? 16 Nov | Girlie AMPS 691; +11=85 Shoot or wait?

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Girlie's mom

Girlie's mom

Member Since 2017
Condo: http://www.felinediabetes.com/FDMB/...7-dose-increase-tomorrow.186728/#post-2073279

Last night was solid high blacks, so increased to 0.75 Units. AMPS is 432 (-259 drop). Not sure whether the increase was a mistake...:confused: Nadirs were okay on some days, but surrounding numbers were atrocious the last three days...

Her nadirs:
12 Nov am+5: 68; pm+7: 128
13 Nov am+4: 317 / pm+6: 169
14 Nov am+9: 130 / pm+4: 180
15 Nov am+4.5: 491 / pm+6=587

Ketones negative last night.
 
LizzieInTexas said:
Just a suggestion on the alarm. See if you can find a ring tone for your phone that isn't quite as jolting. Alarms are one of those things that set my anxiety off BIG time. Hubby got me an alarm clock that has nature sounds and I wake up to ocean waves now :). A much more pleasant awakening. I use a nice bell type tone on my phone that I use on the weekends so I don't have to reset my alarm clock all the time.

I hope this is just a big bounce and Girlie comes back down for you. :bighug:
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It's not the waking up that's the problem - it's the getting back to sleep! I'm not good at going to sleep, and it takes me ca an hour to get back to sleep after I wake up to do a test, and then I go into a sort of twilight sleep - half asleep, half awake. Very boring, that... :-)
 
Wendy&Neko said:
Good luck with the increase. Atrocious numbers must be dealt with.
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I love that - you sound so firmly definitive re atrocious numbers - as if they were unruly children! :-) Atrocious numbers are hereby banished (well, that's my hope, at least...)

I guess I was thinking that I'd rather have her on higher carb food if need be and steadier numbers (even if yellows) rather than these horrific highs with the occasional blue peaking out. Even after 5 months I still feel like I'm still trying to figure out how to deal with Girlie's reactions to food, insulin, etc. Positive though about possible brighter things to come...

Appetite: not sure whether it's Levemir, but she's still eating without the help of Mirtazapine. If using Lev only turns out to mean we got rid of one medication and she has a later onset and longer duration, that will be a significant improvement.
 
Girlie's mom said:
It's not the waking up that's the problem - it's the getting back to sleep
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I am the same way. I rarely go back to bed in the mornings (after TFS), I am too awake. If he is dropping at night I just stay up and deal with no sleep. Luckily I shoot early enough that his nadir is around 10 so I can get 4-5 hours of sleep. Gizmo has been fairly consistent with his nadir almost the entire time he has been on insulin.
 
Girlie's mom said:
Appetite: not sure whether it's Levemir, but she's still eating without the help of Mirtazapine. If using Lev only turns out to mean we got rid of one medication and she has a later onset and longer duration, that will be a significant improvement.
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That would be amazing! And even better if she stops making rainbows in every cycle. Paws crossed for both!
 
She dove down the ladder while I was at work - not sure what to do about this with her evening dose coming up. @Marje and Gracie , I see you're here - hello! Any suggestions? I was planning to give her 8% food, but should I give something a little higher with her PMPS?

Nice seeing blues after that solid high black and red wall, though...
 
Girlie's mom said:
She dove down the ladder while I was at work - not sure what to do about this with her evening dose coming up. @Marje and Gracie , I see you're here - hello! Any suggestions? I was planning to give her 8% food, but should I give something a little higher with her PMPS?

Nice seeing blues after that solid high black and red wall, though...
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I’m glad to see you switched her to Lev. Unless she drops below 68, I’d hold the dose.

I’d see where she is at PMPS to decide what to feed. She might flatten out, keep dropping, come up and then get a second dip, or just head back up until she onsets.
 
Marje and Gracie said:
I’m glad to see you switched her to Lev. Unless she drops below 68, I’d hold the dose.

I’d see where she is at PMPS to decide what to feed. She might flatten out, keep dropping, come up and then get a second dip, or just head back up until she onsets.
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Thank you so much, Marje. She's down to 85 at AM+11, so still going down. I know that Levemir does this and that I have to get used to shooting green. I'm just a little unsure as she's come down SO far today from AMPS 691 and is still going down. I'm still trying to figure out how she is on Levemir, and it's been a bit of a roller coaster, so I'm not seeing clear patterns yet. I have this feeling in my gut that she will dive down below 68 after her PMS - I might be wrong - but I'd hate to see this increase not work as the 0.5 didn't seem to be working. Maybe I have to go with something in between the two, like 0.7 or 0.6/0.65?

