Hey, Pam! How is Alley doing?

Haven't seen a post, but I sneaked a peek at his SS. Looks like he is getting good use out of the .25u. I wonder if he will drop further on that today.

I do note though that he was in the 400s this morning, so a) he probably can't go 24 hrs between shots and b) he is getting a big drop on just .25 unit. I would wait to see how the rest of the cycle goes before changing the dose though. I suspect he is still bouncing from the change of insulin and the 30s the other day. Lev should moderate both the lows and the highs if he is close to the right dose.

Do your syringes have half unit markings? If not you need to get some. It will make dosing .25u and increments of .1u easier. He may only need .2u or .1u bid - every 12 hrs. right now.

Here are my microdose instructions again:
The drop method I use is to practice with a used syringe and water or expired insulin and draw up 1u, then twist the barrel (clockwise if the needle is pointed away from you) slightly until a drop forms on the end of the needle. It will be about the size of the end of a straight pin. Flick it off and twist to form another one. Practice until you get 10 drops that size from one unit and 5 drops that size from a half unit. Those would be .1u drops, so you can dose fairly easily in any increment of .1u. If you want to perfect that, try for a drop HALF that size. Those would be .05u drops. Loads of fun to draw! I have to take off my glasses to see to do that.

 

Practicing like crazy, both my husband and I. Got it! This is so helpful, you have no idea.
Alley is swell, active and eating well, although he never had a problem in the eating department! He now weighs 11.5 and has been up to 12.9.
thanks again,
Pam

 

Glad that was helpful.

I noticed that you shot .3u this am - due to the PS in the 300s, was that what you were thinking?

I am concerned that he will swing low on that dose - as we saw how much action he got out of .25u. So, please get spot checks and also, next time he is high like that, shoot less than you gave the last time he dropped into low numbers (below 40-50). You don't want to set him up for a roller coaster ride. Since that was yesterday and you shot .25u, I would have given less than that. Numbers like he got yesterday warrant a dose reduction because it is much better to give micro doses every 12 hrs that have him swing from 350 to 40 and back to 350 in 24 hrs.

This isn't at all like working with N, or other fast acting insulins and it is hard to get out of that kind of thinking - or it was for me.

I am thinking that he might do well on .1u bid. It would give him a chance to moderate both the highs and the lows

 

Hi Pam,

I was wondering if you shot MORE today b/c the BG was so high?

After yesterday on a LOWER dose and plummeting the way he did and you having to feed him to keep him in the higher greens to keep from bottoming out, then NOT shooting last night b/c he was too low, actually merits a DEcrease, not and increase.

Levemir is not at all like the other short acting insulins...it is beneficial to try to grasp the different thinking that comes with long duration...

You cannot shoot down numbers with Lev like you would with N, Vetsulin or PZI....Lev and lantus are different creatures all together. Continuing to treat Lev as it is a short duration insulin will likely lead to trouble for your kitteh.


With Lev, I found it better to look backward to see ahead...what I mean is that past results are the best indicator of future results with Lev. Looking at the BG in front of you and reacting to it generally leads to chasing BG's you can never catch up with.

If you look at yesterday, you shot .25 on a 370 and kitty plummeted.

That past behavior would indicate that today's 375 ( same BG as yesterday) would need a DEcrease in order not to plummet.

By going UP in dose, you'll likley get another plummet or rebound.

From looking at your SS and seeing BG results form different doses, I agree with those that indicate a lower dose is better right now. I think .1 or so is about right to get the gentle curve Lev is known for.

What do you think?

 

Thank you so much for the concern, but it is my math that is the problem! Only guessed his shot yesterday was .25 as close to it as we could do anyway and everyone saw what happened! So after reading Sheila's post to measure drops, we practiced for a very long time this morning, convinced he got 3 drops. Black stopper on the line of zero, yesterday there was an itsy bitsy more space between the stopper under the line. When I posted the dosage I did not even think it looked like more than yesterday. (Duh!) So he is on drops now, best way for us to measure. I am changing the .30 to 3 drops. His numbers today are great and he feels great. I LOVE this insulin.
Thank you everyone,
Pam

 

Glad you explained that. I know I was a little confused too thinking you gave more than yesterday on the same number.

Nice numbers today but curious about how low he might be headed for tonight's preshot. He seems to be going steadily down. Maybe he will just 'surf' in that range but it still will be a lower number than what you are used to shooting. Others that are better at microdosing than me will be along. Post numbers when you can. This is looking so good.

 

So glad to see you shot on the 210 tonight. That's a great preshot, much better than 300+, so he should be there or below in the AM. My bet is for below 150

 

By your readjusted drop method, it looks like yesterday was maybe .4u?

