Sam - Month 4

Starting off the first day of the fourth month.......with a fur shot

Took a +4 and he's pretty much flat, so at least it isn't rising too much at this point.

You would think at this point in the journey I would have better luck with these things

 

He has some nice numbers going! And today isn't looking so bad for a fur shot, annoying though they are. The times I've done it, I wanted to kick myself.

 

Yup. This one was so blatant that I probably could have re-shot, but I know it's a big no-no, and honestly I was a little curious to see what he would do on his own for a cycle. I'll definitely be more careful tonight! If he didn't have that crazy thick undercoat it would make it so much easier!!!

 

Remember...all data is good data.

 

I went to the store this weekend and found myself a new pair of patience pants....

 

LOVE THEM!!!!

 

Those will give you A LOT of patience!!

 

Lol...They don't fit at all, but for $1.99 at Goodwill, I couldn't resist!

 

Those pants are AH-MAZING!!!!

 

Love the pants!!!

 

Hi team! So I got a feeling of foreboding a few days ago, and today's numbers seem to back it up. It looks like Sam's BG is starting to creep back up, and he isn't responding to the insulin as well. The vial is old at this point, so it could be losing it's punch a bit, but it also looks like he isn't anywhere near being ready to go it on his own without insulin. So in light of needing to get a new bottle anyway, I'm thinking of switching him over to Lantus. Any thoughts pro/con about making the switch?

 

Hmmm...his numbers today really look the same as they have to me. Blue preshot, nice green nadir...and 160 is basically the same as 130 really.

I don't really know about Lantus Djamila. You could surely try it...I just don't know enough to know if it would be better than what you're getting on Prozinc or the same? I think I would go over there and ask them. I've never suggested a switch when someone is getting low numbers like you're getting..only when they were getting high numbers and we couldn't seem to get them down, but now that I think of it, getting low numbers that won't seem to go down is about the same isn't it?

Basically what I'm saying is I'm no help to you on this question. @StephG @Bobbie And Bubba @Sharon14 you've all switched over...any thoughts?

 

I agree with Rachel. The pattern seems pretty consistent to me. If it was me I wouldn't change anything at this point.

 

I switched Colin to Levemir because he's a high dose cat (acro), so I can't really shed any light on a switch for you. I do think your SS is a pretty mix of blue and green that would make many of us envious...

 

Hey Djamila! His numbers are pretty good for such a low dose. I see where you did a NS the night before last and that is when his numbers starting to creep up a bit. Yesterday's and today's nadir was barely green. I would maybe tap him up a bit to .a fat .40 if you can monitor him and see if you can get him to bring it down overall a bit more. And he is so close......... in light of a FS and a 3 NS all in 9 days time.

The one real plus for Lantus is that you would be able to shoot lower numbers more comfortably ( after you have some data to see how he responds to Lantus) than you can with ProZinc which to me was a big plus. The Lantus curve when they are regulated is rather flat unlike the ProZinc curve that resembles a smile.

If you decide you want to give Lantus a try, post over in L & L and see about a starting dose. Usually it is the same dose as on ProZinc.

 

I am debating the switch as well but have another month or two to really think . If Maury was where Sam is, I'd probably stick with Prozinc since it's such a tiny dose but if he does start creeping up as you suspect, then it might be worth the switch. I'll probably be shortly behind you guys!

 

If I didn't feel like this vial is needing to be replaced, I wouldn't be thinking of moving right now. I'm just thinking that if I'm going to have to buy a new vial anyway, and he isn't ready to go OTJ at this point, then maybe I'd rather invest in some Lantus instead of another bottle of prozinc. It's just so expensive around here! That being said, there is still a lot left, so maybe I just give him a bigger dose until it's a little lower in the bottle, and then switch at that point. That would also get me closer to school being out for the summer. It would be a lot easier to switch when I can be home with him more.

