1/10 Alex AMPS HI ~Increase?

Discussion in 'Lantus / Levemir / Biosimilars' started by Caryl & Sebastian & Alex (GA), Jan 10, 2010.

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  1. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    I only gave a tiny bit of R but I had to give some to try to push this down a little as it has seems that present Lantus dose doesn't get Alex down very far from "HI".
    I was so hopeful that last night was something good happening cuz I didn't give any R and I thought the R from 3:30 in the afternoon had worn off :YMSIGH:

    It has been 7 cycles on this dose now.

    Alex ate big breakfast, had his flagyl and shots I'm going btb for little longer I-)

    Morning everyone. :razz:

    yesterday
     
  2. Pat+Raja+Shadow (GA)

    Pat+Raja+Shadow (GA) Well-Known Member

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    Dec 28, 2009
    Enjoy your btb...I am thinking I will do the same....hope you and Alex have
    a good day today!
     
  3. Carolyn and Spot

    Carolyn and Spot Well-Known Member

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    It's rebound. You have read about it in the stickies right? That's what I am trying to tell you, your R is causing this, not helping it.
     
  4. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Yes, I read what you wrote but Lantus alone will only bring him down so far this time around and at this dose, and I'm not willing to let Alex sit in the 300's for longer than i know he should even if it's nice and flat. Not at this dose. I appreciate what you're saying but I know my cat. he gets ketones in the 300's. 250 used to be a great dose for him without any R. Right now it isn't. Right now 400 isn't. When something keeps him below 300 without any R I will happily use it. :smile:

    If you check back to Dec 31st this was already tried at the advice of Cassandra for 4 cycles and it didn't get Alex down fare enough that time at that dose the R was added back in
     
  5. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Re: 1/10 Alex AMPS HI,+2~325,+4~250

    .
     
  6. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Caryl,

    Please look back at your SS from the last time you gave up the R - about 11/27 or so. It took more than 4 cycles for the bouncing to work out of Alex's system, but he became much more flat after the R was stopped. The R is making this worse. The R is driving him above 300 and causing you to have to use it again. It has become cyclical - you use R, numbers go down and then go up, and you have to use R again. Alex's body is fighting the R. You may like the BG's that it temporarily gives you, but it is not solving the problem - it is making it worse.

    Many other ketone prone kitties have come through here and worked up to the correct Lantus/Lev dose without the use of R. No one is saying that you shouldn't use it if you have a high positive blood ketone reading, but using it just to combat high numbers is not helping.

    We all want to help you. Carolyn is incredibly skilled and knowledgeable in this area. She is giving you great advice.
     
  7. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    i didn't say no... I said he needs an increase in Lantus (I think the idea is to use SOMETHING to prevent a high positive ketone reading be it a higher dose of Lantus OR R. Once you get high ketones you have a lot more to worry about than giving R, right)?

    EDT: THAT(11/27) wasn't the last time I gave up the R. And that time i sure didn't mind, I was THRILLED. Look at what his numbers were for the most part. That was the best he was doing since he was dx'd. He only hit red or pink a few times in a at least a couple of weeks there.

    The LAST time I gave it up was when I got a a dose increase to 3.50 and was asked if I would test it without R and I did. That was New Years Eve and he never got very low at all. He didn't bounce. His numbers didn't move much. I was hopeful when he got to 286 but he never got any lower than that and I was 'advised' to increase his dose and give him R if I wanted to after 4 cycles.
     
  8. Cassandra and Sasha

    Cassandra and Sasha Well-Known Member

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    Ketones are a problem, yes, but there is a difference between ketones and DKA. Are you thinking of DKA? You have the supplies to test daily for ketones. Keep watch of them with the blood meter - that is the most accurate assessment of ketones. If you test daily, you will catch them before they get to a high reading. You cannot dose either insulin based on the assumption that he will form ketones immediately, though. That's what you've been doing and it's not working as you can see.

