12/20 Quintus AMPS 619 (NS last night) +3 342 +5 293 +7 185 +9 135 PMPS 196 +1 175

condo: http://www.felinediabetes.com/FDMB/threads/quintus-amps-392-pmps-85-ns-1-124-2-139.188277

Didn't shoot last night following low PMPS. This morning, high AMPS as expected. I'm curious about the "still falling" numbers at +7. I've seen this before, 12/17 for example. How is this to be interpreted? Is it a result of the absence of juice last night? Or something else?

In other news Quintus went out today again (he's been doing it regularly now) and we stayed in front of the building for quite some time. He went and sniffed the leaves in a bush and was generally alert and interested by the world around him. I even wondered if he could still see something, maybe shadows, because he seemed to be looking intently at people going by. I could be mistaken. He also walked faster than I've seen him walk in recent memory. (Click on his name in my signature to watch the video on his Facebook page.)

This is his third day back on Onsior, which could explain things.

In other matters, I've received the methylcobalamin I had ordered. Some of you may remember I spent pretty much all my Saturday reading up on it, and I'm quite convinced it can be beneficial. The only thing I'm not quite satisfied about is the dosage.

Jasper was on 3mg, and that's what everyone seems to be doing, but where does that number come from? I know B12 is hydrosoluble and eliminated though urine but I'm not a fan of putting super high doses of anything into myself or my cat if half or a quarter if it would do the job. I mean, 500mcg/day for a cat is already super-high-dose.

If anybody had data or a source regarding how we ended up using that dose, I'd appreciate.

 

Nice recovery from the NS and the black AMPS, Stephanie. The nadir can shift a bit - it's not always exactly at +6. It'll be interesting to see the rest of your daytime data. I can't enlighten you about the 3 mg dose issue.

It's wonderful that Quintus is feeling well enough to go for a walk outside. Isn't he a handsome boy!

 

Yes, I was so happy to see him interested in the bushes! He sadly gets ill (gooey and bloody poop) when he eats grass, which means I have to hover over him when we're outside (he really loves to eat grass). Otherwise I'd be able to give him a little more free reign...

 

I give a full 1000mg every other day. So far no harm done.

 

And any results?

 

http://www.felinecrf.org/vitamin_b.htm#methylcobalamin

Gizmo gets B12 and B complex. He gets 500mcg/day of the B12. 250mcg mixed with his AM cycle food and 250mcg mixed with his PM cycle food.

One capsule total per day
https://www.amazon.com/gp/product/B0046IET7C/ref=oh_aui_detailpage_o01_s00?ie=UTF8&psc=1

 

Yes, I've read Tanya's page and also dug deep into the possible toxicity for kidneys. So far all I've found is humans on super high doses for months or years -- and of cyanocobalamin rather than methylcobalamin. The distinction is important because the kidneys need to bind the toxic CN group to eliminate it. This group is discarded when cyanocobalamin is transformed into methylcobalamin to be used by the body. So... I'm wondering if those concerns also apply to methylcobalamin.

Which, again, makes me wonder about the dosage. Humans started out with high, high dosages of cyanocobalamin, which does not have the same bioavailability as methylcobalamin. On the other hand, most of the cobalamin in our bodies is stored in the liver under the form adenosylcobalamin -- only a tiny fraction is converted into methylcobalamin. There are missing pieces in this B12 story :-/

 

+9 135
So. Hrm. He's continuing to go down, despite the no shot last night. Do I do anything?
Bearing in mind that tomorrow and the day after I'm out 12h during the day.
I'm worried he'll continue going down and I'll end up with another low PMPS.
Should I think about reducing the dose even more?
I have a suspicion that in his "food mix" he is eating more of the LC paste and less of the HC kibble. Could account for lower-than-expected numbers. This is making me wonder if I should be proactive and lower the dose to 2.

 

I'm tagging @Wendy&Neko for you .. if you could get a +11 then PMPS, that would be very informative.

 

Wonderful. At his worst he couldn’t stand up to eat. Had to hold his bowl for him. Now he jumps around like a kitten.

 

Thanks! So looks like it's not necessary to go as high as 3000. Quintus has wobbly legs and is a bit weak in the hind, but has been for years. It's worse than it was, so I don't know if it's a bit of neuropathy or "just" the arthritis.

