2/7 Latte AMPS-347, PMPS-302

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carolynandlatte

carolynandlatte

Very Active Member
Last night:
PMPS- 210
+2-395
+4-391
+6-456 *sigh*

She is not very active, nor does she eat well with these higher numbers. During the day, once she got out of the reds she started eating. Out of pinks she started eating more and grazed until noon...up/awake, alert, talkative, playful. Hit the high pm again and it was pulling teeth to keep her awake, let alone eat. Caught some intermittent, rapid breathing last night (between 30-47/min). Did not eat overnight. She is over 32hrs kibble free at the moment...by her choice.

If Im doing ketone test right, she was negative this morning. How am I suppose to wipe off excessive urine from strip w/o ruining it? Instructions say to do so...wipe off on urine cup. I am just catching it midstream and counting to 15. is that right?

yesterday:
viewtopic.php?f=9&t=5361
 
Re: 2/7 Latte AMPS-347

((Carloyn))
cat_pet_icon

glad to hear ketones is neg.
I use to just lightly tap the stick to get the excess off, and yes count to 15 seconds sounds right

hoping for a nice drop for Latte.
 
Re: 2/7 Latte AMPS-347

At least this is better than last night's +6! I hope Latte decides on a nice, gentle slide down to more comfortable numbers. (And thanks for your response to my note yesterday.)

I just shake off any excess from the ketone strip. If you read the instructions, they talk about actually timing the 15 sec. I count in my head. I figure if the numbers are beyond trace, it will be obvious and It's not like I leave the house to run errands and then check the strip. I'm glad there are no ketones - but then I don't think you expected to find any.
 
Re: 2/7 Latte AMPS-347

This is way, way out of my area of expertise, but is it possible she might be a candidate for using R? I know nothing about it, but some who know how to use it mught comment?
 
Re: 2/7 Latte AMPS-347

Linda and Bear Man said:
This is way, way out of my area of expertise, but is it possible she might be a candidate for using R? I know nothing about it, but some who know how to use it mught comment?
Click to expand...

I have thought about that in the last 24hrs...if that might be something to consider for her pm cycle. Dont really know much about it, or if its appropriate.

Who are the people who might know how to use it and what kind of treats do I need available in my condo to lure them in? :mrgreen:

Im pretty much game for anything. This girl CANNOT afford to sit so high and get an infection, or heaven forbid ketones. Ketones, requiring hospitalization would be the end of the line for her. I could not afford it. I have also put a limit on what type of heroic measures I am willing to do in the future. Sorry if that sounds bad, but...*sigh* its been thought about long and hard, and well processed with a professional. The biggest act of heroism is prevention, at this point.

Thanks Linda!
 
Re: 2/7 Latte AMPS-347

Carolyn...did your vet or the specialist have anything to say....i don't remember reading about
their input recently...
 
Re: 2/7 Latte AMPS-347

Try changing the subject of your first post to something eye catching like "Advice needed from R users". I hope someone stops by. It might be a slow day on Sunday, so be persistent.
 
Re: 2/7 Latte AMPS-347

First.. I never wipe off my ketone strips. I just tap them on the side of the litterbox. It's gross enough without actually wiping it on something. :lol:

Ok R usage.

I think you have the potential to use R but I'd like to see you increase your basal insulin dose more aggressively as well. I see you are making minuscule adjustments, and I understand why, with her being primarily a microdose kitty, however she definitely needs more and I'd like to see a minimum of 1.75u for 6 doses. On the 7th dose, if she is still faltering, increase again to 2u. No more fat and skinny for the duration.

As far as R usage goes, it's a feeler type thing. By that, I mean you want to start at the absolute lowest dose possible, which we call a TOR (touch of R), and then feel your way through any subsequent increases. This is basically 1 drop of R in the syringe. R is a U100 insulin so it's hard to measure that small, but you must, especially because you do not have an insulin resistant cat. R is quite powerful and should never be used without monitoring and knowledge of how it works, and I am saying this because I know there are people reading this who should not be using R, and who should never even consider using R. You have a situation where R may become your friend.

The reason for using R is to, as gently as possible, knock the preshots, and sometimes the midrange numbers, into a range where your lantus is not overwhelmed. The long term insulins do not really work very well at higher numbers because of their more gentle and slow action. Right now, you can see that the lantus is faltering, and the shed is draining. This is why I am recommending you increase your basal dose as well. Don't be afraid to go higher, you are an experienced caregiver and you know how to intervene if the numbers suddenly break.