    I was referring to the last time you gave it up for a significant amount of time. From what I see on the SS, that was around Thanksgiving. It took more than 4 cycles for Alex to stop bouncing after you removed the R. His numbers were better then once he stopped bouncing because the R was gone. That is the point Carolyn is trying to get across, I believe.

    Do you know what blood ketone reading level Alex begins spilling ketones into his urine as trace?
     
  9. Ronnie & Luna

    Ronnie & Luna Well-Known Member

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    How u doing Caryl? Any updates since that sunny 250? How's Alex feeling?
     
  10. Carolyn and Spot

    Carolyn and Spot Well-Known Member

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    Caryl,

    I am not understanding why you are not hearing me tell you that the R is responsible for these very numbers that you are fighting.

    I told you two days ago his basal insulin could use a bump and the R needed to be discontinued. You did neither. You need to understand that R should not be used in cats that are curving well. R is not meant to shoot numbers down. It is meant to help break high flat numbers and in emergency cases it will be used in diabetic ketoacidosis treatment, but you generally will find it used in cats with Acromegaly, Cushings or IAA on this board. Your cat has none of these. Unfortunately it CAUSES high flat numbers in cats that don't need it. These big numbers you are seeing are the result of something that happened in the previous cycles, not the result of "not enough R". Look at the forest, not the tree. Look at his spreadsheet. Scroll up, then down, then up again. See where it got bad?

    This is not a situation where you should be trying to shoot numbers down, this is a situation where you should be gently and patiently dropping his Lantus curve by systematically and methodically increasing his dose, because that is how you treat a cat using Lantus. If you try to force it, it will backfire on you, and it *is* backfiring on you. Lantus should never ever be responsible for 200 and 300 pt drops, because you will then see an equal and opposite reaction on the way back up. If you can not be patient with this insulin, you will incur a permanent rebound situation and possibly wind up with a cat with glucose toxicity.
     
  11. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Ketones are a problem, yes, but there is a difference between ketones and DKA. Are you thinking of DKA? You have the supplies to test daily for ketones. Keep watch of them with the blood meter - that is the most accurate assessment of ketones. If you test daily, you will catch them before they get to a high reading. You cannot dose either insulin based on the assumption that he will form ketones immediately, though. That's what you've been doing and it's not working as you can see.

    I well know the difference between ketosis and DKA. For Alex it's about 12 to 24 hours for ketosis, 36 for DKA. I have ketodiastix and a limited number of blood ketone strips. Unfortunately even getting the latter on ebay I can't afford to randomly test every day with them(although I have been doing it the past few days up until today) so I try to get a urine test as often as possible. Fortunately for me, Alex's breath has been foolproof. ECID, it has been foolproof. Maybe I get scared, and jump the gun with the insulin..but Alex's breath has never been wrong.

    I was referring to the last time you gave it up for a significant amount of time. From what I see on the SS, that was around Thanksgiving. It took more than 4 cycles for Alex to stop bouncing after you removed the R. His numbers were better then once he stopped bouncing because the R was gone. That is the point Carolyn is trying to get across, I believe.

    Yes, you're right..but we were dealing with much lower numbers so I wasn't scared at all. He was coming down from PS numbers very quickly by himself.

    Do you know what blood ketone reading level Alex begins spilling ketones into his urine as trace?[/quote]

    Yes, at about 3.5, but like I said, I can't keep using those strips like I do glucose strips. They are very expensive and I unfortunately can't afford to use them unless he is sick or I suspect ketones..like over the past few day when he had diarrhea and vomiting, when ketones may have been likely. His breath is a really great barometer otherwise.
    (when I say I don't have the financial means-for reasons beyond my control- to do certain things, I'm not being contrary. And I've said this many times, too many times on this very public baord to be comfortable any more. I honestly just don't. For myself, Alex, Jackson, my mother...nobody. If I did, Alex would have been to the "Cat Mayo Clinic" already..believe me.)
     
