Mid-day R dose question

Howiesmom

Howiesmom

Member Since 2020
For those who give their kitties doses of R, how high should BG be to consider giving a mid-day dose of R? Howie has been having a nice streak of blues lately with some yellows mixed in. I know I should give it around +6-7 if the BG is climbing throughout the day, but I certainly don’t want to poke him more than I have to if he’s not meeting a threshold. Thanks!
 
I've been using the same threshold I use for the morning/evening shots (300), and only do it if he's on his way up or has been stuck in the high numbers. (For example, it's likely that he's going to get some in half an hour when I do a mid cycle check; he was at the bottom of a dip at AMPS and is on his way back up now.) But ECID; you're using a different cutoff than me and your Lantus dosing is different, so definitely don't take what I do as necessarily being best for Howie. I think the main thing to consider is where he's already heading in the absence of R, and then what the effect of R on top of that might be. Definitely don't want to risk bringing him too low. I'll tag @Wendy&Neko and @Sandy and Black Kitty in case they have more specific advice for you.
 
With Levemir, it's a little trickier, because the Lev nadir is later. I see some days, like 12/13, Howie nadired at +12 (also a fav nadir time of Neko's). So you only want to give R mid cycle if he's definitely not dropping, so flat or rising. Based on your experience with R to date, how long do you think R is lasting in Howie? You also want to give it when you know it's action will be done and out of the system before the next shot of R.

What helped me figure out timing was to graph out some typical Levemir cycles for Neko, the superimpose the R action on top of it, once I had an idea of the timing and effect of it. Then look at the combination to make sure there wouldn't be any steep drops. Of course, cats do like to mix it up so it's not an exact science. The graphing does pretty much what Lisa described in terms of figuring out where he's going with and without R. The graphs were just a bit more visual for me.
 
Wendy&Neko said:
With Levemir, it's a little trickier, because the Lev nadir is later. I see some days, like 12/13, Howie nadired at +12 (also a fav nadir time of Neko's). So you only want to give R mid cycle if he's definitely not dropping, so flat or rising. Based on your experience with R to date, how long do you think R is lasting in Howie? You also want to give it when you know it's action will be done and out of the system before the next shot of R.

What helped me figure out timing was to graph out some typical Levemir cycles for Neko, the superimpose the R action on top of it, once I had an idea of the timing and effect of it. Then look at the combination to make sure there wouldn't be any steep drops. Of course, cats do like to mix it up so it's not an exact science. The graphing does pretty much what Lisa described in terms of figuring out where he's going with and without R. The graphs were just a bit more visual for me.
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From what I can see, his R nadir is usually around +3. So how would I know how much longer it’s in his system vs when the L is kicking in after +4? What do you use for graphing? Thanks so much!
 
I just use pen and paper for graphing, very low tech. :p

Howiesmom said:
From what I can see, his R nadir is usually around +3. So how would I know how much longer it’s in his system vs when the L is kicking in after +4?
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Does he seem to be dropping more after +4 on cycles where he has R vs. those he doesn't? I think as long as his numbers are headed back up, you are OK for a mid cycle bit of R. Maybe start with a smaller dose than your preshot R, just to gather data.
 
@Wendy&Neko @Sandy and Black Kitty
I’m getting super confused on what to do with Howie. Per Wendy’s recommendation, I’ve been watching his numbers after +4 when the R is probably wearing off, but then his numbers haven’t really been climbing so I haven’t done any mid-day R shots. And frankly, the R doesn’t seem to be dropping him from his PS numbers at all. I haven’t been checking +1 and +2 any more as all the data from Dec when I was checking them was that his numbers went up, I’m assuming from his meals. I’ve been increasing his R scale every couple of days (mostly following his L increases now). Another member recommended giving more R to help save on the amount of L he is getting. Thoughts on this? He is now on 38 units BID and is back in the yellows. This insulin bill is getting outrageous at these amounts. Anything else you recommend I can try/do? My vet doesn’t have any ideas as I am his first/only IAA client. He is happy and chipper, so nothing to worry about his health that I can tell. I’m just not seeing any progress at all. Pretty soon I’ll have to start using 3 syringes just to administer is L. His next L dose increase on Monday will be a 4 unit increase to 42 units BID. I know I haven’t been posting regularly in the lantus/levemir forum as I frankly don’t know what to say in a daily post besides his numbers. That just seems to jam up the forum for people who really do need help.
 
What are your thoughts on getting Howie retested for acromegaly? I know a certain percentage (1/3) of cats will show a false negative if tested too early after insulin therapy is started. I was conferring with Sandy, and we haven't seen an IAA only cat on such a high dose of insulin and still so stubborn about his numbers. If there is acromegaly in the picture, then there are treatments that can reduce the excess growth hormone and reduce the dose needed.

Howiesmom said:
I frankly don’t know what to say in a daily post besides his numbers. That just seems to jam up the forum for people who really do need help.
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You do need help. :bighug: Don't worry about posting here, it see more traffic and frankly, I look here more often.