Things to understand and do:
1. Set a number that you will NOT shoot R at. in my case, I do not shoot R under 300. I have a different circumstance than you, however, so we can not compare the two, but that seems like a good number for you to start at as well. The goal is to tap the numbers down, and the lower the preshot, the bigger the drop and the more bounce you will incur. You don't want bouncing.
2. First high preshot that you will be home for several hours, you do your R test. Draw up a tiny drop of R in your syringe, and start testing. Test at every hour to track how the R is working. You are looking for onset, offset and overall drop in numbers. You must learn how fast it works, and when it's no longer working. This is very very important.
3. Do not get aggressive with the R. Increases must be tiny until you are certain of how it's working in her. If you push too hard, her body with overreact and you will have a huge mess. You will ultimately be treating numbers that are the result of R, rather than the result of pred.

R is available without prescription, but if you have a RiteAid, you may be able to get up to 20% off of it if you HAVE a prescription and get their free prescription discount card. That's how I get mine. It runs about $50 or so otherwise.

Now I talked about Lantus all the way through without checking to see if you are Lantus or Levemir. If she's on Lev, there's no difference at all. What I said applies to both insulins.

Gotta go test and shoot a couple kitties, but feel free to ask any questions!
 
Re: 2/7 Latte AMPS-347

thanks, Carolyn.

I need to digest what you wrote, recall what I have seen when others have used it, and organize my thoughts/questions before I respond. I will be armed and ready to shoot ,em at ya by pmps, if you have time later tonight.

Again, thank you so much for taking the time to look over her situation and give your thoughts on the matter!
 
Re: 2/7 Latte AMPS-347

Carolyn and Spot said:
however she definitely needs more and I'd like to see a minimum of 1.75u for 6 doses.
Click to expand...

Were you implying to put her at 1.75 tonight? Its only been 4 cycles so far.
I was going to raise it on Tuesday night, and then again to 2u when I have 3 days off next weekend to monitor.
Im used to her taking to increases, especially big one's (.25) pretty hard. That's why they have been so micro. And, thats why I like to make a habit of being home for the first 4 cycles, usually.

She is bouncing today...+6- 141, +7-234, +9- 213 ...in case that info helps.

I asked in a pm..but I will ask here, too. do you have a good example of a ss where someone was using R and it worked the way it should (little bouncing)?
 
not tonight

Do it on your next planned increase, I should have clarified that. Never go less than 6 cycles at any dose. And I answered you in PM about the SS and the quick answer is "no". The next part of "no" is "I hope Jill can think of one". I didn't have a lot of bouncing on my foray into R, but I have an acrocat. They are not comparable to Latte because they are insulin resistant.
 
Re: 2/7 Latte AMPS-347

Gracias! Now I can change my subject line so it does not look like Im talking to myself! :lol:

And I feel relieved. I dont like increasing when I know I wont be around for the first a.m. on the increase. So the scheduled one is Tuesday pm...8 cycles total. And the big whopper increase to 2u on friday night, with 7 cycles to be fully monitored!

See ya after pmps!
 
Im still trying to grasp how she was doing so well and then...*poof* Is it possible ALL my insulin is shot?!?!
amps-347
+2.25-284
+4-214
+6-142
+7-234 :shock:
+9-214
+11-258
pmps-302

Im delaying pred until AT LEAST +1 to see if she starts lowering at all. Might want to wait until +2, though that could throw off our amps (to a higher number). But who really knows anymore. Seems like all the data Ive collected over the months can just be thrown out the window! ohmygod_smile

She is now nearly 50 hrs kibble free...only because I have been home and diverting. She definitely takes in a lot less calories when not eating kibble. Ate really well this a.m. from 7am until noon ( 1 1/2 3 oz cans of wellness). Only a few tsp of babyfood at shot time. Will work on it after pred is given.

Onto the "R" discussion- question/thoughts/concerns:

Carolyn,
Not sure how much you know about latte. One important thing is that she is better with vomiting but still does, AND is not consistent with her eating. Because of this, Im not comfortable with her being too low (nervous leaving her alone below 70/80's for an extended period of time) in case she vomits or does not eat for any further drops. I explained earlier in her condo the dangers of her being this high. I would really like to see her hangin' mostly in the bloos, with a touch of green and if need be, a touch of yellow from time to time. That is where she is comfortable, and that is where she is safe. With all she has going on, going OTJ is really not a priority. General QOL in her remaining time here is most important.

That said - The "R"- I dont know much about it other than when I have seen some people use it and what you explained. My perfect scenario I describe below may not be at all how "r" really works. I will tell ya how I think, or would like to see it help Latte.

