Sam - Month 5

So I've been contemplating making the switch from Prozinc to Lantus. Sam is stable, his numbers are good, but he doesn't seem to be getting any closer towards remission. We've been in more or less the same numbers and the same doses since mid-April.

My impression was that if we moved to Lantus, it probably wouldn't get him any closer to remission, but I was hoping it would flatten out his pre-shot numbers so he wasn't going up and down every day. I talked with my vet (who I really adore right now since she seems super knowledgeable about FD which is a rare and lovely thing in a vet!) and she was supportive of the switch and even suggested the same starting dose as the folks over in the Lantus forum, so that was nice.

Tonight I started to do my spreadsheet studying thing that I do, over in Lantus, and this is what I found:

https://docs.google.com/spreadsheet...ScYgX714dizI6vWCkee3Z1o9D0/edit#gid=361360320

https://docs.google.com/spreadsheets/d/1MRpUrMhTYgP02J-dzSYVPYlZe2SXWaWOANJNPeB1kAU/pubhtml

https://docs.google.com/spreadsheets/d/1w_XZrvXTTkhpRYofcYfwV33bJ_EPD-OwMkYuvj4XjDY/pubhtml

I'm curious if you all will see what I'm seeing, but it looks to me like kitties who are in similar numbers to Sam are getting similar curves throughout the day, even though they are on Lantus. Their curves don't look any flatter than the curve he's getting already.

Interesting, huh? Am I seeing this right? What do you all think?

 

Oops. I forgot this one:
https://docs.google.com/spreadsheet..._IfqcnsBBGrI3Evmva-HXvTW7Q/edit#gid=218014451

This one is actually a bit flatter with more green pre-shots, but the dose is also very different.

 

I see what you mean, and I'm sure not a Lantus expert, never used it, but I wonder if the change in insulin might jump start something in him. Another difference would be that you'd shoot the greens with Lantus. That may make a difference too. But I don't know.... @Bobbie And Bubba had to shoot a very low dose for awhile before OTJ. Maybe she has some insight.

 

Hey Djamila, good job on scouring over the SS. Are you eyes crossed yet? LOL.

Just a few things that you should consider about those links:

Squallie and Rusty are long term diabetics who have never gone into remission. Squallie is on a higher dose , Rusty is on a lower dose and also Rusty is on Lev not Lantus. While they are similar in being longer lasting insulin there are some differences being Lev has a later nadir than Lantus so his curve is going to look a bit different.

Boomer has been in remission twice before and this is his 3rd rodeo on Lantus so it makes remission a bit harder to get again but not impossible.

Aurora hasn't been doing the FD dance, since April and she has had some skipped shots through out the SS due to not being able to monitor. And she is at the stage that with the .25 dose she is on now, she should be giving Aurora a mini meal at +9 through the night to bring down the AMPS number. She is currently looking into an auto feeder so she can do that . There were a few times she did get up and feed Aurora and her AMBG was in the green. After 7 days of being all green numbers she could go to a drop on insulin and possibly be done with the juice. She is soooooo close and her momma is working on it.

And Sharon brings up a good point about Lantus is easier to shoot greens because when you shoot low with Lantus the cycle stays rather flat. Good job shooting green yesterday and by the looks of his PMBG's he probably went lower and did a little bounce at PMBG.

The other thing to consider that ProZinc is an in/out insulin and doesn't have the duration that Lantus has so you could possibly see him stay in green numbers longer through the cycle than you do now. Maybe last night's cycle was more about duration than bounce?

I do understand that it's hard to make the decision. You can try it and you could always go back to ProZinc if it isn't a good fit for Sam and you. And you know there will be lots of help for you over in L & L

 

This is interesting

 

Bobbie, thanks so much for the background on those kitties. Squallie, Rusty, and Boomer were the profile I was looking for (longer duration diabetics, or more than one rodeo). I missed that Aurora was still under the 4 month line. I found two more last night that fit the right profile and still have the smile curves.