Trust Girlie to be tremendously entertaining... :confused:
 
Girlie's mom said:
Thank you so much, Marje. She's down to 85 at AM+11, so still going down. I know that Levemir does this and that I have to get used to shooting green. I'm just a little unsure as she's come down SO far today from AMPS 691 and is still going down. I'm still trying to figure out how she is on Levemir, and it's been a bit of a roller coaster, so I'm not seeing clear patterns yet. I have this feeling in my gut that she will dive down below 68 after her PMS - I might be wrong - but I'd hate to see this increase not work as the 0.5 didn't seem to be working. Maybe I have to go with something in between the two, like 0.7 or 0.6/0.65?

Trust Girlie to be tremendously entertaining... :confused:
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One of our most experienced members taught me a long time ago that newly diagnosed cats do better going up and down in increments of 0.25u unless numbers are green or close to it and need fine tuning with a smaller dose change.

It’s possible she will drop more if she’s getting better duration from Lev and then onset and drop lower. She’s also clearing a bounce so she’s got some “steam” behind her numbers. You are likely to see an active cycle.

I am not able to stay up with you so I think you have to decide if you are able to stay up and handle potentially lower numbers. Yes, you have to get used to shooting lower numbers but you have to be able and available to test when you do.

If you decide to shoot, I’d start with at least a MC food and test no longer than hourly until you know she’s flat or headed up.

You can also shoot a BCS but her cycle will likely look the same as if you shoot the full dose.
 
Marje and Gracie said:
One of our most experienced members taught me a long time ago that newly diagnosed cats do better going up and down in increments of 0.25u unless numbers are green or close to it and need fine tuning with a smaller dose change.

It’s possible she will drop more if she’s getting better duration from Lev and then onset and drop lower. She’s also clearing a bounce so she’s got some “steam” behind her numbers. You are likely to see an active cycle.

I am not able to stay up with you so I think you have to decide if you are able to stay up and handle potentially lower numbers. Yes, you have to get used to shooting lower numbers but you have to be able and available to test when you do.

If you decide to shoot, I’d start with at least a MC food and test no longer than hourly until you know she’s flat or headed up.

You can also shoot a BCS but her cycle will likely look the same as if you shoot the full dose.
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Thanks so much, Marje - I wouldn't even think of you joining me in a PJ party tonight, so no worries there. Just curious: would you have held off on the dose increase for another cycle or more? We've seen those unending black numbers before, and she can really get stuck in them, but that was on Lantus. I wasn't sure what to do, but when she started out so high again today, well...

I have a lot of experience bringing her up from low numbers as this is one of her favourite things to do (unfortunately); I have HC food, MC food, glucose syrup - and tons of supplies. It's a bit new, though, with Levemir and the longer duration, so it will be interesting to see how she goes.

I'm really exhausted, but I want to keep the momentum for her if I can rather than have to back off and start again. I might stall a bit, though, if she's gone too much lower at PMPS, as I have several days in which I could bring her back to a 6 am/6 pm shoot.

Supplies to keep me happy: brownies and Pepsi Max. :-) I swear I'm gaining a kilo a day with all the brownies that are required...sigh... :p
 
Girlie's mom said:
Thanks so much, Marje - I wouldn't even think of you joining me in a PJ party tonight, so no worries there. Just curious: would you have held of:bighug::bighug:f on the dose increase for another cycle or more? We've seen those unending black numbers before, and she can really get stuck in them, but that was on Lantus. I wasn't sure what to do, but when she started out so high again today, well...

I have a lot of experience bringing her up from low numbers as this is one of her favourite things to do (unfortunately); I have HC food, MC food, glucose syrup - and tons of supplies. It's a bit new, though, with Levemir and the longer duration, so it will be interesting to see how she goes.

I'm really exhausted, but I want to keep the momentum for her if I can rather than have to back off and start again. I might stall a bit, though, if she's gone too much lower at PMPS, as I have several days in which I could bring her back to a 6 am/6 pm shoot.

Supplies to keep me happy: brownies and Pepsi Max. :) I swear I'm gaining a kilo a day with all the brownies that are required...sigh... :p
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I tended to be a little more aggressive with dosing because we were here to test. I probably would have increased just because she had seven cycles at this dose after the green (which was likely depot influenced) and didn’t get back into green. She dipped her toes in blue here and there’s but she didn’t have a nice long cycle in it.

