Trying to get Samwise regulated

I am doing a full curve today, you can look at his spread sheet and see. AT +10 he's already high. Should we do a small increment? He is still very hungry and we are not withholding food. He has gained a bit of weight. Not much though.

 

This is where we left off/the background:
viewtopic.php?p=337578#p337578
Other input might help? I was encouraging Sue to post in here for eyes. She got rid of the dog food and is now testing every PS and just did a full curve - all good stuff!

 

Thanks Gator. At PMPS High. Did a 2.3 as near as I could guess on the U100 needle. It has increments in 2 instead of 1's. I liked the old U100 needle better it did the increments in 1,2 , etc.

 

you are using the conversion sheet right? And have it printed out and somewhere obvious like your fridge?
http://www.felinediabetes.com/insulin-conversions.htm

Just to make sure, U100 needles should have an ORANGE cap and the ones you want have 1/2 unit increments.

You want to use the ones that are 1/3cc or 1/3 ml or 3/10 cc or 3/10 ml - all the same thing.

Generally they are:
U-100 31 Gauge 3/10cc 5/16 inch Needle 1/2 Unit Markings
or
U-100 30 Gauge 3/10cc 5/16 inch Needle 1/2 Unit Markings

Does this sound like what you have?

 

They have the orange cap and I'd have to look at the box and see what it says. I do have the conversion chart and we have been going off that. It says that 2U from the 40U needle should be 5U on the 100U needles. We've been shooting 5U on the 100U needles.

 

These are marked 1ml. 31gauge

 

OK you need to get 1/3ml with 1/2 unit markings. Where did you get them from?

 

Wal-Mart

 

Return them. We've found Wal Mart to be very poor at getting people the right syringes. You can read about Beth's ongoing struggle with thm:

http://felinediabetes.comFDMB/viewtopic ... 53#p338553


Print this out and hand to the wal mart pharmacist:

U-100, 31 Gauge, 1/3ml, 5/16 inch short Needle, with 1/2 Unit Markings - Reli-On Brand
or
U-100, 30 Gauge, 1/3ml, 5/16 inch short Needle, with 1/2 Unit Markings - Reli-On Brand



Do not leave the store without verifying that they say all of this on the package. I hope it actually does say half unit markings on the package. Even when Beth had written down the exact correct thing and showed it to the pharmacist, they gave her the wrong thing.

 

Wonderful, I've already used up half the box. Good ol' Wal-Mart, if you want some screw up it's the right place to go. :lol:

 

If you wanted that in bulk you could head over to Sam's club. :lol:

 

BTW my relion u100 syringes do NOT say "1/2 unit markings" on the BOX,
but I have asked to examine the syringes in the box (& bag) to confirm its there before I paid my money.

I use the:
3/10 cc
1/2 inch needle length
28 gauge-

I dont think they had the half unit markings in the higher (finer) gauge at our walmart. Cody never flinches with these so they work ok for us. The u40 syringes you had were probably 28 gauge.

these cost about $11-12

 

I'll get the different size next time. I think I'll order them from Hocks. Then the board gets a bit of money. Sam's #'s still haven't come down much and I've been having the DH do a test at +3 and +6. We'll do another curve this weekend if all goes well and there's no big hoohaw over the holidays.

 

Sue, I'm working on this. Will hopefully have input for you shortly.

 

Hi Sue,

I was looking at your ss and it looks like you were getting some traction on 12/19 with 2 units. But that night you upped your dose to 2.3u and have been high ever since.

I would go back to the 2 units and let Sam show you what he can do with it.

Just my 2 cents.

 

If it were me, I would be tempted to do some experimenting with doses between 1u and 2u (probably in the 1.5 - 1.8 zone). I'm not sure that's the "right answer" but there looks to me to be some rebound going on, whether it's a panicky liver or a dose too high I'm not sure. The shots at 2u on 12/3 & 12/4 look to me like possibly the dose was just a hair too high, and then many high #s since then could support that idea. You already tried dropping back to 1u and didn't get any positive response, but then I'm wondering if maybe the jump up to 2u was just too big a jump, and maybe somewhere between those two is a good dose? Just speculating here, I haven't been following along closely.

