? 03/30 Mowgli New Dose PMPS 371,+2 200 +4 79 Is this quick drop concerning

AmandaE

AmandaE

Member Since 2019
Hi all,

I have increased Mowgli’s dose from 1unit to 1.5units today at his 6pm dosage based on his high BG values this past week combined with advice from my vet to increase dosage to 1.5u. I recognize the advice for SLGS says 0.25u increases at a time, but my gut said that due to Mowglis high numbers this week and the vet recommending a dosage increase to 1.5units justified the half unit increase.

I’m kind of alarmed at how fast his numbers are dropping. I know that 50mg/DL is the concerning point and we aren’t there yet, but I feel like I’m still early in his cycle so I’m a little worried about a hypo episode while I’m sleeping

Should I continue testing through the night? At what point do you start intervening?

Any advice appreciated.
 
You definitely need to continue testing.

I'd go ahead and test at +4.5 and again at +5 (at least)

Also, on SLGS, dropping below 90 means a reduction in dose so you DO need to drop it back down to 1.25
 
I hope Mowgli slows down tonight. Intervene with higher carbs if he goes below 50. Maybe give him a tsp of low carb food now to see if it’ll slow him down. Not too much, you don’t want to fill him up in case you need him to eat later.

As Chris said, tonight shows the 0.5 increase was too much.
 
AmandaE said:
my gut said that due to Mowglis high numbers this week and the vet recommending a dosage increase to 1.5units justified the half unit increase.
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Lantus dosing isn't based on Pre-shot numbers....it's based on how low it takes them. It sounds like your vet was more concerned with the Pre-shot numbers when they recommended the increase of .5

AmandaE said:
I know that 50mg/DL is the concerning point and we aren’t there yet, but I feel like I’m still early in his cycle so I’m a little worried about a hypo episode while I’m sleeping
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There's really no such "rule" regarding a certain amount of drop means you should be concerned. There is however, some research here that has taught us that the +2 can act a little like a crystal ball in predicting how the rest of the cycle will go.

If the +2 is about the same as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS.

If the +2 is higher than the PS (by more than just meter variance), it's usually the beginning of a bounce and you can take a break in testing.

If the +2 is lower than the PS (by more than meter variance) that's your "early warning" that you need to plan on getting more tests in.

With Mowgli dropping from 371 to 200 in just 2 hours, I'm thankful that you did test and catch that 79.....that's a really good example of the +2 being lower than the PS and needing to get more tests in!
 
I want to tweek Chris' point about the +2 and it's role in anticipating the rest of the cycle for cats using Lantus (and for those who use Lev, the timing is different given that Lev's onset is a little later). There is no formal "research" about how well the +2 test predicts the progress of a cycle. There is a great deal of personal and/or group experience regarding the role of the +2 although, as in much of FD, every cat is different (ECID). Chris' observations are also geared to a cat that has a nadir at +6 and many cats have earlier or later nadirs.

Getting an occasional curve will give you a feel for when Mowgli's onset and nadir typically fall. Having this information will allow you to guesstimate whether Mowgli seems to follow the +2 pattern. I would test Gabby at +1, for example, because she had an early onset and nadir.

 
Mowgli’s BG climbed back up this morning to 20.7mmol/L. I lowered his dosage and will do a longer term curve today if I can (Sunday’s=errands)

Based on yesterday’s reaction to the 1.5u it looks like Mowgli definitely could be the early onset type. I will monitor the 1.25u today at +2 to see if this is his ideal dose. I’m glad that I got the +2 last night so that I could catch Mowgli’s super low.

I can say, I’m finding it really difficult to measure 0.25 units,.. the syringe is all or nothing, or maybe I just don’t know my own strength ;)

Anyway! Mowgli made it through the night and was his normal annoying self this morning reminding me it was time for his noms.
 
AmandaE said:
Mowgli’s BG climbed back up this morning to 20.7mmol/L. I lowered his dosage and will do a longer term curve today if I can (Sunday’s=errands)

Based on yesterday’s reaction to the 1.5u it looks like Mowgli definitely could be the early onset type. I will monitor the 1.25u today at +2 to see if this is his ideal dose. I’m glad that I got the +2 last night so that I could catch Mowgli’s super low.

I can say, I’m finding it really difficult to measure 0.25 units,.. the syringe is all or nothing, or maybe I just don’t know my own strength ;)

Anyway! Mowgli made it through the night and was his normal annoying self this morning reminding me it was time for his noms.
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Another great tip I got on fine dosing is to very gently and slowly “turn” the syringe plunger while holding the syringe barrel with other hand. I turn the plunger counter clockwise to move it up the markings ever so slowly. When I was initially trying to get .25 I was pushing syringe trying to get it to stop at the right dose, which is next to impossible on tiny increments. Once I started turning plunger it worked like a charm, added benefit is insulin drips out top in a bead rather then shooting up in the air, one time I got a stray drop in my eye, so I am very happy with the turning method.:)
 
Also, I assume you are priming syringe before drawing insulin by moving plunger back and forth a few times to distribute the lubricant inside syringe that comes on the sides of the plunger? Just make sure after you do this, you push the plunger all the way back to the top flush with very top of syringe before drawing (if using Lantus pen cartridge) so as not to put air in cartridge.
 
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@Sue and Luci , @Julie and Honey thanks for the tips on fine dosing. I do prime the syringe before drawing but I will definitely try the turning method for my next dose and if that doesn’t go well for me I will try calipers... can you just get that calipers at the pharmacy?
 
Hi, I got our calipers at Canadian Tire :) They were regular price $36ish on sale for $16.99. I find them necessary to get the fine doses with BD syringes, which are often either "sticky" from too little lubricant, or well, well, well lubricated lol, and no amount of "priming" helps :) Good luck!
 
nslade001 said:
Hi, I got our calipers at Canadian Tire :) They were regular price $36ish on sale for $16.99. I find them necessary to get the fine doses with BD syringes, which are often either "sticky" from too little lubricant, or well, well, well lubricated lol, and no amount of "priming" helps :) Good luck!
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Thanks! I would probably go for the Canadian tire option. I also find them sticky! That was my problem I tried the rotation method tonight with alright results.
 
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