  12. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Caryl,

    I am not understanding why you are not hearing me tell you that the R is responsible for these very numbers that you are fighting.

    I told you two days ago his basal insulin could use a bump and the R needed to be discontinued. You did neither. You need to understand that R should not be used in cats that are curving well. R is not meant to shoot numbers down. It is meant to help break high flat numbers and in emergency cases it will be used in diabetic ketoacidosis treatment, but you generally will find it used in cats with Acromegaly, Cushings or IAA on this board. Your cat has none of these. Unfortunately it CAUSES high flat numbers in cats that don't need it. These big numbers you are seeing are the result of something that happened in the previous cycles, not the result of "not enough R". Look at the forest, not the tree. Look at his spreadsheet. Scroll up, then down, then up again. See where it got bad?


    That is what I've been waiting to hear. Whether I could increase my dose and to what, at which I would try to not use any R. That is what is in the subject line of my condo today.....I thought that seemed pretty clear?


    This is not a situation where you should be trying to shoot numbers down, this is a situation where you should be gently and patiently dropping his Lantus curve by systematically and methodically increasing his dose, because that is how you treat a cat using Lantus. If you try to force it, it will backfire on you, and it *is* backfiring on you. Lantus should never ever be responsible for 200 and 300 pt drops, because you will then see an equal and opposite reaction on the way back up. If you can not be patient with this insulin, you will incur a permanent rebound situation and possibly wind up with a cat with glucose toxicity.[/quote]
     
  13. Carolyn and Spot

    Carolyn and Spot Well-Known Member

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    You're serious?

    I thought this was pretty clear when I said it two days ago:

    Slowly means same increments as before.
     
  14. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    thank you, Carolyn, it's good to have a set of eyes here with more experience reading spreadsheets that include R.

    Caryl, I think what Carolyn is saying is that the R is giving Alex really fast drops, and those fast drops are setting him up for big bounces, which you then shoot more R into and cause ANOTHER fast drop, etc. His R doses are too big now and they are just compounding a difficult situation. To come down from HI to 325 in 2 hours is too fast a drop, better would be say HI to 450 or 425. Better would be to try to not cause him to go to HI in the first place.

    FYI, you don't need permission to increase the L dose, especially when it falls within the parameters of the protocol. :smile:

    Is your flagyl in a liquid suspension?
     
  15. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Dec 28, 2009
    You're serious?

    I thought this was pretty clear when I said it two days ago:

    Slowly means same increments as before.[/quote]

    Yes of course I'm serious.....

    No OFFENSE, but I really had no idea who you were before 2 days ago and I wasn't used to taking advice randomly.


    I expected that advice to come differently and from someone I knew...I'm really not as dumb as I may seem to you, as I know what 'slowly' means. If things have changed around here, I hadn't gotten the memo and like I said, I didn't have any idea who you were.
     
  16. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    No, I'm not using Flagyl liquid but I don't 'dry mouth' the pill.
     
  17. pjstroop

    pjstroop Member

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    Hi Caryl..

    Glad that your increasing the dose thise evening. From one FD mamabean to another.. I know how difficult it is to see your cat lurking in the 300's, 400's, and that ugly looking black number (or HI).. Pepper's numbers may look good now, but they were not always as pretty.. We've been here coming up on two years and it took us eight months (we were previously on vetsulin) before we saw some sense of regulation. It took 5 units before we saw some breakthrough for Pepper.. so it can be done without R. I have no experience with R.. so I won't even go there. Please take another peak at Pepper's SS (2008-2009) and the dosing procedure we used with Lantus. It's a procedure of working your way up and working your way down.. And then doing it all over if need be :mrgreen: Another one who is similar is Barbara and Tuffy.. I think it can be difficult when you have a high dose kitty and you see that others only have to use minimal amounts of Lantus to see breakthrough. It doesn't always work with some kitties.. ECID..

