1/23 Sami PMPS 373; Yay for NEW INSULIN! +2 239

Yesterday's condo

It is way to early on a Saturday morning, and I didn't get much sleep last night due to the fact that I got up in the middle of the night test Sami, and then at 4:00 am this morning I had 3 kitties, not including the sugar kitty, trying to get me out of bed to feed them, even though I left plenty of food out last night and added more when I was up to test at 1:00 am.

I probably need to move her dose a little later in the morning so I can be more awake when I give her the shot. I was thinking I would go back to bed after Sami's test this morning so I went ahead and gave her the shot just after the test but before she ate. I didn't have any doubt that she would eat, but I wasn't thinking about the fact that the shot would be 30 minutes early. Plus, with the high numbers I decided to go ahead and increase to 1.5 units, which might have been wrong.

After waking up a bit more, still pretty tired and haven’t had coffee yet, I started to input the information into the spreadsheet I realized the fact that the shot was early, and according to protocol I probably should have waited at least one more day before doing the increase because Sami's nadir has been below 200. Plus, I am suppose to be moving her shot later not earlier because I have a dentist appointment on Tuesday evening and might not be home by 6:30 pm to feed and then shot at 7:00 pm.

I hope it wasn't a bad decision to increase today. What do you think should I really have waiting another day? I will be home all day to monitor her so I am not worried about going too low today. I am more concerned after her PM dose if she is lower than normal. I don't want to have to skip a shot tonight so it might be a long night if I have to stay up to monitor. Which means I really need to get some sleep during the day today just in case.

I need to go get some coffee so I can start the think straight.

 

Re: 1/23 Sami AMPS 430

Well...you already know it probably wasn't the best idea to do 2 changes at once, but no point in beating it around now it's done! Good that you are home to monitor, you will know soon enough if it was a bad choice or not :razz: Now the question is how are you going to work out the changes you need to make for Tuesday? Remember shooting earlier means an increase, later a decrease. Hope today turns out good for you both!

 

Re: 1/23 Sami AMPS 430

Yeah, I've been known to do some pretty dumb things when I'm half asleep...but it will probably be OK given Sami's high numbers and the fact that the blues were high blues. Just keep spot checking and you know the drill if she starts to go low. dancing_cat

 

Re: 1/23 Sami AMPS 430

What exactly does this mean?

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421

Now, I am trying to figure out what is going on.

Sami has pretty much stayed level the last few hours even after her shot. I am pretty sure I did not get a fur shot, because I always check after the shot.

What could be going on?

Could it be the NDW? She really didn't show any NDW the last time we increased, at least not for a few days.

It seems that every day brings something new and becomes more confusing.

Sami has been very tired today. She ate at her AMPS, but has pretty much been sleeping since. She also has drank more water this morning.

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

Sami is still dropping slowly at +6, and I don't know what is going on.

Could it be old insulin? We have been using the same vial for more than 60 days. It still looks clear and no floaties. Is there any way to test it to see if it is still viable?

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

These numbers are likely a bounce from the blue yesterday.

How old is your Lantus? I couldn't tell from your SS if you are using the same Lantus from when Sami was diagnosed.

With Lantus, due to the shed. If you delay a dose, you are depleting the shed by a little and some of what you are shooting goes back into the shed and isn't available for immediate use. Thus, it's like you decreased the dose. If you shoot early, you are overfilling the shed and what would be the normal amount that would keep the shed in balance, isn't needed so more insulin is available for immediate use. This situation is like giving a dose increase.

So, increasing a dose and shooting early is generally not advisable since it's like giving a double increase. Since you are not yet familiar with some of the intricacies of dosing, when you have a question about increasing and how to time the increase, it might be useful to post and get feedback before rather than after the fact so you can weigh all of the information before making a decision.

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

She has had blues for a coulple of days but never had a bounce that lasted this long.

We have been using the same vial for over 60 days.

I will keep this in mind for the future, but I can't always get answers quickly enough after posting, and I wouldn't want to delay dosing to wait for an answer.

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

There is a possiblity that Sami got a little bit of HC food last night. I had put a small dish out for one of my other cats and forgot it on the floor. Is it possible that she is still coming down from that High?

She is still sleeping and hasn't moved much over the last few hours. I have wanted to do a urine test, but she hasn't gone to the bathroom lately.

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

HC wet or dry? HC wet is much, much quicker with regard to it's bumping up BG levels and leaving the system. Dry takes longer to raise BG and can hang around for a long time. If this is a possibility, put a note on your SS (and indicate that you're not sure).

I would encourage you to open a new cartridge. My guess is your Lantus is pretty toasty at this point. While for some folks, the 28 days that the manufacturer recommends is very conservative and they can get longer use, if you think that Sami's numbers aren't making much sense, then start a new cartridge. Gabby's numbers get wonky if her Lantus is old and I've never seen floaties.

