R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11 271

Good morning,

After diving deep into green fields yesterday, Rocky has settled on 319 for his morning BG. He visited 503 last night as well, and then I went to bed.

I did give him the reduced dose of 1.50u this morning. I hope that his liver can learn to use it.

Rocky's recap of yesterday's ride:

Re: 3/5 Rocky AMPS 319 +2 193

Here's the link to yesterday. Nice overnight recovery by Rocky. Great to see those blues already. Looks like he's in a hurry to get somewhere today.

Re: 3/5 Rocky AMPS 319 +2 193

Re: 3/5 Rocky AMPS 319 +2 193

GREAT to see that recovery from the bounce yesterday. that's fantastic - to clear the bounce in just a day means that he's getting more accustomed to the lower numbers. i hope he continued down into green numbers again today.

hope you've had a good day, tina!

Re: 3/5 Rocky AMPS 319 +2 193 +304 +6 415

Hi everyone,

I was so busy today that I have not had time to post anything at all but have still been getting the blood test. Unfortunately, after that pretty 193 in blue he went sky high. He hasn't recovered from those hours spent in the green pastures yesterday.

I just feel like I am doing something wrong and it makes me want to cry. All of you cats recover from those bounces so fast and Rocky takes forever. I just don't know what to do any different to make the recovery time shorter for him.

In addition, while he did eat all of his food this morning he did not wolf it down as he always does. He also does not seem as chipper as he did when he was in those too low of greens. He was active, alert, on his toes while too low. No wobbling or anything like that. Now he is sleepy, eyes half closed, and not so excited about eating his poke treats.

For the first time I am worried that he might not be interested in dinner in about 5 hours. I was thinking of moving his shot time BACK by 1/2 hr tonight to 10PM, instead of at 10:30pm. Not sure if that would help him or hurt him more.

Re: 3/5 Rocky AMPS 319 +2 193 +304 +6 415

so his 193 was just a wobble about in the highs of the bounce, rather than the beginning of clearing it. that's ok.

there is only so much we can control with the FD. if you can get him any exercise, that's about the only thing i could suggest to do differently than you are already doing. beyond that, you pretty much have to wait while his body gets used to the green numbers and stops bouncing from them. control what you can and try not to let the parts you can't control get you too down.

it's not true that all the other cats clear bounces quickly. some do, some don't. that's very individual and it can change. you can think they've stopped bouncing, but then if they get sick or something and get into higher numbers, my experience was that they can quickly get unaccustomed to the lower numbers and then begin bouncing again. whoever named this a dance - well, it's an appropriate description.

if he is still high 1/2 hr before his usual shot time tonight, it wouldn't hurt to shoot him a few minutes early. it might or might not make any difference. then your shot time tomorrow would be 12 hrs from whatever time you give the shot tonight.

if he looks like he's clearing the bounce and his numbers are coming down when you check him at 11.5, then i'd probably stick with the usual time.

Re: 3/5 Rocky AMPS 319 +2 193 +304 +6 415

Tina - I know how frustrating bounces can be. :YMHUG: Neko took FOREVER to get better at bounces. I've been at this over 2 years with her and I'm still seeing improvement. But, her IAA makes things a bit trickier and in January she was back to being the bouncing queen. The fact that Rocky tried to clear the bounce earlier is a good sign. He's doing way better than Neko did this far into the FD dance. Some cats just love to bounce. And some bounce practically all the way to remission.

There's not much you can do but try to follow the protocol and maximize the amount of time he spends in safe green numbers. His liver will learn.

Re: 3/5 Rocky AMPS 319 +2 193 +304 +6 415 +10 481

Thank you Julie and Sandy. I wish his liver was a fast learner. I would be interested to know your feeding times for your kitties to see if that might make a difference in clearing a bounce.

I wanted to move his shot time back to 9AM, so, because he is going higher, I will move him back to 10PM tonight and see if a dose of the 1.50u helps him any. He has been getting his shot at 10:30PM for two days now.