FD is exhausting. And if you are doing it alone and working, it can be tough. I also put on more than a few pounds with those late night testing cycles. It’s not only the stress eating but the cortisol from not sleeping that can add on the weight. So even when we convince ourselves we don’t need the snacks, we are still fighting cortisol. :smuggrin:

I hope it goes well tonight whatever you decide to do. :bighug:
 
Marje and Gracie said:
I tended to be a little more aggressive with dosing because we were here to test. I probably would have increased just because she had seven cycles at this dose after the green (which was likely depot influenced) and didn’t get back into green. She dipped her toes in blue here and there’s but she didn’t have a nice long cycle in it.

FD is exhausting. And if you are doing it alone and working, it can be tough. I also put on more than a few pounds with those late night testing cycles. It’s not only the stress eating but the cortisol from not sleeping that can add on the weight. So even when we convince ourselves we don’t need the snacks, we are still fighting cortisol. :smuggrin:

I hope it goes well tonight whatever you decide to do. :bighug:
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Marje, thank you for replying. It is a great relief to know that you didn't think it was wrong for me to increase. I have a really hard time identifying bounces - and when a bounce is not a bounce but indicates the need for a dose increase. I'm also aware that Girlie has a history of going to really high numbers and getting stuck there (at least that's how I see it, but I'm sure someone more experienced would see things in her SS that I can't see).

Also, there is that info in the Myths debunked post re: if numbers are over 300 - shoot - even if it is shooting through a bounce. But I'm also aware that Girlie is just starting to really feel the effects of Levemir and that I'm still learning how she reacts to it.

Just re-reading that, no wonder I'm so confused! I have to laugh at myself... :confused: :p

Thank you for stopping in and offering not only me but Alicia and Lizzie so much detailed and specific advice. The FDMB is really lucky to have you here! And I really, really appreciate it.

I hope you have a gentle night ahead of you. Take good care! :bighug:
 
Girlie's mom said:
Marje, thank you for replying. It is a great relief to know that you didn't think it was wrong for me to increase. I have a really hard time identifying bounces - and when a bounce is not a bounce but indicates the need for a dose increase. I'm also aware that Girlie has a history of going to really high numbers and getting stuck there (at least that's how I see it, but I'm sure someone more experienced would see things in her SS that I can't see).

Also, there is that info in the Myths debunked post re: if numbers are over 300 - shoot - even if it is shooting through a bounce. But I'm also aware that Girlie is just starting to really feel the effects of Levemir and that I'm still learning how she reacts to it.

Just re-reading that, no wonder I'm so confused! I have to laugh at myself... :confused: :p

Thank you for stopping in and offering not only me but Alicia and Lizzie so much detailed and specific advice. The FDMB is really lucky to have you here! And I really, really appreciate it.

I hope you have a gentle night ahead of you. Take good care! :bighug:
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You’re welcome and I’m sorry I’ve had to step back and not be able to be here for you and Girlie often enough to really help you. She is definitely a quandary.

What did you decide to do with last night’s shot and what happened? I checked as soon as I got up this morning; I hope everything is ok.

If she were mine, I’d let her settle into Levemir a bit longer but I would start talking to my vet about getting a prescription for Humulin/Novolin R if you need it there. In the US, we don’t need a script for that insulin. I really think that will be our best bet for getting those blacks out of the picture.

Again, remember that we give tiny doses of it at a time that she is going up to halt the rise. We won’t want to give it any time that it looks like she could potentially head down or if she’s been flat black, red, or pink for a while because then she could head down. If we start by giving it as she is going up, we can curb the increase so the Levemir can start from a better place. Over time, the curve comes down some.

An example of what I mean by halting the rise to give a better place for the Lev to start is on 2/23/13 on Gracie’s SS (once you click on that link, select her 2013 Levemir tab, and scroll down to the date). I had only used R a few times at that point. Yes, she went up that night, but not high and she had a great cycle the next day. That’s the beauty of R when used correctly at the right dose. The cycle you use it, the numbers don’t go up as high, the L insulin works a little better, and then the next cycle, you start from a much better place. Although sometimes the numbers don’t budge much with R (ideally you’ll see about a 100 mg/dL drop over four hours), if they don’t go UP, it’s a victory...yes? On Gracie’s SS that I linked, you can see that as I used R, the curve gradually came down into a lot more green and blue and less yellow and pink.
 
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