PS If you look at my spreadsheet, just ignore the crazy high PMPS. He was under a lot of stress at the time I did the test. He went with me to my mom and dad's house and he did not exactly have a fun time. He was shaking in the car which he's never done before, and then it all fell apart once we got there. Poor little guy! He usually travels really well, but today was definitely not good for him!

 

Then maybe you will want to hold the same dose for now considering there was stress involved.

 

I see you did hold the dose, good choice for now.

 

Okay, now he's just messing with me.

Just kidding about the high numbers, Mama! I think I'll drop like a rock tonight, okay?

PMPS 136 (totally normal, gave the same dose as this morning which had done very little during the AM cycle)
+1 Starts acting like he's going low, but it's only been an hour so I think he must just be in a mood and decide to ignore him.
+2 I'm about to walk out the door. I never test at +2. But something tells me to check. 52. Give him a mess of HC food and leave (I have to bring my neighbor home from the hospital - it's close, but still scary to leave him)
+3 Back home - 60 - give him a little EVO just for fun -- because who doesn't love a little kibble? (only like 10 pieces)
+4 71 - He should be rising on his own now.

So what do I do tomorrow?!?! I'm leaving at +1.5 in the morning, and will barely make it home in time for PMPS. I think 0.5 is a good dose right now -- just not when I can't monitor him. Grrr...y'all know how much I hate changing doses!!!

 

Woah! Sam, what you doing? Did you hear your mom talk about getting more insulin and decided to surprise her to prove that the bottle is still fine???

Maybe give 0.2 if he's in the same range this morning?? I know, I hate changing doses too, but clearly that was (for whatever reason) too high of a dose all of the sudden. Even if you were home, I'd be inclined to reduce since that almost-hypo number at +2 is NOT desirable...but since you won't be home...gah! So maybe stick with 0.2 for similar preshot...or you could skip. I hate to suggest that one, though, because we all know that isn't desirable either!

Okay, I'll just tell you what I would do if he was mine. I'd check his number, if above 130, give 0.2, get that +1.5, and leave food out so he can raise himself up if needed. If under that, I would probably skip. That's just me...do whatever YOU feel good about!

PS - I know you already know this, I just figure hearing from someone else might help since for whatever reason, it's a LOT harder when it's your own kitty looking at you! Had to be talked off the ledge before (once made someone reassure me that NOT shooting a green PS was the right thing to do because though I had advised others not to do it...somehow I panicked when I got one!).

 

It is so much easier to give my logical thoughts to other people, and then get caught up in my own emotional thoughts!

I'm glad I checked this before I shot. I was honestly thinking of just giving him a 0.4 again and assuming that last night was an anomaly. So I went with a 0.2 which might have been a little closer to a 0.3 (oh, these tiny doses!). I don't think it will be enough, but better safe than sorry since I won't be home.

He always has food, but I am leaving him with a bit more than normal. I do think his nadir has shifted earlier the last couple of cycles, so more like +3.5 instead of +4.5, so hopefully the +1.5 will let me know what he's planning before I leave.

If only I didn't have to work...

 

Whew! Exciting! He needed to remind you that he's a cat, Djamila, and won't willingly follow rules or let you get complacent. And you're right - having to work gets in the way. Retirement makes it easier but I still want a regimen that satisfies the requirements of keeping Teasel safe, getting his BG down to acceptable levels and allowing me the freedom to do other things.

 

Ugh. 156. That's why I hate these safety reductions . Okay, off to work. At least I won't have to worry about him going low, right? We'll get him back on track.

 

Oh Sam

 

Merp. You know Djamila, you can ALWAYS ignore what I say and go with your own gut! It won't hurt my feelings...and you know I sometimes tend to the more conservative, which is why you are great to balance me out with the more aggressive approach. Please always always feel free to ignore what I say!!

With luck that was just a food spike and he'll head nicely into the upper greens and then present you with a beautiful preshot again tonight!