This morning I've been looking at OTJ kitties, and you're right that the cycle flattens out for those kitties as they are heading OTJ, but doesn't seem to flatten for kitties that are planning to hang around. So I guess that's one indication of what the kitty has planned. Do you know of anyone with a low flat cycle without remission?

Sam's prozinc is five months old (we just started month 6), so it's quite possible that it's losing duration at this point, but I think the last two PMPS's were food inflated. I got home from work just at shot time both evenings and watched him eat about 30-40 minutes before I got there. (I have a home security camera that lets me spy on him). And the fact that he's still getting food spikes is one thing I'm taking as an indication that he isn't heading OTJ anytime soon. Typically he never eats that late in the afternoon, but I guess he's been hungry lately. It's also possible that it's a bounce since I'm gone all day and can't check later in the cycle to verify. So many options...

I never thought I would be shooting greens on Prozinc, but his data shows it's safe, so if I'm around for a few hours to monitor I've been trying to at least give him a little bit. I've had to just skip a few of them though because of work. This is our busy time of year so I haven't been able to work from home as much as I could in the winter.

I think I'm going to go ahead and give it a try in a couple of weeks once school is out and see if it changes anything.

 

Yes, it does seem counter productive doesn't it? The +9 meal is done when kitty is on .25 unit of Lantus. The AMBG's are always the last to come down to a green number and with this feeding technique, it does that last bit of getting kitty into all greens. The idea is this: when the pancreas is producing inulin and doing it's job the body releases it after a meal to bring down the BG's thus lowering the AMBG number.

 

You are welcome. Here is one kitty who has been a long term diabetic and has a nice flat cycle but still on 1.50 units (I think, going from memory) She used the generic Lantus for a bit and you will see that on her SS ( Basaglar) and is back to Lantus now. She was doing it as a trial for another group she is in.

https://docs.google.com/spreadsheet...Ej14-xfuaYXJFPNTIC-cT8cck/edit#gid=1684765866

Maybe not. If you consider meter variance + /- the AM cycle of 6/5 was basically a flat cycle.

Also, in the last week, you have had 3 NS and 1 FS and still his numbers are mostly in normal numbers.

He is so close Djamila. With Lantus, the +2 will be your best friend to tell you how active the cycle will be and if that number is the same or lower than the Pre shot then you can intervene with some higher carb food if you have to leave for work to keep him safe.

I think I would try switching too. What do you have to lose?

 

Yes, the pharmacy got my prescription today, but I missed the call, so I'll need to get in touch with them to get it shipped.

I'm thinking that either his AM cycles need more insulin, or his nadir has shifted later since those out-the-door tests aren't showing anything anymore. I'm looking forward to getting something later in the cycle this weekend to get a better idea what's going on with that.

I guess I felt like a couple of those NS cycles were kind of cheating since I would have given him a shot if I'd been home. I just didn't feel like I could shoot on a green and then leave him alone for twelve hours. It's nice to hear a more optimistic interpretation of how things are looking.

Cannot wait for the school year to end and have a little more time to take care of him!

 

Ah-ha! Yes, that is the type of spreadsheet I was expecting to see more of! Thank you for finding that one!

 

Apparently the insulin only works at night here. During the day he's just flat flat flat. At least it's a nice flat.

 

Freya's been doing that too lately (albeit with not-so-nice flats). Weird because days used to be more active for her. They must be plotting something...

 

Maybe Sam overheard that he would be subjected to more frequent testing when we switch insulin.

 

(antijinx)!!!

 

So, @Beth 73 was going to switch to Lantus. She bought the insulin, had it in her refrigerator and her kitty dropped into low numbers that she wasn't comfortable shooting and he never went on the Lantus and went OTJ! True story!

 

Maury, we're switching to Lantus!

 

Yes, I was there!! Very exciting!

 

Well, I already paid for it and it's on its way.

Just a few days ago he was getting higher-than-normal numbers, so this is most likely just a nice little break, but I'll enjoy it while it lasts!

 

@Bobbie And Bubba, and anyone else who might be around too, but I can see Bobbie - I'm wondering what your thoughts are on how to proceed from here? Sam is at 98 this morning, and I'll be home until +5. Normally, I would shoot at this number since I'll be home for a few hours, but given the past two days, I'm not sure. Should I let it go and see if he can keep it down on his own? Or give him a shot?