Re: 3/5 Rocky PMPS 362

I gave Rocky his PM shot at 10PM instead of 10:30PM tonight. His BG had dropped from 413 to 362.

Re: 3/5 Rocky PMPS 362 +1 403

Seven hours, if not eight hours, in the red today.. not good.

Use (R) when Rocky bounces?

Over the past few weeks it has become apparent to me that Rocky does not clear a bounce very fast. I was reading through a condo of Cobbsmom and say that she used (R) to keep him from bouncing after those hours his pancreas and liver spent in the green zone.

Can I use this for Rocky too? Can someone please take a look at Rocky's SS and see if this might be a safe idea for him that will keep his organs more in a normal zone rather than taking a high road?

Thank you!

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309

Hi Tina,

I can't offer any specific dosing advice, but I just wanted to share my experience in case it makes you feel any better. We've only been using Lantus for a few weeks, so take this for what it's worth. At first, Jersey seemed to be clearing bounces in 1 to 2 cycles. She's been bouncing for the past several days, though. Right now, we're on cycle #6! I broke down in tears last night and told my husband I felt like we were just sitting back while we watched Jersey die. :cry:

Anyway, I know my response doesn't solve your problem. I just wanted to let you know that you aren't alone - I know how frustrated you feel right now, and I'm sending out prayers for you and Rocky.

Shelly

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309

Awww..thank you Shelly. I'm sorry your kitty is having a rough time clearing a bounce.

Yes, we feel the same about our kitties. Was it suggested to you that you might use (R) to help with a long bounce? I don't know anything about (R) but I am curious why some folks are using it to help keep numbers low while their cats BG numbers are going higher after a string of green numbers.

I think it would be better to try to help Rocky's BG numbers stay within a lower range rather than to let those numbers touch the sky during a bounce.

Rocky was in the RED for 7 hours yesterday. Even right now he is STILL in the stinky pinkies.

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

Hi Tina,

I totally get the reds. We were there for probably 12 hours yesterday, had a black this morning, and are now in the stinky pinkies. Where's the little smilie that has an "ugghhh" coming out of its mouth?! That's the one I need!

No one has actually recommended that I use R to help with bounces, but my vet did tell me to use N this past Tuesday. N is what we started out with, so that's what I had on hand. I actually asked about this in my daily condo, and Sienne and Marje gave me some great information. In all honesty, I don't know that I would do it again. The N didn't seem to have much effect on Jersey, and I wonder if it may have prolonged our current bounce???? I just don't know enough about the Lantus yet to feel comfortable managing two different insulins. It scares me a lot - especially since we lost a diabetic kitty many years ago due to what I believe was hypoglycemia. (He was boarded at the vet's office at the time of his passing.)

If you're interested, here's the link to my condo where we discussed N as a bolus: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=114849.

Hopefully, the experts here will be along soon to help you with Rocky. Besides the information they gave me on Tuesday, I simply don't know anything about R (and very little about N). In the meantime, I would loan you my patience pants, but I don't know if I could do without them right now!

Shelly

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

Hi Tina:

Just a suggestion: You might get more eyes on your condo and answers to your question if you start a new condo with today's date and something line "Add R?" in the subject line.

I feel your frustration. Try to keep in mind how far Rocky has come since you got to LL. Remember that this is a marathon, not a sprint. Sending good vines to you both. :YMHUG:

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

Looks like Rocky is coming down again. i feel you on the bounces! it's still happening w/ Tess too, sometimes better sometimes worse.

We considered R for Tess, but the advisors thought that her bounces were just too unpredictable, so we are left w/ waiting it out.

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

Hi Tina,

Since you've seen my condo where I'm using R, I'll weigh in on my experience. You'll notice Cobb is on a lot of insulin, which suggests some kind of insulin resistance. Cobb is, for some undiagnosed reason currently, a high dose kitty. R was suggested to me, not really for Cobb's bounces but as a secondary tool to help being the BGs down so the Lantus could work better. But you have to consider that I've added a drop - literally, a drop - of the R to a dose of 33 units of insulin a day. To be honest, this last time was the first time I felt the R did anything. I feel like it stopped the bounce, but even with it, Cobb hasn't returned back to those green numbers just yet.

