less common.

    One in four diabetic cats has acromegaly. My vet also thought she had no previous cats with high dose conditions, but that was likely wrong, she just didn't recognize it. A month after Neko got her positive test results (the vet was more surprised than me), she identified another acrocat in her practise. And acros don't all have high doses. A recent large scale study in the UK testing cats going into a diabetes remission study found acros with doses from 1 unit to 35, with an average of 7 units BID.

    I don't know what side effects you have heard about as a result of treating acromegaly, unless it's from older forms of treatment. Yes it's expensive, I also live in Canada. Neko has been treated twice with stereostatic radiation therapy (SRT) in Colorado State University. Three years after her first treatment, the tumor started to come back. It's now almost 4 years since her first treatment. The only side effects of SRT are some possible short term inflammation (which Neko did not have either time) and hypothyroidism (small percent of cats), and that is simply treated with a daily pill. There is anesthesia involved, and there are always risks with that. There is a new surgical option for treatment, hypophysectomy, but the surgeons who perform this operation in the US do not have much experience yet. It is a viable option for those living in the UK. The Royal Veterinary College has done some amazing work and research on acromegaly in cats. Personally, I rejected surgery as an option last year, even though it's done closer to me than CSU. There is also a new drug treatment, but the cost of the drug is ridiculous - no one is treating outside of a research study. Treatment does involve travel. Neko used to hate the 8 minute trip to her vet too. After 3 days of 9 hours a day in a car, each way, she's a much better traveller now. Last year we went by air.

    But treatments aside, the most important thing you can do for Leo is try to get his blood sugar to spend as much time as possible under renal threshold. The majority of people with acrocats do not get them treated but focus on treating the diabetes. As others have mentioned, most high dose cats gravitate towards Levemir. High doses of Lantus can sting, but the longer action of Lantus and Levemir seem to work better for higher dose cats.

    I believe that knowledge gives you power and knowing what you are dealing with can help Leo. Getting the tests done is a good idea. I can give a couple of examples. Acromegaly means excess growth hormone which means soft tissue and bony growths. A few years ago, Neko's vet saw a red mark on her gum and thought that meant tooth infection and probable extraction. I took Neko to a dental vet (she has a heart murmur and I wanted their extra care through anesthesia) and the dental vet instead saw soft tissue grown on the gum, which meant her canine was rubbing the gum. So Neko got a tooth filing and not an extraction. Acros can have soft tissue growth in their throat, which means being careful with pilling and intubation should they undergo anesthesia. And more seriously, excess growth hormone can also mean organ growth. Cardiomyopathy (enlarged heart) is a common issue with acrocats, but unfortunately can be a silent disease until it's too late. When Neko recently went off her food and lethargic, we knew to check her heart, though there were no other signs of heart disease, all because we know she is acro.

    I thought Neko didn't show any acro signs at her diagnosis, other than living in the kitchen and getting her paws on inappropriate foods when she could (muffins, banana bread), but I found out later her eye tearing was probably due to soft tissue growth in her tear ducts. That started 6 months before her diabetes diagnosis. It's thought that acrocats may be acro well before they get diabetes (if they do).

    Sorry for the long novel, I guess I have lots to say.;) Once you get Leo's blood sugar numbers back into good range again, you'll find his loveable personality will start to show again.
     
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  16. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Hypoglycemia event, dosage suggestions welcome. Next dose 8:30pm CST.

    We just had our first pseudo hypoglycemia event. Summary:
    7/28 Thur - normal

    9:00am - 11.0 units
    11:30am +2.5 = 530 BG
    2:30pm +5.5 = 450 BG
    8:30pm - 11.25 units
    Above is normal
    He gets fed every 2 hours - fancy feast classic and baked chicken

    7/29 Friday event
    6am-8am, normal food, Theresa said he ate a lot, normal
    8:30am - 11.25 units
    8:31pm, small portion of food as normal
    12noon +3.5 = 78 BG - VERY LOW, didn't occur in 1+ years
    12:05p +3.5 = 75 BG - Second test, triple checked AlphaTrak2 settings, test strips are all new
    +food
    +1tablespoon karo
    Lots of sweating (me, not Leo)
    12:55p +4.5 = 162 BG - Also very low, haven't seen this in 1+ years
    12:56p +diced baked chicken, vanished in 60 seconds as usual
    1:45p + 5.5 = 145 BG
    1:46p +small bowl food (normal) +1 teaspoon karo

    Dosage suggestions for 8:30pm CST are welcome.

    One of these happened:
    1. hit a vein, unlikely, it was a typical skin shot in the flank
    2. Low food supply, but he had normal food right after the shot
    3. Break thru on condition?


     
    Last edited: Jul 29, 2016
  17. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thank you Wendy and Linda for the long posts. I read them twice. Leo does seem to be doing fine except for the high glucose symptoms and the advancing neuropathy.

    I'll consider insulin from Canada when temps cool down here. I read one of the good posts on it. I'm going to get Leo tested in the next 6 business days. Need to get thru the current (and first) hypo event.
     
  18. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I'm going to setup his google chart over the next 2 hours.
     
  19. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    How's Leo? What meter are you using?

    Just reread see it's an Alphatrack.
     
  20. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hi Jeff, well isn't that an interesting turn of events and hopefully a sign of good things to come. It will be great to see the numbers on his spreadsheet. I look forward to having a look.

    First of all, 68 is the reading on the AlphaTrak2 meter that warns of the potential for a hypoglycemic event. Unless kitty is actually showing symptoms of hypoglycemia (wobbly gait, unusual head movements, etc.) he's not hypoglycemic but rather in numbers he is not accustomed to and warranting monitoring. 75 is a totally normal reading for a cat. I'm so glad you triple checked the reading, Double checking would have sufficed but I SOOOO understand the angst! :). When our kitties get into numbers that they have become unfamiliar with, they do get very hungry and may even seem frantic for food. When my girl pulls one of her "feed me now" tantrums, I immediately test because she does this if she is either high and low and while usually I can judge which is it, sometimes it's tough to detect the difference by her behaviour alone. Next time you get a number around 68, you can just feed Leo again and skip the karo. The karo doesn't need to be introduced unless kitty is showing symptoms or won't eat. Here is info for handling low numbers.