I'm also wondering if there's something else going on - any suspicion of any sort of infection, or other health issue that might be causing him to throw high #s?

 

This is good. I would have and did recommend pushing higher. Hopefully until you might have had some sort of "breakthrough" dose. So Sue you have a couple different viewpoints. :smile:

If you chose to stick with one or drop back you can always go higher later.

The only thing about the "breakthrough" points that you had had earlier were from not eating and and very early on with who knows what was going on. And the dog fud and fur shot are kind of a confused_cat in the past. So I think what you are doing now is kind of in new territory.

I think if you would have pushed up to perhaps 4u and not seen any improvement I would have been really asking you to make 100% sure that Sam had not other health issues going on or was not getting into some sort of naughty fud before progressing more than that. But Joanna is very right to be asking about other issues currently.

Please forgive me Sue, if it's been asked - I don't have a profile of yours to check - but what's the status of Sam's dental? Has the vet ever said anything about the teeth? When was the last dental if you have had one? It's just that we have the same questions when we see some high numbers like poor Sam's. As you know were are a little detailed oriented here. ;-)

Also I think I asked earlier about testing for keytones. I know Sam in an inny/outy cat so maybe hard to get a urine sample?

 

Hmmm, if he wasn't eating well those couple days where the dose looked too high to me, of course that could be the explanation for the #s.

Sometimes it is just a puzzle for a while, until you get enough data to be sure of what is going on. You are doing a great job getting good data to work with so far, so hopefully the picture will get clearer as you continue.

What worked best for us was to be very methodical about the dose - I bounced all over the place trying different things until someone finally convinced me to be systematic about it. So then I started at the lowest dose that I felt sure was not too high a dose, and moved up in 0.2u increments every 3rd day, and Bix got a breakthrough and regulated about a week after that. Of course I can't say that approach works as well for every cat, and with him I was close enough to a good dose that it came together pretty fast. But I can say that none of my jumping around on the dose (not saying that you have done that!) was very productive - it was the steady and systematic approach that worked for us.

I'm sure you will get him regulated, just hang in there and keep working on it like you are. No matter what you try next, you will gather data from it that will help you moving forward, and help you narrow down the possibilities on what his insulin needs are.

 

-if you buy the half unit marking syringes, you can still use the current ones when you are measuring whole units. I think the precision of the half units might be really important to you right now.

- The weight loss /tiny cat concerns me, so I'm glad that you are actively testing and trying to solve this. Good job

- I like the idea of a steady, aggressive, orderly ramp-up, as suggested. increasing .2u every 3rd day. Perhaps back down a bit before you start this just to be sure not to miss the dose. Maybe 1.6u? but don't stay at an unsuccessful dose more than 3days.

- dental issues (and urinary tract infections) can make regulation difficult as they can harbor low level simmering infection, so check it out.

I didn't add much new- just re-inforcing the good advice given

 

thank you guys :YMHUG:

So Sue you have my input + a couple others here. We obviously have different input but since you are the one holding the syringe it is your job to make the synthesis of it all and do what you think is right for Sam. I'm more than willing to try to help walk you though any decision making if you feel necessary.

BTW Sue I just wonted to say that I think your are doing a good job at testing. You are getting all the PS tests AND you are also getting the +3 and +6. That +3 will tell you if you break though and get a fat drop if you need to be testing more that day and maybe even intervening in the cycle with some food [medium car or high carb] to steer the numbers. But only generally if you go below 60 do you want to start intervening. If you think your get a 'scary' +3 you can post in here or in health for more input - and if we do not respond then post in Health too.

The +6 is your more your general guide as well as being your safety to make sure Sam is not going too low.

