3/28, Susie, 265 AMPS, More and More Pinks

Discussion in 'Lantus / Levemir / Biosimilars' started by Summer and Susie (GA), Mar 28, 2021.

  1. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    https://felinediabetes.com/FDMB/threads/3-27-susie-219-amps.245304/#post-2767853

    Frustrating. Susie is getting more and more pinks although she has had a few blues. Is she just bouncing? This concerns me and I won't be increasing her dose on Tuesday until she levels out and comes down from the pinks. Her appetite has waned again. She did not eat all her dinner, evening meal or snacks. She also did not eat all her breakfast. I have cerenia and miratzapan (spelling ?) on order through Chewy.

    She doesn't act well like she did a couple of days ago. Will have to watch her.
     
  2. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    My only advice is to switch to TR - you're holding the dose too long when not seeing better numbers.
     
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  3. Butters & Lyla

    Butters & Lyla Well-Known Member

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    May 30, 2020
    Can you try putting something enticing on her food to get her to eat? I hope you get those meds soon.:bighug:

    I mean, honestly at this point I don't know how much of the high numbers are really due to bouncing vs Susie may just not be getting enough insulin. Sometimes you have to chase the kitty up the dosing ladder quite a bit to get their numbers down. I've had to do this with butters twice.
    Remind me why you aren't doing TR? You'd be able to increase her insulin sooner if you did. It looks like you're testing enough to do it.
    Did you shoot last night? If so, double check the "u" cell I think the dose is missing.
     
  4. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Not sure I want to increase the dose with what I am seeing with all the new pinks. Maybe she just needs a little more time to settle into getting blues again. I don't know but it concerns me.
     
  5. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I did shoot last night. Just forgot to add it to the spreadsheet. I have corrected that. I am doing SLGS because I do not test much at night (at least not yet) and I am nervous about the increases. I just want to make sure she has time to get used to them. I also wonder if the increases I give her don't sometimes affect her appetite. Some days are really good and others are not. I left her second favorite treats for her last night and she did not eat them. Her favorite treat is a "no no" (Temptations) and she doesn't like any human food (tuna, bacon, steak, etc.) so I am sort of at a loss with finding something to add to her food to make it more enticing.
     
  6. Butters & Lyla

    Butters & Lyla Well-Known Member

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    imo, it looks like Susie has simply may have lost steam at this dose. Just my opinion fwiw.
    Have you had a chance to look at other kitties' spreadsheets? You'll see what Susie is doing is not unusual at all. For example, in July 2020 Butters was regularly getting blues and greens (and bounces!) on .5u. Then she just fizzled out. I had to go up to 1.75u to get good numbers again. Then she started earning decreases. but after her last pancreatitis flare in October 2020, she was on 1u and I had to go up to 4.25u to get her back into better numbers. I just want you to know that what Susie is doing is common.
    With testing, the key is getting that +2 and then one more test before bed, and let those be your guide for whether you need to set an alarm or not. Butters onsets a little later than most, so I get a +2.5 or a +3 at night, then a +4.5 or +5.5...and based on these I'll decide whether I need more tests.

    I'm so sorry she won't eat, though. Butters for the most part won't go for human food, but I sprinkle water from a can of salt-free sardines on her food and she will hoover it up. However, if she is nauseous, then she will not eat without cerenia and/or ondansetron on board. I hope you get the meds soon.:bighug:
     
    Last edited: Mar 28, 2021
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  7. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    It's fairly simple - more insulin = lower numbers. Pinks are not lower.

    Take a look at Luci's SS. What would you recommend?

    I'm seeing too many pinks too...
     
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  8. JaxBenji

    JaxBenji Well-Known Member

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    Jul 10, 2020
    Looks like Wendy addressed this previously here. Have you seen TR with a full time job? It has a lots of great ideas for those that can't test much at night (that would be your "work day" if you will). Remember on TR, the minimum tests are preshots and one other test per cycle. A lot of test more than that but you could also load up the auto feeder as Wendy said.

    One thought is you can switch to TR and then switch back to SLGS. For me, I'd be concerned about glucose toxicity (kitty getting used to higher numbers) - Jax had a cycle or two of high blues and low yellows after his dental surgery and I increased as soon as TR let me because I didn't want him and the yellows becoming friends. Everyone is going to take different approaches but I always love hearing how other people handled their kitties (the beauty of this board!).

    You'll figure this out summer - patience is key (though I always tell people I have none :p).
     
