1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291 2 335

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Suzanne & Cobb(GA)

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Yesterday

Not much to report this morning, other than Cobb decided to take a hike up the mountain. All the P's are in place and his appetite is good.

Hope he decides to come down soon.

Hope you all have a good Friday.

~Suzanne[*]
 
Re: 1/3 Cobb AMPS 454

Now Cobb!!..You stop this fooling around this instant! Red is NOT your color!!

Come on down Cobb...there's lot of good stuff to see on the lower floors!

Hope baby bean is feeling a little better today and that you were able to get a little sleep last night Suzanne
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522

Matty is doing better. Not quite as snotty and we haven't heard the gasp today.

Cobb...not good numbers. I guess we could have slept through a quick drop.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522

my niece had whooping cough - it was terrible. cough til she vomited. her older brother had birth defects and they were so wrapped up in his needs they forgot to get her vaccinated. they came to visit us and i couldn't have them in the house because my youngest was only 2 months old with one vaccine in her - so the doc said to keep her away from my baby.

i'm very glad he hasn't gotten whopping cough. some viruses are bad enough! sounds like he might be on the mend.

One thing we haven't talked about but is an option, is to go to larger dose increases with Cobb. that might help us get on top of his numbers instead of chasing them. When cats are on doses of 1-3u, we increase by .25u most of the time. that's a 8%-25% increase. With Cobb, we're now nearing on 10u, and a 0.5u increase is a 5% increase. Many people move to 1u-2u increases at this point. Because cats differ so much from each other, you'll be watching and learning how his body responds to a larger dose increase and whether or not you think that helps. i found even at 15u, punkin's body responded to .5u dose changes. I did, however, sometimes increase by larger amounts if i felt like i needed to get on top of his numbers. Do you know what i mean when i say "get on top" of them? Glucose Toxicity is when a cat gets accustomed to sitting in high numbers and it takes more insulin to knock them down. That in itself seems to increase the dose needed.

We can't use L insulins to hammer down numbers quickly, but we need the L dose to get him at least in the neighborhood.

Another option to consider is using R (Humulin R) insulin to help bring him down. That's what I bought at the local pharmacy (we don't need prescriptions for it here) and I believe Marje mentioned there is another R that costs less (Novolin R perhaps?) I think you've seen the discussions on this on Ozy's condo. What questions do you have about it?

Some things for you to consider. You don't have to worry about them today, of course, I just wanted to put them out there for you when you have time to think about it.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522

Thank you Julie! I think Matty is on the mend. The viruses can last 1-2 weeks so we are hopefully at the tail end. Whooping cough is an awful disease. Glad your niece is okay!!

I am not opposed to a larger increase since we are this high. My DH and I were just talking about, even without an IAA diagnosis, it's obvious there's some kind of resistance there, so would it be prudent to treat him as if he had the resistance to get his numbers down until we can get the test? I understand what you mean about getting ahead instead of chasing the numbers down.

I'm not opposed to the R either. My first question is how do I know when to use it? Would I have used it today when his number jumped over 500? I noticed on some people's SS, the R is used for a short amount of time. Is that because it gets the numbers down and the liver learns more wuickly? How do I get the R? How much is it usually? Is it OTC or do I need to talk to the pharmacist but they can sell it without a prescription? How closely do I need to watch Cobb after injecting the R? Would I ever inject both L and R at the same time? Are there any additional risks associated with the R, other than hypo?

He was doing so well with his pink surfs and then the ugly black number reared it's head.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381

Good job, Mr. C, bring those numbers back down. We want to see yellow! Sending vines for Matty, poor guy. :sad:
Liz
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +6 390 +9 344

Cobb is coming down nicely this afternoon. Maybe a fluke this morning? Crazy cat! :roll:
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +6 390 +9 344

Good Job Crazy Cat! Now, go a little lower, I double dog dare ya!

Rebekah and Ole
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291

In the words of Barney Stinson, Rebekah, "challenge accepted!"