I could check her at pmps +2. If she is high (like what you suggested 300+), then consider using R. I would do it at this point because I know the pred has just hit its onset and will continue to raise her. Usually the higher her BG when the pred has its onset, the higher she will rise. The lower the BG, the less. Of course if it meets a bounce, like I assume it did last night - then the pred has a hay day. :twisted:

Assuming the R takes effect quickly (is there an average time? minutes?hours?), it could lower her while the pred is at its peak...usually another 4-5hrs before her BG's start dropping and or stabalizing again. If the pred is working against a lower number, it cant (in theory) raise it as high as it would w/ a higher one. Are you following me here? :mrgreen:

So when does the R wear off? In a couple hours? Half a cycle? Assuming it would last approx 4hrs, it might wear off right around mid cycle. Mid cycle is when I might expect to see a little release from the pred, so a possible small drop as the R stops working. This might then lead her to a lower AMPS. A lower AMPS would mean less drastic of a drop, less chance of a pm rebound (she typically has large drops between 100-200pts in first few hours and bounces from them in the pm). Ack! Starting to confuse myself here! Hope you are still following!

As for concerns:
Is it necessary for them to eat when you administer R? If she were to vomit, might I lose complete control of what her BG can/will do? She usually takes a 20% drop after vomiting. So basically, considering her issues...would it be safe to even think about this option? Im pretty good at sensing when she *might* vomit or when she is vulnerable. But not always.

I want to say, to anyone else reading this...I am only learning and exploring options at this point. I would NEVER administer this without back up support from an experienced person on the board. And NEVER, NEVER, NEVER until all possible options were on the table and this was the best one.

Other options to explore, in addition to more aggressive dose increases in the coming week nailbite_smile are calling her regular vet and asking what he thinks about any possible infection brewing, despite no symptoms (she is eating pretty good, pooping, peeing, not vo..m..i..well you know what I mean- Im not going to jinx it). She is FINE when her numbers have been down lower, and lookin' a little punky when they are high. The other thought is to call her specialist and ask him about the pain meds for arthritis. I think its time to start something. :cry: OMG, just the words "pain meds" made me cry!!!!! :cry:

So there ya have it! Now its time to think about a +1 and hope she has dropped a little so I can give her pred. (I know, Im dreamin' :roll: )
 
I see this post, but I am on the phone and can't type a logical response.. will come back as soon as I can form a coherent sentence LOL you know how it is when you are on the phone :lol:
 
:lol:

Ya, I was just coming to add for the general public:

+1.5- 255, gave pred - on a crappy number vs a crappy, crappy number. I cant believe just weeks ago I was trying to keep her out of YELLOWS in the pred cycle. Tonight I will be happy just to keep her out of RED or BLACK! :evil: Pink is a given. I have already accepted that.
We shall see how it plays out!

I always feel bad giving the pred when I am delaying the shot to reduce bg a bit. Its only then I can see she would have easily gone down to the bloos. Then I remind myself...she wouldnt be alive w/o out it. Priorities, right? :mrgreen:

1/2 jar bf down the tubes, with hopes she will start gobbling food approx 3 hrs after the pred.
 
Ok I'm off the phone.

First thing, I gotta say it before it blows my head up. One thought kept running through my head reading your post. You have many "interferers" between the vomiting, the potentially bad insulin, poss pain/infection, the light appetite, you not being home sometimes to monitor, for me to responsibly advise you on this. I feel that we need for Jojo to look if she can before you commence usage of R, I just don't think I'm your safest bet with all these variables at play simultaneously. I think we're could also ask on Health for experienced pred/R dosers and again beg Jojo to help. I have to hand this ball to someone that could make a better call than me. The last thing I would want to do would be to inadvertently hurt your beautiful baby girl. Nothing bad is going to happen to her in the meantime, and we can still work with your basal increases and I can answer your R questions.

Assuming the R takes effect quickly (is there an average time? minutes?hours?), it could lower her while the pred is at its peak...usually another 4-5hrs before her BG's start dropping and or stabalizing again. If the pred is working against a lower number, it cant (in theory) raise it as high as it would w/ a higher one. Are you following me here? :mrgreen:
Click to expand...