The PS plus the +6 is also a good indicator of the delta you achieved for the day. You can read about delta in the Newbie Checklist links if you like. You might also read the links about "Liver Training".

So let us know if we can help more and how. Or let us know what you intend to embark on and how. Provide us with a deliverable so we know what to expect and when to start checking in on you to make sure you are doing ok.

 

Thank you every one. I will be sure to try some of your suggestions. I like the idea of going down in insulin but not up. I'm uneasy about an insulin overdose. Sam has had a dental about a year ago and the vet has said nothing about his teeth since. As far as I know he has no urinary issues. He seems to be feeling okay, no crying, etc. He still sleeps and eat a lot. He has picked up a bit of weight, not a whole lot though. We do need to weigh him again. He could be stressed all the cats are in since the weather has turned cold and the other cats steal his heated bed.

 

The thing that worries me with these high numbers [and if you chose to go the dose decrease route], is the possibility of keytones. This is why I suggest you test for them if you are not already - at least until you can get out of the 400+ ranges. It is something you can do at home with urine test strips you can buy at the pharmacy. There are all sorts of methods for getting the urine needed and you can post if you would like input on that. And I also encourage you to add water to Sam's food to to keep him plenty hydrated which can help with keytones too.

 

If you do lower the dose, I'd recommend not staying at a lower dose for long if you don't get improved results. Basically, if you tried something like 1.5 and that's a better dose for him, you should see significantly better #s within a day or two. If the #s aren't any better by then, you know it's not the answer. When I did a dose lowering for Bix I stayed there for like a week or two ... don't do that!!!! The results should be pretty quick and clearcut if that is the right answer.

The benefit I found to a lowered dose trial was it gave me the confidence to raise the dose (which was what was needed for Bix it turned out). I was really scared to raise the dose, and really confused about rebound & stuff. For me, I had to try a lower dose and prove to myself that wasn't the right answer before I had the confidence to raise the dose. Once I proved to myself the dose wasn't too much, that's when I was able to really raise it confidently, knowing that was the only direction to go in.

Not necessarily saying you need to do a trial at a lower dose, just sharing my experience in case that helps you. The key though IMO is to do what you need to do to resolve any uncertainly, so if you need a higher dose you can do that without being freaked out by it. The thought of an overdose IS scary, but don't let it over-scare you.

If you have the Hypo info sheet printed out and have a toolkit stockpiled with HC, etc., you are doing what you need to to manage the risk. Then when you raise the dose, you can do it on a cycle where you will be able to get in a spot test or two if possible, to be sure it is not too much insulin. When you are able to test at the key times to be sure he isn't headed too low, and treat with small bites of HC if you find that he is, it gives you a lot of confidence that you can manage the insulin well.

 

Could this be the wrong insulin for Sam? I wonder about that too. I figured that I'd lower the dose but only for a couple of days if no improvement.
I really hate not having any to talk face to face about this. Emails and boards are fine but I guess I just feel like I need to put my trust in someone I can hear/see. Does that make sense? I know the vet isn't the solution since she was no damn help from the get go. I'm probably just being to paranoid about the whole thing since he's not regulated yet and I really worry about my Sam. :YMSIGH:

 

It may be the wrong insulin for you and Sam - I cannot tell you that right now. Your highest dose is 2.3u. On the other hand you have not explored much with this insulin.

What I can say is that you have not really had a "breakthrough" with this insulin [other than from not eating]. So I think that thought plays into some of the suggestions here to increase the dose.

If you are going to up the dose I think we have given you some input on how to go about that - in a methodical way with some smaller incriments [I had said .3u, Nancy thought .2u]. And making sure you get back to us before you progress above 4u.