 

BRB, let me look at SS.

 

hmmmmmm, He is not making this easy on you. If you can monitor till +5 and have higher carb food and plenty of strips, can you give him just a drop? Do you know how to do the drop?

 

Yup, I can do the drop. Based on his past cycles with similar numbers, I'm not really worried about him going too low. It was more that I was kind of hoping to start counting days.

I think giving him a small dose is probably best, I just needed someone else to give me a nudge in that direction. I think I was getting greedy for the NS's!

 

Because this is his second rodeo, I think as long as he will tolerate the insulin, you give the pancreas some extra support.

 

I went with something around a fat 0.1/skinny 0.2u and will monitor (although I'm pretty sure he'll ride it out just fine). This is a daytime cycle and it doesn't seem like the insulin does much during the AM cycles lately. Thanks so much for your help on this. My head knew he should have a small dose, but my heart really wanted to call it Day 3

 

Looks like it was a good dose to keep him surfing in greens.

 

He had more of a response to it than I had expected. Nice to see him getting a little more action!

 

I like that! He had a pretty good day.

 

@Bobbie And Bubba, I'm studying up on Lantus, and was looking at your spreadsheet. In January of this year, you took two reductions without hypos. You went from 0.4 to 0.25, and then from 0.25 to 0.15.

Were those based on something? Or was it a gut-level decision to see if Bubba could sustain the good numbers with less insulin?

 

Good question Djamila! Those reductions were taking because of being in all green numbers for 7 days. That is the other way of earning reductions on Lantus.

 

Aha! That makes sense. Thank you!

 

I knew you'd be carrying out a meta-analysis before you switch, Djamila!

 

As I get towards the end of a batch of test strips, I usually run a few side-by-side tests with the new batch of test strips on the same drop of blood to make sure they are accurate. They've always been within a few points of each other.

When I started the current batch of test strips, I hadn't done the side-by-sides before I ran out of the old ones. So I don't know if these were accurate with the old batch.

Now these are running out, I've noticed that there is a dramatic difference between these and the new batch. There is consistently around 20 points different, with the new batch running lower. 20 points isn't much if you're in the 300's, but at this point, it's the difference between hypo or not, OTJ or not.

It feels like it's a giant difference right now! SO which batch is correct?!?! The test I just ran, he's either 71 or 52. Well one of those numbers is great, the other one deserves a little nudge upward! I'm going to stop at the store and buy a new batch today so I have a third-point to compare before I run out of the higher batch to try to determine which one is more accurate. I've never seen two batches this far off from each other!

 

Oh my, that is a big difference when you are in lower numbers. I hope the 3 set of strips shines some light on which set of numbers to trust.

 

That is so strange! let us know what the third set of strips says...

 

Maybe he's 62 . Hope new strips shed some light for you though!

 

I think Yong is the winner! I just tested my civvie (since I could stab his ears all day and he wouldn't care) and got 84 (old strips), 66 (new strips), 70 (newest strips - the box I just bought). That's only one test, so I'll need to run a few more side-by-sides, but based on that one, it looks like the past couple of weeks might have been reading a bit high. Which makes me think that 55 yesterday might have been a mild lime green. Oops. Thank goodness he free feeds and knows how to steer himself back up!

I'm curious to see if the pattern holds in a few more tests. I knew there was meter variation in how it read the blood sample for a cat, but didn't realize there could be this much variation from one box of strips to the next!

 

This is scary! I wonder if the results box to box are more consistent with human blood?

 

Hmm...I could run a test on myself, but that hurts!

I have to run to a meeting, but will try it when I get back home in a little bit. I'm curious about that too!

 

New test strips: 84. Newest test strips: 82. Didn't have enough blood to try the old test strips, and frankly ready to throw them in the trash anyway.

Oh you guys!!! What if I've been overdosing him for the past two weeks?!?!?! I mean, he's clearly survived it, but my poor kitty!!!

 

You'll never know, Djamila. Sam's been OK through it all, hasn't he?