No. LOL

So when does the R wear off? In a couple hours? Half a cycle?
Click to expand...
Every cat is different. I think Jojo reports something like a 4 hour onset with SD and a late offset as well.. some cats short, some cats long. It all depends on how toxic the cat is, and who the cat is. Leo is pretty solid, in the door at 2, out the door at 4. Earlier it wasn't like that, but now he's better regulated so he responds differently to it. So, roughly, the onset is 1-2 hours and the offset would be 3-5 hours...ROUGHLY. In order to know how it is in Latte, you would have to run an R test, without incorporating Pred into the cycle and test like mad. And then you'd want to do it a second time. Then you would re-incorporate Pred into her system simultaneously and record that data. That's how it's done, pretty low tech huh? I call it stumbledupon dosing, whereupon you stumble into your dose, rather than use any actual thinking. :lol:

As for concerns:
Is it necessary for them to eat when you administer R? If she were to vomit, might I lose complete control of what her BG can/will do? She usually takes a 20% drop after vomiting. So basically, considering her issues...would it be safe to even think about this option? Im pretty good at sensing when she *might* vomit or when she is vulnerable. But not always.
Click to expand...
Yes. Yes. No, not safe. No guessing in R usage when vomiting is a potential hazard IMO.

So.. what now?
1. assess your insulin efficacy, that's most pressing..
2. continue your increases as planned of the basal insulin.. you *are* still getting response, the increases could cover you
3. we start hunting for seasoned R/pred users

..C
 
Ah well! Guess its back to square one. Really does not sound like a safe option for her. She is not an eat on demand cat. She typically has less of an appetite during the time frame I would want to be using it. Poor enough, that Ive actually resorted to just spoon feeding babyfood for the first few hours of her cycle until she gets off her butt after the pred kicks her appetite a bit. This is why I assumed switching to any of the short acting insulins would not be safe.

I really dont understand how her insulin could be bad. It came from the coupon for a free box of pens. The first two were fine. Why would the others be bad? In the back of my head I cant stop wondering if thats the problem tho. I cant afford anymore, so its not an option to go out and buy some to see if it works better. We are stuck with what we've got. And I tell ya, we are pretty darn lucky just to have that!

I have not asked on health if anyone out there using pred also uses R. I have asked how people manage the diabetes with the pred. Any strategies? I got a lot of ECID so your pretty much on your own. Ive never asked again, because of that.

Now its confession time :o - when I first came to this group (recommended by Jamie and Boots-both GA), everyone told me I was crazy for taking her off the pred if she needs it (in a nice way, of course). I was told we could work the diabetes around it. I resisted and opted for chemo instead. That didnt work out so well. Went back to the pred. But what happened to the people who told me we could work the diabetes around it? Part of my decision to restart it was that I really believed in what everyone here was telling me, and assumed there would be some guidance. But now, I kind of feel like Im paddling a boat against high tides - alone. I get a lot of great support here. Really I do! I love this board a ton, and everyone who makes it so special. But I do feel a little SOL when it comes to getting help with Latte's BG's. I hope it is not because of my expectations, excuses, or attitude that has prevented any creative ideas from coming forward. I get frustrated often and easily. In fact I may have officially developed a bipolar personality over this! :roll: (not that there is anything wrong with it!). But I will do anything to help her, as long as she has a spark in her eye and shows me she wants to keep fighting. I just wish I new how.

Now I bet your head is really ready to blow up! :lol:

Will keep with increase plan-
1.75u on Tues night
2.0 on Friday night (with many cycles to monitor)

Will call specialist about pain meds (okay..there I go crying again! :? )

Will get in touch with regular vet to discuss whats generally going on with her and BGs

Who knows what kind of changes will take place in a week....or even a day, for that matter.

ETA: I do want to reiterate how important the support is to me here, even if you dont know what to do to help. Without the support, I would have likely given up a long time ago. Just wanted to make that clear as a bell! :mrgreen:
 
carolynandlatte said:
Ah well! Guess its back to square one. Really does not sound like a safe option for her. She is not an eat on demand cat. She typically has less of an appetite during the time frame I would want to be using it. Poor enough, that Ive actually resorted to just spoon feeding babyfood for the first few hours of her cycle until she gets off her butt after the pred kicks her appetite a bit. This is why I assumed switching to any of the short acting insulins would not be safe.
Click to expand...

I don't know if it's safe or not safe. It might be totally safe. I just can't knowingly advise you knowing that I don't know what I need to know to help you SAFELY. And I really really hope we can find you that person. But you have as much said yourself, ECID. You *are* on your own for the most part because there is no other cat just like her. Much like all us acromoms sometimes feel we are on our own. We have a stellar network of friends and many very good very experienced advice-givers, but no two acro's are alike, or get the same treatment.. we have to feel our own way through, and sometimes we have to borrow some BOS from each other. :D

I really dont understand how her insulin could be bad. It came from the coupon for a free box of pens. The first two were fine. Why would the others be bad? In the back of my head I cant stop wondering if thats the problem tho. I cant afford anymore, so its not an option to go out and buy some to see if it works better. We are stuck with what we've got. And I tell ya, we are pretty darn lucky just to have that!
Click to expand...

