Leoberry (aka Leo)

OMG - Little Dude just gave me 3 leg lovin's. They were pretty wimpy. But he knew he touched me as he went by several times.

 

Leo:
Look at second tab in his google sheet. A bit higher average pre-shot, the last 2 days.
And that 500 nadir must have been a bounce. I'm staying on protocol, and waiting 6 cycles to increase from 11.0 to 11.5, which is only 5% increase. We are strict on the food for the past 10 days, no carb treats or carb food.

Little Dude:
Major, Major progress. I sat next to his food bowl, and put in one kibble at a time. Just barely touching him.
Then, he let me touch him. Then next thing we both knew, he did a head bump on my hand. And then I rubbed his head about 5 or 6 times.

This is after 4 weeks of trying to tame him. We'll never know if he was ever rubbed in the past. Wow. Theresa is big time jealous. But this is a big win for both of us. And of course, he is very soft.

 

Great news about Little Dude!

 

Ohhh I'm so happy to hear about Little Dude!

 

Fantastic news about Little Dude! Those leg lovins must have been an absolutely stellar moment for you! Bet it was hard not to bend down and try to pick him up! And then to be able to stroke him. I'm so happy for you.

Now on the subject of Leo........ I see he got a lower AMPS this morning so it'll be interesting to see where he is at PMPS. Our "normal" dose increases with a beginning cat can be as much as 25% so yes those 0.5u increases at the higher doses seem tiny. The problem with our high dose furkids is that like any other cat you don't want to miss the right dose but at the same time you don't want to be skimping too much. Now bearing in mind that I am not a PZI user, from what little if any drop you've seen the last few days, I think I would consider upping the dose by 1u (10%) and see if that has any impact if another increase is needed. Before you do that though, can you try to get some readings between +6 and +8 to see what he's doing in those hours.

 

on Little Dude:
Thanks everyone. It is so rewarding to have this breakthrough. He let us touch him some more today. We want to cuddle him, so maybe that is in the future.

on Leo:
Thanks Linda. He had a "low" nadir today. The 8/14 AM shot was in 2 places because he squirmed. But it all went subQ in the haunches.

I am fearful of a July 29 repeat, where he got that surprise low nadir. That was at 11.5 units.

PMPS is in 60 minutes. Plan follows, open to input:
- 8/14 PMPS
- test PM nadir at +4.5 (1am)
8/15 Monday
- If similar values to 8/14 AM values, then increase to 11.5
- test AMPS, then AM+4 and AM+6 tests

 

Jeff, I understand you don't want any "surprises" and with that nadir Sunday mid day cycle and the drop last night, I would stick to 0.5u increases right now, but it's just something to think about should Leo keep moving up the dosing ladder. Only consider more of an increase if you are comfortable with it and then only when you can monitor. Keep in mind while Leo went low on the 29th compared to where he had been, that cycle was a thing of beauty. If Leo does have IAA or Acro, then the trick is to try to get ahead of the problem and then keep Leo there and unfortunately, sometimes that means you are going to get some surprises but we control that by monitoring and sometimes by lowering dose for a cycle to accommodate our schedules.

Leo's PMPS was up last night probably in response to his lower nadir but he had a beautiful drop of almost 50% at nadir last night. All in all Sunday's cycles look very promising that you may be honing in on Leo's ideal dose.

 

Leo:
Thanks for the continued help Linda, and others. This whole ride has been challenging. My vet is good, but has no experience with high-dose kitties. So not much help there. But the help from you and others on this forum have been invaluable.

Now that he seems to be responding to proper food and insulin dose, I'm ready for a few surprises. Let's see what happens with the new 11.5u today.

I added a trend line to Leo's preshot averages curve, on the second tab. It seems to have a good downward trend. He had a good low AMPS today. I am hoping Leo becomes less of a science project, and becomes regulated. We miss our old pre-diabetes kitty. He is getting brushed about 5-10 times a day, accompanied by lots of purrs and rolling around.

