Sunday, June 24, 2007

Levemir has gone to pot.



Or wherever insulin goes when it decides not to bother working in your cat anymore....

This has been a horrible week. It started when I realized - a little slow on the uptake here, I guess - that Scruffy's charts didn't match any of those nice, calm, hammock-shaped levemir curves that everyone else seems to have. We had up-and-down-jerking, just like with BCP PZI. Only difference was, the down part of the jerking was significantly lower/nicer than anything PZI had produced. I had been pretty much ignoring the high numbers - and they WERE high - because I thought I had a reason for them. Most of them were occurring directly after I had changed the dose by some minute amount: Levemir isn't very forgiving in Scruffy, for some reason. And a few of them, I'd been out and missed the 12 hour shot. (Although, what happened to all those earlier 16 and 18 hour durations? Gone with the Wind?) It also appears that Levemir has started to operate in some ways like PZI did - when it's done, it's done, and he can go up 200 points in an hour or less.

When I started levemir, there were two things I wanted: 1) better numbers and 2) not to have to use boosters. (Well, okay, that's not totally acurate - I also wanted thick hair, and for Milkshake to not have seizures.) For some reason, I deluded myself into thinking that he was doing okay without boosters for the first month or two. He was spending hours every day well under 200, and most of the time, under 150. Unheard of. His numbers were still better than they'd been for the last year and a half, if not more. I had tried using small amounts of R with the BCP in the past, and it was very unsuccessful. His bg levels would drop, significant but manageable amounts, but then he'd start having high flat numbers that were even worse than what I was trying to correct with R. I had never tried N, and wasn't particularly interested in learning about it at the same time I was trying to make the acquaintance of Levemir. I had used BCP boosters fairly frequently, with no particularly impressive outcome.

So, here we are. I've given Scruffy two .5R boosters in two days. I don't have a good enough grip on when his onset is with Levemir - it seems, like everything else about this stupid disease and my beloved little cat - to vary erratically, unfortunately. I have to decide whether to give the R by itself, which is what I did this morning, and then give the Levemir afterwards, or if it might be okay to give them both at the same time. Yesterday, I gave him Levemir first, and when he headed even closer to 500 in the next hour, I gave him .5R. He was so high at that point that I could have given him a whole unit, instead of a half.

All in all, I'm discouraged about the whole thing again. I was so happy with Levemir. It's still better than either of the other two insulins we've used, so I suppose I should quit complaining and just keep plugging away. Which would be easier to do if there weren't a furry little being whose life depends on my doing better than I have been - plugging away isn't enough....

Monday, June 18, 2007

The " bump" is officially a lipoma.

Boy, it seemed like it took forever for the lab results to come back. According to Antech, the cells are adipose. (I think that's what the vet said. I'll get a copy of the report the next time I'm down there.) He seemed comfortable with that report, although he said that it's never a good idea to totally assume that it's not gonna turn into something worse. For now, he thinks that occasional monitoring (aspirations) and checking growth will be sufficient. Thank goodness. Lipomas are supposed to be slow growing, although this one wasn't noticeable when Scruffy was shaved for the first time last year and it's certainly a good size now. At least now I know where to look and what to watch.

Sunday, June 10, 2007

May bg #'s with Levemir

Off and on, for most of April and May, Scruffy's had herpes symptoms, mostly snorting and sneezing. He was supposed to have a dental in April, but was too snuffly. He did have the blood work done on 3/30/07. The only out-of-range results were cholesterol at 228 (range 75-220), monocytes at 636 (range 0-600), and T-4 at 0.5 (range 0.8-4.0) And of course, his glucose level, which was 320....

He also in January, 2007, had an appointment with a veterinary ophthalmologist to examine what had been a very small area of discoloration in his left eye. While we were there, I noticed that there was also a brownish area (different from the hourglass-shaped one of the left eye - this one was just a little blot.) The original spot was diagnosed as a "focal iris nevus." The doctor felt that there was minimal concern about either of them at this time, but that the left one should be watched, and checked again in a year. It continued to enlarge and change shape, and when I took Busy to the ophthalmologist, I mentioned Scruffy's eye to her, and she suggested changing his follow-up appointment to September, 2007.