Just because there have been occasions where Sami's rebounds were brief, doesn't mean that will always be the case. Anything and everything can change. The current highs could be a combination of a bounce plus HC or any number of other factors that aren't immediately evident -- like old Lantus. Keep in mind that the hormones related to rebound can stick around for up to 72 hours. It's been about 24 hrs since the last blue number so a bounce that started around the PM cycle yesterday can still be going on now.

Unless it's an emergency, an issue like whether or not to change a dose can be brought up several hours before you need to make a decision. You should give yourself the benefit of time to look at all of the pros and cons. There will always be times when people aren't on the Board or are busy with an emergent situation and need to prioritize where to put their attention. If it were Sami in the middle of a crisis and needing lots of experienced eyes being attentive to his and your needs, you'd want those folks front and center. A dose change is generally not an immediate issue. However much time you can give people to study your SS and engage in a decision making process with you will be appreciated.

 

Re: 1/23 Sami AMPS 430; +3 439; +5 421; +415 Need advice

Sienne & Gabby ,

Thanks for your response.

At this point at +8 Sami is back on the rise. I have been using the vial for more than 60 days, and this might be the problem. I just got a prescription called in for the pens/cartridges so I can pick them up later today. They are a lot more expensive, but if I do in fact need to toss the bottle I am using it would have lost at least $50 worth of insulin anyway, I still have about half a bottle.

Anyway, I really am not sure what the issue is today, and just want to look at every possible option.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

I totally get it that everyone isn't just waiting here for a question. I try to give it enough time, but it isn't always possible.

Anyway, I am getting prescription called it, but I am not sure I want to switch just yet, because if it is a bounce I don't want to toss the insulin that might still be good? What is a good time to wait to try to determine if it might be the insulin and not a bounce? I really don't want to keep you in these 400's for too long, but I just don't know what the best option is.

Should I just switch to the new cartridge/pen? What if I do that and her numbers stay the same?

or

Should I give it another dose to see what happens? I am pretty sure that she DIDN'T get a fur shot this morning, but I guess I can't be 100% that the shot wasn't done incorrectly. Is that possible even if it wasn't a fur shot?

Any advice you can provide is very much appreciated.

Thanks.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Tina & Sami :?:

I don't have the answer, although 60 days seems like a long time to use the same Lantus. But.. it is ovious I still don't know as a newbie.
Just wanted to send (((hugs)) your & Sami's way.. hope the #s come down & that you get your insulin figured out!

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Thanks Nicole,

It is so frustrating. I just would hate to spend close to $200 just to find out that the insulin is perfectly fine.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Hi,

I can see you've got a bit of a quandry going on here.
If memory serves me correct truetrack hasn't got a good rep. That makes comparing the readings you got from that to now 'difficult in my view'. Yet you looked as if you were getting good numbers off your 1.10.
The fact that when you then went to the Relion they were in the 300's shows the difference between them. Not sure why the jump to the 1.50u but see you got a good reaction off it and then backed off shooting the next shot.

Your red the following day could well have been the body's response to what it considered to be a low number (the blues)or that Sami went even lower.

Your presently working for a breakthrough dose. This is where hopefully you get to a point that the insulin really starts working on Sami's bg's and you then start down the dosing scale (with a good chance of late nights, lots of coffee and HC on hand ;-) )

Whether to change the cartridge now is your choice, especially if finances are a consideration. Once you open a new cart your on countdown for it.
The fact you shot 30mins early should have created some carry over but instead Sami is flatlined. Bear in mind ECID and some cats you can shoot 30 mins early and know it will be ok (that is through experience, knowledge and knowing your cat and being around to monitor). Hence why 15 mins eaither way is recommended.

Seeing as it's the week end, if your not a worker and will be home to monitor, I would consider starting a new cartridge (the 3ml ones work out cheaper in the long run-think you have got this?)in the morning.

Remember, unless you get a low (under 50 at any point)number in the cycle, you hold the dose for 6 cycles (3 days)minimum, sometimes longer cos it depends on what numbers you are seeing.Can take longer for a dose to show any real impact. Beans who work all day have to leave increases till the week end when they know they are home to monitor. You have to have a life too and not be stressed something bad is happening to kitty while your working etc.

One way to check for fur shots is if you can smell insulin on kitty's fur, or an obvious one is if kitty pegs it before your done!

It is frustrating in the early days but you've already come a long way, just need to be patient and keep asking questions. If they don't get answered one day, just ask them again. Can always ask questions in health too.
Are you checking Sami for keytones? Cats do sleep a lot during the day, but if his behaviour is uncharateristic, it's good to dot your I's and cross your T's. Bear in mind your more likely to be hyper sensitive to every little thing with him. I know I was with Lucky.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

tina, you mentioned the possibility of sami getting into some hc last night... wet or dry? if it was dry... the effects could still be in kitty's system.

have you held the insulin up to light to see if there are any crystals forming? they're so tiny that i had to use a magnifying glass in order to see them.

many start a new cartridge when they're unsure...