Little Dude:
The first few touches a few days ago have turned into a total breakthrough of trust. Now, when we go on the porch, we get instant leg lovin. And if we sit on the ground, we have major rubdown sessions. This has been a huge success for us, and we are so happy to welcome him into our family.

He has major ear mites, so we do washdowns after front porch visits. He lives on the front porch now. Once we get those cured over the next couple of weeks, he can come in the house and meet his jealous siblings.

 

Lovely AMPS! Keep going Leo! Jeff, you are definitely making progress even if sometimes it doesn't feel that way. Leo is one lucky guy to have you trained and willing to brush him 5-10 times daily.

The progress you have made with Little Dude is remarkable. So happy the little guy will soon become a permanent member of a wonderful family! I'm betting Scoobs has been instrumental in all this progress ....just saying!

 

Summary:
- Leo is back to cruddy numbers
- 12u doses now
- will increase by 0.5 every 2 days until he can achieve some "blue" 100-200

Insulin cost:
- On last tab on Leo's spreadsheet
- at 12u doses
- Prozinc = $2,850/year
- Lantus = $2,230/year

At these high dosage levels, insulin is real expensive. Since the Prozinc didn't really solve the problem, I'll probably revert to Lantus after this PZI vial.
- Lantus is readily available, PZI has to be ordered/shipped
- Lantus is cheaper, and I can get it even cheaper from Canada

If there is some other advantage to Prozinc, I'm all ears. At these prices, we'll consider radiation if Leo has Acro. His neuropathy is bad, even though he's now getting 2 x 3mg Zobaline tabs daily.

 

Well Jeff, I think @Bobbie And Bubba can tell you what the pros and cons are with prozinc vs lantus. Maybe she can help you with it!

 

Hi Jeff,I switched to Lantus after not getting a good response to ProZinc, but as it turned out, Bubba was a late nadir cat and with Lantus and it's flatter cycles, it allowed me to shoot lower numbers.

You might want to consider Levemir for Leo since he is a high dose kitty. The reason is that in higher doses the Lantus stings and Levemir does not. It might be a good idea for you to post in the L & L forum to get feedback from all the high dose peeps.

 

Thanks Ruby and Bobbie. Good info. After today, I'll probably migrate to the high dose forum. Levemir does sound like a good option. I need to evaluate pricing as well. Thank you.

 

I think the high dose forum isn't active. You can try, but you may not get much info from people there...most have migrated to the forum for their insulin.

 

Thanks Rachel. I just looked, and you are right. The high dose forum is not happening.

Per the hint from Bobbie, I did a +7hr test on Leo today. Same result as +5hr test. Would have been great to have a lower nadir. Bumping the dose to 12.5u tomorrow.

It looks like standard 10ml Levemir is $290, similar to Lantus in pricing.
https://www.drugs.com/price-guide/levemir

Aug 18 - now ~1/2 vial of PZI consumed since it was just opened on Aug 6.

Thanks everyone for the help.

 

Jeff check the Supply Closet for the Levemir. Allan Hamman sells there a lot cheaper and Sharon14, Collin is High Dose and she buys through him .
http://www.felinediabetes.com/FDMB/threads/levemir-pens-35-exp-5-18.160959/

 

Thanks Bobbie. I will check. Leo is going thru insulin like water. Now up to 12.5u per dose. Probably similar to most high dose kitties.

 

Yes, I am sure that a lot of the other HD kitties parents can relate.

 

I'd also vote for Levemir. It is very similar to Lantus in cost, duration but is said to sting less and have longer, flatter cycles in HD kitties. Good luck, Jeff!

 

I hope the Lev works! You should definitely check in on the L&L forum and see if they can give you some info on Lev.