5/1/07

+
10.5 138
AM PS (+12.5) 203 fed 1.5u
+
4.5 396
+7.5 418
PM PS (+11.5) 354 fed, threw up 1.5u
+5.5 320

5/2/07
AM PS (+12) 292 fed 1.5u
+4 418
+10.5 310
+11 fed
PM PS (+12) 1.5u
+4 380
+5.5 355

5/3/07
+
12 200 fed, threw up
AM PS (+12.5) 1.5u
+6 118
+10.5 103 fed
+12.5 92
+14 97
PM PS (+14.5) 106 1.5u
+1.5 141
+2 146

5/4/07
+
8.5 51 fed
+10.5 99
AM PS (+11.5) 193 1.5u
+4 268
+8 239 fed
+11.5 372
PM PS (+12) 1.5u
+3 281

5/5/07
+
9 74 fed
+10.5 150
AM PS (+11) 1.5u
+6 355
+9 324 fed
PM PS (+12.5) 392 1.5u
+1.5 397 threw up

5/6/07
+
8.5 284 fed
AM PS (+13) 319 1.5u
+5.5 264
+7.5 211 fed, threw up twice
+ 9.5 160 fed
+12 149
PM PS (+14) 164 1.5u

5/7/07
+
5.5 155 fed
+8 158
AM PS (+11) 190 1.5u
+3 180
+6 166 fed
PM PS (+10) 200 1.5u

5/8/07
AM PS (+8) 82 fed, threw up
+9.5 93 fed
+10.5 91
+12 83
+14 81
+15.5 83
+18 121
PM PS (+19) 157 fed 1.5u
+4.5 306
+7 287

5/9/07
AM PS (+13.5) 309 fed 1.5u
+3 386
PM PS (+11.5) 430 (Ate Busy's dry food) 1.5u
+4 385

5/10/07
AM PS (+12.5) 246 fed 1.5u
+3.5 260
+5 259
+10 119
+11 104 fed
PM PS (+15.5) 189 1.5u
+2 331

5/11/07
AM PS (+8) 396 fed 1.5u
+1.5 434
+5.5 372
+8.5 296
+11.5 215 fed, threw up
PM PS (+12) 1.5u fed
+5.5 fed 31
+5.75 fed 37

+6.5 73
+7 101

5/12/07
+10 170
+12.5 174 fed
+13 175
AM PS (+14) 214 1.0u
+2 374
+3.5 408
PM PS (+9) 419 fed, threw up 1.5u
+4.5 413

5/13/07
AM PS (+12.5) 482 fed 1.5u
+1.5 441
+4.5 401
+11.5 91 fed
+13.5 84
+16 129
PM PS (+17) 191 1.5u

5/14/07
+6.5 339 fed, threw up
AM PS (+8) 357 1.5u
+1.5 384
+8 129
+9 97 fed
+10.5 76
+12 92
+13 101
+13.5 99
PM PS (+15) 112 1.5u
+1 144

5/15/07
+7 76 fed
+10.5 138
AM PS (+11) 1.5u
+2.5 149
+6.5 129
+7 fed
+8 129
PM PS (+10) 231 1.5u
+2.5 248

5/16/07
AM PS (+10.5) 356 fed 1.5u
+4.5 360
+7 336
+11.5 263 fed
PM PS (+12.5) 259 1.5u
+4 361

5/17/07
+12 128 fed
+13.5 130
AM PS (+14.5) 176 1.5u
+4 215
+8 133 fed
+10 173
PM PS (+11) 1.5u

5/18/07
AM PS (+10) 261 fed 1.5u
+2.5 412
PM PS (+11) 320 fed 1.5u
+4.5 373

5/19/07
+9.5 389
AM PS (+12) 420 fed 1.75u
+6.5 401
+8 322
PM PS (+11.5) 326 fed 1.75u
+4.5 270

5/20/07
+12.5 210 fed
AM PS (+14) 292 1.75u
+4.5 384
+9 239
PM PS (+10) 264 fed 1.75u
+2 263

5/21/07
AM PS (+13) 359 fed. threw up 1.75u
+6 265
+8 164
+10 91 fed
+12.5 128
+14 162
PM PS (+14.5) 1.75u
+2.5 265

5/22/07
+5 167
+8
167 fed
AM PS (+11.5) 196 1.75u
+3.5 341
+6.5 340
+10 303 fed, threw up, ate Busy's gravy food
PM PS (+13) 430 1.75u

