Guidance and reassurance please

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Steven Oreos Dad

Steven Oreos Dad

Member Since 2021
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Hi Steven can you please to your signature Oreo's date he was diagnosed,what you are feeding ,is it LC wet, any dry at all ,and the meter you are using and the insulin
 
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https://felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Here is the link to read about Levemir and the dosing methods you choose to follow either TR or SLGS these will tell you when you need to decresse or increase his dose
I'm going to tag a few members for you, to me it looks like you should have reduced his dose when you got that 46 , 61 and 83 BG reading

Steven almost all of us feed our cats small snacks during each 12 hour cycle, bigger meals at AMPS and PMPS and smaller meals during the cycles

You would decrease by 0.25 units
Are you using the syringes with half unit markings ?
Also is it possible for you to test him more during each 12 hour cycle, especially at night
Do you have any high carb food in case you need to bring him up to safe numbers

@Sienne and Gabby (GA)

@Marje and Gracie

@Chris & China (GA)

Hi ladies looking at his SS Oreo is on Levemir, shouldn't Steven have decreased his dose?
Thank you
 
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Food chart
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
For your hypo kit you can get the following and also look at the food chart

Have some honey on hand also


med and high carb food on hand in case he drops too low and you need to bring his BG up to safe numbers

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs



Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs




Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Or any other ones from the food chart, I gave the link above
 
Steven Policano said:
He’s at 91 right now
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That's still a nice safe number but since you don't have much data yet, I'd get another test at +8

The morning shot should be starting to wear off by now because it usually nadir's around +6, but every cat is different (ECID) and we don't know about Oreo yet.

If you want to, you could give him a teaspoon of his regular low carb food

ETA: I also meant to add that you need to get at least 1 other test on the PM cycle, 2 would be better, because most cats go lower at night so we want to make sure he's not going to drop too low while you're sleeping. And yes sometimes there may be nights where you'll need to stay up later than usual...we call them "pajama parties".
 
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Steven just want to make sure you read post #6 please hit the like button so we know you have read what we told you :cat: Also about reducing his dose post #11
@Steven Policano

https://felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/



Here is the link to read about Levemir and the dosing methods you choose to follow either TR or SLGS these will tell you when you need to decresse or increase his dose


Steven almost all of us feed our cats small snacks during each 12 hour cycle, bigger meals at AMPS and PMPS and smaller meals during the cycles

You would decrease by 0.25 units
Are you using the syringes with half unit markings ?
Also is it possible for you to test him more during each 12 hour cycle, especially at night
Do you have any high carb food in case you need to bring him up to safe numbers
I listed some above
 
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Chris & China (GA) said:
That's still a nice safe number but since you don't have much data yet, I'd get another test at +8

The morning shot should be starting to wear off by now because it usually nadir's around +6, but every cat is different (ECID) and we don't know about Oreo yet.

If you want to, you could give him a teaspoon of his regular low carb food

ETA: I also meant to add that you need to get at least 1 other test on the PM cycle, 2 would be better, because most cats go lower at night so we want to make sure he's not going to drop too low while you're sleeping. And yes sometimes there may be nights where you'll need to stay up later than usual...we call them "pajama parties".
Click to expand...
 
Steven don't see your reply you just did
If you want to copy what a member wrote and then reply to it copy it and it should say reply , then hit reply
 
Diane Tyler's Mom said:
Steven just want to make sure you read post #6 please hit the like button so we know you have read what we told you :cat: Also about reducing his dose post #11
@Steven Policano

https://felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/



Here is the link to read about Levemir and the dosing methods you choose to follow either TR or SLGS these will tell you when you need to decresse or increase his dose


Steven almost all of us feed our cats small snacks during each 12 hour cycle, bigger meals at AMPS and PMPS and smaller meals during the cycles

You would decrease by 0.25 units
Are you using the syringes with half unit markings ?
Also is it possible for you to test him more during each 12 hour cycle, especially at night
Do you have any high carb food in case you need to bring him up to safe numbers
I listed some above
Click to expand...
Ok I’ll do snacks mid day. I can right now cause I’m working from home. I hope he’s stable by January when I have to go back. The syringe has 1/2 markings. Also we do have high carb fancy on hand as needed and karo for rescue situations.
 
Diane Tyler's Mom said:
Steven don't see your reply you just did
If you want to copy what a member wrote and then reply to it copy it and it should say reply , then hit reply
Click to expand...
Ok I’ll do snacks mid day. I can right now cause I’m working from home. I hope he’s stable by January when I have to go back. The syringe has 1/2 markings. Also we do have high carb fancyon hand as needed and karo for rescue situations.
 