 

I saw your comments in the Lantus/Lev group and decided to follow your link and see what Leo's story is. If you want to switch, most (all?) high dose kitties usually go to Levemir. Lantus might/might not sting in a cat, but it does have a more acidic ph. Lev is neutral. I always do a double-take when people say that Lantus stings - it might in some cats, but punkin got up to 15.5u and never reacted to his shots. I know others who also have had cats on high doses and not had a problem with it. So a blanket statement is rather iffy on that topic.

Have you seen this sticky in the Lantus/Levemir insulin support group about the depot insulins? I especially like the very first link called "Lantus & Levemir, What's the Difference?" That should help you understand how they work. One big difference between the 2 is that the nadir is typically later with Lev than with Lantus. Some cats end up having their nadir on Lev at the next preshot, so you really have to wrap your head around shooting a lower number because the Lev typically takes another 4 hours or so before it onsets.

The high dose group is inactive - I didn't know there was anyone with a high dose kitty here on the ProZinc/PZI group. Most typically emerge in the Lantus/Lev group and just stay there. The high dose group got bent out of shape in 2010 and left en masse to a facebook group. I started right after that in the Lantus group and just stayed, and others have as well. Now there are many high dose kitties there - we've had as high as 100u per shot and kitties with iaa/acro/cushing's, or a combination of those. There is plenty of experience in the group and several of us who either have or have had kitties with high doses help others with high dose kitties.

In any case, just holler if you need help. Punkin had acromegaly only - you can look at my signature line for his story being treated at Colorado State University for that. @Wendy&Neko Wendy's Neko has both iaa and acromegaly and Wendy's had Neko treated twice there for it. You might want some help in figuring out a starting dose when you switch. We can take a look at how he is doing at that time and what dose he's on and give you a hand going through the options.

Hang in there - you're not alone. The most recent study showed that one in 4 diabetic cats has acromegaly, and it's not rare for us to see insulin auto antibodies either (iaa.) You have lots of company in your boat!

 

Hi all

Thanks for the ongoing support and help. In the past 2 months I read all the stickies in all the forums. Thanks for pointing them out. I've also read a lot of web literature. The flatter cycle for Levemir sounds interesting. Actually any nadir sounds interesting at this point.

I already read about @Wendy&Neko, and Neko's CSU treatment. Now I've ready thru Punkin's treatment too. Also I read about Punkin and Anya - such a sweet pair of kitties. I'm sorry that Punkin is gone. It is amazing that all the kitties on this forum have such great parents.

That's an interesting story about the high-dose group....too bad. About the 100u/shot....heck, even at Leo's current 12u/shot the expenses are $2,500/year or more (last tab on Leo's spreadsheet). I don't know how people can afford insulin at 50u or 100u per day. Anyhow, I'll migrate over to the Lantus/Lev group. But it is pretty busy.

I saw Punkin's SRT was ~$4,000. That is roughly 1.5 years of Leo's insulin now. Time for me to get him tested. He may have IAA, so SRT won't fix that. If he has Acro, the economics make sense.

Thanks everyone for the continued help. Leo currently lives in the kitchen. Always hungry. We have 3 different beds in there for him. And I brush him multiple times a day. Did someone ask me for baby Leo pic from 10 years ago? Here is the heart melter (a shelter adoption for Leo and Chinus both).

 

What an adorable kitten pic!

IAA is said to be self limiting, around a year. Neko's IAA started to break right after her radiation therapy for SRT, smf that was about 9 months after she started insulin.

Many people have been buying their insulin from and online Canadian pharmacy - details here, might make things cheaper. Note that the Canadian Postal Service may have a strike on it's hands as of August 25th, so you'd have to order soon, if that should happen.

 

Thanks for the IAA update Wendy. For the next vial of insulin, I will probably buy it locally. Texas is still 95-100, so I can't risk a shipment that is improperly cooled.

 

Leo's neuropathy seemed to get pretty bad this week. I've read all about it. At some point, I guess they can't walk. But I don't want to think about that right now.

