? PLEASE HELP. MARKIES PMPS IS HI (ABOVE 500)

[Silvina]

This is previous thread

http://www.felinediabetes.com/FDMB/...5-25-224-7-75-498-dosing.186034/#post-2066119

@Marje and Gracie helped me with the spread sheet so I was able to start using it again, so I put some data there.

Yesterday Markies had low numbers, then he bounced and used Humulin R to bring numbers down. Probably should have come down much more during the night while I was sleeping and then he bounced to the sky so he reached HI.

I need to know what to do. Markies right now is not looking too good. He vomited some yellow foam. I also need some dosing advise.
I feel that dose is too high and Markies is bouncing. There is another thread about his. But now my question to you is, should I bring down this HI with Rapid (0.25 or fat?)

I have the sense that Rapid solves me one problem but brings me other. It seems like too long lasting. I used to have another Rapid isulin, that used to be better for him, a much shorter acting one so didn´t add to the long lasting isulin (in this case Levemir).

However I do feel also that Levemir dose could be a little high at this moment for Markeis.

 

[Marje and Gracie]

Silvina

It’s ok to take down the 911. We normally only use that for emergencies such as hypos, DKA, etc. I know this HI feels like an emergency especially since he’s vomited and he has a past history of DKA.

I don’t think the dose is too high. I think he’s dropping fast and then you aren’t testing to slow it down. Then he dives hugely.

He started at 300 this morning and by +3, he was already at 179. With Lev, onset is usually +4 or after but you didn’t even test him after he onset. We don’t know how low he might have gotten or how fast he dropped. We don’t usually adjust the dose on what we “think” happens but based on the HI, I’d say he probably dropped quickly since he was already headed that way. Big dives cause big bounces.

If you are going to use Lev, you have to refocus on when you test. You are doing a lot of testing early on but Lev nadirs later in the cycle so you are missing the data you need. You can’t test on Lev like you did on Lantus. The cycles are very different and so you must learn to manage Lev to take the benefit this great insulin has to offer.

Vomiting yellow foam is indicative of tummy acid. If he hadn’t eaten in a long time, that could cause him to vomit yellow foam. Gracie would occasionally do this and so I would give her a small freeze dried chicken snack at about +9 or so to stop the acid from building up and it worked well without impacting her BG.

When using a fast acting insulin to knock down the numbers, you must be there to test and steer the cycle. If you shoot it and he drops fast, you are putting him into a vicious dive/bounce pattern. If you look on the evenings of 10/26 and 10/27, you gave him a whopping dose of R both nights and he took big dives. He doesn’t have acro or IAA so you don’t need to shoot so much R. I’d back it down to 0.1u (one tenth of a unit) and then test him hourly, tonight, to see if he drops. If he does, feed it to try and keep the BG more level.

You also need to test more to see exactly what his duration on R is...don’t guess. I’ve used R extensively and if you don’t know what his onset, nadir, and duration on both insulins is, you should not use R.

I know you worry about DKA but getting him into this dive/bounce scenario with R is not good either. You just want to give enough R that he only drops about 100-150 max over the duration of the R and that then gives the Lev a lower number to start from.

I have a friend coming now so I have to jump off the board but I’ll check back in later and give you some more tips about using R.

 

[Silvina]

Silvina

It’s ok to take down the 911. We normally only use that for emergencies such as hypos, DKA, etc. I know this HI feels like an emergency especially since he’s vomited and he has a past history of DKA.

I don’t think the dose is too high. I think he’s dropping fast and then you aren’t testing to slow it down. Then he dives hugely.

He started at 300 this morning and by +3, he was already at 179. With Lev, onset is usually +4 or after but you didn’t even test him after he onset. We don’t know how low he might have gotten or how fast he dropped. We don’t usually adjust the dose on what we “think” happens but based on the HI, I’d say he probably dropped quickly since he was already headed that way. Big dives cause big bounces.