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  9. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    The +2 and +2.5 are my bedtime test. I shoot her at 6:00 and go to bed between 8:00 and 8:30. Will get some +4.5 or +5.5 test in too but at this point, with her being so high at +2, I didn't think I needed to test later.

    I do look at other kitties spreadsheet. I guess what I am questioning is that she is starting to get some blues now but also starting to get some pinks. Does she need to settle into the 1.75 units a little longer since it is bringing her down in the daytime but shooting her up now at night. I will stick with the protocol and increase her to 2 units on Tuesday which is a full week after her last increase.

    I do look at a lot of other spreadsheets. I just became concerned with the new pinks (but happy with the few blues). Next time I shop I will get some salt-free sardines (ugh). Also, I should have the cerenia soon. Thanks. Lyla. I appreciate your help.
     
  10. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    Hi Summer. Your SS doesn't look too bad. I see that her numbers seemed to go higher at PM yesterday when she didn't want to eat. Maybe it's actually the higher numbers that are causing her to not want to eat because she doesn't feel well? It looks like she ate a can of Fancy Feast this morning? She's definitely been on the 1.75 dose long enough for it to "settle in." I've seen really bad results from people being advised to hold the dose really long (even 10 to 14 days -- advice from a different group NOT this one) -- like my friend Zorrain who just joined the group. I would not leave Susie at that dose. You're getting in quite a few tests. I don't think going to TR would really cost you much sleep -- unless she looks like she's going to drop on you at night and that would be the same anyway ... you'd stay up or set alarms to test her regardless of which method you are using. Do dose increased in the mornings maybe? I shoot Darcy really early in the morning (like 5:30 a.m.) so that in the evening the +4 number is only at 9:30 p.m. Even if I'm a little late and don't shoot until 6 p.m. in the evening, then it's only 10 p.m. at +4 time. Tonight, I have to leave the house at 5 p.m., but that should still work out. I'm not badgering you, only just making observations on the spreadsheet. I think the really compelling spreadsheet is Lyla's with Butters -- how she had to go so high with Butters to get those numbers under control before coming back down again.
     
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  11. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Why did you drop the dose on 3/27 when she was getting the pinks? I would hold your dose for a couple more days because you did have blues and yellow yesterday. Just a high AMPS today. Interesting that you dropped the dose but got better numbers yesterday. All so confusing.
     
  12. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Now look. Susie had a decent +3 this morning (204). Usually these numbers are high. I do wonder if she just needs time to adapt to increases but I will increase to 2 units on Tuesday. I always thought TR required a lot more testing. I might switch to it this week. At least it allows for more flexibility in increases and decreases. She also ate some treats after the +3 so hopefully she will go back and finish her breakfast soon.
     
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  13. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Lyla's spreadsheet is compelling. I did notice earlier in the year when she did not take a reduction with low greens. I would be really afraid not to reduce. You might be right about the higher numbers upsetting her appetite. I'm not sure that is always the case. Okay, so if I want to go to TR tomorrow, and increase to 2 units, do I just change my spreadsheet or should I shout it out! Just kidding. Other than changing the spreadsheet what else do I need to do to make the switch? I never think you are badgering. We girls from the south have to stick together, Suzanne.
     
  14. Butters & Lyla

    Butters & Lyla Well-Known Member

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    So if you want to switch to TR and increase her to 2u tomorrow, it's always good to get agreement from one of the more experienced members like @Sue and Luci or @Bandit's Mom or @tiffmaxee because they would tell you if they thought you should wait longer.
    To get eyes on your condo from the experienced people, as well as tagging them you can always edit your title, add the "?" prefix, and then write "thinking of increasing" or "time for an increase" something similar to the end of your title.
     
  15. Butters & Lyla

    Butters & Lyla Well-Known Member

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    with TR, there are specific ways cats earn a reduction. I know it seems scary thinking about dealing with the low greens but you just need practice and then you won't find it so scary. You'll become addicted to the greens:D.
     
  16. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I just remembered something. If I switch to TR, and I get a test of 90 or less anytime during a cycle, I will not be able to reduce her dose will I? I'm not sure I want to go that route yet. I thought with TR you don't reduce until you get a test of under 50. I honestly would not be comfortable not reducing with a score of 90 or less. I only have one more day, after today, before I can technically increase her dose to 2 units so maybe I will hang in with the SLGS a little longer. What do you folks think @Sue and Luci, @Bandit's Mom, @tiffmaxee.
     
