When does Depot kick in?

Hey guys, just checking in.
Rusty had about 4 days of pretty good numbers, for him, yet at his PMPS he always gets in the red or black, as if the insulin isn't lasting long enough.
And again this morning!
I was soo excited that he was finally going pink, blue and yellow quite evenly throughout the day, even at his AMPS, but ALWAYS up at night.
I thought that his 'depot' would start taking care of that.
Does anyone have an explanation for when he might start flattening out, with good numbers?
Once again, he's hiding under the bed, and comes out later, to eat and go outside for a bit.
This is NOT what I expected 1 1/2 months ago, when he began insulin! He bites me and still jerks when I test him, and is scared of me, the rest of the time!
He is not the same cat I used to have.

 

The issue isn't the duration of the insulin or the depot. Rusty is bouncing. He sees good numbers and his liver and pancreas panic and pump out a stored form of glucose and counterregulatory hormones. He's clearing the bounce relatively quickly and then bounces again.

 

Bouncing: When the glucose drops rapidly, or the glucose drops to an unfamiliar number, of the glucose drops below normal, hormones release stored glucose (glycogen) which is converted to glucose and raises the blood levels back up. It can take up to 3 days to clear, based on reports on FDMB.

 

Hey Sienne and BJM,
But he's been 'Bouncing' pretty much the whole time! 3 days my ass!
Does it normally take this long?
I know my protocol is SLGS, but how long CAN it last? Months? Years?
My kitty doesn't even like me anymore.
I thought that's what the depot was for?

 

Is there anything else that may be going on to elevate the glucose? Changes in the household, dental issues, chronic feline herpes, bladder issues?

Maybe check some +10s and +11s to see if he's just burning through the Lantus faster than some cats. If so, switching to Levemir, which tends to last longer than Lantus, might help smooth out the curves.

 

He is as bouncy as Hyde

Hey Rusty!! The ear pokies are to help you. Please stop fighting yo mama!

 

This is not an accurate statement. Onset and nadir for Lev is later than Lantus. At one point, literally years ago, stating that Lev had a longer duration was a frequent statement. Then it finally dawned on everyone that it was a matter of everything being pushed a couple of hours later and duration was the same. It's the reason the TR Protocol is written for both Lantus and Lev.

That said, there are some cats who get greater duration with Lantus and Lev. And, of course, there are some cats who get less. Likewise, there are some cats who do better on Lev than Lantus and their curve does smooth out and there are some where this is not the case.

Bounces can take UP TO 3 days. As a cat's system gets more used to lower numbers, the bounces are shorter. If you look back at my earlier post, I noted that Rusty is clearing bounces pretty quickly. You've been at this dose for more than a week and the nadirs are trending up. I'd increase his dose.

 

I was basing what I stated according to Dr Gilor's dissertation
PHYSIOLOGY AND PHARMACOLOGY
OF DIABETES THERAPIES IN THE CAT:
INSULIN DETEMIR, INSULIN GLARGINE,
EXENATIDE AND THE INCRETIN EFFECT
BY
CHEN GILOR
DISSERTATION
page 76
"End of action of insulin detemir was reached at 13.5 ± 3.5 hours and for insulin glargine at 11.3
± 4.5 hours."

 

I have one of the bounciest cats going, and I've been told (about a zillion times) that cats bounce until they don't. Some cats stop bouncing soon, some take longer, and some never stop. It's frustrating, but you do learn to live with it. Hang in there!

 

Thanx to all!
I have thought of switching, as I do his PMPS at 11 pm sometimes!
His numbers are getting better, and my wonderful Vet (who calls me AFTER work, as she knows I have slight agoraphobia ) says I should stay at this dose, but not to test so much. (When Rusty jerks, he rips his ears! They are a mess! ) I truly don't know what to do.
When we went up to 1 unit, he got an 85 and 97, or something, and I was told he had 'earned' a decrease. ?
I guess as said, they bounce til they don't. Period.

 

When you follow SLGS, which your signature indicates you are following, a test below 90 mg/dL earns a reduction.

For Lantus TR, you have to go below 50 mg/dL in recent diabetics (less than 1 year), to earn a reduction. You are testing enough to try following that protocol, if you'd like.

 

I understand that, BJM, but also we are to go 6 cycles at one dose.
I'm just wondering when this insulin **** is gonna start helping instead of hindering!

