1/31 Paul-Kyle- welllll....(that's a DEEP subject!)

[Melissa&Paul-Kyle]

So- 4 cycles into the LESS insulin and we are getting the same or better numbers than on MORE insulin. (knockwood,antijinx)

For the record- the dose is .75u now

Pamela had some questions I'll answer in this post:

"But then on the other hand, I wonder what it would be like if you fed one hour AFTER his shot to give the insulin a little more time (especially now on the one unit)?"

Gonna answer this one with a question that has been REALLY bugging me for awhile.

Why do we talk about "AFTER his shot to give the insulin a little more time" if with L's there is a shed effect that creates an overlap so onset is really just a word rather than an action?

I don't understand this, and I don't understand why Vicky can move Gandalfs shots around and see an effect the next day or even the next cycle if this shed effect is supposed to build and work for 24 hours or more.

it seems like any effect Gandalf has would be 24 hours or at least 2 cycles further down rather than right away.

Also- I don't have a clear picture of when PK's insulin "starts to work" b/c, going by the shed effect, his insulin builds up and anything I see as dips or rises are effective from 2 doses or more behind.

PK nadirs when I feed him. period. If I never fed him, his curve would be flat and perfect- I'm convinced ( well- he'd be dead, too, but you get my point) anyway, if I feed him at +9, then around +2 his numbers start to lower.

if I feed him at +12, then his +5 ish starts to lower.

If I feed him at +2,, his numbers continue to lower after shot UNTIL I feed him, then he spikes for the next 3 to 5 hours...

Anyway- the comments about onset of a dose are frustrating me if we are to believe in this shed effect- does that make sense? This isn't vet or even PZI- how is there an onset? SOMEONE make me understand this, PLEASE! @-)

"Can you insert some comments on your spreadsheet, like how he is feeling/acting/playing etc.? Does he interact a lot with the other cats? I always read the comments and think they can give certain clues at times."

If there is anything of consequence or importance like illness, med, subQ or feeding differences, I put it directly IN the SS right next to or IN the reading at the time the important thing was relevant.

In general, Paul sleeps A LOT, inside if its cold outside, outside if it warm outside. He rarely does anything more that I am here to see, but I am not up his butt 24/7 to see what's going on with him.

On occasion he will devil or chase the old ladies in the cat room, and I only know he is doing this b/c the old ladies squeal, shriek, hiss and spit at him. Generally when he does this, his BG's are lower (200's) or have been regulated for a few cycles- not alot of ups/down's.

Before and since the diabetes, he has been roughly the same cat...the only distinct difference I have noted since moving to the new house is that he doesn't "play" with the alpha male Timothy as he used to- sparring and being frisky. I attribute this to Timothy's age and him not playing back with PK.

Otherwise- he is a cat and just does catly things like sleeping and eating. He is ALWAYS slow at everything and just doesn't DO much- never has. Even when we play with toys and strings and whatnot, PK bats AFTER the toy goes by generally...always has.

"Also, I know you feed him raw, but exactly how much is he getting each feeding? Does he have his food all to himself? What supplements do you add to it? Are all your cats back on the raw now?"

I feed Dr. Lisa's raw recipe (see www.catinfo.com for supplement mix) mixed with Special Kitty- the current batch Paul eats is made this way. It is about 60% raw and 40% SK.

Paul gets 2.6oz per meal BID at shot time right now. Any feeding differences are noted in an orange bar across the SS or right IN the BG reading.

I started controlling his food amount AFTER the great sickness of '09 a few months back. I started him at 3oz BID, then 2.8oz BID and now 2.6oz BID- all for about a month's time each.

PK has lost about a pound or two according to how he feels when lifted.

The other cats are all eating Friskies in some manner ( pureed, or mixed) and I stand in the room at mealtimes to make sure everyone stays at their food and finishes. PK does NOT touch anyone else's food.

There are no mid day, shot pr pokey snacks or treats and the only thing the cats access between meals is grass---ugh.

I think that is all the questions answered....let me know if there are any more. Thanks for asking!

 

[Terri and Lucy]

Hi Melissa--sorry I haven't been able to address your questions about food. The chemo messes with my brain and I'm just not sure what you are asking.

However, when I look at your spreadsheet, I don't see the same thing that you see. I don't see the .75 working better than the 1.0. What I do see is that 1.0 wasn't quite enough but 1.25 was too much. The 1.0 gave him very nice peaks but there is some evidence that his body wasn't ready to experience that joy so it panicked. Instead of backing off, I would have fatten the dose a teeny tiny bit to reduce the preshots, and used food at peak to prevent him from going any lower.