I'm increasing his Zobaline from 2 x 3mg tablets a day to 3 tablets (9mg/day).
He also gets an injected veterinary B12 once a week. If there is some other amazing stuff I can also do, I'm all ears.

 

Hi Jeff, since you've been reading about it, I'm sure you know the best thing for neuropathy is regulated numbers. If you can get him to exercise a little, that will help his muscles. I have pet stairs by my bed and the sofa so Colin can get up to sit with me. Also have you had his potassium levels checked, too little can cause weakness as well. One other thing I recommend you keep an eye on is Phosphorus levels. Fancy Feast is high in Phos, and our high dose kitties stay in high numbers a long time and that puts extra stress on their kidneys, a lower Phos diet may help slow that down. When do you plan to switch insulins?

 

Hi Sharon

I'm scheduling his blood test this week. And his insulin will get changed this week to Levemir. The Prozinc vial is already running out. Probably 5 days worth. He barely exercises anymore. He does have to jump onto a platform, then back down, to get to the litter box. The platform blocks the little dogs from the litter box "treats". Since he pees a lot, he does that exercise 10 times a day.

I'll get his potassium and phosphorus tested. That will be part of the acro and regular blood test.

Theresa wants me to contact an internist specialist. I'm not sure they will tell me anything more than I've learned on the forum. And it will be more money.

Are you getting your high-dosages of insulin from Canada?

thanks for the help...Jeff

 

Good to point out that neuropathy is best achieved by regulated numbers. I appreciate that, and already knew it. This attempted ramp on Prozinc didn't achieve that so I'll ramp him on Levemir. And it will be faster than this 6 week ramp on PZI.

 

I haven't ordered from Canada yet. I started by buying a single pen of Lev from a local pharmacy, and since then I've gotten it from Alan on the Supply Closet. He is in Tx and I get it in a couple days. I'll order from Canada in the fall and spring. Colin doesn't really exercise anymore, he's always been sedentary and now at 13 and with neuropathy, laying around is his favorite pastime. He does go outside a little and mostly lays on the porch, and he enjoys catnip sprinkled on several scratching pads and he gets a little exercise with that. Colin's walking isn't too bad-I've seen much worse in videos. He sleeps in the living room and has to walk several times a day to the kitchen for meals. Maybe if Leo is hanging out in the kitchen you could feed him in other places so he has to walk to get to his food. Colin also gets some exercise with a feather wand. He lays down on his back and bats at it which moves all 4 legs.

 

Ok, thanks Sharon. I have contacted AlanH. I'm in Austin...so maybe I'll receive it in 24 hours once I order it.

I guess all cats get sedentary as they get older. That's a good suggestion to move his food around. Maybe many high-dose cats don't feel great. Yesterday, Leo had a high BG day. The chart for Colin is interesting and is encouraging that high doses can regulate problem fur kids.

 

AlanH has come thru with the Levemir - will arrive Tue or Wed. Thanks for the suggestion Sharon. That will be 1,500 units and should last 6-7 weeks.

Leo is now at 13.5u. Instead of re-starting him at 1.0 units on the new insulin, I'd like to ramp him quicker, then taper as the doses approach 10.0. Maybe
day 1: 4.0/dose
day 2: 5.0/dose
day 3: 6.0/dose
7.0
8.0/dose
8.5/dose
9.0
9.5
10.0 (9th day)

I know Levemir is a depot insulin. He has achieved some nice yellow nadirs recently at 11.0/dose.

 

When Colin switched from ProZinc to lev, I was told to use the same dose I was on which was 5u. I went with 4u. Maybe tag Wendy or Julie and ask their opinion on a starting dose.

 

When are you going to make the switch Jeff?

 

@Wendy&Neko - changing insulin, advice requested.

Changing from PZI to Levemir tomorrow (Wed), or Thursday. New insulin arrives today (confirmed). Leo dosed 13.5u this morning. There are 2 or 3 doses of the expensive PZI left.