 

No, for safety's sake the lower dose was the right decision. I would have given him the full dose if I'd been home, but going 12 hours unsupervised, it was better to keep him safe. I just have to remind myself that his "bad" numbers are still pretty good.

 

@Yong Sam is supposed to be 11 pounds. Would you mind figuring out his calories? I've always just gone with the visual approach: Hmmm....he looks chubby (cut back on food). Hmmm....he looks skinny (add more food). Not a very precise system

 

219.6 calories per day

 

Huh. He eats (at most) 200 calories per day. I guess that's where activity and metabolism factor in as well, huh? He doesn't run around much. He's a bit of a coach potato - despite the myriad of toys he is offered on a regular basis. He prefers to just watch Atticus chase the feathery/lazer/mousy things around.

 

Bet his eyes are in great shape, LOL.

 

Metabolism and Activity level do play a part

 

LOL! There's always a bright side!

 

I'm really conflicted tonight. Sam is at 90 right now. We are stalling which is always super fun (sarcasm). What if he doesn't rise? I think what I really need is someone to tell me not to shoot on a high green. @Rachel , weren't you just saying somewhere that you had this dilemma one time? I shot on a 113 the other day, and that's basically the same thing. If I skip a shot, I know he's going to rise in a few hours. But shooting on a green is stupid, right?

 

Update: 94

 

Shall I say "yes" to that? Better too high for a day ... Or you can try what I did with Teasel a few times when he was on ProZinc: feed him his dinner, wait 30 - 45 minutes, retest and shoot then.

 

Lol...too late. I gave him a teeny tiny dose (Note to future readers: Do NOT try this!). I'm going to keep a very close eye on him, I promise, and if he ends up getting some gravy he'll be the happiest cat alive anyway! My money is on a rising number through +2, and then a totally safe green at +3 which seems to be his nadir these days.

 

Whoops! So sorry, Djamila, I missed you earlier! We've been having some internet issues due to a pretty bad storm we're having. I have been there and had to get Sue to tell me not to shoot (but I was heading right to work then so I couldn't have monitored). I would have said don't shoot BUT this is you. You know what you're doing, you know how to steer if needed, and you've shot very low numbers before due to Sam being Sam. I'd be worried if most people did that, but with you I'm not. Skipping would be sad since you really want to get him back OTJ. Let us know how he does!!!

 

Thanks, Rachel. I would never recommend someone else do this either! I know it's risky. And would never ever even consider it if I wasn't going to be sitting here with him all evening.

So far so good though - he's at 116 which is pretty much the same as his pre-shot.

I know it's crazy to shoot this low, but I felt like I had enough data to predict what the cycle would do. And to predict the consequences if I left him without insulin right now. We'll find out if I was right or not in a few hours!

 

Hey Djamila. I present to you on behalf of FDMB the Coveted Balls of Steel and for whatever it's worth, I would have done exactly what you did tonight by reducing the insulin, feeding and shoot. You know what to do to keep him safe. Just what is the lowest number ProZinc should shoot? I don't remember, never got to that point on ProZinc.

 

I am humbled and honored by this prestigious award.

We'll see in a couple of hours if I've earned it or if I should have received the "gee, that was dumb!" award

There isn't a defined lowest number for Prozinc. I have always said I wouldn't shoot below 120 because 120 is a healthy, non-diabetic number. However, Sam rises mid-cycle if I don't shoot on the low numbers, so right now I'm basing it on my estimation of his nadir. Lacking a crystal ball, that means I'm guessing and going with my gut.

 

Your gut has served you well in the past. Feeding the curve tonight through the nadir to help him surf along will keep him safe. You are experienced at this dance.

 

Lol congrats on the award!!!

You do have tons of data on Sam and you KNOW he will rise...and since this is his second time around, you gotta do what you gotta do. I think you made the right choice. I'm excited to see what numbers he gets tonight!

 

Whew! 81 at +3, and he's usually been rising by +4, so that should be about it for the night. That was kind of nerve-wracking! Thanks for all of the encouragement tonight, everyone! I was kind of expecting y'all to just tell me I was insane!

