Zeke 1/28 - Numbers all over the place - Switch to Levemir?

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Meridith and Zeke

Meridith and Zeke

Member Since 2017
Prior Condo

Zeke's numbers are crazy. One day will have really good ones and start thinking time to do some tweaking with the dose to get us closer to our goal, then next he is throwing pinks out there! I was planning on upping his dose this morning then he threw the 76 out there at amps. We are getting to the end of our current pen and have one full pen left of Lantus so now is the time to also consider if I should switch insulins to Levemir since I will be ordering again soon. I am really at a loss right now on which way to go. Why has his numbers not gotten more steady since we have been on this dose, now over 7 days? Other then the skinny dose after a long night of steering and the BCS when he was at 52, his dose can't get anymore consistent then it already is because we use a caliper to help with drawing the dose.
 
I hate to say this but I think the problem is less with the insulin than in the way you're dosing. I'd really encourage you to stick more closely with TR. Decreasing from 2.75 to 2.63, especially after a drop into the 30s, is likely not such a good idea. It looks like the reduction didn't hold but you held the dose for 5 days. You increased to 2.69u for 4 days and then increased back to 2.75. You've held that dose for 8 days with 2 BCS shots.

For TR, you're holding doses for longer than is necessary. With TR, if the nadirs aren't where you want them then after 3 days, you increase the dose (unless the nadirs are primarily below 300 and then you hold the dose for 5 days) by 0.25u.

If you give a reduced dose, you end up destabilizing the depot. I think that's one factor that's influencing numbers. Holding on to a dose that isn't giving you the results you're looking for can also cause glucose toxicity to develop (i.e., Zeke's body adapts to being in higher numbers and treats the higher numbers as his new "normal"). And, he's bouncing.

 
Sienne and Gabby (GA) said:
I hate to say this but I think the problem is less with the insulin than in the way you're dosing. I'd really encourage you to stick more closely with TR. Decreasing from 2.75 to 2.63, especially after a drop into the 30s, is likely not such a good idea. It looks like the reduction didn't hold but you held the dose for 5 days. You increased to 2.69u for 4 days and then increased back to 2.75. You've held that dose for 8 days with 2 BCS shots.

For TR, you're holding doses for longer than is necessary. With TR, if the nadirs aren't where you want them then after 3 days, you increase the dose (unless the nadirs are primarily below 300 and then you hold the dose for 5 days) by 0.25u.

If you give a reduced dose, you end up destabilizing the depot. I think that's one factor that's influencing numbers. Holding on to a dose that isn't giving you the results you're looking for can also cause glucose toxicity to develop (i.e., Zeke's body adapts to being in higher numbers and treats the higher numbers as his new "normal"). And, he's bouncing.
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But what about his ps this morning? 76, then he has risen since? I was going to raise his dose then I seen that preshot.
 
What you're seeing is the bounce breaking. You did exactly the right thing. You don't want to increase a dose when a bounce is breaking. There can be a good deal of momentum that would drive the numbers low.

I suspect you're going to have to evaluate cycle by cycle. The good news is that Zeke is clearing these bounces pretty quickly. The bad news is that it makes it hard to figure out when to increase.

All of that in mind, I'd try to stick with 0,25u increases and reductions and see how it goes. If there's still a lot of bouncing, after a month or two, Levemir may be a good option Just remember, it's not a magic cure. Not every cat has a different experience than with Lantus. You also need to be prepared to a later nadir. It was not something I could do with Gabby given my work schedule.

 
Sienne and Gabby (GA) said:
I suspect you're going to have to evaluate cycle by cycle. The good news is that Zeke is clearing these bounces pretty quickly. The bad news is that it makes it hard to figure out when to increase.
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So, would you say if his number shows that he is rising, safe to go ahead and do the increase? There has been several times I was looking at increasing, then he would start the day out with a good preshot so I would hold off. That is why we have been on this dose as long as we have been and why I finally posted. Most his nadirs have been under 200 with this dose, so holding for 5 days is going by TR already.

Sienne and Gabby (GA) said:
If there's still a lot of bouncing, after a month or two, Levemir may be a good option Just remember, it's not a magic cure. Not every cat has a different experience than with Lantus. You also need to be prepared to a later nadir. It was not something I could do with Gabby given my work schedule.
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Our current pen only has about a week or so left and we have only one pen left. Guess I can always see if there is any single pens available on the supply closet. Just don't want to order the normal supply until I know if I will be switching or not. As for the later nadir, no issues there. Of course there will be a learning curve getting used to it, but there is 3 of us that can test here, that is why we are able to get so many tests done both am and pm cycles.
 
Wise words by Sienne on Lantus dosing. I agree, try to follow TR closely for a while and see if you can see improvement. Levemir does work better for some, but not all cats. Neko became a lot flatter, but not all do. And I did feel like a newbie again for the first month after the change, learning her new patterns. The good thing is you have been at this a while and can get lots of test data with all the people testing.
 
It's always a dilemma if a bounce may be breaking. You don't want to raise the dose if the numbers are continuing to drop. If you stall, you want to shoot as soon as you see numbers rising beyond what you would attribute to meter variance. (Just remember to not give Zeke his meal.)

 
Sienne and Gabby (GA) said:
It's always a dilemma if a bounce may be breaking. You don't want to raise the dose if the numbers are continuing to drop. If you stall, you want to shoot as soon as you see numbers rising beyond what you would attribute to meter variance. (Just remember to not give Zeke his meal.)
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I did the dose increase tonight. He was holding about mid 200's. Raised him a full .25u.

We were doing the smaller increase and decreases because we would raise him and within a couple days would earn a reduction but it would fail and when we went back up it would be back to earning a reduction again. So figured would do smaller ones and see if he would hold better.
 
Sienne and Gabby (GA) said:
You hold the dose until your cat drops into the 40 - 50 range (on a human meter) three times before reducing. A drop below 40 is an immediate reduction.
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Yeah, that was our game plan this time around, Chris suggested it since he kept doing it. I am starting a new thread and while going through all his wonkiness, will probably be posting more here. :)
 
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