Misho from Bulgaria II

Here is our new topic ,I hope I did it the right way . Thank you BJM for your instructions :thumbup
At PMPS this evening I reduced his does by 0,25 and shot 1.5 In the meantime I read the sticky Lantus&Levemir TRP the part about reducing as I don't know if I have to hold this reduced dose and for how long. It says

You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up.

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and then

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s.

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Well I am a bit confused because 1.75 today dropped Misho to 36 but if the reduced 1,5 doesn't work and the numbers are higher tonight, shall I go back to 1,75 or I have to shoot the so called skinny 1,75 if I use the common sense :smile:
The other thing is that tomorrow I have to drive to another city and will be back for Misho's PM shot i.e. I won't be able to monitor his BG after the AM shot. And just for his morning shot may be it is wise to shoot 1,5 again just to be on the safe side. Does it makes sense ?

Misho's story part I HERE

Congrats on the reduction. :mrgreen: You did a great job handling the low numbers.

If Misho bounces after the low numbers, you wait until the bounce has cleared to evaluate the 1.5U dose. If he's not getting into green numbers after the bounce, then more insulin is needed. I'd give him at least couple of days to see how he's doing on the 1.5U dose before decided if it's failed.

For tomorrow, shoot the 1.5U dose, and make sure you leave plenty of food for him to snack on if he goes low.

You got the post done correctly.
You could edit the first item in this thread to link to the previous thread, so if someone reads this, they can go back to the previous thread to read backwards.

It can take about 3 days for a bounce to clear. Some folks "shoot through" the bounce and take the reduction at the next shot ... but that can mean staying home testing to make sure the cat is safe.

Good morning everyone! For now things seem to be OK. I shot 1,5 this morning and will keep the dose for a few days as you suggested. I have never been away since I take care of Misho and today I feel a bit uneasy but I hope everything will be OK. Wendy it is not possible to just leave some extra food for MIsho because the minute he see s the food it will be gone I gave him a little bit more than usual .
BJM I linked PART 1 but it is only visible in my first post may be I have to add it to my signature but have no time now. Going for a wlak with my dogs ( I owe them lately :sad: ) and I leave shortly.
Thank you for your support guys it really means a lot , we wouldn't have done it without your help :YMHUG: Have a happy day ahead !

What you did was link to your 2nd thread from your first thread, instead of linking from your second thread to your first thread.

In other words, the link is in the first thread, and goes to the second thread.

I came back just in time for Misho's PM shot but was unpleasantly surprised by his pre-shot number 478,8 :sad: As I was away all day I have no idea what has happened. Is this high preshot number due to decreased dose or a bounce because of hypo :roll: I have the feeling it is the hypo and I know it is my fault to leave him alone but I had no choice. This happens for the first time since April and here is the result...
As I didn't know if I have to go back to 1,75 I shot the same dose and gave Misho only 2/3 of his evening meal. Will go back to check at +3 and give him the other 1/3. May be when I have the numbers after PM shot it will be more easy to make a guess of what caused this red number.

Good morning,

I'm not one of the most experienced members here, but that 479 you saw could certainly still be part of the bounce from the low numbers. Definitely stick to the 1.5 units for now. Once the bounce ends, you'll be able to tell how the new (1.5 unit) dose will work. I know it's frustrating to see those high numbers right now. When our kitties are bouncing, there's just not much else we can do but wait them out.

Hang in there - you're doing great!
Shelly

Bounces take roughly 3 days to clear. Time to put on the "patience pants", grit your teeth, and just wait it out.

Thank you Shelly and BJM ! I am trying to do everything I am expected to but with every day I become more and more frustrated. Needles to say I lack normal sleep since April and no good news to make me feel a bit better. Whenever I decide we have almost done it and something like this happens and troubles my hopes. I have to confess that without a vet that can help and doing it all alone is an uphill work and I don't find it normal. You are the only people on whose opinion and help I count that is why I post so often and I do apologize again for being a nuisance.
At least Misho doesn't show any sign of discomfort , I have seen Hi reading and I have seen readings below 32 but if it wasn't the glucometer I would never guess that his BG is abnormal. And frankly speaking I have no idea how people who do not home test manage with diabetic cats. For me it is absolutely impossible to shoot whatever dose I am supposed to w/o knowing the pre shot number.
Well patience pants doesn't fit me but are my only choice :sad:

Glucose numbers vary; they are never constant.
There are numerous factors which affect them:
- the cat's specific physiology
- the food batches (these change every time the manufacturer gets slightly different products)
- activity levels
- stress
- time of day (usually dawn and dusk are the active times for cats; varies with cat, though)
- indoor vs outdoor life
- other medical issues
- the insulin dose and type
And probably more.
Controlling glucose is like using your hand to hold water. You won't be able to hold much, though you may be able to guide where a lot of it goes.