 

Melanie, so sorry you're having such a hard time....We all wish our kitties would just get with the program and be cured yesterday, but it just doesn't work that way. Rusty is still actually very new to the sugardance, and there's just no way to rush him...He's going to take as long as he's going to take. It was 4 months before I started seeing "routinely" decent numbers in China

You're testing enough now to do TR if you want to change and if you can continue getting at least 4 tests per day in, I'd encourage you to try it. That way you're able to change dose earlier (every 3 days if needed instead of once a week)

Doing the more frequent dose changes can help "get ahead" of any glucose toxicity he might be developing from holding a dose too long

If Rusty were my cat, I'd go to 1U with your next shot

Hang in there .....we really do understand how frustrating this can be!

 

Thanx Chris.
I don't even know if what he's doing is bouncing! He gradually goes down, then gradually back up. But it's the straight line of red and black at his PMPS that makes me think the insulin isn't lasting.
What is done then?
April thinks he didn't have good numbers at 1 unit, but wants me to TRY to go higher than .75, but not quite 1 unit!
I'm gonna give it a go!
Now I thought the dose change was 6 cycles (3 days) not a week?

 

A second option to consider here, is whether or not Rusty "held" the dose reduction when you went from 1.0 to 0.75u. The idea with a reduction is that the cat's good numbers continue AFTER the reduction. In Rusty's case, it's pretty clear they did not. He's not getting any green numbers now, so I would go immediately back to 1.0u and try again with it.

When you have a failed reduction, you don't have to wait x number of cycles to increase. You decrease because the cat dropped below the reduction point, and if the same good numbers don't continue after the dose reduction, but instead trend up, then you call it a failed reduction. There's more on this on the Tight Reg Protocol sticky - it might be on SLGS sticky as well, I'm unsure, but it would apply to any dosing method you're using.

Just fyi, it is strongly discouraged from anyone giving advice off board. All advice needs to be given in public so that peer review can occur. Can you remind April to please post her advice here in public? It's both for the safety of the cat and to protect the advice-giver in case they make any errors. Peer review is safest for everyone.

 

On SLGS (which you have in your signature), you hold the dose for 7 days and then do a curve and reductions are earned if they drop below 90 (which is why we originally told you to reduce when he dropped to 85 on the 4th)

On Tight Regulation, you only hold it for 6 cycles (3 days) and then re-access if the current dose is getting him where you want him and reductions aren't earned until they drop below 50

As long as you can test at Pre-shots and once "mid-cycle" somewhere on the AM cycle and always get a "before bed" test at night, you can do TR

No matter which protocol you use, if you do a reduction and the numbers don't get them back where you want them, you don't have to hold the dose for any set number of cycles...you go back up...it's called a "failed reduction"

 

Just to add a little more and clarify - the guidelines for increasing the dose are different when you're going up the dosing scale. That's one phase.

Once you've gotten to a dose that can bring a cat into numbers that cause a dose reduction, you're in a different phase - trying to maintain blood sugar in a safe range that keeps the cat in decent numbers - the definition of that is spelled out on both the TR and the SLGS stickies.

The guidelines that spell out to wait a week (SLGS) before increasing the dose don't apply once you've entered the next phase. So you can go ahead and increase back up to 1.0u. If he'd gotten seriously low on the 1.0u dose, then I'd suggest going to a dose a little under that, but in this case, because he barely got under 90, I'd go ahead and go back to it.

 

Ok. I will dose 1 unit, starting in the morning, so I can watch him.
As for April giving advice 'off board' she's not. We have PMs, but I do with alot of members, Chris being one! Isn't that the Purpose of PMs?
And it's not advice, it's answering questions 'I' have, and alot of venting!
I guess I didn't read the rules for this diabetes site. Could you be so kind as to tell me where to read that I'm not allowed to talk with my FRIEND, who lives an hour away, and had her kitty (one of 6 she and her boyfriend and roommate have) go in remission. If we discuss an increase, or something my Vet tells me, I post it.
If it's private, hence PM, I don't.
I've opened quite a few new threads, and have listened to posts from most. She is one of many people I am talking with to try to save my cats life.
And I don't need to remind April of anything she is already aware of.
Thanx tho, for the reminder.

 

Melanie --

No one is saying not to talk to a friend. The support is invaluable. When we refer to "off board" recommendations, it's probably not entirely clear what that means. If you and Chris were to have a discussion about Rusty's dose via PM, that is considered "off board." In other words, any recommendations about dosing should be in your usual thread that everyone has access to.

I've had lots of people send me PMs asking a dose related question. What I usually do is let them know I'll reply back in their condo or I copy and paste my response in their condo so everyone stopping by that thread will see what I've said. Just like you did today when you let us know April suggested a dose between 0.75 and 1.0u, that helps us to understand what a friend may be suggesting and offer you the pros and cons of that suggestion. No one here (past or present) would want to provide less than adequate guidance. However, anyone, no matter how experienced can mistype, make a mistake, or be less experienced in a particular area than someone else. Having all of the information in a public forum gives you the benefit of more than one set of eyes.