    Now that Leo has had a reading of 75, he's definitely earned a reduction in dose. Folks using human meters generally make reductions at a reading of 90 with high dose kitties to give a little extra cushion. I use the AT2 meter and my reduction number is 120 or less but that is my personal choice based on my personal experience. You may want to do the same or you can set the number a bit higher if that makes you more comfortable.

    We usually recommend a reduction of 25% so in Leo's case that would take him down to about 8.5u. Leo will probably be higher again for a few cycles as he will probably bounce from that unfamiliar lower number. Hold the dose as the bounce can take 3-6 cycles to clear. Every cat is different. You may find yourself going up and down on doses if this is a case of IAA starting to break. Once you have done a couple of reductions you will get a feel for whether you want to reduce by 25% or less depending on how well the reductions hold.

    Since you haven't seen any low numbers until now, I suggest you get your pre-shot test tonight and post for advice if Leo's PMPS is lower than 300.
     
    Last edited: Jul 29, 2016
    Reason for edit: fixed suggested reading for posting tonight
  21. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I can't believe how helpful you guys are. It brought tears. It has been extra tough, just losing Scoobs 4 weeks ago. Anyhow.

    Leo is normal and symptom free all day, like "Thanks Dad for all the extra special attention, including the warm chicken meals." No outward signs anything is different. He is back in his favorite space, laying right in front of the refrigerator door :)

    Thank you for the advice. I read the new posts twice. I'll continue to test today. I have ~75 recent AlphaTrak2 strips. Expensive but they work. All of it is cheaper than a single emergency vet visit.

    8.0 or 8.5 will be his dose for tonight. I can test him until 2am.

    These low numbers came out of nowhere. Literally. He had nadirs of 300 since Sept 2015, and all high numbers since then. I feel guilty for not being aggressive on the insulin until now. Maybe this move to PZI was what he needed. Below 100 - that is extraordinary for him.

    Will work up his spreadsheet now. I'm pretty much not working today. I'm a computer security consultant in my other life, and have a PhD in computer science. But none of that helps here.

    THANK YOU SO MUCH :)
     
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  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Jeff, I well remember the first time my Menace gave me one of those shocking numbers. Thankfully she wasn't quite so dramatic as she had been dropping slightly before the first major drop occurred so I was a little more prepared for the possibility. You've been through quite the emotional upheaval of late and to have that low number arrive out of the blue had to be terrifying. I feel for you but you handled it like a champ, did what you needed to do to keep Leo safe and next time it won't be nearly so scary.

    The PZI you are using may very well have been instrumental in pushing Leo's body into "submission". It is beef based which is the closest to cat insulin. I had considered trying it myself but Menace started her reductions before I got around to it and my vet wasn't sure if that switch would help or not because she didn't know if the antibodies were against all insulin or specifically against the human recombinant insulins. You may be on to something!

    This is indeed a different ballgame than any of us were ever prepared for in the beginning. We often call it the sugar dance and as you can see, our kitties sometimes like to change the steps just to keep us on our toes! :)
     
  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Although it was surprising, it was good to see lower numbers today. Thank goodness you are home testing! Neko went absolutely crazy yelling at me for food when she got to 100 for the first time.

    Sometimes a change in insulin will impact the antibodies for a while, if IAA is present. I've seen several high dose cats start out on Prozinc with either acromegaly or the combo of acro/IAA and seen no progress until they changed to Lantus or Levemir.

    I have a MSc in computer science. I find that with my math degree help me see patterns in spreadsheets. But otherwise useless. :p The last couple of years I've been reading every paper I can get my hands on about acromegaly and IAA (precious few there) and have to learn a whole other set of jargon.
     
  24. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    Wow! That was a nice surprise. I hope it is the start of something good (anti jinx)
     
  25. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Definitely didn't see that one coming! Glad you were testing and caught it! :)
     
  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    @JeffJ I was just peaking back at your summary of numbers and wondered, have you been doing pre-shot tests to ensure it was safe to give Leo insulin? We recommend getting tests before each shot to determine if BG is high enough for a full dose, needs a reduced dose or should be skipped all together. We also test as you have been doing to see where the insulin dose is taking the BG. I'm assuming you will be preparing to give Leo a shot about an hour and half from now. I am in EST. Please take a test before feeding Leo and before giving any insulin just to make sure it is safe to do so and also that the dose we proposed is appropriate. You don't want your pre-shot tests to be food influenced. :)
     
  27. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks everyone for the continued help, all of which I've read twice.

    Updates.
    1) Leo's spreadsheet is now in my sig...that was a procrastination for sure.
    2) PZI - this may have done it. I like the fact it is beef based and human recombinant DNA based, it sounds so technical :)
    3) 8pm (+11 hrs) Leo is at 363 and dying for food as usual. He'll have to wait until +12 hours PMPS for more.
    4) Wendy - yes, too bad our fancy degrees don't seem to help much here.
    5) Linda - yes I skipped a bunch of pre-shot testing for awhile. He was always at high numbers. Now I'll be more diligent.

    +11hr test is 363 today. I'll test PMPS and if above 300 will give 8.0 units.
    PM dose will be in 1 hour (9pm CST). I'll test, then dose, then test and monitor thru Saturday 1am.
     
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Sounds good! I'll have a peak at Leo's spreadsheet very soon! :)
     
  29. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    9:00pm PMPS 340
    9:01pm applied 7.0 units to be conservative
    9:02pm fed the voracious kid, he was "starving".
     
  30. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    11pm +2hrs = 507
    back to the same old sky high number
     
  31. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    7u tonight is fine. Don't be discouraged by that higher reading again. He's probably bouncing from that run of lower numbers yesterday. He might stay up for a few cycles but don't be tempted to up the dose back to 11.25u again. Keep him on a lower dose for now. I do think though the 7u may be a bit too much of a reduction but I understand completely that you want to keep him safe especially over night. You could take him up to 8.5u when you can monitor.:)
     
  32. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Thanks for the advice Linda. I'll follow it. Tomorrow I'll AMPS test, then give 8.5u if he is "normal" at 400+. Thank you.
     