WTHeck Cobb?? I'm liking the number but incredibly confused by today's cycle? Did I sleep through a dip & bounce last night??? I don't see anywhere in that 12 hours it could have happened.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522

cobbsmom said:
I am not opposed to a larger increase since we are this high. My DH and I were just talking about, even without an IAA diagnosis, it's obvious there's some kind of resistance there, so would it be prudent to treat him as if he had the resistance to get his numbers down until we can get the test? I understand what you mean about getting ahead instead of chasing the numbers down.

I'm not opposed to the R either. My first question is how do I know when to use it? Would I have used it today when his number jumped over 500? I noticed on some people's SS, the R is used for a short amount of time. Is that because it gets the numbers down and the liver learns more wuickly? How do I get the R? How much is it usually? Is it OTC or do I need to talk to the pharmacist but they can sell it without a prescription? How closely do I need to watch Cobb after injecting the R? Would I ever inject both L and R at the same time? Are there any additional risks associated with the R, other than hypo?

He was doing so well with his pink surfs and then the ugly black number reared it's head.

He could also have acromegaly - that's more common than iaa, although a fair number of kitties have both. For now, several of us are talking about a good strategy to help move him out of high numbers. In the meantime, let's stay with the same plan, so don't make dosing strategy changes from what you're currently doing (4 cycles, if everything's over 300, increase by 0.5u) until we get back to you.

It'd help if we got a little more info.

One thing that can affect cat's BGs is if a cat's dental condition isn't perfect. Diabetic cats tend to have bad teeth - not all, but the potential is there. Have Cobb's teeth & gum ever been looked at by a vet or cleaned? does his breath smell bad, not just like cat food, but bad? if you look, do you see any red areas near the gumline around his teeth?

Another question - i think you've mentioned before, but would you repeat what his feeding patterns are? When he is fed, if it's on a schedule or grazing, and what he's eating.

Sometimes infections can raise BGs - do you see any signs that might say "infection brewing?" overall, is he mostly energetic?

In response to your questions - R can behave differently in iaa cats than others. So we would choose the "Right" time to try using R, depending on his cycle and your schedule, and one of us would monitor him with you. We would start with a miniscule dose to see if he reacts to it. then you would check his BGs for the subsequent 5 hrs or so, so we could determine how he reacts to it. If he doesn't react, then we would try it again a different day with a slightly bigger dose.

I'm actually thinking that I saw a reference on the High Dose forum by Jojo (former advisor here) that the way a cat responded to R was one indicator of iaa. So it might tell us something about that.

You seem very level-headed and well able to handle this. I just want to add, because there are always people who read everything posted, this isn't a tactic for someone to apply to another cat. it needs to be done carefully. So lurkers, don't copy.

R isn't used as a primary insulin except by vets because it will bring cat's BGs down, but in the average cat, it's duration is about 4 hours and then it's out. in iaa cats, it can last significantly longer. my experience with an acro cat is that it lasted about 4ish hrs and was out. One of the nice things about it is that you can really lower the range overall with it. Overall, cats do best with a long-lasting insulin like the Lantus/Lev insulins, so R is used as a "bolus" insulin to supplement the L (basal) insulin that provides longer support.

In Oregon we can buy R at any pharmacy, no prescription required. The Humulin R was about $65 when i bought it at least 2 years ago. One bottle that's practically indestructible. I still had at least 1/2 vial left when punkin died. I want to say the Novolin R is more like $25 - but I'm repeating what I heard second-hand, so you'd want to check on it. Either one would work. I don't know if your state needs a prescription for it or not.

You do need syringes that can measure a very tiny amount. Donaleen ended up ordering syringes that would make that easier. The Terumo thinpro from American Diabetes Wholesale cost something like $13.79 and have a nice long thing barrel that lets you measure small amounts. The first dose to try would be 0.1u, so you might play with your syringes and see if you can measure that amount with whatever you're using. There are pictures of tiny doses on the New to the Group sticky. you can draw up 1unit and then, holding your syringe needle up, "screw" the plunger to press out drops. If you can get 10 drops out of a unit, that is the equivalent to 0.1u per drop. Donaleen's syringes would only work 4 drops out per unit. I suspect the difference might come from how fine the gauge of the needle is.