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  17. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Just tagged them.
     
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  18. Bandit's Mom

    Bandit's Mom Well-Known Member

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    This is what I tell folks who are scared to switch from SLGS to TR. The choice of dosing protocol is not set in stone. You can switch from one to the other at any time (though switching back and forth too often would make no sense!). Why not switch to TR to get her close to her ideal dose faster? Once you start seeing high green, you can always switch back to SLGS. The longer you keep a cat in higher numbers, the more insulin is needed to get their numbers down. I also have to warn you that everyone that we have nudged into following TR gets addicted to green and doesn't make the switch back to SLGS! :D
     
  19. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Thanks, Bhooma. So do I have your blessing to switch to TR and go up to 2 units tomorrow morning?
     
  20. Bandit's Mom

    Bandit's Mom Well-Known Member

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    That makes me feel like The Godfather! LOL!

    Jokes apart, yes please. She does need more juice. 2U tomorrow it is. Good luck! I am sure you are going to be shooting the 50s soon! :D
     
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  21. tiffmaxee

    tiffmaxee Well-Known Member

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    I agree with all of the above. You also need to consider renal threshold. You are above that too much will over time will damage her kidneys. I’ve tried to keep cats in a range to get used to it and bounce less. It just doesn’t work.

    You might want to get an auto feeder since you go to bed early. That way you can keep her safe at night without a lot of testing.
     
  22. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    ARRRRRRRR!!! Don't scare me with "the 50s"! I will be happy just to get in the low 100's, Godfather. Just kidding. I thought about my comment to you earlier and was hoping you would not take it the wrong way. I appreciate all your advice and help. Will make the switch tomorrow.
     
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  23. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I have an auto feeder. If I test, feed and shoot at 6:00 then what time is best to set my auto feeder for her half can and then when is the best time to set the other feeder for a few treats? I have been giving her small evening meal too soon I think. Only about two hours after her PMPS meal so I probably should push that back to maybe +4?????????? And the treats at +6????????????????. Thanks, Elise.
     
  24. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Thanks for the link, Susanne. She has been so high for so long that I just thought I didn't really need to test at night. But, I DO know that when her numbers start coming down I will need to be much more attentive to more frequent testing at night.
     
  25. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Oh, I've never had a green. I'd like to see if I could get addicted to them.
     
  26. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    I know exactly what you mean! Darcy has been sooo high for sooo long that I sometimes think... oh why bother to test... I'm just going to get a high number and get upset. But then the other voice kicks in and says but... it could happen.... or he could drop low... this could be the day/night.... besides, I'm building a huge data bank.
     
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  27. FrostD

    FrostD Well-Known Member

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    May 27, 2020
    If it helps at all, I chose TR to get mr kitty into better numbers faster. Looking at my spreadsheet, it took 2 months of TR to finally get there. If I had done SLGS it would be at least double that time, probably even longer because he'd have been higher longer.

    But now that we're lower, I'm debating a modified SLGS with reductions below 70 or so. The lower numbers are just more difficult for me to manage right now with the baby, so SLGS would give me a bit more wiggle room.

    Then I may go back to TR once the "maintenance" of the lower numbers won't be so difficult. Downside is chances of remission are slimmer and slimmer.
     
  28. FrostD

    FrostD Well-Known Member

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    I was the same, but look at 3/18! Literally over one cycle it happened
     
  29. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    So what changed with Mr. Kitty? Did he have a dental or something? Or did he has an infection that cleared? I wonder why all of a sudden he started getting better numbers. This is actually very encouraging to see. Congratulations on the better numbers!!
     
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  30. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Suzanne, hang in there. Your Darcy will get there. I honestly think the few greens I have seen were just "flukes". It will be wonderful when we both get to the low 100's - won't it? We'll both have to have a virtual party. Hang in there. I don't know anything about Levemir but it does look like you are getting away from some of the red numbers. Have you tried anything else like Lantus?
     
    Last edited: Mar 28, 2021
  31. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Sounds like a smart plan, Melissa. I like that we do have control over what is comfortable and what is not. I mean that eventually all these decisions are ours. I don't blame you for needing to take control with a baby in the house. Hope everything is going well with your young one. Mr. Kitty has made a lot of progress in the last week. You must be happy about that.
     