I won't be able to get a +11, physio appointment right on the hour. I'll be back just for shot time. I can at the most grab a +10.5 before leaving.

 

I'm sure Wendy will have a wise answer for you. From what I understand, it's better to find a consistent dose you can shoot twice a day (even if its lower than you'd want) instead of a good dose once a day and a skipped shot. Just because of how Lantus and the depot work, you want that consistency. Do share anything you find about the b12. I considered it for Asia, but I'm a less lotions and potions the better with her, since she doesn't have constipation or any other issues, really, I don't want to upset the balance.

 

Asia has arthritis too, we've been doing acupuncture. While some things have had no improvement, and other things (arthritis related) have gotten worse since FD, specifically the leg stuff with her has improved. I'm not sure if it was a tinge of neuropathy that has mostly resolved with getting diabetes a little more under control, or if the acupuncture has fixed this one issue and done very little to resolve other arthritic things (leaning towards a combo of both, but mostly the former).

 

Gizmo could barely walk when I started the B12. He had a sever panc attack, then treatment with high dose of prednisone and then FD. Took about 3 months for significant improvement and 6 months 100%. Then arthritis set in. Started cosequin about 2 weeks ago.

 

Inching back up, 189 at 20 minutes past +10.

I'll be back for the PS, but am worried about having a lower PS than usual, and then being stuck tomorrow morning and not knowing what to do if the number is still low at AMPS. I can't really monitor tonight. Well, I can, but I should sleep.

 

yes, that's why I'm wondering if I should go down to 2 right now. Because as I see it we'll be getting to 2 at some point in the next week anyway.

 

Yes, that sounds like a good plan, I'd see what Wendy thinks about it too. It's funny to hem and haw about these doses because I suspect as soon as the food switch is complete, it will all go out the window anyway!

 

One of the paradoxical aspects of using Lantus is that we tend to expect that if you shoot a lower than usual number, then you will be dealing with dropping numbers for the cycle. That doesn't necessarily happen. Often, you end up seeing a flat cycle. If you look at the SS from a cat that is regulated, giving insulin doesn't cause numbers to drop into a crisis range. Rather, you see a cycle that does not have a marked nadir.

Taking a look at Gill & George's SS may help to put this in perspective. (There are multiple tabs to look at.)

 

FWIW - I used to look to Sienne for advice on dosing when I started. There are few others out there with her depth of experience. Putting something like "Dose ?" in your subject line normally gets eyes.

As for the nadir, I wouldn' worry about it moving around. It's not unusual for it to be later when they are breaking a bounce. As I jokingly used to say, Neko's nadir on Lantus was reliably somewhere between +3.5 and +13. The nadir is the lowest point in any given cycle.

As for shooting tonight, Quintus is on his way up. On this forum, we suggest that if you get a number below 150, that you stall without feeding, and post for help. If he ends up below that at PMPS today, it's likely just a double dip and still safe to shoot without help. And as per Sienne's suggestion, shooting low is a good thing. The cycles are much flatter. I hated shooting high numbers as I never knew what the cycle could look like, big drop or not.

 

PMPS 196

So, do I do 2 or 2.25?

 

This cat, however, is not exactly regulated :-|

 

I would stick with 2.25u. You helped drain some of the 2.5u depot last night with the NS.

 

So, he went too low to shoot for me on his sixth 2.5 cycle. Now we're down to 2.25 with one "empty" shot hanging around. I'm trying to guesstimate if I'll be "safe" until Friday night, where I will either be shooting two hours late, or not shooting, or shooting a reduced dose, or doing something creative.

If I understand the depot, when we lower a dose, the cycles should come up gently (if we consider the depot to be a function of the last roughly six shots). Is that reasoning roughly correct?

 

Neither are most of our cats to start.

I would stick with 2.25 and try to see if you can get consistent dosing for 6 cycles to stabilize the depot.

 

I know I won't because I can't shoot on time Friday night.

 

Nice in theory, but it must be taken in context. Often the reason people lower a dose is because their cat earned a reduction. That often causes a bounce, so you'll see numbers go sharply up. Unless the depot is over full, in which case you can see the depot influence 4-6 cycles after the reduction, and sometimes see lower numbers because of that. Then if there are skips or reduced doses, that also messes with the depot. Plus the possibility of healing beta cells, throwing in yet another random element. Predicting what a cat will do, can be crazy making.