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  33. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    1:30am - got major cuddling and rubdown on kitchen floor. Lots of purring.
    AMPS: 380 (9:29am)
    Food: 1:30a, 5:20a, 7:30a, 9:31a;
    Dose: 9:30a - 8.5u PZI ...spreadsheet updated
    Alert and hungry as usual. BG lower than normal...hope he is making a breakthru.
    Measuring weight now too - see column by comments. He is a big boned boy. 15-17 is normal for him. Diagnosed last year at ~12 pounds...we felt real guilty since he had lost so much weight before we diagnosed.
     
  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I can tell your kitties aren't spoiled! ;) Looking good! We'll see where that 8.5u takes him today. I'm just running out to do errands but will have a peak at Leo's SS numbers when I get back. You must be thrilled to see that lower AMPS today. I hope this is the sign of a breakthrough!

    As for missing the weight loss, I think many of us have done the same. I was trying to get my girl to shed a few pounds and initially thought my efforts were finally succeeding. It wasn't till I picked up my young male and my sugar in quick succession that I realized just how much she had lost. I also attributed the sheet of cement on the bottom of the litter box to my old guy whose kidney's are not working 100%. Wrong on both counts. The important thing is we did get the diagnosis and are giving them the best care we can. Hindsight is 20/20. :)
     
    JeffJ likes this.
  35. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Linda. I'll test at +2 and +4 today. He is getting real cranky during blood testing.

    Yes they are really spoiled. Theresa and are both hopeful on the new low numbers. I clean the litter boxes 2x/day. Glad to hear that Leo isn't the only one who was diagnosed late. He sure does pee a lot.
     
  36. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Are you sure giving him his favorite treats every time you poke? bonito flakes and PureBites are favorite low carb treats at my house. Once they know a treat is coming, and the treat only then, they start to put up with the pokes. You also can get a +2/3 and then somewhere around +6 rather than a full curve at first. That should give you a clue if it is going to be an active cycle and how low the insulin is taking him that cycle.
     
  37. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Sue. He is getting fed little amounts every 2 hours. I'm going to get those treats too. Good suggestion on measuring the cycles.

    Chart updated thru +4 for today, with nadir = 360. Will PMPS test too.

    Problem over last 2 months is (pee + litter) on his back hocks. What a mess and it is glued on from the litter. He hates having it cleaned. Hoping the BG can get driven low and we can resolve the neuropathy.
     
  38. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Hi Jeff. Wonderful to see all the numbers on the spreadsheet but you used the sheet for those using a human meter.

    To make sure we keep the fact that you are using the AlphaTrak meter front and centre for anyone providing assistance, can you please add another row onto the sheet at the top indicating the readings are from a pet meter. See Menace's sheet HERE to see what I mean. That red bar along the top grabs attention and with the two scales of measurement between pet and human meters being different, it's important to make your pet meter use is obvious to ensure you get the right advice.

    You may also want to put a row in to indicate Leo is a high dose kitty too just so some lurker doesn't take a look and think his dosing is "normal" and decide to copy it. :)

    As for Leo's numbers, I'm not seeing the pattern for IAA however, you missed a lot of pre-shot tests and didn't hold doses more than a day or 2 in most cases so it would be hard to discern the pattern with the data you have accumulated so far.

    If you can get pre-shot tests twice a day and random tests between about +3 and +8 when the expected nadir (lowest reading) would occur as often as possible, you''ll get a better idea of how Leo is doing on a dose. Unless there is a low number calling for a reduction or skipping a shot, we usually hold doses for a minimum of 6 to a maximum of 14 cycles. You have more flexibility with the PZI to make small dose adjustments for overnight or personal commitments when needed based on pre-shot test numbers. I used to hold doses for 5-7 days but now while Menace travels down the dosing ladder, it's a little more erratic and based on readings as they occur. It really comes down to knowing your own cat because some cats settle into a dose faster than others.
     
  39. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Oh cxxxxp (cussword self censored). I put the banners on the top for now. I'm going to see if I can cut/paste this into the proper spreadsheet. That looked like the correct spreadsheet because it has 1-600 for the blood glucose range. The other sheet has BG range for 1-30.

    I'll start doing tests for preshot, and 2 within (+3, and +8).

    I don't understand this entirely "we usually hold doses for a minimum of 6 to a maximum of 14 cycles". I need to give him shots every 2x per day, everyday correct?

    Thank you for the continued help Linda. It looks like Menace has pretty high numbers too. I'm glad we're in the tech age with online interaction and modern medicine. Probably most cats before 1980 just died from diabetes.
     
  40. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes my Menace has proven to be quite the "menace" when it comes to getting her regulated but we are making progress now and her dose has reduced considerably. :D With IAA, it's a two steps forward and three steps back proposition sometimes but I am happy that her dose is now more than 50% less than it was a few months ago. Right now, I am not sure Menace isn't on too much insulin so I am "experimenting" a bit and reduced without her getting all the way to my usual reduction number. Every cat is different to some extent and it's learning to read your own cat that gives you clues as to what to do at any given time.

    Ok my turn to do the OH C&&P! I didn't mean to confuse you, I'm in Canada. We use a different scale to measure BG thus the 1-30, so not only do I need to make sure everyone knows I use a pet meter but also need to be able to translate my readings to US numbers. Look on the US values tab on my spreadsheet and it will make more sense. Finding the right sheet can be hit or miss for new folks with so many to choose from. I use the International one whereas you use the US one.

    When I said "6 to 14 cycles" I meant at least 3 days up to 7 days with two shots being given each day. We try to keep the dose the same so if kitty bounces on a new dose, we leave enough time between dose changes to ensure the bounce (increased numbers) has cleared before making changes. :)
     
  41. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    PMPS = 591, back in black (bad)
    7:30pm last food
    9:29pm PMPS test
    9:30 8.5u

    Ok, thanks Linda. I understand the 6-14 cycles now. Maybe I don't need to change the spreadsheet. The Alphatrak2 puts out content in 1-600 range.
     