I don't even have words for how much I appreciate this community! You are all absolutely the best companions one could wish for along this journey!

 

And Rachel, I hope the storm passes safely!

 

Sometimes going rogue pays off!

 

Wowwww! That's awesome how that worked out, Djamila! Sam did great and look at that nice blue preshot it gave you this morning!

As for being insane, well...we're ALL mad here! But considering how Sam is stubbornly staying right on the edge of OTJ, I think what you did was perfect (to clarify to anyone who might be lurking and reading this post: Sam is on his second round of FD and Djamila is one of our most experienced caregivers here. Please DO NOT TRY THIS AT HOME).

Storm safely passed and I stayed tucked inside listening to my weather radio announce flash flooding in the area! Glad that's over...it's always a little nerve wracking!

 

So glad you stayed safe! A friend of mine was caught up in a flash flood a few years back and only narrowly escaped. Those things are terrifying!

Sam certainly is being a bit stubborn about this whole thing! I think he just likes the attention!

 

Congrats on BOS award . Nicely done, Sam!

 

How I feel about the past few weeks of Sam's FD journey, as illustrated by Lionel Penrose's stairs:

 

Hahahahahhahahaa!

 

Love it!!

 

It looks like he's doing so well! But how do you even draw up those teeny tiny doses? I'm over here looking at 4u and can't even imagine what 0.2u looks like, hahah.

 

I squint a lot.

Even harder than pulling up the dose is the injection though: Since the plunger barely moves, I never feel entirely sure that he even got the shot until I see his numbers come down.

He is doing well. As my hopes of him going OTJ have faded, I have to keep reminding myself of that: he's healthy, he's active, his legs are strong, his coat is good -- he may need this dinky dose for the rest of his life, but all of the important things about his quality of life are good. So I'm trying to hold onto some gratitude about that part.

 

Teasel's all over the place still but I keep saying to myself that he feels better on Lantus. That's what gets me through.

 

Found another formula that gave me quite a different caloric intake, just entering ideal weight / maintaining weight. So re-calculated with Sam's weight 11 lbs. 176 calories per day. Guess we could do averages? lol Would give 197.8/day for Sam

 

176 is closer to what he's getting right now, although he doesn't even eat all of that. The last couple of days he has barely been eating anything. He declares a hunger strike every once in awhile when he wants a change of food. Heading to the store later today to get his royal highness something better suited to his delicate palate.

 

The hunger strike is over. New flavor of Primal Raw seems to have ended his protest.

And I added a ton of extra water because he's dehydrated from the warmer weather and his refusal to eat all day. I wish I had realized what was happening sooner! Poor baby!

 

I'm so very thankful that I have three good eaters here - makes life so much simpler.

 

Have you tried dog food? It's highly recommended by Frank. Lmao.

 

LOL!

 

Of course. I get home 30 minutes late for shot time and he's at 79. All data says it would be okay to give him at least a small dose, but I'm skipping tonight. We're going to take a little FD vacation this evening. Dosing will resume as usual in the morning.

 

Whoa! All right Sam, just throw us another curve ball! You know what no shot means, right Djamila? You can have a glass of wine and go to bed early if you want.

 

I'm taking it as an excuse to go out without worrying about him...and yes, getting that glass of wine! Fingers crossed he doesn't go too terribly high tomorrow!

 

Sam, hope you didn't party too much while your Momma was out

 

He was pretty low again this morning. If I was home, I would have given him a small dose and monitored, but I have to be at work all morning and won't be back until later, so I skipped in the interest of safety. It makes me nervous though because the last time he had NS for two in a row he peed on the reusable grocery bags and ended up at the vet.

 

His SS looks fabulous to me, Djamila! Of course my reference standard is Teasel's so most SSs look better to me.