I am trying to do everything I am expected to but with every day I become more and more frustrated. Needles to say I lack normal sleep since April and no good news to make me feel a bit better. Whenever I decide we have almost done it and something like this happens and troubles my hopes.

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I'm sending lots of hugs to you! I know how frustrating it is, but you really are doing a great job.

My kitty, Jersey, was on Lantus, which is similar to the Levemir you're currently using. We started on a different insulin and switched about a month later to Lantus. We really didn't see much progress until about 6 weeks after we started the Lantus. I remember thinking that I was doing something wrong, and I couldn't figure it out. I was trying so hard, and I was losing hope. One day, things all finally seemed to "click" with Jersey. Just a couple of weeks later, she went into remission. She no longer gets any insulin, and she's doing great. (We were very fortunate that Jersey went into remission so quickly.) Just try to take one day at a time. You're doing all that you can. Sometimes it just takes time for the overall numbers to come down. You'll get there.

I do apologize again for being a nuisance.

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You are not being a nuisance. We all know how hard it is to deal with diabetes, and we're here for you - whether that's to answer questions about the dose or to just give you some moral support. :YMHUG:

Shelly

You are right Shelly ,just some moral support sometimes means a lot ! I don't know if I am patient enough but I think the decreased dose doesn't work.Tonight the numbers are again higher at + 4 which I cannot understand. Is it time to go back to 1,75 or I have to wait ?

I haven't commented on any of your posts before, so a belated welcome. :YMHUG:

The 1.75 took him down to 36, so I would be hesitant to suggest going back to that dose just yet. I would maybe try a "fat" 1.5u first instead (just dropping the plunger to the bottom of the black line instead of the top).

Thank you for your welcome and advice KPassa ! I shot the f1.50 this morning, hope to see better readings.

It is our 2nd day on f1.50 and at +7 Misho was in the green. The reading was 57,6 but I gave 1 spoon of Diabetic dry because I didn't want him to drop more than that. Half an hour later BG- 2,9 so I gave Misho some honey to lick and 2 more spoons of kibbles. I remember last time we were in the green you advised to decrease the dose but tonight I shot the fatty 1.50 again and I don't think his BG tonight will be as low as this morning. What bothers me is that always after low readings Misho bounces,today at pink PMPS :sad: But I guess this is a part of the journey. My question is do I have to increase insulin again at some point or I have to hold the dose? And second one- is the dry diabetic OK for low numbers or it is better to give him some extra of his usual food Animonda canned( what I did the first time)?

No, I would definitely hold this dose and not increase again. If he drops below 50, then you might even want to decrease the dose back to 1.5u.

With Mikey, when he's in the 50s and I'm nervous he might continue dropping I have him eat some of his regular food and he'll float along in the 50s for a few hours instead of dropping further. Even when he's in the 40s, because we've been at this so long, I still use just his regular food. In your case, however, if Misho drops to the 40s, that's when I would suggest a little bit of the higher carb food. Not sure what food options you have in Bulgaria, but I'd be more inclined to offer him a little bit of some wet, gravy-style food maybe mixed in with his regular food than the dry food or honey.

Thank you KPassa ! I will follow your advice and use only his regular food.Misho hasn't been that low to panic and I guess some extra food will always do .

It's a matter of experimenting and finding out how carb sensitive your kitty is. The longer time he can spend in the greens, the more the pancreas will heal. Often a couple tsp of regular low carb will help them do that.