    Last edited: Jul 30, 2016
  42. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    AMPS = 470
    +4 = 410
    PMPS = 440
    Dosed 8.5u (9:30am, 9:30pm)
    1:30am next test

    I'm doing more blood samples these days (on Leo). Is Relion Micro calibrated for cats? Is it accurate?

    I just saw the amazon prices
    $29 for "Relion Micro Blood Glucose Monitor System"
    $35 for 100 strips ($0.35/each)
    That sure beats the AlphaTrak2 at $1/strip.
     
  43. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Jeff, the Relion Micro is quite popular here but the scale of measurement is different because that meter is calibrated to read human blood which is quite different from feline blood. That said, the reference numbers on this site are for the most part based on the use of a human meter so if you want to switch, there is no problem. You will find Leo's numbers lower using the Relion meter. The lower the BG, the closer the readings would be on the two meters. When kitty is running in high numbers....high is high. The difference in the readings is really only important when you get down to lower numbers like Leo did the other day. With a human meter the warning of the potential for a hypo event is 50 rather than 68.

    The human meter does not read as high as the pet meter so if numbers are high enough (roughly over 500) you might only get a "HI" rather than an actual number on the human meter. Hopefully Leo is going to behave himself and stay below that threshold from now on but just something to be aware of.

    I would also suggest you speak with your vet about switching just so they understand your readings should you need to consult them in the future. If you make the switch, we have the human meter equivalent of "normal" numbers for cats that you can provide your vet.
     
  44. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thank you Linda. That is something to think about. I appreciate all the details and the implications. Relion does seem to be a better match for FDMB because of the scale. I could always setup a 2nd tab with an auto-converter for the other tab (via some spreadsheet magic). If I work the numbers with the vet, I'll let her know. She is not experienced with high-dose cats.
    I
    The low BG scare the other day made me distrust a single meter. It would be nice to have a second meter around.

    I cloned and modded your sig, and included pics in mine. Scoobs is in the pics too :-(

    I re-reviewed Menace's numbers. That must be a great feeling to get him down from 16 all the way to 6 units/shot. Do cats still eat and pee excessively when you get them regulated? Leo is always starving (and peeing a bunch).
     
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Unfortunately there is no conversion formula for the two scales of numbers. We know what the normal BG ranges are for both meters but to translate any one reading from pet to human or vice versa is virtually impossible with any accuracy. There is also the 20% meter variance that is allowed by the FDA for human glucometers and that % applies to the AlphaTrak2 meter too. It's really best to pick one meter and stick with it unless you're into driving yourself crazy. As a retired medical professional I was curious about the correlation of the readings particularly at moderate readings so I have been dual testing for over a year. At this point, I can pretty much guess what the human meter will read but every so often it throws me an unexplainable curve ball. So I use my AT meter as my final decision maker when it comes to dosing but quite frankly, I see no tangible reason not to use a human meter with the reference numbers provided on this site. It's really a matter of preference.

    Cats definitely drink and pee much less as their numbers come down. I used to deal with a cement slab and conpletely understand the foot cleaning issues that result. At this point, the litter boxes look far more normal although when Menace's numbers go up, I notice an little increase in urine output but certainly not to the same degree as when we started this journey.

    As a general rule, you can expect Leo's appetite to go back to a more normal pattern once he's better regulated. Menace gets antsy for food when her numbers are high, is pretty much normal when in a decent BG range but when her numbers drop lower than she is used to or too low as they did last night, she often gets absolutely obnoxious. I call it her early warning system but even that doesn't work all the time and I personally wish it would go off sooner than it does. She didn't start her frantic food pleas until she got to a reading of 61 on the pet meter last night which is too low! :eek:

    Love the pics of your furkids! Absolutely stunning kitties! :cat::D
     
  46. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks for the kudos on the pics. I also appreciate the help with Leo, and additional info on BG meters.

    Wow, Menace sure did get low last night. She almost looks too low. You're doing something right to be able to get her more back to normal dosing!

    I am looking forward to some regulation with Leo. The eating and persistent meow/crying from him is tough. He has perfected the art of acting like he has never been fed ever.
     
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  47. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I know how tough the food issue is and admittedly, saying no to my kitties is not one of my strong suits. When they are unregulated they can't use the food they take in as well, so within reason, if Leo is at an ideal weight or needs to put some on, it's OK to indulge him a bit. Unfortunately my little girl needs to shed some pounds so I am trying desperately to keep her on a set amount of food but I do have my weak moments!:)
     
  48. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I got busy at work, last 2 days. Just gave Leo his PM PZI shot. Have one dose left for tomorrow am. Will go to vet. I think they have to order it.

    I still have Lantus. Should I give him a similar amount? 9.5 units? Or cut it in half to be safe. He does not have a recent history of ketones. Last ketones were 1 year ago on initial DX. Thx.
     
  49. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Hmmm...I don't know about that. Since Lantus is so different, I'm not sure about the idea of just using a dose or 2 to hold him over. Is it possible your vet will have some PZI in stock?
     
  50. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    If he doesn't have any in stock, maybe another vet in town will, and he could write you a script
     
  51. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I'll find out in a half an hour. Thanks for the input.
     
  52. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Noon - the vet had called multiple other vets in town. No one carries it or had extra. The order is put in, and will arrive via FedEx on Friday. Totally my fault.

    At the dosage being used, PZI is more expensive.
    $260 Lantus = ~2.5 months worth = ~$100/month
    $130 PZI = 1 month exactly = $130/month

    PZI doesn't seem any more effective than Lantus on Leo. So after this next vial, I may switch back. Also, Leo is being slowly ramped on PZI. With luck, we'll achieve another day of 60-200 nadir.