There are no other risks associated with R, other than hypo, which is true of any insulin injection. You do have a hypo kit (extra strips, high carb gravy cat food or karo) already pulled together, right? if you don't, you need one. A lot of people put an unopened box of strips away so they always have 50 available. If you have a low numbers run, you can go through 20 pretty easily in a day.

Yes, there might be a time when you inject both Lantus and R at the same time. We time things carefully so that the nadir of L and the nadir of R do not hit at the same time. We'll figure out the onset of R, the nadir and the duration of R by doing a test with one of us that have used the R. So timing is very important. If you want to go this route, we'll pick a day and a time in the cycle when his numbers are "right."

*whew* did i overwhelm you with info? what other questions does this bring up?
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291

if we ignore that 522 this morning (sometime strips are wonky), he's dropped steadily since amps. that might mean that we're seeing a bounce clearing. anytime you see steadily dropping numbers with no nadir during the cycle, that makes me wonder if a bounce is ending.

i'll cheer him dropping into yellow anytime! now if only we could get him to like blue and green better!

as though you need something else to do! but you're going to want to watch him tonight in case he keeps going down.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291

Ok. Let me know what you all come up with.

DH isn't sold on the R just yet... mainly because his numbers kind of come down and then bounce back up. But he fully admits he isn't the one doing this and hasn't read and researched as much as I have. He'd like to give Cobb a little more time doing what we're doing since we are seeing some progress. I also think he'd like a diagnosis lf something else before we switch gears to the R. That being said, we'll cross that bridge when we come to it.

As for the hypo kit, I have the Karo and HC food. I would have extra strips if the post office had delivered them yesterday when they were supposed to. We're going to Walmart tomorrow to pick some more up, but if he starts dropping tonight, I'll send DH... the Walmart is about 10 minutes away. We should have enough to get through the night.

As for your other questions...

Cobb does not have bad breath, other than cat food breath. Cobb has never had his teeth cleaned. Several vets have told me that they would have to sedate Cobb to do a cleaning, and given his near stroke experience when he had his bladder blockage a few years ago, they have all recommended against it. That being said...I know he did lose a tooth about a year ago. But he never seemed to be in pain from it so we didn't know until a vet visit. I will put dental on our list of things to discuss with a new vet.

There are no signs that an infection is brewing. He is much more energetic than he's been in years really. He is jumping all over the place... being his former PITA (pain in the ***) to be honest. He laying on beds instead of under them, and in the past week he's stopped laying in the baby's closet. He moved there from our bathroom where his food is. He's out in the hallway now. And he has stopped peeing in our living room. New food and me joining here coincided with me doing a massive cleaning of that carpet. But he hasn't peed anywhere outside his box since the food switch,

Regarding his eating habits... he is fed on a loose schedule, meaning I put down 1/2 can at 8am and 8pm. Those are his shot times. Sometimes he eats it immediately, sometimes he leaves some to eat later. For the 8am feeding, it is usually all gone by 1pm. His evening feedings are a bit different because he is a PITA if he doesn't have any food overnight. He eats the majority of what I leave down immediately. I leave another can, split into 2 feedings in a timed feeder, which deploys around 10p and 2:30a. He eats both of these completely. He is eating Friskies Special Diet off Dr. Lisa's list. The whitefish (4% carbs), turkey and giblets (5%), and beef and chicken (5%)...all pates.

Talking about acro, what is the treatment for that? I've been trying to read up on it, but there is very little information. Reading through the symptoms, Cobb really only has the high dose. The hunger was there when he was on dry food... not so much any more. And then he hasn't made any snoring sounds since the food switch either, so that may have been weight related - not that he's lost a lot of weight, but he looks more tone than he did 2 months ago. What I've found is that radiation is the treatment for acro? Is that the only treatment available? If I know I'm not going to do radiation on a 12yo cat, does it still make sense to get him tested for it? Just curious...