If you are going to use Lev, you have to refocus on when you test. You are doing a lot of testing early on but Lev nadirs later in the cycle so you are missing the data you need. You can’t test on Lev like you did on Lantus. The cycles are very different and so you must learn to manage Lev to take the benefit this great insulin has to offer.

Vomiting yellow foam is indicative of tummy acid. If he hadn’t eaten in a long time, that could cause him to vomit yellow foam. Gracie would occasionally do this and so I would give her a small freeze dried chicken snack at about +9 or so to stop the acid from building up and it worked well without impacting her BG.

When using a fast acting insulin to knock down the numbers, you must be there to test and steer the cycle. If you shoot it and he drops fast, you are putting him into a vicious dive/bounce pattern. If you look on the evenings of 10/26 and 10/27, you gave him a whopping dose of R both nights and he took big dives. He doesn’t have acro or IAA so you don’t need to shoot so much R. I’d back it down to 0.1u (one tenth of a unit) and then test him hourly, tonight, to see if he drops. If he does, feed it to try and keep the BG more level.

You also need to test more to see exactly what his duration on R is...don’t guess. I’ve used R extensively and if you don’t know what his onset, nadir, and duration on both insulins is, you should not use R.

I know you worry about DKA but getting him into this dive/bounce scenario with R is not good either. You just want to give enough R that he only drops about 100-150 max over the duration of the R and that then gives the Lev a lower number to start from.

I have a friend coming now so I have to jump off the board but I’ll check back in later and give you some more tips about using R.

Thank you very much!!! This makes much sense!!! This Humulin R is very different than the Rapid I used to use here in Argentina. We used to use a 40/80 insuline whic for me was fast and used to wear off also fast from the body.

A Huge problem from this insulin Humulin R is how to charge it into the syringe. I know this might be stupid. Doctors in the ER told me to put 9 units of physiological solution and 1 of insulin and then put the syringe in the fridge all charged and use it.

Then in this forum I learnt that I could use the BD ultrafine syringe by itself without physiological solution but I cant imagine how to charge 0.1 units. So I may need help on that.

0.25 its´perfect because its the first mark on the syringe, but what is 0.1?

I just read this before testing Markies at +1.5 which was again on HI, so I shot him 0.25 Rapid (I decreasedd 0.25 of Rapid, I was giving him 0.5). I wish I had read that before.

But well, I will be here to test and to feed to avoid big drops.

Im still completing the ss.

 

[Silvina]

I have some questions.

1. As I said, how to charge 0.1 in the syringe? I don´t even understand that number. Sorry for that.

2. How can I know when R is wearing off Markies body if Levemir is working at the same time? I actually was not using all this years R with Markies. I decided to use it this last months. Levemir was ok with him and his nadir was arround +7 or +8. If you see my threats I tried to start from scratch but things happen here and also Markies health is also weak, so for example when gingivitis gets bad seems that his BG goes up too. Also as he has hemobartonella that comes and go, I need to know what protocol would be good for him. When cat´s health is weak and that impacts his BG and also mom is not in good shape (probably this is is the biggest change I need to do, keep using the ss, using the forum regularly and not when an emergency happen... but Im on an emergency state more or less since a year an a half and the rest of the time Im drained). However I have the intention to do things right that´s why Im here and also if you see my previous threads, I also had the intention before to put things in order. Well.... Im talking too much.
The question was, how can I know when R is wearing off?

3. At nights testing is awful for me. I go to bed very late (4 or 5 Am) and wake up 12 or 1 PM (finally I don´t sleep so much). I usually wake up to feed Markies but as Im under medication is hard for me to test, I mean to us my brain to coordinate and test, etc.. that´s why there are some nights. that I didn´t even test. Much sadness and stress here. So night cycle will bee difficult to handle. Is there a chance that night dosing be different than day dosing that can prevent big drops?