    Thanks to everybody who has helped me. High dose kitties are such a challenge. We are being extra diligent on food regulation and food type. I also baked a brisket for the cats on Tuesday ($2.00/pound). Leo and Chinus were having conniption fits waiting for the first bite :)
     
  53. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    So just a thought......if you are considering going back to Lantus and you have some available now, you could cancel the order for the PZI and just switch now. Lantus is a good insulin and if per chance Leo is an IAA kitty, as much as I'd like to think the PZI was the magic wand that got him down that one cycle, that is pure speculation and may have just been Leo's system having a good day.

    ETA I can just picture those kitties sitting at your feet while you carve off some brisket for them!:D:woot::D:woot:
     
  54. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo and Chine went bonkers for 2 hours waiting for those brisket slices. I liked it too!

    That is a good suggestion to switch to Lantus. I'm so close with PZI now to regulating him. PZI was not the magic sauce. And I don't feel that I took the Lantus high enough - that was because of the vet's suggestion. But I really like your suggestion.

    I can't cancel the PZI order. The vet, the vet admin, and a vet tech all got involved in this last minute PZI because of me. The admin called over 10 other vets for me looking for spare PZI. I didn't know she was going to do that. So a box of chocolates is going with me tomorrow to pick up the PZI.

    Menace' curve is PZI, and I've reviewed it a bunch. the regulation is amazing now. Maybe that could be Leo in 2-3 weeks. Leo had 2 mid-cycle yellows in the last two days. So maybe I could get Leo regulated on PZI, then switch to the Lantus, which is cheaper and more readily available.

    Thank you Linda for the help and suggestions.
     
  55. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Too bad about the PZI but I agree with the hoops they jumped through to get it for you, cancelling wouldn't be an option. If it's arriving tomorrow, that's not too bad and you have some flexibility with the PZI such that you can maybe give his shot earlier and work your way back to your normal over a few days. Don't be surprised though if it takes a few days to get Leo's numbers down again.

    Menace isn't on PZI Jeff. She is on another long acting depot insulin called Levemir. She started on Lantus but it is acidic and she was one of those kitties that was having discomfort from the injections once we got to about 6 or 8u (can't remember exactly now). So I switched to Levemir for no other reason than to avoid having her indicate she was unhappy every time I gave her shot. I don't think the difference between the action of Lantus and Levemir had anything to do with the progress we have made. I am over the moon at the reduction we have managed to do so far but as you can see there are still days where her numbers are a bit higher and so her dose goes down and then up and then down. It's sometimes one step forward and three steps back and it does take loads of patience not to increase too quickly when you see those higher numbers. :)
     
  56. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    When you were buying Lantus I take it you were getting it from a local pharmacy and buying the 10ml vial based on the price and shelf life you provided. We can save you even more money on the Lantus. Many folks here buy their insulin from Canada from Mark's Marine Pharmacy and I believe it's under $200 for a pack of 5 - 3ml Solostar pens. Inside the pens, are small vials that folks use with syringes so they can fine tune doses by 0.25u at a time. So for less than what you paid, you'd get 1500 units of insulin vs. 1000 units for less money and the real saving is that the Solostar pens usually have an expiry nearly two years out so even those with kitties on small doses, can often use up all the insulin rather than ending up with all sorts of waste. Here's a link to some info re: Canadian Pharmacies. I believe Mark's is somewhere further down the list.
     
  57. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks for these details Linda. I somehow forgot that Menace was not a PZI kitty. But that progress should be a locked thread to show people that regulation can be achieved. It is amazing. Now I understand why Menace is on Levemir. The main thing I do not like about Lantus is the stinky smell. PZI doesn't have that.

    I do have the Canada link, and read about it a bunch. That price is the clincher, and a great argument for Lantus or Levemir. I can't do it now because this is Austin TX and it's 100 everyday. Using your numbers, and assuming 20 units/day for Leo:

    $260 Local - 1,000 units = $0.26/unit x 20 = $5.20/day
    $200 Canada - 1,500 units = $0.1333/unit x 20 = $2.67/day

    So that is half price. Wow.
    1,500 / 20 units per day
    = 75 days worth
    vs 50 days of the 1,000-unit vial

    Leo just had 2 mid-point yellows in the last 2 days. He seems to feel better then. When he is in the black, I think he gets crankier.
     
  58. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Successful 9.5u dose given.
    There may be one more dose. Picking up the PZI insulin after 9am tomorrow.
    First use of U100 5/16" syringe for PZI using 2.5x conversion chart. Much thinner needle, and no poke thru tent.
     
    Last edited: Aug 4, 2016
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  59. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I don't even want to imagine how hot it is in Texas. We are sizzling up north too with temps around the 90s but it feels more like 104 with the humidity! I can't remember the last time we've had so many heat warning days or that I have spent so little time outside enjoying the summer because of the heat!

    Those are really nice drops Leo's has had the last couple of days. I notice a big difference with Menace when her numbers go up too. It's heartbreaking when all they want to do is eat and sleep and don't seem very engaged but it does get so much better and it looks like you are on the right path with Leo.

    I used those 40u 1/2 inch needles while helping with another cat and I remember thinking they looked like daggers compared to my skinny short ones. Makes it easier to fine tune the doses too.:D Sounds like Leo won't have to miss a shot.....you could always shoot a lower dose (whatever is left) if need be to tie him over till Friday night shot and shoot a bit earlier Friday night. Whatever works for you.
     
  60. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks, really hoping to replicate Leo's BG drops. For the PZI, there is a little bit left in the vial. I'll know in a couple hours when I extract it. It's is silly that they provide those huge U-40 horse needles. Poor kitties.

    The vet confirmed the insulin will be here today. Good thing I work from home (mostly). ...Yes, there are no heat warning days here until it gets over 105. I don't know why they bother, it is always toasty here in the summer.

    On July 7 we adopted a stray. He will come within 3 feet of us now. We trapped him before. Got him snipped, and treated for ear mites, fleas, shots, and expensive dental work. His urethra may be infected, and his ear mites are back. Tried to trap yesterday. Trying again this morning. He is warming up to us, and just darned cute.

    I am going to buy some FreeStyle Lite strips for the AlphaTrak2 today. Besides expensive insulin, $5-6/day of strips is $150/month on AlphaTrak2.
     