And while you are still working with ProZinc you can be researching the other insulins out there. I think you will get a lot of positive feedback about the other insulins. What I do suggest is looking at the spreadsheets of the users of other insulins. Likely you will find many using other insulins adhere to a "tight regulation" ["TR"] protocol. This usually requires much more testing, maybe more interventions with various carb foods and perhaps some sleepless nights making sure kitty does not go too low. The folks who do TR put in a lot of hard work into it. Supposedly the practitioners of TR have had good success rates putting cats into remission with these type of protocols. So the idea is that maybe a lot of effort up front will pay off so that one has the best shot of not giving insulin anymore. But some people do struggle with the other insulins too - sometimes for extended periods - sometimes they are a magic bullet and other times not. There are TR protocols for PZI which call for shooting it TID or three times a day but that is not something we typically focus on here [but it's always an option for the determined]. Unfortunately, I've heard that support for those who do not wish to do TR or wish to use these insulins in modified ways with the other insulins may be limited. So this is something you can always ask - can anyone help me with non-TR for my kitty? - if non-TR is even something you would even be interested in. And lastly PZI and ProZinc is fairly flexible [time wise] which is something your might lose moving to another insulin but if that is not important to you that's good because you might have more options. And ultimately if you find no success with ProZinc then your options are fairly limited to other insulins. There are absolutely advantages to other insulins like Lantus or Levimir that I'm not covering. And some think there are some advantages of Levimir over Lantus. But again I think you can get anyone in those groups to speak to those advantages and they would be in a much better place to tell you those advantages than I.

I was paranoid about other insulins too when we started. I did some existential hand wringing over the topic of my own when we began. For some cats and beans PZI is the best for them for other cats and beans other insulins are the right fit. ECID.

 

When I was considering switching insulins, I posted over in the Lev forum asking if people there thought that was an advisable route to go in. I got some great advice that convinced me to stick it out with PZI, and Bix got regulated soon after that. Personally I don't think that for most cats there is a "right" or "wrong" insulin, though of course there are some cats that respond well to one but not another. But from what I have seen, much of what works or doesn't work has to do with the approach taken/protocol used with the insulin. I've seen cats switch from PZI to other insulins and do better more IMO because of the ease in knowing how to dose the other insulins than from the actual differences in the insulin. And on the other hand, some cats actually do seem to respond better on one insulin vs. another.

So anyhow, not sure that is much help but if you are considering it, I would read the stickies on the L & L forums, and consider posting on either or both forums asking for feedback on whether or not you should switch based on the data. I agree though that there is still room to try more incremental dose increases on PZI and see if you get a better response. The cases that to me seem like ones that should be considering other insulins are ones where they have tried both higher & lower doses and can't get a good response. Although there are a couple mystery green #s that you have gotten, if those were tied to non-eating, they may not be indicative of anything else... i.e. he may just need more insulin, and once you get the dose high enough, he may do just fine on PZI.

 

I can't say for sure, but I don't think Wally World has the relions in 1/2 unit marking.

But the ones I got from them.... the brand name ones... had a circle on the right side that SAID 1/2 unit markings. Gator, didn't you post a pic of the box somewhere?

 

Well, we've tried higher and lower and the green #'s seemed to stem from him not eating. He goes the the vet on the 4th and we'll ask her about upping the dose. She goes off the frucostamine test but all that says is high or low. I always have the husband take a SS with him.

 

Well they DO have then, just maybe not at every store. I've seen them at one store. I thought Beth you said you went back and the real pharmacists found them for you? So many cats to keep together in the mind :roll: . Anyway, Wal mart may be more frustration than they are worth. Besides, I really do like the one from Hocks linked in the Sticky better.

You really have not tried any higher than 2.3 which is not a lot of insulin really. If you chose to try some higher doses we have given you some guidelines for that. And I think you can do it now in a fairly safer way that you are testing more. You really do not need the frutosamine test with the amount of testing you are doing now. I've read something here about converting BG numbers into some sort of average that could compare to the frutosamine test but I can't remember where than is out. I can tell you that I'm 99% sure the frutosamine test will show that you are not not regulated and you need to raise your dose. Good to hear you are headed to the vet. You might ask them about testing your kitty's urine for keytones at home and how to go about doing that.