    This is just another perspective of letting the Lantus work its magic!

    Hang in there ((Caryl))

    ETA: Check out Janice and Spike's SS too... this is another higher dose kitty on LL.. without R..
     
  18. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    THANKS Paula ♥
    Thanks for the support :YMHUG:

    Know of any ketone prone kitties that have done this without any R????(I know, I know, give 'em an inch) :mrgreen:

    xoc
     
  19. pjstroop

    pjstroop Member

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    Know of any ketone prone kitties that have done this without any R????(I know, I know, give 'em an inch) lol!

    Why yes! Pepper had trace ketones while on vetsulin and the first few weeks of Lantus.. I know.. where is this in my profile!
    However, he was not DKA as Carolyn had mentioned. My vet during the transition from vetusulin to Lantus kept Pepper in the clinic with him for 6 days.. $$$$$$ chi-ching!! There he did receive some fluids (due to ketones), and a dental..
    Poor Pepper.. and poor pocket book! However, Pepper had some bad gingivitis going on (just another thing) and bacteria in the mouth gets into the blood stream.. hence.. causing the higher numbers too..

    Therefore, when we started LL.. the J-team (nostra jojo) were very aggressive with Pepper's increases due to his history..

    I just see similarities with your Alex and feel the frustration.. :mrgreen:

    Off to make dinner... mac n cheese anyone??
     
  20. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    THANKS!!!!, increases should be aggressive with ketone kitties.
    Enjoy the mac and cheese---and send some over
    :mrgreen:
     
  21. Carolyn and Spot

    Carolyn and Spot Well-Known Member

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    As I said at the time, I was trying to help you as a user who has had well over a year of R experience and 4 total diabetic cats in treatment over the last few years. I can clearly see that you're not interested in learning, and that you're only interested in being correct. I do not have time to argue about things that I actually do know, especially with the unwilling. Several people have told you who I am. I am sure you can find someone else whose advice will mean more to you than mine and at this time I bid you good luck and adieu. :)
     
  22. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Well, then you don't know me at all. Like I said in a post a week ago a lot of things get lost in translation when communicating this way. I couldn't give a darn about being right as long as I help my cat. How can I be correct about most things that I know nothing about? However, I THOUGHT I had to wait for an ok to do certain things around here and I THOUGHT they had to be handed to me. Nothing more and nothing less. On my end it's simple. No ego involved. I've only been here since September. I am not an advisor to anyone. If this is what is meant by "spirited interchange" I have enough problems...I just want to do what's right for my cat and follow the 'rules' of this board, as I thought there were rules. And that is fine with me because I need the structure as far as dosing is concerned as long as someone will help me when I feel that Alex is in danger and that's why I tell strangers in pet stores that this board is so great. When talking to me, ketones always have to be addressed because they are more important than anything.

    To be honest, no, I don't like the way you spoke to me. You came at me and came at me and came at me about the dental thing and if I chose to stop that conversation I am a person too and I have the right. I have been down that road before and I have a dental regimen for Alex for the time being.

    Maybe you DO know more about R than everyone on this board, but I've done nothing to you to elicit the sarcasm that you feel that you need to use when posting to me. I'll continue posting and If no one wants to help me out of friendship to you, well I guess it's Alex's loss then.
    Good luck to you too and adieu to you as well.
     
  23. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Re: 1/10 Alex PMPS 426,+2~392,+4~347

    Hopefully it will have gone down some by the morning....
     
  24. Carolyn and Spot

    Carolyn and Spot Well-Known Member

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    I was not actually going to respond to this post but I think that guilt-tripping people who have been trying to help you since you showed up here is unfair. If they choose not to help you, it is not out of friendship to me, it is out of your attitude with them. You are correct in that I have not posted in your condo before two days ago, however I have been reading your condo for almost 2 weeks now and decided to help out the girls here in LL since you were consistently refuting their help and observations rather boldly for someone who's got 4 months experience. Keep that in mind when people try to help you in the future. No one wants to help when they might get told off for trying.