R is incredibly powerful. A drop...a tenth of a unit...brings Cobb's BG down about 100 points within 2 hours. A bigger drop could set up a bigger bounce, and could instigate a hypo episode. You have to be vigilant with R because it is in and out of the system quickly, within 4-5 hours. You cannot mix up the vials - ask Rebekah how awful that experience was. R is not a tool to be taken lightly.

I'll leave it to some if the other R users - Julie, Marje, Sandy - as to whether you should try it. You have to be around to monitor, and you have to listen carefully and follow what the advisers tell your- a drop literally means a drop. It's so small that you are unsure if any got in.

~Suzanne

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

Hi Suzanne, Shelly, and Anne,

Thanks for weighing in on R. Yes, I could see how even one drop might instigate another significant drop in BG and then the possibility of another bounce. However, Rocky's bounce numbers are very high to me, and i would be willing to try just one drop if it was going to bring those BG numbers into the 200s rather than the 300 and 400 level.

Research in humans and mice has shown that organ damage begins to occur when the blood sugar is above 140. If you look at Rocky's SS, since January 10, 2014, Rocky has spent WAY MORE hours and days in the pinks, reds, and even touched a few blacks, with a BG of above 140.

I have been reminded many times that this diabetes/insulin dosing is a dance, but it seems to be a dance that Rocky's liver is not learning. I am wondering if it can ever learn to do this dance, and in that case, as his caretaker I should do whatever it takes to keep his BG as low as I can keep it as his liver is not doing it.

I woke up at 4AM and took Rocky's BG both yesterday and today specifically so I could get his Nadir. It was above 300 on both days.

I am not sure if "R" or "N" would help or hurt Rocky. I guess one wouldn't know how their cat might respond until it was used on their cat.

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

I really so understand your concern about the high numbers. I will share this with you. Cobb spent almost 8 months after starting insulin above 400...usually above 500. However, I know he was diabetic for a year before that - as a previous vet told us insulin wasn't needed and we could just control the numbers with diet. So it is very possible that his numbers have been above 140 for almost 2 years. At his previous two vets visits, he had no other health issues. Heart was fine. Lungs were fine. Blood tests, except the diabetes, were perfect.

I don't say that to diminish your concern at all. Just to share our story of spending a great deal of time up in those horrible numbers!

And Cobb still bounces into the 300s after dropping some times. We have a beautiful rainbow on Cobb's SS. This is the first time his bounce has been stopped in it's track with the R and brought back down into the 200s. Was it the at? Or is his liver finally learning? We'll never know for sure - as I'm never sure he actually gets his drop of R. It is so unmeasurable!

Rocky earned his reduction (something Cobb has yet to do), which means his liver is learning. It is just freaking out! :smile: In my opinion, no need to be as concerned as you are about his liver not learning. You're at a reasonable amount of insulin right now.

And keep in mind, a lot of people who use R either have cats who bounce uncontrollably or who have either diagnosed or suspected high dose conditions. I don't think Rocky is that uncontrollable in his bounces just yet. Are they higher than you want? Definitely. But his liver will learn!

Also, R is incredibly nerve wracking (to me at least) because it is so hard to measure. I want to give him enough, but not too much!! That +1 test after the R is given always has me holding my breath.

Re: R?? 3/5 Rocky PMPS 362 +1 403 +3 338 +6 346 +10 309 +11

First, I wouldn't use N as a bolus insulin.

I also don't think Rocky is bouncing all that long. What is happening is that his numbers come down, he bounces, and then his numbers are back in the blues or lower within 1 - 2 cycles. I don't think that R may be useful in this scenario.

Just my 2 cents.