 

You could also post for opinions on the Lantus & Levemir forum, but we generally switch at the same dose, as Sharon suggested. If Leo had been seeing a lot of blue or green, I might be more conservative to start. One thing to keep in mind is that sometimes kitty can have an initial strong reaction to the insulin, especially if there are antibodies (IAA) in play. It's like they get confused at first by the new insulin. As an example, take a look at Jack's spreadsheet - he switched end of May. So that means you want to make sure you pick a time when you can monitor to make the switch. If there's a strong reaction, sometimes it's the first cycle, sometimes the second.

 

Thanks Wendy for the great advice. I'll start Leo at a higher dose. He could use some blues and greens. Wow, Jack is soaking up the insulin too!

 

Leo had a low BG reading today = 65.
I suspect these aberrant issues could be from shooting near a large capillary. Anyhow, no issue...just fairly low.

Levemir did not arrive today. USPS indicates delivery tomorrow.

 

Nice number! Good luck with the switch to Lev. Did you get the bloodwork done?

 

I'm a little sad,, it feels like you're 'leaving' the prozinc family....

 

Hi Sharon - Lev arrives today. I'll dose PZI tonight as well.

Hi Ruby - Prozinc is more expensive and must be specially ordered. I hoped it would be more effective, but alas, it was not. I'll either start and maintain a thread in the high-dose forum or the Levemir forum.

Leo gets a vet visit and bloodwork on Thursday. This visit is with an internist. We had to get our vet to refer us to them. Seems silly to me. And 1 hour round trip driving there because it is way north Austin. Leo travels well in the car carrier, but he doesn't like it.

 

Well Jeff, I will find your thread! I do want to know how Leo is doing on Levemir
Did your Levemir arrive yet?

 

Hi Ruby. I'll post a link to the new thread here.

The Levemir arrived at noon today. I never dosed by extracting from these syringes before. Looks pretty easy.

Leo is having another great day, which has been rare. He may have achieved the good range of doses. While in the blue and green range yesterday and today, he has been very alert, and more active as well.

 

Here's a video showing how to draw from the pen
http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/
In the L&L forum you are to start a new thread each day and link the previous days thread. I don't post everyday, but I do check out other peoples threads(called condos)
Glad Leo's feeling good. Are you getting the Acro/IAA tests?

 

Thanks for the link Sharon. It's a good video. I already read the FAQ there and watched the video again. It is interesting that people aren't using the off the shelf pen syringe units. I guess it's more accurate with a U-100 syringe.

I might post to the high dose forum. I could wake up the forum with the daily exploits of Leo.

Yes, on Thursday (tomorrow), Leo will get the Acro and IAA tests. At least I have told them to. If they are lame and didn't pass the instructions, I'll tell them to pull blood and get the tests done anyhow.

 

The tests are only run on Wednesdays at MSU. My vet pulled the blood Mon AM and overnighted it. I read that IAA is a fasting test too. My vet didn't do the IAA even though I requested it I will watch for you on the high dose forum!

 

Thanks for the info. Crud. I hope they can just chill the blood until they send it. And of course, there has been no feedback from the vet to fast Leo. If we fast him, he will drive us nuts for food.

 

When the fasting was mentioned on Jacks(Saltycat) thread, others chimed in and said their vets hadn't mentioned it either. Karen(& Lily)said her vet had called MSU and they told him to fast. So I don't know how important it is.

 

Ok, thanks. I'll have them pull blood, and they should figure it out. If it doesn't work, I'll schedule yet another appointment at my regular (close) vet.

 

Good luck at the vet today!

 

Best of luck to you both at the vets! Hope everything comes back normal.

 

Thanks everyone for the help. Going to the vet as scheduled, in 4 hours.
Leo has started Levemir.

I don't think I can close this thread. But I started his new thread as a high-doser over here.