On Friday night, see if you can still do 2.25 units, even if late - barring any surprises Quintus throws in the meantime. From my own experience, it's really hard to figure out a good dose if you are jumping around in dose.

 

I did 2.25 (maybe 2.2).

 

Thanks everyone!

Bumped into my vet as I went to buy food and more strips (they're out of strips! yikes! I have about max 15 left). He reassured me regarding low numbers and shooting low numbers. Guideline he gave me is that down to around 2 mmol/l (36) there is not much risk. He told me what we want for Quintus is to keep him as much as possible between 4 and 8, dark green and low blues, which seems in line with what TR is aiming for, right? Anyway, just to say I'm going to be a little less chicken about low numbers (but still prudent) and my aim is to accelerate the food transition starting Friday evening, when I'm done with my long days away from home for a bit. Like that hopefully when I start work again Jan 4th I can leave a cat that is on LC wet food and reasonably under control!

 

It sounds like you have a great vet!! Yes, what he said is in line with what we do here.

Good luck finding more strips!!

 

So unusual. Wish mine was good. He doesn’t even know Silver is out of remission. Not telling him.

 

He's just more "in a hurry" than me even -- he would have shot the NS last night and stuck at 2.5. He was however very sympathetic to the fact I'm feeling at the end of my rope between work, illness, FD and xmas coming up and am scared of the low numbers.

 

So now that I'm "low" on strips (I will have to try and get more tomorrow evening, but that's going to involve a bunch of phone calls during lunch break and running out after the PM shot again) I'm wondering what to test tonight. Suggestions?
(15 is not disastrous... but still, feeling jittery. If I can't lay my hands on some tomorrow night I'm stuck until Saturday.)

 

Get a +2 to +3......that should let you know if you need to test any more later in the cycle

 

+2 175. Feels flattish?

 

Any chance of getting a human meter and strips and meter as backup. Preferably one where you can get strips at late hours? You may not use it much, but at least it'll tell you when he's in the danger zone.

A bit of movement, but not excessive. Paws crossed for a night of blue surfing.

 

Can you pick up an inexpensive human meter and strips JIC? Not a bad idea to have an emergency back up meter anyways. I think I have 5 (one is a combo ketone/BG meter). At least you could test so you would have an idea where he is at.

 

@Wendy&Neko
GMTA

 

So, "late hours" here means "everything is closed" ;-)
I'll find a vet with spare strips, they all have them here and there are about half a dozen practices within a mile of here. I'll just have to phone around and head out when I'd rather not, but I'll get them.
I've looked at pharmacies but human meter strips cost roughly the same here as pet ones.
I will think about getting a spare meter though, that sounds like a good idea. And make sure to stock spare strips now that I see we're getting somewhere and I'm comfortable my vet is on board.

 

Yeah, I think I'll go for that and get us to bed! I'll check later once if I can't sleep or wake up in the middle of the night. Otherwise, see you folks at AMPS, which will probably be sleepy-time for most of you -- except the Aussies!

 

What does this mean?

 

Great Minds Think Alike.

It sounds like you have an awesome vet! Very lucky you! Tell your vet to do some networking with the vets in the states!

Always a good idea to get a backup meter and order strips in bulk and decide on a time to reorder number that won't leave you in the lurch even if the mail is delayed (my reorder number is 200, but I still have to test a lot with this unpredicatable girl).

 

Spare meters are a great idea. Stories of tails swiching meters into water, being microwaved instead of the rice sock, etc. Keep a spare package of strips in the hypo kit. Cats always have the worst timing, so know when you are low on strips.

 

+3.5 124 (and he ate more of his meal 20 minutes or so ago)

 

2.25u could actually be a good dose!

 

Good night!

 

Where are you Stephanie? UK?

Most pharmacies will give you a free meter when you purchase strips. Just a thought.

 

She's in Switzerland

 

@Stephanie & Quintus I sent you a response PM a few days ago about Quintus’s SS. I just need some help from you so I can do it. Please check your PMs. Thank you, dear!