It's also why we often will encourage you to let us know what a vet recommends. Vets aren't infallible either. Just as an example, some time ago, a member's vet recommended a particular medication for that person's cat. The cat had multiple medical problems and was on several drugs. I'm a science geek. I wasn't familiar with the new med and started reading. It turns out, there was an adverse interaction between the new med and one of the other meds the cat was on. The person's vet wasn't aware of the interaction, contacted a veterinary pharmacist and found out the information we provided was correct, and the vet changed the prescription to a safe drug. That's why we ask that information be available not just for you but to anyone who is trying to help you.

 

Thank you Sienne.
That was very kind and helpful.
Took Rus up to not quite 1 unit, as was ALSO suggested by many people on here, and was up ALL night! You can look at his SS, but suffice it to say, he had a real bounce this AMPS! After being in the 100s all night, this morning he was HI.
So, I gave him the not quite 1 unit (Thank God I didn't go full unit last night!) and we'll see what happens.
I stayed up to test last night, cause he hasn't been in the 100s for a while. But he went 'up' instead of normally down, so I went to bed at 5 am. Wonder why he did that? They always go down after insulin.
Bizarre!

 

Another problem.
This is off topic, but since you're all on here, I'll ask.
Rusty has terrible flea bites all around his neck and on his head. About a month ago, I bought Revolution, I think, cause I have a full box of Frontline Tritak, yet that didn't work either, it seemed. Now, he goes outside, just for about a half hour (in and out, in and out)! so I realize they're in the home, too.
But, I've never seen him this bad, and although he hates his flea comb, I never get any when I do comb!
What do you guys think of returning to the Tritak, and not placing it where the insulin goes, I know that?
The Vet's not in today, and the $30 a month Revolution didn't do s h i t! (I think if you spread it out like that, they won't censor it!)
Anyone have luck with ANY topical flea med? Or any other suggestions? Please. Poor baby!

 

My local shelter uses Capstar in addition to a spot product on incoming animals. That knocks out the adult fleas asap and gives the larvacide time to work without the cat being eaten so badly. You can give it daily, although that is expensive. Shelters may take a dog tablet and cut it down for cats to save money.

 

Thanx BJM! But our animal shelter isn't open today! Go figure! I know my Vet spoke of Capstar, so I think I'll wait til tomorrow, and maybe get Advantage, it used to work long ago.
I'm gonna call around and see if the Humane Society is open, or somewhere!
I just combed by his neck, cause he's sleeping and doesn't notice, and got ONE. And about 5 black spots. (Not babies, I think dead ones) I don't know.
Do you think I should try the Tritak again? I know for some reason I ended up calling the Company that makes it, so I don't think it worked, or I wouldn't have switched to Revolution.
I just don't know...

 

Melanie -

You might want to add something to your subject line re. asking for help with the flea issue. People may not think to look in your condo since it's an on-going thread from yesterday and if they've already read your posts, they may skip over things that are posted today. Adding something to the subject line also let's people know you have a specific question. We try to maintain one condo, per cat, per day but there's no reason to not adjust the subject line as you may have questions to ask as people respond.

Rusty's numbers last night were beautiful! I honestly doubt that if you'd shot a full 1.0u it would have made a difference. Ideally, you want to see Rusty in normal BG numbers.The longer he's spending in numbers like last night, the better the chances that his pancreas will heal and even more important for the short term, the more he'll get used to spending time in lower numbers and eventually stop bouncing. (He really is quite over zealous in his bounces!!) What I'm seeing is that when Rusty's numbers drop quickly (e.g., from a PMPS of 348 to a +2 of 180), it triggers a bounce. What you also saw yesterday was an AMPS in the 500s and numbers in the higher 100s by PMPS. He's continuing to clear bounces quickly, which is good. It's no doubt hard on both of you -- Rusty may feel pretty lousy from those big changes in numbers. Hopefully, his body is readjusting to the lower numbers.

 

The flea discussion has come up a few times - here's a search for "fleas" from the box in the upper right corner, resulting in these posts.

 

If you caught one flea in your comb, there likely are more fleas around. They live in the carpet, if you have any. The black spots are flea-droppings. If you put Rusty in a bathtub and shake his skin/fur with your fingers (like a dog shakes off water) you'll see black spots in the bathtub. Sprinkle or spray it with water and you'll see red run out. That's Rusty's blood that they consumed.