 

Bright side? Maybe he's closer to remission than we thought?

 

That's what I was thinking! And he isn't bouncing like crazy, so he must be rather flat

 

Yes, he's been okay, but he's definitely been hungrier than usual the past few days -- which makes sense! I just tested myself and got 98 (old strips), 80 (new strips), 82 (3rd batch from today). So the old strips are now in the trash. Apparently they work pretty much the same for cats and humans!

And I will not acknowledge that other comment except to say that it has occurred to me too!

 

Also just realized that I wrote last night's dose as 3 instead of 0.3!!! Oops! I promise I didn't give him 3u last night!!! It's all fixed now.

 

Sam hit a lime green (rare for him!) on a 0.2u dose tonight. He's fine, it's barely past the line (45) and he was gifted a few kibble pieces just for fun, and a bit of a nudge to have a bit more of his regular food. Then he was at 52. Going to get one more test before bed to make sure he's staying in the regular greens. It looks like he's probably been getting a bit too much insulin the past few days though and it makes me feel awful, even though he's clearly survived it just fine. I think the 0.2 is fine for the AM cycle, but he might need a drop or two less for the PM cycle.

 

Sam's looking good, Djamila!

 

You were here for his first dramatic drop a few months ago! So it's a poetic harmony for you to stop by this evening! See how much less stressed I am about all of this now? Meh. He's hypo. No big deal. I can handle it.

Hermione's looking good too!

 

It's so much easier once you've weathered the first one! Hopefully Hermione & Sam can have a big OTJ party together

 

Oops. I think I overdid it with the kibble a wee bit. He's up to 73 already. Oh well, at least he's happy!!!

 

Well look at you Djamila so cool calm and collect! Good job catching the low number and your idea of less at the PM cycle is a good idea since a lot of kitties do like to go lower during the night .

Just keep in mind that the kibble takes longer to bring the numbers up so higher carb wet food also is best.

He is looking really good!

 

Ditto!

 

Well at least Sam had a really good treat! I love to see how calm you are about all this!!

 

You guys! Look at that pre-shot! I've seen some of your kitties that will occasionally give you a strangely low pre-shot, but Sam doesn't do that. Sam is consistent like a Swiss clock!

I just got a 58, so I tested again and got a 60. Very strange wavy cycle today that is making me wish I had grabbed a test later in the cycle. But he was rising, or at least I thought he was rising, so I stopped the curve I had been planning for today. And then, bless his heart, he gives me a lower-than-ever PMPS.

Yesterday afternoon and this afternoon, I tried waking him up and giving him a +9 snack like @Bobbie And Bubba had mentioned. I don't know if it's that, or the change in test strips, or a combination of the two, but either way, I'm rather pleased with my little sugar kitty tonight! I think I might try setting the timed feeder tonight to see if the sound of it opening will get him to eat during at the middle-of-the-night +9 as well. Can't hurt to try, right?

 

Lovely number, Djamila!

 

I want to like that post several times!!! What a BEAUTIFUL preshot! Definitely try the timed feeder...worst that happens is he doesn't eat it (and let's face it...how often do our kitties refuse food?).

 

Clapping

 

Woot woot! This is very exciting Djamilia and if he keeps this up, he could very well be ready to go OTJ

I do believe that the +9 snack is the ticket. It really does work when they start getting into the micro doses like Sam is on. It makes their pancreas throw insulin to help break down the food resulting in a lower AMBG number.

Remember me telling you about Beth73 who bought the Lantus to make the switch and her Elmo went OTJ before she started?

 

Sigh. He did get up and eat when the feeder opened, but it didn't work this morning. It looks like he's feeling a little blue today . Baby steps, right?

 

Yes, baby steps ... he'll get there.

 

With meter variance it's a green I got into the habit of before shutting the feeder lid to press down onto the tray to make sure it was completely seated or it would not open. He is still looking really good.

 

You know how Sam is though...he needs time to settle in to a new thing before it really starts to take more permanent effect.

 

He's been "settled in" to the 0.4u dose (or around there) since April 24th. How much time does he need?!?!?