5/23/07
+8 353 fed
AM PS (+10) 378 1.75u
+5 145
+9 40 fed
+9.5 92
+11 106 fed
+14 100
PM PS (+16) 138 1.5u
+1.5 182

5/24/07
+8.5 369 fed
AM PS (+9) 1.75u
+8 122
+9.5 74 fed
+12.5 55
+13.5 69
+15 87

5/25/07
AM PS (+22) 431 fed 1.75u
+3 453
+5 377
+10.5 309
PM PS (+12) 344 fed 1.75u
+4 235

5/26/07
+12 75 fed
AM PS (+14) 233 1.75u
+3 426
+5.5 412
+8.5 370 fed
PM PS (+9) 1.75u
+5 263

5/27/07
+12.5 77 fed very stuffy and sneezy; ate little
+14 71
+15 92
AM PS (+15.5) 98 1.75u
+2 125
+4 120
+6.5 120
+8 132 fed
PM PS (+10) 147 1.75u
+2.5 231
+4 224

5/28/07
+11 83 fed
AM PS (+13) 100 1.75u
+3 48 fed
+4 42 fed
+6 55
+9 80 fed
+10.5 77
PM PS (+14) 236 1.5u

5/29/07
+7 331 fed, had hairball
AM PS (+8.5) 409 1.75u
+1.5 433
+9 147
+10.5 92 fed, threw up
+13 104
+14.5 105
PM PS (+15) 113 1.5u
+3 156

5/30/07
+6 170
+9.5 177 fed
AM PS (+10) 169 1.5u
+2 107
+3.5 48 fed
+4.5 37 fed
+5.5 34 fed
+6 36 fed
+7.5 88
+9 109 fed
+11.5 172
PM PS (+14) 300 1.25u
+1.5 431

5/31/07
+8 365 fed
AM PS (+12) 385 1.5u
+2 355
+6.5 58 fed
+9.5 118
PM PS (+12) 204 1.0u

This is pretty much where I started feeling like I needed to start over. Too many high numbers, too many low numbers, too much dose changing. It appears that after each dose change, even if it's only .25, there's at least one day of really lousy numbers, frequently in the 400's. And I don't want him in the 40's or lower. I'm not actually even all that enthused about the 50's. All of this month's experimentation with dosage didn't seem to produce any certainties. I think 1.75 is too much. (Is that a tiny little Levemir rebound that he was getting on 1.75?) . 1.0 is too little. 1.5 seems a little erratic - sometimes it works a little too well. I'm sort of liking 1.25 in general. I started out shooting every 12 hours and then discovered that sometimes he's still going down WAY after 12 hours. So now, unless he's really high - over 350 - I'm just waiting a while to see what he's doing, since this tends to happen a lot at night when I'm desperate for sleep. I don't know how people do TID with Levemir - it doesn't seem like a particularly forgiving insulin for using with a scale. And I'm still not comfortable shooting very low, because some of his lowest numbers - the 30's and low 40's - have happened when I've shot over 200 and even 300. It doesn't give me confidence to shoot when he's 100 or under......

All that said, I like Levemir. A LOT. There's a - this sounds dumb, but.... - "calmness" to it that he didn't have with BCP. I think he's feeling good. He bounces around, he even has started being assertive/aggressive with the other cats, which he never did before. Even though he does periodically go lower than I want him to be, and it's pretty much always unfortunately a surprise, there is still an element of what seems like his body having more control or something. I can't explain it. I just think this is good stuff for him. I had previously worked very hard to assure that he got his shot at least an hour or preferably more before he ate, because of the food spikes, and with the long duration that tends to happen with Levemir, I can't do that any more, but the food spikes don't seem to be as much of a problem as they used to be. The time of onset isn't any shorter than it was with BCP. I don't know what makes the difference. I just think, if you add up all the hours and hours that he's been under, say, 200 since we started Levemir, it's an amazing improvement.












Thursday, June 7, 2007

Scruffy has a bump.