 

yah, I would save the $$ on the Fructosamine - doesn't really tell you a lot from what I can tell, just a tool that seems useful for initial diagnosis, and as a gauge maybe if you aren't home testing, though still limited in usefulness

Hey, I found Walmart has a Relion version of Ketostix, under $5! Behind the counter. I hate supporting the WM thing, but when youz broke, youz shop at W'Mart!!! :roll: When I win the lottery :mrgreen: I will shop elsewhere.

 

Please try to keep in mind that 2.3 isn't a very large dose. My Charlie was at 6u bid before we had a bit of a "breakthrough". We dropped back (apparently a little too much)and are still trying to find his ideal dose, but I'm relatively confident that it'll be below 6. So just keep the faith! Slow, steady increases will very likely get you the results that you're looking for.

 

Happy New Year everyone! I keep hoping for regulation soon!

 

Happy New Year to you too!

Waving the magic wand that you get regulation this year.

 

Thanks Rob, Sammy will go to the vet on the 4th. Don't know what good it will do but hoping to up our insulin and get some kind of movement on those damn high numbers.

 

Sam did not go to the vet today. The DH is sicker than a dog, well not our dog who is fine. Anyway, he's coughing his head off with almost pnuemonia so he rescheduled for next week.

 

Hope DH get better soon.

You're starting to see some better numbers now, not alot better but better, I would go up to 2.5u now so you don't lose any momentum.

 

Yeah, I am getting better #'s. He had a 196 for a +5 today! Hopefully, DH will be able to keep Sam's appt. It's next Tuesday the 12th and if he can't I will go. I need to talk to the vet anyway. But, we will go up in insulin for sure to get him regulated. When I picked up some insulin yesterday the tech said she wouldn't worry about numbers in the 300's. Well, I do! I am the original worry wart. :lol:

 

Hi Sue,

Glad to see you back. I like that blue! Maybe he just needed a dash more.

 

Could be, I have been trying to keep track of his numbers a bit more than the AMPS and the PMPS. They were always HI so I thought do a +3 or 4 and a +6. I do hope he's getting more used to the insulin.

On a sad note, which if off topic for this I had to euthanize my horse, Ronan Thursday. It was quick, it was painless and he's in a better place. Cushings is a terrible thing for horses. So much pain he had in his feet. I'll miss the big guy.

 

I'm very sorry to hear about your Ronan. :sad: Feet and legs are everything to horses. I'm hoping he's now running around in green fields free from his pain. What kind of horse was he?

 

He was just a grade horse but very pretty. He was a dun roan with strawberry blonde/red mane and tail. He was also a very good horse, level and loved me like I loved him. It's tough but he was not getting any help from either bute or the peroglide he was on. I wish I could figure out how to put a picture of him up.

 

You have my deepest sympathies about Ronan. I love that name. And I can imagine what a tough thing that was to do. Hugs.

 

(((((Sue))))) I am so sorry. Run free Ronan. rb_icon

 

I'm so sorry for your loss. Fly free Ronan.

 

Yeah I named him that because of his dreads on his mane and tail when I first got him a couple of years ago. That and I liked the guy that played him on Stargate Atlantis. To bad it's off the air, we loved that show. I'm just glad he's up there running free now. My poor pony, Chester, his buddy is a bit depressed cuz his bud is gone. I hear him whinny from time to time. rb_icon :YMSIGH:

Did you see Sam's PMPS? Good eh? I will keep a close eye on him tonight for possible hypo, though the last time he had a low number and we didn't shoot he was in the 500's a couple of hours later. So I'll test him around 9 or 10.

 

Dang it! Sam's meter said Hi again this morning.

 

Sue,

Did you shoot 2.3 units last night at 99? I think he could have gone low last night and this morning could be a bounce. What do you think?

 

Could be, I did shoot last night (2.3). I fed him right after the shot so he did get food in him again. He was ready to eat this morning, I overslept, the alarm didn't go off so I was super rushed but got him checked and shot before I left.