Oh, the feeder worked, and he ate. It's just that eating didn't give a better AMPS. So it's the impact that didn't work. Sorry I didn't explain that very well the first time!

I was also hoping that having a +9 snack during the night would keep him from waking me up at 4am (Nope. Still woke me up). I already get up at 4:30 to test/feed/shoot. I don't really want to get up even earlier than that!!! Especially since today was the last day of school! So basically it didn't work at all for the morning cycle. But it DID work again for the PMPS, so I'm going to keep the feeder going and try it again tonight. As Rachel said, sometimes Sam just likes to take his own sweet time to adjust to something new.

Does anyone have any thoughts about the AM dose? Should I lower it a bit to aim for two shootable numbers? Or just keep going the way we are right now? 0.3 doesn't seem like too much during the AM cycle, and 0.2 seemed like not quite enough, but the last three PM cycles have been NS's, so wondering if I should lower anyway?

 

LOL I was thinking the feeding routine...he needs to be settled into that!

Hmmm...the dose is a tough one! 0.2 didn't seem like enough like you said...I really don't know WHAT to suggest. Maybe do a fat 0.2 in an attempt to get 2 shootable preshots? I'm not even sure if you can pull up a fat 0.2, but worth a shot maybe? (pun intended).

 

I drew up the 0.3 and then let out a drop. so we can call that a 0.2f, I think. Or a 0.3s. Or maybe a 0.25?

I kind of don't want two shootable numbers. I love NS cycles! But if I was shooting a higher dose and was 0.3 different between AM and PM I would try to balance it, so it seems like the right thing to do. We'll see how it works...

 

PS We were supposed to start Lantus today.

 

That's why he's keeping you guessing! @Beth 73 just had to have the Lantus in the fridge to make Elmo go OTJ.

 

Maybe if I wave it in front of him a few times, he'll drop those AMPS numbers! (haha)

 

And wouldn't you be spooked if he did?!

 

LOL..now I kind of feel like I should try it...

 

Keep it in your back pocket as an option if he doesn't drop soon!

 

We had another NS (Hooray!) this evening, and an interesting end-of-cycle tonight. I fed him at +9, and didn't bother picking up the leftover food because I figured he had just eaten and wouldn't be hungry anyway, and Atticus likes to eat late in the cycle when I can let him. Well, Sam snuck into the kitchen at +10.5 and started chowing down. I got up to make sure it was Atticus I was hearing and saw that Sam had eating a TON of food and was looking at me with pleading eyes. I figured the damage was done, so I gave him a bit more and figured he'd just have a high number and need a shot tonight which wouldn't be the end of the world. But at +12, his number had actually gone down into NS territory.

Did y'all catch that? He ate a full meal and his BG went down.

I'm trying not to get too excited. Really I am. I'm trying so hard to keep a level head here.

It's not working very well.

 

Pancreas is working!!!

 

So exciting! Hermione & I are sending positive thoughts

 

Pssst... Maury... there's Lantus in the fridge now

 

Ohhh! That's a sign of Mr. P....

 

Yep, that's what me is thinking too!

 

Alas, we are back to blue tonight. Now I'm re-thinking that idea about lowering the dose a bit to get two shootable numbers. It's way more fun to skip a shot!

 

!

 

I know it's more fun to skip a dose but optimum is to shoot every 12 hours to Keep him in all greens. ( hate being a kill-joy)

 

Oh dear...I just realized that the last time I gave him 0.2 in a PM cycle he hit lime green. Looks like I should have done 0.1 instead. Would have been nice if I'd noticed that an hour ago! Hopefully he'll stay in the dark greens tonight!

 

!

 

You're killing me with the faces Kris!

Stay in those darker greens Sam!

 

You should know by +2 if it's going to be an active cycle and you can steer him up a bit it you need to.

 

He's fine. I worry too much!

