6/22 Mouse AMPS 493 +4 499 +8 472 +11 HI PMPS HI +2 HI Dosing change?

[Sam Q]

First Post in this thread:

Do I need to try to start fresh from something like.5 again?

We switched to Levemir in March and loosely used a version of SLGS to increase to 1u….decreased and increased again. Now that I can see it on the spreadsheet and not just the libre application I think we might need to go back to a lower dose and start again under the TR protocol. What are your thoughts? I’m in love with seeing a bell curve but the sides are steep when it happens and then followed by a period of high numbers before it finally goes into a bell curve again. Not as bad as when the vet had us increasing Lantus too fast and caused the Somogyi effect that looked like check marks instead of curves. I know my spreadsheet looks intense. I hope my OCD is a gift.

I appreciate your feedback.

 

[Chris & China (GA)]

You can sure tell when he gets into food he's not supposed to have, can't you?? Bad kitty!!

Now that I can see it on the spreadsheet and not just the libre application I think we might need to go back to a lower dose and start again under the TR protocol. What are your thoughts?

No, starting over is almost always a waste of time and just allows glucose toxicity to set in....you've made small adjustments and gone up at a reasonable rate so dropping back and starting over wouldn't do a bit of good.

The problem with your spreadsheet isn't your OCD as much as it is using the different meters. Trying to figure out when he's really earning reductions is hard when we know the Libre is saying "LO" but we know it's not necessarily the truth. Do you think you could just skip the Libre and test only with your Relion? Having consistent numbers on the spreadsheet will make it easier for everybody to figure out what's really going on.

The fact that he dropped below 50 three times on 3 different cycles at the 1.25 dose (even with the Libre on the 16th, 17th and 18th) makes me think you should probably have reduced to 1.0 and held that dose longer.

@Wendy&Neko is who I'd suggest take a look. She's got a lot more experience with Levemir than I do.

What dose of Lantus was he on before you switched to Levemir?

 

[Bron and Sheba (GA)]

Hi Sam and Mouse
There is actually no such thing as the Somogyi effect. It was a very small study done I think in the 1930s but has never been proven in cats.
What you are seeing with the low and then high numbers is bouncing. Bouncing happens when the BG drops too fast, too low or lower than the cat is used to. This causes the cat to dump stored glucose and regulatory hormones into its system as it thinks it has to save itself. This causes the BG to skyrocket. A bounce can last from 1 to 6 cycles (3 days) and once a bounce starts, there is nothing you can do but wait it out.
This is what is happening with Mouse at the moment.

Have you been following TR over the past few months? The SS says TR but you say you might start again under TR.
Either way you have not been taking some of the reductions Mouse has earned.
With SLGS you reduce the dose if the BG falls below 90.
With TR you reduce the dose if the BG falls below 50.
Also at this point, you need to be increasing and decreasing in 0.25 (1/4) unit increments, not going from 1 unit to 1.1 unit. Or from 1.25 to 1.1 unit.
I don’t think starting over is a good idea. You need to be following with the TR or the SLGS method properly, take the reductions when earned and be aware of the bouncing. Using both the libre and the other meter together is confusing. I would stick with one or the other.
I think we need to see where he is after he comes off the current bounce..

 

[Sam Q]

You can sure tell when he gets into food he's not supposed to have, can't you?? Bad kitty!!



No, starting over is almost always a waste of time and just allows glucose toxicity to set in....you've made small adjustments and gone up at a reasonable rate so dropping back and starting over wouldn't do a bit of good.

The problem with your spreadsheet isn't your OCD as much as it is using the different meters. Trying to figure out when he's really earning reductions is hard when we know the Libre is saying "LO" but we know it's not necessarily the truth. Do you think you could just skip the Libre and test only with your Relion? Having consistent numbers on the spreadsheet will make it easier for everybody to figure out what's really going on.

The fact that he dropped below 50 three times on 3 different cycles at the 1.25 dose (even with the Libre on the 16th, 17th and 18th) makes me think you should probably have reduced to 1.0 and held that dose longer.

@Wendy&Neko is who I'd suggest take a look. She's got a lot more experience with Levemir than I do.

What dose of Lantus was he on before you switched to Levemir?

The Vet had increased to 3 and in March was recommending 4 when I found this resource and started to research. His curves looked like checkmarks and now I question everything. I keep thinking I need to ween off the Libre but a combination of Anxiety and OCD keep me wanting to use it for a little while longer. I know using two is going to cause a headache but the numbers I can't see drive me to worry. I will likely have to give myself a deadline. Thank you for this advice.

 

[Sam Q]

Also at this point, you need to be increasing and decreasing in 0.25 (1/4) unit increments, not going from 1 unit to 1.1 unit. Or from 1.25 to 1.1 unit.
I don’t think starting over is a good idea. You need to be following with the TR or the SLGS method properly, take the reductions when earned and be aware of the bouncing. Using both the libre and the other meter together is confusing. I would stick with one or the other.
I think we need to see where he is after he comes off the current bounce..

Thank you for your feedback!

 

[Chris & China (GA)]

I keep thinking I need to ween off the Libre but a combination of Anxiety and OCD keep me wanting to use it for a little while longer.

Hey I totally understand! When we were new, there wasn't even an option of using the Libre! But not being able to easily check China's numbers also meant learning her "tells" so I'd know when it was really important to get a test in right then! You're forced to learn more about how the insulin works in your cat...how your cat responds to foods of different carb levels, etc. I was an admitted test-o-holic (you can tell by looking at China's spreadsheet) but I'm actually glad the Libre wasn't around.

I think the Libre is a great tool for new people who haven't gained the confidence to use a regular meter, but I do agree that you should really try to wean yourself off of it. There are times where too much information just makes it more confusing....and keeps you from really understanding what's going on with your cat.

 

[Wendy&Neko]

I am glad you went with 1.0 units. It is fine to double check the Libre Lo’s with a human meter and I have seen that is recommended. You don’t want to reduce unless he’s below 50 on a human BG meter.