Good morning from Bulgaria!
Wendy I tried with the dry diabetic formula just once but I think that some extra tsp from Misho's usual food is my choice. Misho was initially on the dry diabetic but the daily prescribed dose for his weight was sth like 65 grams ??? which with his persistent hunger at this time was absolutely impossible. Misho kept crying all day for food. When I read it is better to feed him wet and we switch to Animonda canned diabetic I had a packet left and I just tried the other day but I definitely prefer his usual food and some drops honey in case of need.
This morning we wake up with a pink pre shot again :sad: It always happens when I least expect .Last night I though over this

The longer time he can spend in the greens,

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with Misho the greens are only 2 maximum 3 hours( I guess @+5 he is already in there) and then he bounces - sometimes it is a slight one and sometimes like today from 126@+9 to 326 at pre shot :roll: Will ever this change and why he spends only a few hours in greens and doesn't surf as you say in this range ? :sad:

Misho's spreadsheet is starting to look better. Less red, more blue and green so it is improving. Some cats are just bouncier than other - Neko is one of them. The saying is that they will keep bouncing until they stop bouncing. It's up to the cat, not us. Anything under 120 is normal numbers, so Misho had two really good cycles yesterday. When you first see him get into green, try giving him one or two tsp of his regular low carb food, that can often help them surf longer.

Wendy&Neko said:

When you first see him get into green, try giving him one or two tsp of his regular low carb food, that can often help them surf longer.

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This what I do Wendy once I get a green reading I give him some food as to avoid lower one and because I have seen other kitty's ss with many hours in the greens after that I am sad that with Misho it isn't like this. As you say every cat is different , I can do nothing more and it really is up to him and not me. :sad:

If you want to check out Michelangelo's spreadsheet, it took him about 2 months on Levemir before he stopped bouncing around like a ping-pong ball.
flip_cat

KPassa said:

If you want to check out Michelangelo's spreadsheet

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I did the first time you posted here and I liked the latest numbers on his ss. :thumbup
Honestly sometimes I have the feeling we will never get there :sad:
it is our 5h day on f1.50 and I think that tonight we will have green numbers ,can anyone please give me advice how to proceed tomorrow?

You've been getting some lovely numbers with this dose so I would probably keep holding it steady for a little while longer. Unless Misho drops below 50, then you'll want to reduce back to a regular 1.5u. ;-) I hope you see green tonight, too. :mrgreen:

I agree with Kay - you're getting great nadirs. Stick to this dose and we'll hope he flattens out a bit as he gets used to those greens.

Thank you both for your thoughts ! Well we didn't see green as I expected but the numbers were not bad and all blue. Hopefully with the time Misho will get used to lower numbers and will not bounce . At this point I will be happy to even see more blue than yellow but may be the most important is if he flattens out as you say . We will see.
Have a happy week all of you!

Re: Misho from Bulgaria II-URGENT question

It's 5 p.m. here time for PM shot but Misho's number is below 150 first test 145,8 second attempt 140,4. BJM once said my no shoot should be 150 . So now I don't know how to proceed to wait for a high reading or to shoot and test. Anyone experienced please advise! I am typing on cell hope it works. THANK YOU !

Re: Misho from Bulgaria II-URGENT question

I would wait a half hour (without food) and retest to see if bg rises

Re: Misho from Bulgaria II-URGENT question

Another deciding factor is, are you able to monitor during the cycle, and prepared for food intervention.

Re: Misho from Bulgaria II-URGENT question

dirtybirdsoaps said:

I would wait a half hour (without food) and retest to see if bg rises

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I did wait about 45 minutes- next reading 9,6 so I shot and gave him his PM meal- I feed him twice daily at insulin shots.

Darin & Charlie said:

Another deciding factor is, are you able to monitor during the cycle, and prepared for food intervention.

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I am if I am supposed to stay I will. I have seen ss with shots at readings like 63 :roll: and I don't know when I will be allowed :smile: to shoot under 150 . But for now I follow the instructions not to.
Thank you to both of you for your help, it is always easy when someone with more experience gives you a hand. :YMHUG:

Re: Misho from Bulgaria II-URGENT question

Great job on stalling this morning! :thumbup Once you see how Misho reacts with a stalled shot on a lower number, you'll feel more comfortable doing so again in the future. Remember, with Levemir, you are often "shooting the nadir," so you're going to have to become more and more comfortable shooting lower and lower pre-shots. Don't worry; we don't expect you to shoot a 63 right away. You ease down into it. Today, you eased into shooting a number below 150. Next week, you might ease into shooting a number below 130. It's a progress thing and you guys are making some great progress. :mrgreen:

Re: Misho from Bulgaria II-URGENT question

KPassa said:

Great job on stalling this morning!