 

Try giving extra attentions and maybe go through the motions as if he were getting a shot? Just an idea

 

I would have done the same if I was you! Let's hope he doesn't decide to use a bag as a litter box...if he does, as long as he pees a normal amount, I wouldn't worry too much. If he pees, you know he isn't blocked, and I'd just keep an eye on him then to make sure he isn't feeling crummy.

 

He's only at 123 tonight, so he got a little reduction until he gets back up to more normal numbers. And no inappropriate peeing, so that was a relief! @Yong, I like that idea of going through the motions/routine for him! That's a great idea!

 

And just before nadir....Sam pukes the entire contents of his dinner on the floor.

Oh, and a hairball too.

Poor kitty! Glad he got it out though!

 

Good to get that hairball out! I'm amazed at how much they can vomit at one time.

 

He only gets like two of them each year - he's not much for shedding (unlike my civvie who is a little fur factory). But yes, it was an impressive amount to come out of a relatively small kitty.

He's now doing his "pre-hypo" routine, although I just tested him and he's still at 86. He might be in for a couple of extra stabs this evening....

 

Woo Sam! Glad he got that hairball out and I'm dying to see how he's doing this AM!

 

How did things go last night?

And ugh, recently Freya was leaving me small hairballs to wake up to every morning. So gross. But we live in a cool climate, and she was beginning to shed really badly. Once I had a good go at her with the Furminator, no more hairballs! Maybe he just needs extra help getting rid of all the fluff?

 

The cold slimy ones you step in in the dark are the worst!

 

Sorry I got lazy about updating last night after leaving a comment like that! He got down to 57, so no hypo, but he was pretty actively steering himself through the +3. He free feeds, so he pretty much just stayed in the kitchen by his favorite food dish and kept snacking.

I finally just gave him about 8 pieces of Evo to calm him down and he went to sleep and started to rise a little bit and seemed more comfortable. It was a pretty good size drop on a tiny bit of insulin, so it looks like I need to be a bit careful with him for a few days. I gave the same dose this morning though because he tends to run higher during the day (and I'll be here to monitor until +3.5 this morning).

Brushing Sam can feel futile sometimes because not much hair comes off, no matter which style brush I use. Plus he bites me whenever I brush him. He hates it. Atticus gives up a kitten-sized ball of fur nearly daily during shedding season, so he makes up for Sam's light shedding! Even Sam's hair balls are laughably small compared to Atticus' cigar-sized hair balls if I don't keep up on his brushing! I learned a lot about ECID when I got Atticus. The two look similar, but could not be more different in nearly every way!

 

EEEEWWWWWW! Thankfully, I have not experienced that yet!

 

Help! Someone remind me that it's just a number! I don't know what's going on with Sam's numbers today. I moved him back up to 0.4 again, so maybe I gave him too much? What are these numbers?!?! I was worried he'd go too low with the move back up, but he went the opposite direction. I double checked, and he didn't get into the EVO. The box is still sealed.

He's eating like a ravenous piggy, so I thought he was going low, but definitely not that. Ugh.

 

Does this kitty even need to be taking insulin, his numbers look good to me without a shot. I wish Buddy's numbers were like his.

 

I have no ideas for you, Djamila. Kitties who have been in remission or are headed there again are way out of my league.

 

That's a good question, actually! My vet and I were just talking about this last week. I was just starting to think about stopping him for a few days and seeing what happens, but with his numbers going up like this today, I'm not so sure.

I wish @Sue and Oliver (GA) was here!!!

 

Out of my league too, unfortunately. I totally know what to do when a kitty is dropping down the scale, but when they've been stuck on the bottom rung for two months, I'm lost. He's likely missing a shot tonight anyway because I'm working a late schedule this evening and probably won't be home until past the hour window. What a lousy day to miss a shot though with his numbers doing whatever it is they're doing right now.

 

I'm sure you've searched out any/all info stickies or threads on FDMB about dosing into remission.