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  32. carfurby (GA)

    carfurby (GA) Well-Known Member

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    I think the pinks you are seeing is just bouncing because Susie is not used to blue numbers yet. It may see you should do the opposite, but it's best to increase to get her more used to blue numbers and then the bouncing should settle down. :bighug:
     
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  33. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I agree, Carla. The longer I keep her in high numbers the more damage it does.
     
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  34. FrostD

    FrostD Well-Known Member

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    I wish I knew. He's been high for 8+ months now Nothing changed except increased doses, he got sick with pancreatitis and got antibiotics + fluids.

    So likely I just hit a breakthrough dose for the glucose toxicity
     
  35. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I am SO happy for you, Melissa. You and Mr. Kitty have been diligent and patient and now it is paying off!
     
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  36. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I think the biggest "roadblock" for me, mentally, when I think about the constant increases in insulin is that I keep thinking of insulin as a medication and not a hormone. This is why I am fearful of constantly increasing the dose. It is like constantly increasing a dose of amoxicillin or clavamox. There comes a point when you are going to damage your cat with increases of these prescriptions. I need to get it in my head that insulin is not a damaging drug when increased. Yes, you have to monitor your cat with any increase of insulin but it is not a prescription drug - so to say.
     
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  37. FrostD

    FrostD Well-Known Member

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    Thank you! I'm just glad he's feeling better, though like Lyla said I know it can change any time. Susie's numbers aren't horribly high, you'll get there soon!
     
  38. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Her nadirs are all above 150, she needs an increase. More insulin will also help lower those bounces. Cat's don't "settle in" to blues. Instead, they get used to higher numbers, get glucose toxicity and you have to increase even more to get over it. If you hold a dose too long, the dose will start to look worse. Remember, we decide how to change the dose based on how low it's taking the cat. As per both dosing methods, she needs more insulin.

    I can somewhat sympathize about the worry of increasing since I had to go up to 8.75 units, but Susie is still on a relative small dose. A cat needs however much insulin they need. Susie needs more.
     
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  39. Sue and Luci

    Sue and Luci Well-Known Member

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    Actually that's an increase from 1 unit (using calipers) a 'fat dose' is considered being something between 1 and 1.25 - on my calipers I have to use mm to reach that dosage.

    So 1 unit for me on the calipers is 1.32 mm
    1 unit + .10 = 1.42 mm
    1.25 = 1.65 mm

    I could write 1F (as in fattening the dose, which is probably easier for everyone else to understand, but for me the calibrations works)...sorry for the confusion.

    Luci has pulled off an entire day of nice blues with yellow bookends (high AMPS and PMPS) so has bought herself another day at this dose...I was leaning toward another increase soon...each day is a new day...so we will have to evaluate tomorrow based on TR dosing method recommendations of increasing every 6 cycles (3 days) if the numbers aren't very good...
     
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  40. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    I guess I am really losing it. You say a dose at 1.25 is higher than 1.42? I always struggled with math but this does not make sense.
     
  41. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017

    It will make more sense when/if you start using calipers to measure your dosage.

    These are the measurements for the syringes I'm using (each syringe may measure differently, so you can only use these IF you're using Relion syringes)...

    0.13 mm = 0.1u
    0.26 mm = 0.2u
    0.33mm = 0.25u
    0.39 mm = 0.3u
    0.52 mm = 0.4u
    0.66 mm = 0.5u
    0.79 mm = 0.6u
    0.92 mm = 0.7u
    0.99 mm = 0.75u
    1.05 mm = 0.8u
    1.18 mm = 0.9u
    1.32 mm = 1u
    1.65 mm = 1.25u
    1.98 mm = 1.5u
    2.31 mm = 1.75u
    2.64 mm = 2u

    So I increased from 1 unit to a fat dose (which was 1.42)...then to 1.65 on my calipers which is 1.25 units on my syringe.... Does that help??
     
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  42. Summer and Susie (GA)

    Summer and Susie (GA) Well-Known Member

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    Dec 20, 2020
    Yes, it makes sense. The 1.42 was mm and that was what confused me. I thought you were saying 1.42 units. Wow, you really have the measurements down. I am not using Relion. I am using UltiCare Vet RX syringes and Marje was nice enough to figure out the main mm's for me on the caliper which I have. I don't have all the tiny measurements to refer to. Just the .25 unit, .5 unit, .75 unit, 1 unit, 1.25 unit, 1.5 unit, 1.75 unit, 2 units.
     
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