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

There are many who feel that the vials last longer...there's no way to tell. If you are in doubt, throw it out....that's my motto. My Levemir (which is supposed to last a tad longer) looked funny this morning and I had left it out overnight at 74 degrees so I tossed it and opened a new one. The cheapest part of this equation is the insulin when you are using the cartridges....even at $200, that's only $40 a month....I know I spend about twice that on strips.

If you're wondering about the effects of high carb, just take a look at my Morris' spreadsheet....he stopped eating and the only thing he WILL eat at this point is his old high carb food so that's what I am feeding....he was down to .10u and getting greens...overnight he has shot to 500's and .75u....all due to high carb, and not a lot of them.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

I do try to move the shot time only by 15 minutes at a time, but I was very tired this morning and wasn't exactly thinking correctly. Being tired and making changes was a bad combination. Next time I need to just do what I have been doing so I don't screw up.

So you wouldn't start the new cartridge with tonights dose. It is due in the next half hour. I was thinking of just starting the new cartridge tonight, but if it would be better to do it in the morning I will do that. If I did start tonight I was considering dropping back to the 1.25 dose just in case it is the insulin. I wouldn't want her to go too low overnight, although I will still check her during the night.

I have tested Sami for Keytones, but haven't had the opportunity today. I have tried to keep an eye on her and try to catch her going to the bathroom, but so far today I haven't seen her go. A few times she went upstairs and could have gone but I didn't catch her. I will try to test as soon as I can, but thankfully she hasn't show any keytones in the past 5 months.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Jill, I have tried to look at in the light and with a magnifying glass and I can't see anything in it. it is difficult because the glass vial keeps fogging up when it comes out of the refrigerator. I think I will start a new cartridge tonight unless it is advised that starting it tomorrow morning would be better. "Kate and Lucky" advised to start in the morning, but I don't know if that was to start it during the week in the morning or meaning start tomrorow morning rather than tonight. I was a little uncertain of that.

Oh, and the HC food was wet.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

if you have doubts about the juice and you have some more, I would go ahead and switch. That will put your mind at ease and it's an easy thing to try.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Okay, I will use the new cartridge tonight. Should I reduce the dose back to 1.25 instead of the 1.5, because maybe yesterday was the insulin too.

I need to shot within 10 minutes.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Hi,

I only suggested the morning shot thinking of you in terms of getting spot checks and the fact you had blues yesterday.

Becasue your not sure, maybe hooting 1.25u would be erring on the side of caution (though you need to try and avoid dose hopping wherever possible because your data has other factors coming into play) and dependent on what spot checks your going to get before sleepus.

See what other folks think.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

I will be able to get at least one spot check before I go to bed, and would get up at least every 2 hours to check again. And I would get up more often if I thought she might be dropping too quickly and I can even stay up all night if that is necessary.

And at this point the shot is already 20 minutes later than this morning.

 

Re: 1/23 Sami AMPS 430; ADVICE PLEASE; +10 406

Gave 1.25 units at 7:00 pm, from the new cartridge. Hopefully we will see some better numbers over night.

Thanks for all the help today. One of these days I will know what to do without asking 10 million questions.

 

I am convinced that it was the insulin.

Sami is at 239 at +2 after her PMPS of 373. I am very happy about this. I will probably be up more tonight, checking her to make sure she doesn't go too low, but I am happy to see those 400's go bye-bye. If she gets down into the blue again tonight we might see some higher numbers again tomorrow. But at least we will know it is only a rebound and won't last

Thanks again for everyone's advice and support. I have noted on my spreadsheet when the new cartridge was started so I know how long I have been using it.

 

Great news! Yay! I thought 60 days sounded looooongggggg LOL :mrgreen:
Very happy for you & Sami!

 

definitely get a +3 or +4 off of this, this is a big drop for +2. Looks good!

 

I was told that I could probably use it for up to 6 months as long as the liquid was clear and there wasn't anything floating in it. I guess that was wrong. So glad I pushed the vet to get the prescription called in today before the pharmacy closed at 6:00 pm today. Otherwise it would have had to wait until Monday night to get it because the pharmacy is closed tomorrow.

I got it at Costco and it was $178 for 5 cartridges.

I also found out that you don't even need to be a member of Costco to get prescriptions there, although we are members and there is a slight price reduction for members. The price at the CVS pharmacy would have been $70 more.

Now we can enjoy the rest of the weekend.

 

Absolutely, I should be up at least until the +3, and depending how much she drops in the next hour will determine if I get up for +4. I am already planning on not getting much sleep tonight, but I can always catch up with some cat naps tomorrow.

 

Thanks for the info about getting the RX at Costco, that is the lowest cost I have seen.. hopefully that is the same here where I live!

 

$178 is still very expensive, but the way I look at it is the 5 cartridges will last 225-300 days, verses 45-60 days with one vial costing $96. In the long run the cartridges are a lot less expensive. I will still be throwing out a lot of insulin, but that is okay.

 

update?