Lucy, on Lev and PZI, is picky picky picky. With PZI, she needed .9 units--.8 and 1.0 just wouldn't do for her. Now on Lev, I have to pull the dose to 2.5 units and then adjust so that I can just barely see the mark on the syringe. Just a hint of the mark--not the full mark. When I get it right, she does great. When I screw up, she either goes low (42 this morning at +14) or she zooms. It sounds like you may, unfortunately, be stuck with a very picky boy, like Lucy.

 

[Sheila & Beau GA & Jeddie GA]

M - my understanding of the action of lev is this:

IF you shot one dose of lev, it's onset would be between +2 and +4, nadir would be between +7 and +10 and it would taper off at about + 12 to +15 finally being totally gone by +15 to +18 - that's one single shot. Now overlay another shot on top of that starting at +12. Depending on how soon the waining shot fades and the waxing shot takes effect there may or may not be much dip in insulin action, but potentially you could see an "onset" (lowering of BG) at +1 to +4. With the right dose, one shot is fading while the other takes over so there is no chance for the BG to climb really high.

My + numbers are guesstimates, but ECID and then you also have to add in any bouncing from too much insulin, or a slow uptake from a difficult shot location, etc.

Does that make sense? I hate the term "shed" and the concept that there is a storage shed of insulin that the body draws off of is misleading, I think. The action of these two insulin causes them to have a longer duration, but it is not like a bank where you can deposit money and take it out as needed. I have two cats that react immediately to the first shot of lev, no storage shed building required. I think the mistake is in calling the process of finding the right dose by starting low and going slow a "shed building" process. It's still a situation where if you give too much you cause a fast drop, to possibly too low numbers, and bounce, but if you don't give enough it causes little drop and the numbers stay high and flat.

 

[Terri and Lucy]

I hate the term "shed" and the concept that there is a storage shed of insulin that the body draws off of is misleading, I think. The action of these two insulin causes them to have a longer duration, but it is not like a bank where you can deposit money and take it out as needed.

I agree. The medical term is "insulin depot" and we should use that term. However, I do think there is something like a bank. As I understand it, the bank gives out loans based upon need. "Dissociated Levemir® molecules can readily enter the circulation, where they reversibly bind albumin, further delaying distribution to target tissues." (http://www.diabetesincontrol.com/index. ... le&id=3632)

But I don't think the bank offers long-term savings accounts. The expectation is that the account will be depleted from one shot to the next (reversibly bound, see above) so that you don't get surprise hypos from too much overlap. But.....you don't want the account to be depleted so early that you get no overlap. That's the balancing I think we all have to do to enjoy the benefits of the low-flat Levemir response pattern.

 

[pamela and tigger]

M - my understanding of the action of lev is this:

IF you shot one dose of lev, it's onset would be between +2 and +4, nadir would be between +7 and +10 and it would taper off at about + 12 to +15 finally being totally gone by +15 to +18 - that's one single shot. Now overlay another shot on top of that starting at +12. Depending on how soon the waining shot fades and the waxing shot takes effect there may or may not be much dip in insulin action, but potentially you could see an "onset" (lowering of BG) at +1 to +4. With the right dose, one shot is fading while the other takes over so there is no chance for the BG to climb really high.

Very good Sheila. That is what happens with Tigger. It is pretty cut and dry with him...not too many surprises (usually)...his onset seems to be between +2 and +3.

My + numbers are guesstimates, but ECID and then you also have to add in any bouncing from too much insulin, or a slow uptake from a difficult shot location, etc.

Exactly, and add in food, their health and whatever else is going on around them which really does make it ECID. When I give you a suggestion Melissa like holding off on the food until +1 or so, then I am speaking from my own experiences mostly since that would usually work for us. But PK is quite different than Tigger in how he handles food and insulin. So it was just an idea to try.

But like I said I am glad to see you back to feeding +12/+12 and I was just trying to add on a little something more to that. Which was probably not a good idea since you should probably stay with the BID feeding schedule (for now) while you are still adjusting the dose. I like Terri's suggestion of trying to get somewhere between 1.0 and 1.25. As you know some cats are real "picky" like she says. We've seen that with a lot of cats as you know.

 

[Vicky & Gandalf (GA) & Murrlin]

But I don't think the bank offers long-term savings accounts. The expectation is that the account will be depleted from one shot to the next (reversibly bound, see above) so that you don't get surprise hypos from too much overlap. But.....you don't want the account to be depleted so early that you get no overlap. That's the balancing I think we all have to do to enjoy the benefits of the low-flat Levemir response pattern.

I don't have time to think this through and comment intelligently about it, I just wanted to say I love the banking terminology!! Long term savings accounts....Terri, you crack me up!!