 

Let's see what others think. I think 2.3 may be too high. He got a long ride out of it yesterday. 99 at +12 is amazing, and you can't be sure he didn't go lower after that. Next time, wait 30 minutes and test again to be sure he is headed up.

I know it seems minute but I would consider 2.2 to see if you can get a nice curve and a shootable number at pmps. Your curve yesterday was a 12 hour descent!

Can you or DH get some tests in today to make sure he doesn't go low? If you get a number under 200 tonight, come on for help.

 

Wow. You have stumped me as to what this pattern of high numbers then occasional low PS numbers means. The two things that come to my mind are a) chronic rebound b) not getting much or any food that cycle. This thing is that for rebound you did drop back to 1u before for 2 1/2 days to check and didn't get very far.

We usually don't like to shoot below 150 or even 200. And if we do we try to reduce the dose. You can read about things you can do when the number are below your "no shoot" here:
viewtopic.php?f=24&t=32652
Yes, and I encourage you to come on and post as Sue said. You may want to start a new topic as this one is getting long.

I myself am hoping others might have a better idea. I just wish I could remember seeing another patter like this - it seems familiar but I can't put it together. The pattern maybe looks like a "wonky" number pattern where there is some outside influence on the curve happening - UTI or something like that?

 

Sue,

I would think that it is time for you to try a new insulin. Have you looked into Levemir?

Was he on pzi prior to remission?

I've studied your spreadsheet and read the postings. It seems you are doing a great job but the insulin just doesn't seem to be working. Many long-term diabetic do well when switching to Levemir, but Lantus is an option too.

I would urge you to discuss these two insulins with your vet.

Best,
Pam & Layla

 

Pam do you think insulin the the only thing that is not working here? Do you suspect any other issues going on? That's a very distinct pattern Sam has going on. EDIT: Further, I don't think Sam has ever been in remission.

 

I don't know if something else is going on. Unfortunately, that pattern is nothing but high numbers and this has gone on a long time.

What I've gleaned from the other posts is that Samwise is eating lower carb food, no longer eats the dogfood, etc., so if the food is okay, there has to be another reason.

If the insulin is not old, hasn't been shaken, dropped too often, or left in the sun for long periods of time, then I would think the most logical step is another insulin.

If the bloowork/chem panel is within normal limits and the vet cannot find a reason for the high numbers it can't hurt and might help to try another approach.

I'm not an expert in interpreting numbers - but high and flat for a prolonged time period needs action. My own cat is difficult and doesn't fit any mold whatsoever in all the great dosing guides in the sky. When on PZI we had to shoot TID and that was fine for years, but all I can say is that the moment we switched to Levemir, she became a better cat. Layla's numbers are not bronzed but most cats don't have her history of DKA and HL.

I don't think, based on my cat, there is such a thing as a perfect dose. The perfect dose is the one that works today, tomorrow, next week. Next month, the needs might change and another adjustment might be needed.

If he is going to the vet I would urge them to do the bloodwork and maybe the C&S for the urine to rule out any infection that might also be contributing to the numbers.

Best,
Pam & Layla

 

Gator, if I read the history correctly, then Samwise was in remission for a year (the timeframe might be off). He was in remission when he had his dental last summer based on Sue's post.

Best,
Pam & Layla

 

So, I'm asking this because I want to learn, and I don't understand. I thought that the pattern she saw yesterday was encouraging - that maybe the food and the insulin increase finally kicked in for a 196 at +5 and then a very unusual duration with 99 at +12. The higher number at amps today could have been a bounce since she shot 2.3 at 99?

Sue, have you gotten any numbers for today?

 

I'll start another post after this one. No UTI, he's been eating pretty good. He always eats about an hour or so before his first shot in the morning and he eats through out the day. He's skinny which is why we don't with hold food. He did have a very good low day then it goes up high again. Rebound? Could very well be. He goes to the vet tomorrow. confused_cat