 

Maybe he is just working up a hairball and you'll have a "present" when you get home

 

It's just a number!!!!! And really, those numbers are all around the same. For all we know, could be "oh look a squirrel" syndrome keeping him kind of flat.

I miss Sue so much....especially at times like these! You could certainly try an OTJ trial to see what happens...

I don't really have any good advice for you, but I'm going to try to think about it some...we'll figure something out!

 

We all miss Sue!

 

This is beyond my comprehension, but I am totally jealous! Hahah. He honestly looks like he's headed in a great direction, so you shouldn't feel bad! Maybe he got Freya's secret message about throwing the odd unexpected number lately...

 

All right, here's what I've got so far for you Djamila:

• Generally a cat is considered OTJ if they range from 40-120 off insulin for 2 weeks (you already know this, I know)
• Sam's numbers have actually been sliding down the scale fairly consistently. I know it's almost entirely blue, but there have been a few greens lately and if you look at the numbers, you can see at the start of the blue section, he was hitting those higher numbers more often and now he's more often at the lower end of the blue scale, with the occasional green even.
• Your mid cycles have been about the same throughout. Could be due to the insulin getting old (how old are we talking again?) or could be due to the lower doses being given. There's probably other options but I don't know what they are.

Now all of this is stuff I'm sure you've noticed, but I just wanted to list it out for my sake. I don't have any brilliant ideas on what to do, but I do have a suggestion. Next time you have a NS if you can...get a +2. Kitties whose pancreas are kicking in often go down at that point rather than up with the food spike. I don't know the science behind it, but it is something we've noticed here. Might tell us something?

As for going OTJ...you could try a trial or you could wait a bit. I don't know what to say really because on those NS days, you really didn't have much change in the BG numbers that evening...which makes me wonder if the insulin isn't really affecting him much. BUT...it could also be that Sam is sliding reallllyyyyyy slowly down the scale and needs the insulin for awhile longer to get him there. Either way, I DO see improvement. I know it's not much, but it is something.

I'm 100% sure that this post isn't really helpful and is mostly me rambling my thoughts out...but I just wanted to share the thoughts I have for now. At least you know you're not alone in being unsure what to do!

 

Rachel, thank you so much! Yes, it is helpful! And everyone else too, for the reminders that whatever is happening, we are part of a wonderful wonderful community!

Mostly I don't think he's ready for an OTJ trial given the dose he is still on. We aren't even down to a Drop yet (my favorite dose!). However, it's also occurred to me that maybe his dose is as big as it is because the insulin is so weak at this point. It's five months old on Thursday and the sticky says 3 months. I don't think there's any way to know if it's working or not unless I just go buy another bottle of insulin and see what happens. Although, given the drops he's had, I'm pretty sure it is still working at least somewhat.

I did +4's on two of his NS days, but haven't tried a +2. On the +4's, he had gone up, so I took that to mean he still needed the insulin, but maybe I should try closer to the shot time and see what we get (if he ever gives me another NS).

We decided to cancel the afternoon class today, so I came home on time. His PMPS wasn't as bad as I was expecting. And tonight I'm pretty sure he got away before the insulin got in him, so he may have started his own mini-trial tonight . He's been less than cooperative with the shots the past couple of days.

Ugh...I still don't really know what to do, but at least we are all in it together!!!

 

I think secretly none of us know what to do half the time, and we just evaluate the data and our cats as individuals and do what feels best in weird situations. It can be so confusing and frustrating when you just want to make the right choice. I'm struggling with that too right now, with Freya's own brand of strangeness. But... look at all those nice blue and even green pre-shots compared to all the yellows not that long ago. He's really doing so well! Looks to me like you've been doing the right things.

 

I really appreciate everyone's encouragement today. I'm not quite sure why I got quite so upset about his numbers, but it really did get to me this morning. He seems back on track this evening. At least for this cycle.

Amen to that! But at least we get to bumble around in the dark together!

 

You hit the nail on the head here, Blair!