Anyway, today looks better in that the drop in BG wasn't as extreme, but he was still under renal threshold for a good amount of time.

FYI, on my syringes I have to look out for misprinted lines. There has been as much as a quarter unit of space there. so I check where the stopper top is in relationship to the zero line every time before drawing the dose. You do learn what a drop of space looks like. I remember "hoping" that I was actually giving any insulin when I was first doing the .1u amounts.

Looking good!

 

Agree with Vicky. So nice that you had a preshot to work with that wasn't too low to shoot. Makes things so much easier. Just curious though, did he get anything to eat after the +10 at 123?

You and your DH are doing so well learning to measure those small doses.

 

Okay- I understand better with the explanation now, thanks!

Regardless of what the .25 actually was or not, now that you are measuring drops I think it is agood idea to start fresh with the current data being the benchmark...

so, what you measure as .3 or 3 drops is going pretty well, so far. I agree that syringe lines can be off - one syringe I got was actually MISSING the 0 line, and started at the .5u line! If I had gone by lines rather than double checking on space I would have ended up shooting almost a full until to a cat that plummets on .4!

I remember when Sheila questioned if her cat was getting ANY insulin at all with her tiny microdoses! :lol: He musta gotten something, b/c he is doing fine as kitty wine these days at The Falls! (knockwodd,antijinx)

 

A little disappointed that he did not respond to the 2 drops last night.
Started out this morning after food at 361. Lower than yesterday's start at 375. 3 drops again.

 

Just keep in mind that this morning's 300+ could have been a result of the dose changes, between no shot, 3 drops, 2 drops - all that is bound to catch up to him at some point. Remember that ocean liner. Even tiny doses like this can turn the wheel.

I even forgot that myself when I predicted 150 for this AM. We're just too excited how well you and Alley are doing!

 

I agree that with so many ups and downs it is hard to tell what he is reacting to now - just be patient and let this dose settle so you really know what it does all by itself (and not following a deep low, higher carb food, etc.).

It is early days yet.....

...and you are doing really well.

 

Still curious about that. If it was a food spike number or not.

 

Sorry I didn't answer sooner (with all this lack of sleep, I feel like I have a newborn again!)
Yes, the 210 was after food, before shot. But obviously the 2 drops didn't do much.
Just checked him again, at +8 and he is at 189, no food since noon. We free feed low carb wet from morning to noon. So he will be hungry at dinner time, we pull the food from 12 - 6 pm. then he free feeds until bedtime, except last night we put some frozen wet food out at midnight just in case. Just when we thought his curve was at +8 or +9, he curves today at +6!!!
Nothing to be taken for granted when dealing with cats I guess.
But I will take the high over the low any day.
Pam

 

I wonder if the feeding times aren't part of what's giving you lousy preshots then. My feeding schedule is as follows - Feed after shot. Food is probably available for at least 2 hours after shot, then, since I have a timed feeder, it goes off approximately 5 hours after shot. It's about 2/3rds 5.5 oz. can of food each "meal" and other cats have access to it and other food is down in the house as well. I never take up food. Even on long acting insulins, they can have a low and will feel the need to eat.

Gandalf is trained to his feeder - when it goes off he goes to it so he usually always gets food at +5. He's always been a grazer, so he'll go back to it a few times during the day, but it's probably all gone by +10 which is generally just past nadir for him.

Food can be used to your advantage to smooth out the hills and valleys, especially on a longer acting insulin. I recommend it be available at all times to cats on long acting insulins. Unless they are glutons and eat everything and everything when it's put down. Frankly he is maybe trained now to do that since there's no food available for 6 hours.

 

Vicky, Alley had food all day long, and he also is a grazer, I just added a teaspoon to his dish when it was empty, Had a great day, shot 4 drops, but I am convinced that your suggestion leaving out the food was the reason he did not go too low, just right.
Thanks
Pam

 

I must learn patience! My short term goal was to not hit the "red" zone anymore. So much for that! Hit 401 AMPS, staying with the 4 drops for now. Only gave him 2 drops last night, which probably was stupid, he was at 254 PMPS.In the first 3 hours after his shot he usually is dropping 100 pts. I feel he is close at 4 drops right now, will wait to see if it should go to 5 drops by the weekend. If I am brave enough to give him 4 drops tonite, I think his AMPS would be better.
I see that all the midwest is getting hammered. The TODAY show even had a correspondent in Michigan City, IN this morning (our home town) reporting on the lake effect storm. And it may even hit close to 70 today in Denver. Go figure!
Pam