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Actually it was evening here :smile: I have just checked his BG at +3 because I expected low numbers earlier and it was green :mrgreen: So I gave Misho just a little drop of honey to lick and 3 spoons of his food because I had to go back home and take some stuff so I can stay overnight at Misho's place as he as I have said doesn't live at home, we are too many with my 3 cats and 2 dogs. Most likely it will be a long night because if he is green at only +3 I will now have to check more often. I don't have I-net there but will be with my cell but hopefully I won't have urgent questions :roll:
With shooting at low numbers what bothers me is that I don't know when the insulin will kick in and the BG start to drop . If Misho was at home I woudn't be that hesitant çause I could monitor him. But now....So far I know what usually happens and go and check BG at +5 and +7 but it is with higher pre-shots. I guess you are right KPassa and I hope so much to see progress with Misho.
I have to go now. THANK YOU for your support , it means so much to us both. Good night from Bulgaria ,Misho and me cat_pet_icon

UPDATE -at +4 BG has dropped lower and is 70,2 it was 82,8 @+3 .I gave Misho another drop of honey and some more food for the insulin to work on as we have a whole night ahead.

Re: Misho from Bulgaria II-URGENT question

Di&Misho said:

KPassa said:

Great job on stalling this morning!

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Actually it was evening here :smile:

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ohmygod_smile Haha! Good evening, then!

Di&Misho said:

With shooting at low numbers what bothers me is that I don't know when the insulin will kick in and the BG start to drop . If Misho was at home I woudn't be that hesitant çause I could monitor him. But now....So far I know what usually happens and go and check BG at +5 and +7 but it is with higher pre-shots.

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Well, tonight you're building data on how his numbers work when you shoot those lower pre-shots. :thumbup You're becoming "data ready" so when you start seeing lower numbers, you'll know how Misho reacts and whether or not to skip (because you can't monitor) or give the shot anyway because you're comfortable knowing how he'll react. You're doing a fantastic job and it's nice to see how well Misho is responding.

Re: Misho from Bulgaria II-URGENT question

Well ...I will be building data and Misho will be as happy as he can be because of the extra food I give him :lol: This guy would eat me if he could , always hungry though his daily menu are 3*100grams each :roll: and tonight he already had extra 50 grams.I hope this will be enough for his BG to surf and not drop.

Re: Misho from Bulgaria II-URGENT question

Hi Diana,

Have you thought about posting in one of the insulin forums? It sounds like you have all of the "basics" in place - feeding, testing, spreadsheet, etc. It might be helpful for you to start posting in one of the insulin forums at this point. We have three different ones - Relaxed Lantus, Lantus-Tight Regulation, & Levemir. You can post in Relaxed and Tight Regulation even though they say "Lantus" in the name. If you start posting Misho's numbers in one of the forums, individuals there can help you with "advanced" techniques such as shooting lower numbers.

Just a couple of notes about the different forums: Tight Regulation (TR) is based on a protocol that was published in a scientific journal. The TR protocol gives specific guidelines on when to increase a dose, etc. For example, TR protocol indicates you should re-evaluate a dose every 3 days to see if it needs to be raised. The Relaxed Lantus forum also follows a lot of the same basic guidelines, but it's based more on a "start low, go slow" approach. For example, members in Relaxed Lantus may hold doses longer than the 3 days recommended by TR. In either case, there are going to be individuals with a lot of experience to help you with your questions. I'm not sure how active the Levemir forum is; hopefully someone can speak to that.

If you do decide you would like to move to one of the insulin-specific forums, just click on the name of the forum you want to join, and start a new thread. For the subject line, we ask that you put the date, your kitty's name, and the numbers for the day. For instance, your subject line for today might look like this "9/23 Misho AMPS-142, +5-193." As you get new readings in, you can just update the subject line of your post to show your new readings. Each day, we ask that you start one new thread on the board. So....tomorrow, you would start a "9/24 Misho" thread.