As for the R dose, on a day when you can monitor closely, I'd try 3U R for these low yellow preshots. 2uR isn't doing anything and his L dose is growing fast.
 
Wendy&Neko said:
What are your thoughts on getting Howie retested for acromegaly? I know a certain percentage (1/3) of cats will show a false negative if tested too early after insulin therapy is started. I was conferring with Sandy, and we haven't seen an IAA only cat on such a high dose of insulin and still so stubborn about his numbers. If there is acromegaly in the picture, then there are treatments that can reduce the excess growth hormone and reduce the dose needed.


You do need help. :bighug: Don't worry about posting here, it see more traffic and frankly, I look here more often.

As for the R dose, on a day when you can monitor closely, I'd try 3U R for these low yellow preshots. 2uR isn't doing anything and his L dose is growing fast.
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Thanks for the response today! I can certainly talk to my my vet about retesting for acro. His first IGF-1 results was 83. I know the normal range goes up to 92 or so. He’s been on 2.5uR for BG 200-249. Should I try a 1 unit increase and go straight to 3.5? Sandy had said to not increase more than .5 at a time. Im Just wondering if I need to be even more aggressive? I gave him a mid-day shot today of 1.25u and there was no effect. I love him so much and will do what I can within my means. But getting 10 pens at a time from Marks that hardly lasts 6 weeks is getting difficult. Do you not recommend doing a sharp increase of R and decrease some of his L as recommended by another member? That seems to almost follow what my vet had originally said of doing a 2:1 ratio of L:R. Thanks, Wendy!
 
83 is higher than I've seen of other cats getting the test and being "normal", worth a retest. I've seen recommendations for cats that retests be done on cats on the high side of normal.

I don't like the 2 to 1 ratio of L:R. Even on kitties on really high doses of L, I haven't seen much more than 3 to 1. You could try a 3.5 tomorrow if you can monitor as you normally do. See what a 1 unit increase does.
 
Wendy&Neko said:
83 is higher than I've seen of other cats getting the test and being "normal", worth a retest. I've seen recommendations for cats that retests be done on cats on the high side of normal.

I don't like the 2 to 1 ratio of L:R. Even on kitties on really high doses of L, I haven't seen much more than 3 to 1. You could try a 3.5 tomorrow if you can monitor as you normally do. See what a 1 unit increase does.
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If I started a 3:1 ratio with his next dose increase tomorrow, that would be 28L:14R. Right now, I’m not even on a 10:1 ratio. I don’t know how he would react to such a switch. I’m working from home due to COVID through Jan and then have to go back to the office in Feb. it would be so nice to get a handle on this while I’m here 24/7!
Is there any reason to also retest the IAA to see if that level has gone up? He first tested at 63 on 9/30/20.
 
I'm not saying to switch to a 3:1 ratio, just that's the highest I've ever seen. R dosing is very individual to what the cat needs. Neko's R ratio was more like 16:1. More R was too much for her. You'll have to find out what works for Howie. Make gradual changes in R amounts until you find what works for Howie.

No need to retest the IAA. We know he has that and that won't change.
 
Wendy&Neko said:
I'm not saying to switch to a 3:1 ratio, just that's the highest I've ever seen. R dosing is very individual to what the cat needs. Neko's R ratio was more like 16:1. More R was too much for her. You'll have to find out what works for Howie. Make gradual changes in R amounts until you find what works for Howie.

No need to retest the IAA. We know he has that and that won't change.
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Sounds good...thanks, Wendy. The 1 unit R increase this AM yielded basically no change/results. Should i try a bigger dose increase tomorrow or hold at this one? I know ECID but I’m in total foreign territory without any vet knowledge/experience to support me in addition to your expertise!
 
Don't base your decision on how an R dose is doing based on just one cycle. Try a couple cycles at it before increasing if needed.
 
Wendy&Neko said:
Don't base your decision on how an R dose is doing based on just one cycle. Try a couple cycles at it before increasing if needed.
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Just wanted to let you know that Howie goes tomorrow (Tuesday) for his IGF-1 retest blood draw. It took a little more than a week to get the results last time. I did a lot of reading last night on acro kitties and he seems to have classic signs. I will be shocked if it comes back negative again given that he was 83 in Sept. Assuming it is positive, I will go straight to getting him in cabergoline. I will be the first acro kittie for my vet. Not sure how much research he’ll do vs just go along with what I want to do. He’s great like that. So first things first will be test results. Any thoughts on if cabergoline would even have an effect on such a high dose kittie? Started 42 u BID today. He did drop back down into blues today which was nice to see!
 
The IGF-1 test is just once a week, and the blood has to be there by Tuesday to make the Wednesday run, so yes, it will be over a week to get results.

Neko was my vet’s first acro, or she thought she was. Until she learned more and discovered another at the practice.

I have seen a cat on the 30+ units of insulin on cabergoline, but the caregiver didn’t do it long as he decided to do SrT instead.
 
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