Haven't seen anyone else complaining about their free ones, and you really are getting a response, so let's work on the thinking that the efficacy may be okay, and that her dose just needs to be increased. Remember steroids do not leave the system very quickly, they leave a wake. Next time you purchase insulin, look into Canadian pharmacies and Levemir pens. They'll be cheaper.

I have not asked on health if anyone out there using pred also uses R. I have asked how people manage the diabetes with the pred. Any strategies? I got a lot of ECID so your pretty much on your own. Ive never asked again, because of that.
Click to expand...
Ask again. Let's see what we can drum up.. I'll ask around as well. Sad to note, but likely many of those users have moved on. If their kitties are GA, they are in many cases no longer on the board. Some of these people are like.. when you're doing your own thing, dosing wise, posting on FDMB falls by the wayside. You find yourself having to explain yourself all the time, maybe you don't post so much.. you know? One place you might post is HD group. We may have someone there who can help you. Be sure to link today's condo to your post, since it explains so much of your situation.

Now its confession time :o - when I first came to this group (recommended by Jamie and Boots-both GA), everyone told me I was crazy for taking her off the pred if she needs it (in a nice way, of course). I was told we could work the diabetes around it. I resisted and opted for chemo instead. That didnt work out so well. Went back to the pred. But what happened to the people who told me we could work the diabetes around it? Part of my decision to restart it was that I really believed in what everyone here was telling me, and assumed there would be some guidance. But now, I kind of feel like Im paddling a boat against high tides - alone. I get a lot of great support here. Really I do! I love this board a ton, and everyone who makes it so special. But I do feel a little SOL when it comes to getting help with Latte's BG's. I hope it is not because of my expectations, excuses, or attitude that has prevented any creative ideas from coming forward. I get frustrated often and easily. In fact I may have officially developed a bipolar personality over this! :roll: (not that there is anything wrong with it!). But I will do anything to help her, as long as she has a spark in her eye and shows me she wants to keep fighting. I just wish I new how.
Click to expand...
I expect it's more to do with they don't know what to say. If the people that know (and there may not be anyone left that used lantus and knows) are gone from the board, other people might just be afraid to hurt her and you too.

One more final thing. You have a kitty who has far more important things going on than feline diabetes. You must find a way to manage it all and that means sometimes FD takes a back seat. You want her comfortable, not stressing because YOU are stressing. With the exception of Roxanne, all of my FDs have had medical conditions that took precedence over their FD. Let it slide. Aim for blue, not green, if she's sick... don't hold yourself to your own high standards... OR her previous numbers. You treat with the pred first, the lantus second. Does that make sense? If her numbers go up, her dose goes up.. but it's not nearly as important as her pred and her QOL. Sometimes those other things are going to badly affect the bg's. Stand back, take a breath and look at her. She's 250. What's she doing? Is she napping in the sun? Did she swat your foot when you walked by? She's ok. You didn't fail because she's not a .25u green kitty. You succeed every day that she's alive and happy. ((((hugs))))
I will try and help you out as best as I can. If we see her headed for toxicity, ie: her numbers are flatlined anywhere, we'll bring out that R and we'll fix it. Until then, take a deep breath, you've done so much that I don't think you've taken the time to say, "I'm doing ok, and so is she. I'm a good mom."

PS: I loved Jamie. It was the most shocking thing for me to see she had passed. God got an angel back that day. :cry:
 
Re: 2/7 Latte AMPS-347, PMPS-302, +1.5-255, +4- 334

Carolyn,
Thank you for being brave enough to step into this condo! :lol: :mrgreen: It sure can get messy at times! Our discussion really did mean a lot to me.

"If her numbers go up, her dose goes up".

I will try to remember that, and pass no judgement on her numbers. I guess I just thought we were at the right dose for our needs. Body chemistry changes, I suppose. Its just a number. Dont like it, change it.

Time for our evening bath/bed. I will get one more dismal check. Because I gave pred late, she has a while longer to riseI sure wont be awake to see how high it goes! We will be back...TOMORROW! :mrgreen: Look for Latte's super secret surprise party on Wed! You are invited!!!
 
I guess I just thought we were at the right dose for our needs.
Click to expand...
You did not fail. I think you are blaming yourself. I hope you are not. (((hugs)))

See you tomorrow and thanks for the invite to the party!
 
(((Carolyn)))

Sorry I'm no good in the way of help, but I can give you a big ol bear hug...so here
And here's one for Latte too!

I have to admit that sometimes the discussions here are so far over my thick head that I kinda sneak out the back door without a word. :oops: My bad...and never again.

Hugs, vines & prayers for you & Latte.
 
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