You can certainly keep posting on this main Health board if that's where you feel most comfortable. I just know that this main board can get really busy and sometimes you may not get all of your questions answered. Moving to one of the insulin groups may help with that - especially when you get into issues like you did this evening where you were stalling or when you want to shoot low numbers (e.g., numbers in the 60s).

Do you have any questions about the different insulin forums? I was a member of TR, so I'm relatively familiar with it. Wendy (& Neko) is also a member of TR. I know Kay (KPassa) is a member of the Relaxed Lantus forum, so I'm sure she'll be able to give you more specific information about it than I can.

And, yep, looks like you might be in for a busy night of testing. (It's great to see Misho in pretty blues and greens, though.) If you run into trouble, just let us know.

Shelly

Re: Misho from Bulgaria II-URGENT question

The Levemir forum is very quiet. You'll get more immediate feedback in TR or Relaxed. Take a look at each and see what fits best for you.

Re: Misho from Bulgaria II-URGENT question

Good morning everyone! Shelly thank you for your detailed post- the thing is I don't know where we belong , I mean to which exactly insulin group But as I was asked to move my posts to one of the insulin forums before may be it is time to do so :smile: I am sorry I stayed here quite long I don't know why I thought that all of the experienced members read and post mainly here may be this was the reason why I kept asking my question in the Main Board. Thank you to all of you who helped us in the meantime it is good to know so many people are willing to give a hand in case of need :YMHUG:

Re: Misho from Bulgaria II-URGENT question

Don't apologize!!!! I'm not trying to "force" you off the Main board. I'm sorry if I made you feel that way. I just think you might be getting to that point in regulation where an insulin support group would be more helpful to you. That's a really good thing - it means you did a great job getting all of the basics down.

Okay, so let's see if we can help you decide. BJ mentioned the Levemir group isn't very active, so let's rule that one out. We're down to the Relaxed forum and the TR forum now. The TR forum is going to ask you to go, for lack of a better way to say it, a bit more quickly in terms of increasing the dose, and they're going to encourage you to shoot lower numbers more quickly (when it's safe to do so, of course). The TR protocol, according to the research, has the best chance of getting a cat into remission if it's started soon after diagnosis. The Relaxed forum, as I mentioned, may go a bit more slowly when it comes to raising the dose or shooting lower numbers. That's not a bad thing; some people like this approach because it fits better with their schedules, their ability to test, etc. And I know a lot of people in the Relaxed forum have had cats go into remission, too. How about this? When you feel comfortable with it, just pick a forum and post there. If after a few days you don't feel comfortable there, you can always move to the other forum. Both forums are going to have experienced users who can help you, although I think the TR forum has more people on it for more hours of the day; it's busier in case you need help.

There is no pressure. If you want to keep posting here, keep posting here. We'll help you no matter where you "end up" on the board!
Shelly

Re: Misho from Bulgaria II-URGENT question

Shelly & Jersey said:

Don't apologize!!!! I'm not trying to "force" you off the Main board. I'm sorry if I made you feel that way.
.......although I think the TR forum has more people on it for more hours of the day; it's busier in case you need help.
Shelly

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It is OK Shelly , I already posted in the forum I chose . My idea was to post where it is busy as you said as my only source of help are the experienced people from this forum. I can't call our vet for advise or any other close to me person on reasons I have explained in the very beginning. TR might be more busy but I think that what I follow with Misho is more like the Relaxed Lantus so I decided to join them and from now on will post there. Thank you for all your positive input I am happy I found this message board , you all gave me much advice and I do appreciate this very much :YMHUG:

Hi Diana,

Just checking in to see how things are going for you and Misho. I didn't see any posts from you on Relaxed Lantus or on the TR board, so I just wanted to make sure you were okay. Looks like Misho may have had a little bounce going on today. I hope the numbers come down during this next cycle; I know those higher numbers are hard to see.

You're doing a great job testing, by the way!
Shelly

Hi Shelly , thanks for asking ! MIsho is doing fine as always,it is me worring too much :smile: I didn't have a question so far and this is the reason why you didn't see a new post . Today I did as it seems ,as you have said, Misho has bounced. Yes, I don't like to see these pink numbers but I think that as a whole things look much better lately.
Have a great day Shelly :thumbup