    I respect that you love your cat and want to help him, and it's unfortunate that the same respect isn't returned to the LL people for their knowledge, experience and attempts to help.
     
  25. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    I was not actually going to respond to this post but I think that guilt-tripping people who have been trying to help you since you showed up here is unfair. If they choose not to help you, it is not out of friendship to me, it is out of your attitude with them. You are correct in that I have not posted in your condo before two days ago, however I have been reading your condo for almost 2 weeks now and decided to help out the girls here in LL since you were consistently refuting their help and observations rather boldly for someone who's got 4 months experience. Keep that in mind when people try to help you in the future. No one wants to help when they might get told off for trying.

    I respect that you love your cat and want to help him, and it's unfortunate that the same respect isn't returned to the LL people for their knowledge, experience and attempts to help.[/quote]


    That's just plain ridiculous. If anyone feels that I've 'guilt tripped' them then that's them, not me.. As for not respecting the opinions of the people who I've gotten help from, why don't you ask Rebecca for a copy of two of the emails I sent to her last week. I told her that I felt my cat would be dead without their help. That is a direct quote. If that isn't respect, I don't know what is. And it's certainly not meant to make anyone feel guilty.
     
  26. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Man, I am hesitant to post in here because I feel that you will snap at me too, and I am nobody with any experience; All I have is a cat with FD, like you.

    I, too, have been reading about Alex from time to time, and my heart breaks for Alex. Poor Alex; too much bantering about what to do and not enough doing what needs to be done. I have puzzled over the reason one would ask for advice, then go against the advice received, or just reject it, over and over and over, then say oh man, what a great site! HUH?

    This site has done well by me, but I don't need to send off private emails or letters to someone; I will publicly pronounce how I feel about the site so that ALL can see what I have to say and how I feel. People go by what they can see and read, not by behind the scenes stuff about which they know squat. Sending praise is good, but also post it publicly so that those praised and those who admire those praised can see your praise.

    Toss a ball underhand in front of you. You will see that it bounces lightly a bunch of times along the ground.
    Smash a ball overhand in front of you. You will see that the ball ZOOMS past you on up in the air!
    You post and say OMG what is happening here? What to do?
    You are told to toss the ball underhand lightly and you will not have the big BOUNCE.
    What do you do? You decide that's a bad idea and you smash the ball into the ground again.
    You then ask what to do and are told that you did not follow the advice so why bother repeating it.

    I don't know much of much, but I do know that the people on this site are talking from actual experience. They know what's worked and what's not. They have seen things that you better hope you never have to see, and they have helped people through those times.
    Yet, you know better.

    I don't know about the R you are giving, or whatever all else you have in your bag of goodies for Alex, but if these experts told me to cut that out because it's causing the BOUNCES, I would cut it out in a heart beat. Yet you dismiss this advice and go along your merry way, giving what you were told should be stopped.

    All I keep thinking is poor Alex. Please try what has been suggested to you as a good way to break these HIs; give Alex a chance to try this advice.

    Sometimes. less really is more.
     
  27. Caryl & Sebastian & Alex (GA)

    Caryl & Sebastian & Alex (GA) Well-Known Member

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    Dec 28, 2009
    I'm not going to snap at you Gayle. I am going to tell you though that my situation is different than yours because of ketones and If Alex had the numbers that Shadoe has on a day to to basis he wouldn't be here anymore. That is why R was suggested to me by this board. I never heard of it before I was here. I have no other goodies in my bag. I have no bag. Just so you know that.


    All I was asking for was a Lantus increase yesterday.
    Good luck to you and Shadoe.
     
  28. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Correct me if I am wrong but it looks from the above that the board has said the R may be making the problems much worse for Alex. Short term fixes are just patches that often end up making things worse.

    Maybe it may be an idea to cut out the R to see what happens.
     
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