I'll definitely get a +2 to see where we're headed tonight since he threw this low number at me unexpectedly. It's the weekend so DH is home to help with Matt. Right now he's holding him in the rocker, and they're both asleep. I wish I could figure out how to post a picture, it would melt your heart!!!
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291 2

+2 is a probable food spike. DH accidentally gave a whole can and he ate most of it. But he rarely drops at +2. Cobb usually nadir around +7. We'll keep an eye on him tonight and hope he surfs the yellow wave or even finds a blue valley to explore tonight!
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291 2

Paws crossed Cobb finds the yellow brick road again tonight. To upload a picture, use the UpLoad Attachment tab below the text entry box and you can load a picture from your computer. But it has to be small enough - it will tell you if it's too big. Other people post pictures to something like photobucket and use the IMG button to point to it. Sounds like a cute pic. :-D

I saw your question about treating acromegaly. The "gold" standard is SRT or stereostatic radiation therapy. Neko, Pepper/Nancy, and Punkin/Julie all did that at Colorado State University. Neko was 11, Pepper 15 and Punkin older than Neko (can't remember exact age}. CSU is one of two places in North America that does SRT, which is four days in a week of imaging and radiation. Other places offer basic radiation which is a once a week for many weeks treatment. Both of these options require time/travel and $$. Not everyone can afford both. Without treatment, the option is to manage the disease, which means treating the diabetes symptoms and being aware of the effects of the growth hormone. Tommy/Lauren (photosquirrel) is a great example of this. Until Tommy's urinary issues this year, his SS was a sea of green and blue and he's 19 this year. The main issue to manage is organ growth and watching for heart growth, which can be treated but is a side effect that is often not visible until it is too late.

Not all acros have obvious symptoms. Neko never did snore. Her main symptom was intense fascination with food. She also didn't like bright light.
 
Re: 1/3 Cobb AMPS 454 +2 428 +3 522 +5 381 +9 344 PMPS 291 2

suzanne, thanks for answering all of those questions! woot!

the role of R is to pull the numbers down so the Lantus can work better with them. Sienne uses the example of R being a speedboat and easy to turn, where Lantus and Lev are more like moving barges. They are very good basal insulins, but you can only increase so quickly with them and the numbers take longer to respond. R can dart in and out, relatively speaking.

We did the SRT when punkin was 12. wouldn't have thought i would do it, but . . . the stars aligned and i made the decision to go. i'm not sorry, but yes, it was expensive. I talked a number of times with Dr. Lunn, a leading acro researcher who was at Colorado State and is now at Univ of N. Carolina at Raleigh, about the treatment. It doesn't solve everything - punkin did remain diabetic although some cats go off of insulin, but his dose dropped from 15.5u and rising fast to 4.5u at its lowest point. His voice had deepened - someone told me he sounded like a pack a day smoker when he meowed - and that didn't revert back to what it was before, but it came some towards normal. His pupils were blown open from the tumor pressing on his optic chiasm and they did return to partially closing. they never went back to slits again.

Dr. Lunn did tell me there is nothing wrong with just giving more insulin as the cat needs it. It's a personal decision that only you can make. Lauren did wonders with Tommy by not being afraid to press on with the insulin, get his numbers down and keep them there. She's been a role model for just using insulin. At 19, Tommy is now nearly 3 years past his acro diagnosis, which is pretty good.

eta - i forgot to respond about the dental part. all cats have to be sedated to get dentals. if he's had teeth falling out, he probably needs one. for whatever reason, i've heard many of the cats here have issues with FORL - Feline Odontoclastic Resorptive Lesions http://www.dentalvet.com/patients/cats/could_my_cat_have_a_forl.htm Those can result in teeth coming out or needing to be pulled. We have seen that some cats insulin needs can really come down when they get their teeth taken care of. I don't think we can say it's likely that his nearing 10u dose is from only that, but Sandy/Black Kitty said that getting his teeth taken care of made a dramatic change in BK. I'll let her tell you the story.
 
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