1/17 Quincy AMPS 114 dose questions

Good morning,

Haven't posted in a while (spreadsheet is current though), in part because Quincy was pretty steady state with his diabetes and dealing with a lot of GI/potential lymphoma issues instead. He's really faced a lot of challenges in the past two months with the latter, particularly with vomiting. He's been off prednisone and only on leukeran for almost 8 months now, and I fear our luck has run out with that. When Quincy goes in for his next 3-month check in a few weeks, I think it's going to be time to discuss starting him on something like budenoside in addition to the leukeran. I'm afraid to try something else, but I'm increasingly afraid to do nothing. He's going to be 13 next month and it's almost 2 years since his diagnosis, so I'm getting nervous.

Quincy has been on 0.5 BID for 3 weeks now and it's been a pretty good dose for him - usually PS #s under 120 and spot checks under 100 for the most part. He dipped below 50 once, on 1/1/10, and I've caught him in the 50s a few times at an evening +3 or +4 check. I have been able to bring up his number a bit with a little LC. I am wondering if he's earn a slight decrease given these numbers and even if not, I am thinking it may be a good idea to do so given the increased vomiting frequency. A few times I have found myself giving him food to balance the Lantus only to have him throw it up. Actually this morning he vomited soon after his shot, so this message is very timely. And there was an evening earlier in the week when I gave him a few small snacks after an early # in the 50s, and hours later he vomited everything. I think it was just too much in his tummy.

I've been feeding him small meals with a while now, which seems to help. They are a combination of boiled chicken breast and Merrick cowboy cookout. I think I've done what I can in terms of diet changes. His appetite is very good, and other than the vomiting he seems pretty good too - great energy level, inquisitiveness, tolerance for Katie the dog, etc. And I'm happy that he's done pretty well lately in the BM dept (anti-jinx). We've seen tootsie rolls for a while now, which is a relief and I hope it lasts.

Anyway... I'd appreciate input on the pros/cons of a dose decrease. I was thinking of trying 0.40. I was wondering how to measure it, though. I've seen photos, but is it maybe 0.5 with 2 drops twisted out? Just want to come up with a consistent way to measure this shaved dose.

Thanks for your help. Hope everyone's new year has gotten off to a good start!

 

It's great to hear the Quincy is feeling good. I don't want to weigh in on dose amount since I know there are others who have kitties on pred or who can evaluate the food/dose issues. One suggestion, though, is that maybe trying to get a few more spot checks in might allow you to catch Quincy if his numbers are lower and he would earn a reduction.

 

Hi Laura, good to see u posting again

Hows Quincy doing this afternoon? Any updates?

 

Nice to see you! Have been hoping you two were okay.

It is incredibly difficult and frustrating to manage vomiting and insulin, I know. Can be terrifying if they vomit or don't eat well and you do need to be able to have a buffer if his vomiting has increased. From your SS, on 12/26 he went to 32 and could have taken a 0.25u reduction at that point, so decreasing to a skinny 0.5u or a fat 0.25u would be a good idea, IMHO. What I do on skinny half unit doses is measure the full half unit and then twist a drop or two off, depending on what I want to do with the dose. Get a good feel for the drop size that you are taking of and just try and stay consistent each time.

You know my thoughts on Budesonide. Can't say enough good things. Very highly recommend the Wedgewood tiny tabs that we get because they are so small and easy (and effective).

You know we're always here if you need help. Come visit more often. Give Quincy some big kisses from me!

 

Thanks for the suggestions. I think I'm going to try a lower dose starting this evening. I am going to fill a syringe to 0.5 and see how many drops it takes to get it empty. I will probably do 1 or 2 drops less than 0.5, but I'm curious what "0.50 minus 1 drop" corresponds to (e.g. .4 or maybe .3). I don't think he's ready to go to .25 yet.

Quincy's doing well this afternoon. He ate about 1 hour after his shot, and then again +4 and just now (+8). I didn't test his BG. Wanted to give him a little break from testing. Instead, he spent a little time outside in the yard enjoying the grass and plants before all the rain starts here in southern CA.

p.s. just to clarify, Quincy's not on prednisone. He *was*, but has been off since June, soon after his BG #s skyrocketed and indicated hyperglycemia.

 

Re: 1/17 Quincy AMPS 114, PMPS 118 new dose

Well, I filled a syringe to .50 and twisted out drops until it was empty. It took 14 drops, although they weren't uniform. So maybe it was more like 12. If it was 10 drops it'd be 0.05 per drop and with 14 drops it'd be 0.036 per drop, so I decided to reduce Quincy's dose by .4 drops, which would roughly be 0.35. If he goes too high, I can bump it up to just 2 drops less and see. Until his vomiting settles down, I think I'll be ok with Quincy running a little higher, like in the 130-150 for pre-shot. I know my vet will be happy about that because he's been concerned about Quincy having a little buffer, which is more important now given the uptick in vomiting. I wouldn't want him to creep up to the 200s, though. I don't think he will though (knock wood!) I have been using one of the free Solostar pens this month, and I have found for some reason I've had more problems with bubbles than with the vial. So, I think Quincy's probably gotten a few doses that were lower than 0.50 already.

Fingers crossed this holds... and more importantly, that his GI tract settles down and the vomiting decreases big time.

 

good luck with the new dose, and I'm also sending anti-pukus vines... I'm glad to hear you all are doing ok.