I've spent the last week snipping pounds and pounds of fur off my sweet boy. I found a tiny little trimmer at PetSmart that he didn't mind so much - only about a half inch across, and it runs on one AA battery, so the shaving has been quite a lengthy procedure. And then, once I got his sides pretty much mowed, I noticed that he's got a great big round circular "bump" on his right side. It's soft, and it doesn't seem to move, and he doesn't seem to feel anything when I touch it. He's pretty crabby usually, and he hates for anyone to touch him below the waist, so not reacting to the "bump" being touched seems like a good sign. Hopefully. You can see the bulge above, on his right side.

April bg #'s - end of BCP, start of levemir

By April, 'o7, I had reached a peak (or a PIT) of desperation. Scruffy's numbers were getting consistently more horrible. Food spikes were rampant. He had ear infections and herpes attacks repeatedly. I had been trying TID, BCP boosters, reducing doses, increasing doses, etc, - you name it - for months. On top of which, Milkshake had had 12 grand mal seizures in a week totally out of the blue, and I was in quite a state, aside from getting no sleep because I was waking up every half hour to make sure he wasn't having a seizure. The Levemir had been sitting in the refrigerator for 9 months because I was afraid to switch again. (Scruffy'd ended up in the hospital with DKA when I changed from U to BCP.) However, at this point, there didn't seem to be much to lose; it seemed unlikely that he'd do any worse on Levemir than he was doing on BCP. I had a couple of basic things I was hoping for from Levemir: 1) I didn't want to have to use a booster 2) I didn't want him in the 50's or lower on any sort of regular basis. Other than that, I was pretty much open to see what happened. (And HOW I wish I could figure out enough Excel to do one of those lovely charts...) My real goal should have been to find someone/something like LevLand (the ISG) where I could get actual input and information; while I did read everything I could find on using Levemir, I didn't have enough of a grip on the whole process to make it work. And I was still fighting the temptation to try to inflict a sort of "PZI-like" approach to this new stuff that was clearly not correct or effective. While I realized that it wasn't working, I didn't know why or what to do about it. Suffice it to say, from my vantage point of more than a year later, it makes me shudder to think how poorly I did with this wonderful insulin. I regret everything! Including my stubborness about using an R booster. Poor Scruffy.

April, 2007


4/1/07
AM PS
(+7.5) 356 fed 1.0u BCP
+3 466 1.0u booster BCP
+4.5 393
PM PS (+5.5) 363 1.0uBCP
+6 fed
+4 433

4/2/07

AM PS (+14) 375 fed 2.5u BCP
+3.5 330
+6.5 314
PM PS (+9.5) 337 2.5u BCP
+10 fed, threw up, ate again
+6 41 fed
+7 55
+8 99

4/3/07
PS (+14) 404 fed 2.0u BCP
+5.5 212
+8 192
PS(+10.5) 206 fed 2.0u BCP
+3.75 380
PS (+6) 403 1.0u BCP

4/4/07
+
6 354 fed
AM PS (+9.5) 335 2.0u BCP
+6.5 271
PM PS (+7) fed 2.0u BCP threw up
+4.5 362

4/5/07
PS (+13) 412 fed 2.0u BCP
+4 408
+6 388
PS +
10 351 fed 1.0uBCP
PS (+7.5) 343 1.0u BCP

4/6/07
PS (+7.5) 342 fed 1.0u BCP
+4.5 437
PS (+10) 403 1.5u BCP
+1 fed
PS (+ 7) 329 1.5u BCP

4/7/07
PS (+6) 356 fed 1.5u BCP
+3.5 358
+5.5 339
PS (+11) 394 1.5u BCP
+.5 fed
PS (+6.5) 428 2.0u BCP

4/8/07
+4 298
PS (+7) 198 fed 1.0u BCP
+5 388
PS (+7) 439 .5u BCP
PS (+2) 464 fed 1.0u BCP
+3.5 379
+6.5 281

4/9/07 *****
AM PS (+14)
477 fed ?u BCP (forgot to write it down)
PM PS (+9) 385 fed 1.0u LEVEMIR!!!!! First dose
+2 411
+4.5 334
+6 321
+8 287

4/10/07
+12.5 263
AM PS (+13) 274 fed, threw up 1.0u Levemir
+3 395
+6 376
+8.5 413
+9.5 388
PM PS (+11) 412 1.5u
+1.5 427 fed
+3 449
+4 381
+6.5 326