    Attached Files:

  61. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Actually if you read a lot of veterinary documents, they recommend a 1/2 inch needle. What's not clear is if this has anything to do with the depth of the skin on our cats or just because that is the standard size available in vet syringes. I have tried the 6mm (about 1/4 inch) human needles but found them a little too short and more prone to fur shots especially if kitty moves at all. There are folks who do use them though. Perhaps their kitty's fur isn't as thick or their kitty isn't quite as plump!:woot:

    I think we are a little wimpy up here when it comes to too cold or too hot compared to you folks. As soon as the temperature hits 90 given it gets very humid here, they usually start issuing heat warnings. I've never had the pleasure of visiting Texas (on my bucket list!) but I have been in Nevada and Arizona in May and I just can't imagine what it must be like in the summer months. I am a heat lover but 104 is just a bit too hot for me.

    Little Dude is adorable! Love those copper eyes! He's a lucky kitty to have you looking after him.

    I understand completely about the cost of the AT2 strips. Not sure if you have read up on using the FS strips or not but in case you haven't here is a message I put together for someone else who wanted to use the FS strips because it's important to clearly understand the implications and how to use them as safely as possible.

    "Having thoroughly investigated the FS vs. AT strips (checking patents, manufacturing location, assay used in the strips, calling both human and animal divisions of Abbott etc.) I am 99.9% sure the FS strips and AT strips are identical in their physical composition. The AT strips however have been batch tested to determine what code on the AT meter will produce a reading closest to animal lab values. Without the AT code for each vial of FS strips, your results will not be as accurate as those using AT strips with the meter set to the appropriate code. My own cross checking elicited results within 10% of the AT strips. Others have indicated their results were within 5%. The difference may depend on how high or low the reading being compared is.​

    I am not advocating use of the FS strips in the AT meter, but they will work. If you choose to do so, it is imperative that you have your AT meter set on one of the cat codes (known codes are 08, 37, 38, and 93) to get a reasonably accurate result. Do NOT use the code on the FS strip vial as that is for use only with older FS human meters. By using one of the cat codes, you stand a 25% chance of getting accurate readings.​

    It is also imperative that you keep some AT strips on hand to do baseline checks of your results with the same drop of blood, each time you open a new vial of FS strips or alternately, use AT meter control solution to ensure the strips are readings within the expected range. Also double check any unexpected or low FS strip readings using an AT strip.​

    All meters have an allowed variance in their results of up to +/- 20% and using the FS strips in the AT meter adds another variance into the picture so your results, while in the ballpark, may not be as accurate as is possible."​

    Last but not least, make sure your vet knows you are using FS strips so they understand that the readings are a little different than lab values/AT with AT strips.
     
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  62. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Little Dude - that stinker got partways in the cage and I almost had him. Then he bolted. It's a shame because he didn't get fed (at least here) today. We paid to have his top canines (long ones) and one molar removed. They were busted off. Poor little guy, must have been in extreme pain. Expensive surgical extraction. So we are invested in him, and he is already healthier.

    Thanks for the FS vs AT strip info. I'm going to keep a copy of that. AT strips are just too expensive. And overall, I bet all these strips are $.02 each to make. Now to find the best web deal for those FS strips.
     
    Last edited: Aug 5, 2016
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  63. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    PMPS 484
    Dose increased to 10.0 this morning.

    Need to drive some decent nadirs soon. His neuropathy is pretty bad now. He tries to counteract it with lots of purrs. He is getting 3.0mg Zobaline (Cobalamine) daily, and a liquid B12 shot weekly.
     
  64. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    One of these days you'll hit that sweet spot. You're doing great because our high dose kitties definitely test your stamina, endurance and patience. The saying around here is that this is a marathon not a race and no truer words were ever spoken with our furkids! I reduced my girl a week or so ago and now am having to increase again so it's a bit of roller coaster ride but it does get better so hang in there!

    The neuropathy is definitely difficult to watch but the Zobaline and B12 should start helping soon as will getting him on the right dose of insulin to get his numbers down. The good news is that it's not painful for our kitties and they seem to cope pretty well.
     
  65. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Hope the new dose means a lower nadir today.
     
  66. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks for the support. Fingers crossed for the lower nadir today.
     
  67. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Preshots 400-480 over past several days.
    AMPS 400 today

    Going to make 2 changes:
    - 10.5 tomorrow evening if no drop
    - Reduced food allowance
    - We reduced food input today to 1 can Fancy Feast, 2 hours prior to AMPS. Previously it was 2 cans.
     
  68. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Based on Leo's weight, if the 15.5lbs is his ideal weight, then he would need about 280 calories per day which would equate to roughly 3 cans of Fancy Feast per day based on the average calories in a can of the different FF flavours. If he's particularly active or sedate, you can adjust accordingly. You don't want to pull back on the food too suddenly because not only could that effect the amount of insulin he needs but also could be hard on his liver. Cats should lose weight very slowly if that is the goal. And right now with Leo not yet regulated, he will be hungrier than usual and not able to get the nutrients he needs out of what he does consume. I would suggest you cut down by perhaps a 1/2 can to start with and weigh him to see if he is maintaining/losing/gaining according to what is appropriate for him at this time.

    If he is particularly hungry all day, break his food allowance up over his two shot meals and a few snacks through the rest of the cycle. That helps keep food in the system for the insulin to work with and will keep him more satisfied and not so hungry at shot time.
     
  69. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Linda. Yes, 15.5 is his ideal weight and he is 16.5 now. He is getting overfed. So I'll start reducing and tracking that more closely. I had not realized she was giving him 2 cans for breakfast. He is starving all the time - typical of unregulated cats.

    In summary, we were not sure how much food he was getting. Now I'll tightly regulate that. I have been spreading the food out over the 16 hour day. Now there will be less of it. At least he likes the Fancy Feast. He has never been a picky eater, even as a little kitten.