Sorry, about testing not so close to shooting and closer to Lev nadir, I realize now that usually at +7 +8 and +9 Im at mom´s house for dinner, every night almost every night (she has cancer so Im with her every night and come back kind of late since I take her to bed, etc). That´s why I miss the +8 test that I used not miss before when dad was alive. I tried to change schedule to shoot earlier but on weekends as I need more sleep I end up screwing things up.

shut... need to go back to 12/12 and If I want to sleep more on weekends I just wake up and go back to bed. Then I will be able to test at least at +7

 

[Marje and Gracie]

I have some questions.

1. As I said, how to charge 0.1 in the syringe? I don´t even understand that number. Sorry for that.

2. How can I know when R is wearing off Markies body if Levemir is working at the same time? I actually was not using all this years R with Markies. I decided to use it this last months. Levemir was ok with him and his nadir was arround +7 or +8. If you see my threats I tried to start from scratch but things happen here and also Markies health is also weak, so for example when gingivitis gets bad seems that his BG goes up too. Also as he has hemobartonella that comes and go, I need to know what protocol would be good for him. When cat´s health is weak and that impacts his BG and also mom is not in good shape (probably this is is the biggest change I need to do, keep using the ss, using the forum regularly and not when an emergency happen... but Im on an emergency state more or less since a year an a half and the rest of the time Im drained). However I have the intention to do things right that´s why Im here and also if you see my previous threads, I also had the intention before to put things in order. Well.... Im talking too much.
The question was, how can I know when R is wearing off?

3. At nights testing is awful for me. I go to bed very late (4 or 5 Am) and wake up 12 or 1 PM (finally I don´t sleep so much). I usually wake up to feed Markies but as Im under medication is hard for me to test, I mean to us my brain to coordinate and test, etc.. that´s why there are some nights. that I didn´t even test. Much sadness and stress here. So night cycle will bee difficult to handle. Is there a chance that night dosing be different than day dosing that can prevent big drops?

Sorry, about testing not so close to shooting and closer to Lev nadir, I realize now that usually at +7 +8 and +9 Im at mom´s house for dinner, every night almost every night (she has cancer so Im with her every night and come back kind of late since I take her to bed, etc). That´s why I miss the +8 test that I used not miss before when dad was alive. I tried to change schedule to shoot earlier but on weekends as I need more sleep I end up screwing things up.

shut... need to go back to 12/12 and If I want to sleep more on weekends I just wake up and go back to bed. Then I will be able to test at least at +7

Here is what 0.1u looks like:

It’s a little less than half way between 0 and 0.25u. It doesn’t have to look exactly like that but the goal is for you to draw it consistently to about that place. It’s a small amount.

I am not familiar with Rapid but Humulin R has a duration of 4-6 hours with most of the cats I’ve seen having about a four hour duration. Markies might be different.

It’s really important that you know his onset, nadir, and duration with Levemir before you use R. When using R, you want to avoid overlapping the nadirs of the two insulins.

Let’s say you give 0.1u at preshot. The most you want him to drop is 100-150 mg/dL by the time the R wanes. If you give it a PS and it has a four hour duration, you would likely see a drop at +1 and +2, less of a drop at +3, and either flat or rising at +4. Then with Lev, you might see onset at +4 so the R gives him a lower number to start the Lev onset from. That’s the goal. You can also give it at the end of the R cycle after he nadirs and has climbed fast and then test hourly to see what the R does. That allows you to see the onset, nadir, and duration.

Keep in mind that you might not always get the same response from R every cycle. It might not always drop him or it might drop him faster than you want. Testing is important to know how much to give and when to give it.

Either giving the R at preshot when the BG is high or after the Lev nadir will allow you to determine what kind of duration he gets from it, typically. Once I knew this with Gracie, I didn’t have test every hour. I knew her nadir with R was at +3, generally.

Rule of thumb with R is to start at a low dose, monitor, note what it does...when does it onset (usually between +.5 and +1), nadir, and when does the BG level off or start rise. With this info, and knowing the same info about Lev with him, you can figure out when the best time to give it is. I always liked using it as Gracie was just starting a bounce.