 

Sam isn't feeling well. Last night about an hour after I went to sleep he started crying. I woke up and tested him and he was fine, but kept crying. He would eat and drink, but then go back to crying. The only thing that made him stop was if I picked him up and held him and walked around. He pooped and peed yesterday and peed during the night, so all functions seem to be working, but something was definitely not right in his little world. This morning he seems calmer, but still staying close. Whenever my wild little kitty wants to be close, it's a sign he isn't feeling well. I have no idea what's wrong though since all of the P's are fine at this point. Hopefully it's just a mood and nothing to worry about, but we both got a somewhat sleepless night.

He does get occasional IBS, but gets a pre/probiotic every day that keeps it pretty well under control. I'm hoping it's just that and he had an upset tummy that will settle itself soon.

 

I'm sorry Djamila

Hope Sam feels better soon

 

Keeping fingers crossed it resolves. It's so stressful when these furkids aren't feeling well. Is he prone to furballs? UTI? When Teasel would begin one of his (past) bouts of cystitis, the main sign at onset was more vocalizing and wanting my attention.

 

Thankfully neither. He usually gets a furball about once a year, and he's already had one for this year. He gets diarrhea though, so I'm sort of expecting that to appear sometime today. He usually leaves it right next to the litter box so I don't miss it (icky).

What are the signs of cystitis? Treatment?

 

Cystitis can be sterile or due to UTI. Sterile cystitis is often stress induced (Teasel's case). It shows as yowling in litter box, bum licking, restlessness, peeing outside the box, peeing in small amounts with red blood/clots. In the early days I was given pain meds and antispasmodic meds for Teasel. I learned when to use them and when to "watch and wait". I rarely had to take him to the vet because I knew the signs and that it would play out the same way treated or not. Since he has added water in all his meals and (probably the biggest factor) TONS of attention/TLC from me it's been a non-issue. His sister has the same tendency.

 

I was just googling it and it sounds like increased attention and lower stress are key treatments. I wonder if that's why he was comforted by being cuddled, and then would start crying if I put him down. Sounds like he's feeling a little attention deprived. Funny since he normally shuns attention! What do you think about trying a little Rescue Remedy on him too? I don't know what might be stressing him since nothing is really different right now. It would sure be nice if they could talk!!!

 

Why not try the RR? Maybe he'll hiss at furniture too? Has anything in your routine changed - time away from home? more preoccupied with work projects? moving things around in your apartment? How about a Feliway diffuser setup?

 

I tried Feliway about ten years ago and it made Sam go nuts. Although considering Atty's reaction to the RR, maybe I just didn't wait long enough for the calm part to kick in?

Summer break started on Tuesday, but I've been gone pretty much the same hours as work since I spent Tuesday with my nephew and Wednesday I was in the mountains hiking. So the cats didn't change routine much. Maybe it weirds them out that I'm relaxed instead of stressed?

Or maybe I got too excited about those green numbers? There's a reason we aren't supposed to talk about those things!!!

 

How is Sam feeling this afternoon?

 

He still seems a little out of sorts, but there are also still no "symptoms" of anything in particular. He had a quiet day, but now he's being fussy and clingy. He just kicked Atticus out of my lap for no apparent reason, and then sat down and meowed at me. But he didn't want to be picked up or scratched or anything. He just wanted to complain a bit. And make sure he had my whole attention. I'm curious to see how test and dinner go tonight. Thanks for asking!

 

Sending positive energy your way.

 

Pretty normal numbers for Sam. And he took his test and shot well and cooperated. I have to get on a webinar for work in a few minutes. I think I'll keep my mic on mute in case he decides to serenade again!

 

I do hope Sam is OK. But this sounds kind of like what Maury does to me! lol. I've started noting it in my SS but still can't figure it out . When this started (wish I dated dated it now ) I used to get up right away. He responds appropriately to the command "show me", as he is a cat it is only when he feels like it and we'd end up upstairs standing in the living room... staring at each other... . These two probably have a PM with each other on that secret cat board!

 

LOL! I was thinking that too!

He seems a little more himself now, and still no diarrhea, so I think he's just messin' with me. I think Kris was on the right track: he had just come down with a case of attention-itis.

 

He just needed some love from his mama!

 

Cats!! They're great communicators in their own subtle and mysterious way. Dogs are just so obvious by comparison.