4/11/07

AM PS (+13.5) 325 fed, threw up [EXPERIMENT] .5u R, 1.5u L
+1 229
+2.5 99
+3 55 fed
+3.25 58
+3.5 62
+5 99
+7 55
+7.5 78
+9.5 81
+11 84 fed
PM PS (+12) 120 1.5u
+2.5 286
+4 282
+6 370

4/12/07
AM PS (+11.5) 386 fed 1.5u
+2 443
+5 364
+6.5 325
PM PS (+11) 352 fed 1.5u
+5 390

4/13/07
+
12.5 386 fed
AM PS (+13) 2.0u
+2 417

+4 383
+5 350
+9 238
+11.75 153 fed
PM PS (+12.5) 181 1.5u
+4 270
+5.5 352

4/14/07
AM PS (+
11) 377 fed 2.0u
+4 390
+10 342
PM PS (+11.5) 2.0u
+4.5 335

4/15/07
AM PS (+13)
318 fed 2.0u
+6 77
+6.5 79
+7 54 fed
+8 57
+8.5 65
+11 68 fed
+12.5 55
+14 88
+15.5 103
+17 115

4/16/07
AM PS (+23) 278 fed 1.5u hairball
+2 480
+6.5 380
PM PS (+11.5) 282 fed 1.5u
+4 397

4/17/07
AM PS (+12) 107 fed 1.0u
+1 142
+2.5 183
+4.5 211
+5 197
+6.5 245
+8.5 349
+11 368 fed
PM PS (+11.5) 1.5u
+4.5 345

4/18/07
AM PS
(+13) 375 fed, threw up 1.5u
+5.5 360
+7.5 314
+11 181
PM PS (+12 fed, threw up 1.5u
+6.5 210

4/19/07
+13 176 fed
AM PS (+13.5 1.5u
+3 323
+8 278
PM PS (+9.5 269 fed 1.5u
+5 349

4/20/07
AM PS (+11.5) 349 fed 2.0u
+4.5 353
+6 417
+8 472
+11.5 442 fed
PM PS (+12) 2.0u
+3.5 361
+5 254
+6 201

4/21/07
AM PS
(+12.5 115 fed 2.0u
+1.5 158
+2.5 177
+4.5 209
+7 190
+9 154
+11 132 fed, threw up
PM PS (+11.5) 2.0u
+3 173
+4.5 139
+6.5 126

4/22/07
+
12 98 fed
+13 90
AM PS (+13.5) 111 2.0u
+2.5 151
+5 134
+7 102
+10.5 106 fed
+12 104
+13 104
+15 92
+16 95

4/23/07
+
21.5 138 fed
AM PS (+22.5) 193 2.0u
+2 392
+4 375
+11 217

PM PS (+12) 2.0u fed
+1 186
+2.5 98
+3.5 105
+5.5 70
+6.5 82
+7 75

4/24/07
+
10.5 230
+11.5 260 fed
AM PS (+12) 1.5u
+4.5 247
+11 159
+11.75 158 fed
PM PS (+12) 1.5u
+5 62
+5.5 53
+6.5 43 fed
+7.5 64

4/25/07
AM PS (+11.5) 154 fed 1.0u
+1 214
+3.5 130
+5 96
+7 88
+8 113
PM PS (+12) 210 fed 1.0u
+3 405
+5.5 380

4/26/07
AM PS
(+12.5)
369 1.5u
+4.5 446
+7.5 438
+9.5 403
PM PS (+11) fed 1.5u
+4.5 358

4/27/07
+
12.5 203 fed, threw up
AM PS (+13.5) 234 1.5u
+5.5 79
+6.5 58
+7 49 fed
+7.5 44
+8 68
+8.5 135 fed, threw up
+10.5 176
+13.5 420
PM PS (+14) 1.25u
+1.5 433

4/28/07
AM PS
(+7)
378 fed 1.25u
+4 381
+6.5 341
+9.5 247
+12 192 fed
PM PS (+12.) 5 215 1.25u

4/29/07
AM PS (+10.5) 314 fed 1.25u
+7 312
+
7.5 314
+
10.5 369
+
12 352 fed. threw up
PM PS (+12.5) 1.5u
+3.5 375
+5.5 403


4/30/07
AM PS
(+12.5) 386 fed 1.5u
+4 388
+6.5 338
PM PS (+11.5) 278 fed, threw up 1.5u
+1.5 237
+4.5 193
+6 149