    AMPS = 400 today
    +2 = 1/2 can food
    +5 = 400 also
    +5 = 1/3 can food
     
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  70. Ruby&Baco

    Ruby&Baco Well-Known Member

    Joined:
    Apr 21, 2016
    I'm reading all the post just now Jeff, i'm glad that you are testing and wow that must have been a scare that Leo was low all of a sudden! Glad you caught it by testing him.
    Well, he did gave you a nice number, so maybe it is a sign for the future (anti-jinx) :rolleyes:
    So happy that a lot of people can help you with the high dosing of Leo!
     
  71. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Ruby. Yes it was very scary. He didn't really hypo, but he got low real quick and I Karo'ed and tested him. He did like eating the Karo mixed with his food...but he pretty much likes eating everything.

    I'm hoping we can get him into some yellow ranges this week. His neuropathy is pretty bad now. You and Baco must be having fun OTS now.
     
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  72. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo summary:
    Last 11 days - preshot tests 400+. And generally 300+ in between (except for Aug 3).
    One more shot at 10.0, then increasing to 10.5. He is miserable for food, and especially cranky before the PMPS + dose. Poor kid.

    Little Dude summary:
    On a positive note, Little Dude, our orange stray recent adoption - got within 2 feet of Theresa during the evening meal tonight (outside). That is a huge gain of trust for us. Maybe another week and he'll give leg-lovin.
     
  73. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Try feeding just prior to the shots. Some of those high preshot numbers are food influenced. Take the preshot reading, then feed, then shoot.
     
  74. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad to hear about Little Dude! I've socialized several ferals, it takes patience, but it's worth it. Good luck!
    Good luck with Leo's dose increase.
     
  75. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    So glad to hear you are making some progress with Little Dude. Fingers crossed he will start trusting you both more and allow some physical contact in the very near future. :D

    Jeff, if Leo is already miserable for food, don't try to reduce too much. He can't effectively use all the nutrients in what he consumes so he needs more right now. If you reduce too much, he may start losing weight and that could lead to ketones and you don't want either of those scenarios. It's a fine balancing act but sometimes you have to listen to what kitty is telling you rather than going by general formulas for calorie intake. I give my girl a set amount of food daily however if she is high and getting frantic for food, I don't hesitate to give her a little more those days despite the fact that she needs to lose a few pounds. Right now I am aiming for maintaining rather than losing.
     
  76. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks all for the help and advice. We are looking forward to Little Dude getting closer to us. He hung out in our suburban front yard between 7:30-midnight last night.

    I will be careful on Leo's food reduction. I am able to smell ketones as well. We had a small mistake this morning - Theresa fed Leo 2 cans before 7am. So now he's not hungry for the moment. AMPS will be off even when I wait until 9am. The small positive is he gets this small window of great contentment. It is real neat to see him in his old relaxed state for these small periods.

    1:30am test = 330
    For that (PMPS +5hr) test was not food influenced. He didn't get much food after PMPS shot, and he didn't get any food for 3 hrs before the (+5) test. Rest of today and tomorrow will be tighter food controls.
     
  77. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'm assuming you just mean you're able to smell ketones.....not that you have already!?! I wouldn't rely on smell alone as they show up in urine a day or so after they start in the blood so there isn't always a strong enough odour for us to detect at low levels. If you can get Leo to pee on some plastic wrap in the litter box or set up a separate box with fish gravel, you can test that way using human ketone sticks from the pharmacy. Some folks can sneak up and put a strip or spoon under their kitty to get a sample but that doesn't happen in my world!
     
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  78. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks. I have neglected to get a ketone kit. I'll get it today. I do not smell any ketones on Leo today (or recently). I did smell tuna breath though.
     
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  79. Ruby&Baco

    Ruby&Baco Well-Known Member

    Joined:
    Apr 21, 2016
    tuna breath omg Jeff, you made me laugh so hard just now :joyful::joyful::joyful::joyful::joyful::joyful:
     
  80. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    There are definitely some fun times with our cats. Glad you enjoyed the humor!
     
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  81. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I don't know where Leo's yellow numbers went - from 4 days ago. We're trying to do better feeding. Tonight doing 2.5 hour light feeding before PMPS. Then increasing dose +0.5 - to 10.5.
     
  82. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    These high dose kitties can be challenging and very frustrating. Looks like Leo he had a bit of movement and then the dose went stale. You just need to keep going until you get to the dose that start bringing him down. I have patience pants but they're kind of in rough shape so I can't offer to loan them to you! ;):woot:

    shredded.jpg
     
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  83. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Linda. WHOA - I didn't know your cat had such sharp claws.:)

    Leo is on the new vial of PZI. I am a bad end-of-vial insulin estimator. There were 4 more doses at the end of that last vial. Anyhow, the last dose was out of the new vial.
     
  84. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    3-4 hours leading up to each shot, Leo seems to get frantically hungry. This may not get reflected in the testing. I think the insulin is wearing off and he is hitting a calorie deficit. Especially in the evening before preshot, he begs and cries persistently for food.
     
  85. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Oh that's not her claws. She's very good about her manicures and super gentle. That's Momma rubbing her sweaty palms on her pants trying to figure Menace out! :p

    That frantically hungry behaviour is why so many of us split food out over the course of 24 hours. I think that frantic behaviour serves to raise their BG to some degree too so I try to keep Menace relatively sated within reason. It's a trial and error proposition to find what works best for your cat because some cats will eat more at a meal and some like to graze.
     
  86. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    No yellow today. He is acting more regulated. We are regulating food tightly within reason. He is not gaining or losing weight currently. Summary:
    5am, 7am = 1/2 cans Fancy Feast
    9am - 355
    9:01am - 10.5u
    9am, 11am, 12noon- 1/2 can or less each
    2:30p - 380
    2:30 - 1/2 can
    TBD 9:00pm PMPS, 9pm, 11pm - food; then 1:30am test

    Small victory of no red or black.
    Sticking on 10.5 for 4 doses, then increasing to 11.0.
    Fed fresh cooked similar portion of Tilapia (fish) on 2 feedings. Leo and Chinus love it. Little Dude (outside) did not touch it.
     