The fleas around here have become resistant to Frontline, so we've used Advantage and Revolution. I'm not familiar with Capstar. Flea-combing as much as you can helps. Do you know to drop them in soapy water so they die? You can buy diatomaceous earth at a garden store and sprinkle it either around your house or inside your house. It's mined from earth and is from shells of diatoms. They have sharp edges that you won't notice, and Rusty won't notice, but it cuts through the waxy coating of insects and they will dehydrate and die from it.

Our locally-owned pet store has it for sale in a small jar, calling it "food grade." You're supposed to put it in the cat's food. I haven't figured out how that would work, and it cost about $5 for a jar that probably held 8oz. At any garden store, you can find a large bag for maybe $10 - I still have my first bag that I bought probably 15 years ago. We don't have fleas anymore because our cats are all inside only now, but it was a lifesaver when they did go in and out.

I've put it in a large sieve - it's like a heavy flour - and then tapped the sieve against my hand to sift some out. We have huge problems with carpenter ants around here and every time we get bark, I sift in the area touching the house to prevent carpenter ants from getting into our house. It really works and it's harmless for non-insects. When we had carpet, I'd sprinkle it throughout the house on the carpet. You can just leave it there and it doesn't hurt anything. It's far less toxic than anything else, although I would avoid directly breathing it in while it's airborne and you're sifting it. It's heavy so that's not especially hard to do, it falls right down.

Anyway, hope that helps a little.

 

That helps get the tapeworms which fleas may carry. Farmers add it to the feed to help reduce worms in the livestock. It won't help on the outside unless you carefully dust some into the fur.

 

I have also dusted my cats's fur with it.

 

Thanx girls! That's very helpful! I don't go out much, but there's a Lowe's right by me!
So put some around my duplex, outside, and sprinkle some on a vacuumed carpet, right Julie?
Also, BJM, if I rub it in his fur, when he licks himself, it won't harm him, right?
Sienne, I was so concerned about that low drop, that I went to bed at 5 am, cause I kept testing! He only went up 9 points in 5 hours! I thought he was doing better at .75.
And Julie, does this stuff attract the bugs to EAT it? That's what it sounds like. Great, cause I fight bugs alot here, set in the trees!
Sorry about changing discussions, but my mind is continually going, with clutter, and I sometimes can't help it.
Chris said something earlier on, in this thread about glucose toxicity, if you stay at one dose too long. I don't understand, because once a kitty evens out, wouldn't you keep them on that same dose, or continue to go down to try for remission?
This stuff just blows my mind, and there's not much left to blow!
Thanx again, everyone! ♡

 

Capstar is also available at WalMart now (and other places that sell pet supplies)

On glucose toxicity, what I meant was that if you continue on the same dose and aren't getting better numbers on it, if you don't increase, glucose toxicity can set in which means having to keep going higher and higher in dose to "get ahead of it" again

Once you "get ahead of the toxicity", then the idea is that they'd start having much better numbers and start to earn reductions again

 

Thanx Chris.
I thought Rus was having better numbers at. 75, yet he always went up at PMPS, as if the insulin isn't lasting long enough, as I said.
I girss we will all get it figured out, including Rusty!

 

It isn't likely (there could be an exception); it is often added to feral cats food and water to help control the worm load.

 

my understanding is that is how this works - i'd doubt that bugs would be attracted to it, it's basically ground shells/dirt.

 

Sounds good, girls!
So it's called 'diatomaceous' earth, or dirt?
As said, I will check Lowe's tomorrow, when I get out. And leave it on the carpet? That was my only other question. Vacuum first, then just sprinkle, sprinkle!
And rub it on Rus, too????
Okie-dokie! ♡

 

Food grade diatomaceous earth.
I got some on Amazon.

 

You don't need food grade unless you're going to feed it to your cats. I just bought a 5-10lb bag at a garden center and sprinkled it on the carpet. sure, vacuum first then sprinkle. Leave it for a week or so and repeat. I don't remember exactly what the flea's entire life cycle is - I want to say a month for the eggs to hatch and become mature, so I'd probably repeat the process for a month. It's not like the diatomaceous earth becomes old or will stop working, i'm just assuming you want to vacuum at some point during the month. I'd try to keep it on the carpet for a month. If you walk barefoot on it you might notice your feet might feel extra dry.

 

Hey BJM,
Were you the one who said Walmart carrys Capstar now?
Is it a prescription, or OTC?
Anyone? ♡

 

That was me, and it's OTC at my WalMart

 

Cool. Probably less expensive, too! (Than my Vet)
But I live near the new one, that is only groceries and some supplies. Called them - they don't have it!
I just might go myself and check, as they have quite a large pet section!
Thanx Chris! ♡