You don’t want to give it if it looks like he might have a bounce clearing cycle. If you are familiar with his cycles, you should know when he might be due to clear a bounce; don’t give R. And remember, sometimes they get a high BG before the bounce clears so look for that.

I’m so sorry for all your family health issues and it is important for you to spend time with your mom. I wouldn’t use R when you can’t be there to monitor him.

Did you give the R today at +2 when he was HI? If so, I’d put it in the +2 column. Then it looks like he probably onset at Lev+3. He took way too much of a drop so 0.25u of R is too much for him. If a big dive from the R starts, it might not let his Lev bring numbers down. Ideally, if you gave the R at Lev+2 when he was HI, it would have brought him down to about 400 by the time the Lev kicked in. Then the Lev could start from a lower number.

Does that make sense?

 

[Silvina]

Here is what 0.1u looks like:
View attachment 32036

It’s a little less than half way between 0 and 0.25u. It doesn’t have to look exactly like that but the goal is for you to draw it consistently to about that place. It’s a small amount.

I am not familiar with Rapid but Humulin R has a duration of 4-6 hours with most of the cats I’ve seen having about a four hour duration. Markies might be different.

It’s really important that you know his onset, nadir, and duration with Levemir before you use R. When using R, you want to avoid overlapping the nadirs of the two insulins.

Let’s say you give 0.1u at preshot. The most you want him to drop is 100-150 mg/dL by the time the R wanes. If you give it a PS and it has a four hour duration, you would likely see a drop at +1 and +2, less of a drop at +3, and either flat or rising at +4. Then with Lev, you might see onset at +4 so the R gives him a lower number to start the Lev onset from. That’s the goal. You can also give it at the end of the R cycle after he nadirs and has climbed fast and then test hourly to see what the R does. That allows you to see the onset, nadir, and duration.

Keep in mind that you might not always get the same response from R every cycle. It might not always drop him or it might drop him faster than you want. Testing is important to know how much to give and when to give it.

Either giving the R at preshot when the BG is high or after the Lev nadir will allow you to determine what kind of duration he gets from it, typically. Once I knew this with Gracie, I didn’t have test every hour. I knew her nadir with R was at +3, generally.

Rule of thumb with R is to start at a low dose, monitor, note what it does...when does it onset (usually between +.5 and +1), nadir, and when does the BG level off or start rise. With this info, and knowing the same info about Lev with him, you can figure out when the best time to give it is. I always liked using it as Gracie was just starting a bounce.

You don’t want to give it if it looks like he might have a bounce clearing cycle. If you are familiar with his cycles, you should know when he might be due to clear a bounce; don’t give R. And remember, sometimes they get a high BG before the bounce clears so look for that.

I’m so sorry for all your family health issues and it is important for you to spend time with your mom. I wouldn’t use R when you can’t be there to monitor him.

Did you give the R today at +2 when he was HI? If so, I’d put it in the +2 column. Then it looks like he probably onset at Lev+3. He took way too much of a drop so 0.25u of R is too much for him. If a big dive from the R starts, it might not let his Lev bring numbers down. Ideally, if you gave the R at Lev+2 when he was HI, it would have brought him down to about 400 by the time the Lev kicked in. Then the Lev could start from a lower number.

Does that make sense?

Ill read you later.. I will try to avoid R as much possible but will try to lear as much possible about Rapid too... Thank you Marje!!!! you are so nice to helping me like this!!

 

[Silvina]

Im going to start changing schedule a little in order to be able to test at +8 before leaving to mom´s house.

 

[Marje and Gracie]

Ill read you later.. I will try to avoid R as much possible but will try to lear as much possible about Rapid too... Thank you Marje!!!! you are so nice to helping me like this!!

You’re welcome.

I certainly don’t want your to miss this important time with your mom.

 

[Silvina]

Thank you dear!!!

Markies pmps looks good!!! 315!!! not bad