  87. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Tomorrow, may try same strategy as 8/3/2016.
    No food between +2 to +6, then test at +6.
    This assumes I can stand the persistent whining and crying. Currently have been giving 2 hour feedings of 1/2 cans or less. If I put out 2 or 3 cans, he will try to eat all of it.
     
  88. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I really think the hunger part of this situation is sometimes the hardest to deal with. I know I am the biggest sucker for those soft eyes peering at me and those meows that grow progressively louder the harder I try to ignore Menace. It's heart wrenching! Probably worse because like you apparently I am prone to catering to my kitties, sometimes too much. I have a furry senior citizen here whose appetite is very picky these days but he loves fried pork chops, poached chicken and steak so there is always a supply of one of these in my freezer for treats. Unfortunately (or maybe that should be fortunately) my little sugar isn't the least bit interested in any of my home cooking! :p

    Maybe little Dude will come around in time or he may be like Menace who doesn't like fish.....but then it's soft and for her, if it doesn't crunch, it ain't edible except for grilled cheese and bacon or peanut butter sandwiches. :woot:
     
  89. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    The persistent hunger is tough to deal with. Another high number (430) to end this day. Will stay on 10.5 for another 2 shots, then 11.0.

    Looking at other traps for Little Dude, like drop traps. He has bad ear mites now. Theresa thinks his castration site is infected. So he needs a vet visit. He came within 2-3 feet of me tonight. Building trust takes awhile.
     
  90. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    We are regulating Leo's food more closely. Summary status:
    - 1/2 cans of Fancy Feast classic every 2-3 hours
    - BG = 340 - 460 in last few days

    Bumping him to 11.0 units on Aug 12.
    Targeting a nadir in the 200's.

    I'll probably move back to Lantus after this PZI vial, for cost reasons. The PZI is not any more effective on Leo. And the Lantus is at least 30% cheaper.
    .
     
  91. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Here's hoping this increase will help Leo!
     
  92. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Rachel. I plotted Leo's AMPS and PMPS for 7/30 - 8/11. In Leo's google sheet, it is the second tab (see top tabs in the sheet).

    The PMPS is trending down with the increased dosage. Also better food regulation. I'm hoping increased insulin will continue that trend.

    Theresa and I were talking about our cats tonight. I'm spending all this time treating Leo, successfully since he is alive. Then Scoobs got that intestinal issue (June 29), with no symptoms and died 2 days later (July 1). We keep wishing we could go back in time and somehow see some small symptom earlier to save him. He just started throwing up, and we took him to the vet the next day (Thursday), then he died that Friday during surgery. Or we wish somehow the vet could have done some miracle and diagnosed necrotizing intestines on Thursday. But his major intestine was all dead. There was no blockage. Grief is a hard thing to deal with. I guess a lot of cat parents have the same guilt issues. All I know is I sure miss my sweet boy Scoobs.
     
    Last edited: Aug 12, 2016
  93. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    We totally get that Jeff. I still feel guilty about gypsy...I should have seen much earlier that something was wrong so I could have hopefully helped her. But we do what we can. I think our kitties know we love them and do whatever we can for them. Gypsy had a good life...and when it was time, I let her go rather than allowing her to suffer. Scoobs knows you loved him...and that you did whatever you could to help him.
     
  94. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Jeff, our kitties are all too capable of letting on nothing is wrong even when they are feeling quite ill.....the only common kitty trait I wish didn't exist. If we get them medical attention when we do see something off, that's all we can do. I think most folks here can relate to what you are going through but you got Scoobs to the vet as soon as you knew there was a problem. Many kitties wouldn't have had that care. Scoobs lived a good life with all of his needs more than met and was obviously adored, loved and very lucky to have you and Theresa as his pet parents. He knows that and he wouldn't want you beating yourselves up. :bighug::bighug::bighug::bighug:
     
  95. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Rachel and Linda. It has been 6 short weeks since Scoobs left. He just seemed so young at age 8 to leave us. We have his tribute shelf setup. We tried watching some videos of him, and I can't do that yet. He was a friend to all who met him (person, dog, or cat), and he was a kid to us.
     
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  96. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo's numbers are not falling much. See his spreadsheet. We are strict on food now. Today:
    AMPS = 330
    then dose = 11.0 (increased from 10.5)
    5am, 7am, 9am, 11:30am - 1/2 can food each time
    +5 = 350

    I might as well be injecting him with water. The injections are in his flank. Different spots to ensure effectiveness. I guess the main change is he is out of the 400-550 range from a few weeks ago.
     
  97. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Jeff, you've been hit with a double whammy between losing Scoobs and now dealing with the frustration of a high dose kitty. My heart goes out to you, but you are doing everything you can and the day will come when Leo will surprise you with another lovely lower number. You are making progress although not as quickly as you'd like. Unfortunately, baby steps are necessary to keep Leo safe.
     
  98. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Thanks Linda. It has been a tough month.

    We went on vacation to Canada. When we came back:
    - Leo had lost 1.0 pounds at the boarding facility, I think due to stress
    - Scoobs was gone 5 days later, which devastated us
    - Leo's neuropathy was pretty bad, and we were afraid of losing him too
    - So no more real vacations for awhile

    Leo's plan:
    - keep increasing by 0.5u every 6 doses to drive BG reduction
    - increase cobalamine to 2 x 3mg pills per day starting today

    On a positive note:
    Little Dude (orange outside guy) got within 18" of Theresa during one feeding, and same for me during another feeding. And he almost gave me leg-lovin. It is so rewarding. And he is doing air-dough, and he rolls over for food. I have no idea where he learned that.
     
  99. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Sounds like things are progressing nicely with Little Dude and he seems to be feeling good, so hopefully no infection from the neutering.
     
  100. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Theresa took pics, and had a vet tech evaluate the neuter site. They said he is okay. He doesn't mess with it. I would think if it hurt, he would be licking it or he would not be playful. Yet, no excessive licking there. And he looks real healthy, plus the rolling around on the ground for food.

    Thanks for the post.
     
  101. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Smart to take pics to show the vet!
     
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