Steven Policano said:
Ok I’ll do snacks mid day. I can right now cause I’m working from home. I hope he’s stable by January when I have to go back. The syringe has 1/2 markings. Also we do have high carb fancy on hand as needed and karo for rescue situations.
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OK, when you go back to work you can always get an automatic feeder and set times for it to open, we can talk about that down the road
Do you know what method you want to follow yet? It dictates when to reduce or increase
You can always switch back in the future

Right now either one I would reduce His dose tonight to 0.75 unit
Oreo is a cutie :cat:
Am I correct
@Chris & China (GA)
 
Diane Tyler's Mom said:
OK, when you go back to work you can always get an automatic feeder and set times for it to open, we can talk about that down the road
Do you know what method you want to follow yet? It dictates when to reduce or increase
You can always switch back in the future

Right now either one I would reduce His dose tonight to 0.75 unit
Oreo is a cutie :cat:
Am I correct
@Chris & China (GA)
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Sure will be interesting going forward. He’s one of 5 cats
 
Steven , I just checked your spreadsheet , did you see we told you to reduce Oreo's dose to 0.75 tonight in post #23 and #24, please test him @+2 or @+3 to see where he's headed
If he starts to drop you will have to feed him either LC or MC depending how low he drops
@Steven Policano


anytime Oreo drops below 50 (or 90 on SLGS) he should have his dose reduced by .25
Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Basaglar, & Levemir ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

  • SLGS PROTOCOL
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
Oreo has already dropped below 50 and 90 so far
Please read the two Protocols and decide which one you want to follow
I'm just trying to keep him safe , please try and check in every now and then to check anyone's reply to you
@Steven Policano
 
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@Steven Policano You really need to reduce that dose. There are experience members who would shoot a 70 but with Oreo so early into treatment, that's really too low to stay with the 1U dose.

I really hope you're awake and testing tonight!

This is what .75 looks like in a syringe with half unit marks.
187488970_467933384311004_8262355639426917578_n.png
 
Diane Tyler's Mom said:
Oh boy ! ,you might have to feed them all Fancy Feast Pate :p
Try and get 2 tests after you give him his insulin at night
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Chris & China (GA) said:
@Steven Policano You really need to reduce that dose. There are experience members who would shoot a 70 but with Oreo so early into treatment, that's really too low to stay with the 1U dose.

I really hope you're awake and testing tonight!

This is what .75 looks like in a syringe with half unit marks.
187488970_467933384311004_8262355639426917578_n.png
Click to expand...

Sorry I did reduce the dose to .75 I was up last night pulled data from 7-29-2021 and added it to the SS as I wanted to show where we were coming from on this journey before FBDB. I systematically put 1 while doing that. Although Oreo was diagnosed 7/1 the vet said we didn’t need to test him. “Because he’s already high and we know that” that was Novilin and I had the vet switch to Levimir
 
Ok I understand. This morning is hectic. I treated him when I got up (late for an appointment) he didn’t want to eat so I separated him from the other cats and he eat his pate while I was gone for an hour. We are at 228 AMPS. I know this isn’t likely ideal. But do I stick with the .75?
 
Steven Policano said:
Sorry I did reduce the dose to .75 I was up last night pulled data from 7-29-2021 and added it to the SS as I wanted to show where we were coming from on this journey before FBDB. I systematically put 1 while doing that. Although Oreo was diagnosed 7/1 the vet said we didn’t need to test him. “Because he’s already high and we know that” that was Novilin and I had the vet switch to Levimir
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OK good that you reduced to 0.75 , I see you had 1 unit in the cell before
 
Steven Policano said:
I’m reading thru the roomp info and if I understand correctly I should probably do 1un
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Read this link
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

This is if you are following TR Protocol
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

This is for SLGS Protocol about increases
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
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Bron and Sheba (GA) said:
Oreo earned a reduction in dose down to 0.75 units so you need to stay at that dose unless he earns another reduction.
The dose is based on the nadir..lowest point in the cycle…not the preshot.
Can you get some tests in during the cycle?
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yes. Every couple to 3 hours or more frequent good?

thanks for your help
 
Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose

  • The dose is based on the nadir..lowest point in the cycle…not the preshot.like Bron stated above
  • Can you let us know what Protocol Method you would like to follow :cat:
 
Steven Policano said:
yes. Every couple to 3 hours or more frequent good?

thanks for your help
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I would get a test @+3, @+6, and @+9 more after that if he drops to unsafe numbers
You want to start to scatter the tests one day maybe @+4, @+5 @+7
Same goes for tests during the night cycle

It's like filling in pieces of a puzzle
If you are not sure about something please ask
You need to test more often after you shoot at night, he could be dropping very low and you can miss it
 
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Idk which protocol. I’m reading them. I kinda get it but I feel like it’s a foreign language because I still feel overwhelmed
 
Steven Policano said:
Idk which protocol. I’m reading them. I kinda get it but I feel like it’s a foreign language because I still feel overwhelmed
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With TR you need a minimum of 2 tests per cycle - one preshot and one sometime mid cycle. In cycles where the BG is on the lower side, you would need to get additional tests.
 
That I can do. I can do more once I get the Libra back on sooner. I have an appt next Wednesday but The vet has walkins tomorrow.
 
Steven Policano said:
That I can do. I can do more once I get the Libra back on sooner. I have an appt next Wednesday but The vet has walkins tomorrow.
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Let me just double check on how many tests you need to do to follow TR and how many for SLGS. Only because I was a testaholic :cat:
When you get the Libre put back on just be sure to make a note on your SS

@Chris & China (GA)

@Bron and Sheba (GA)

@Bandit's Mom

@Sienne and Gabby (GA)

Hi ladies I totally forgot how many tests you need to do to follow TR and how many for SLGS that's because I am a testaholic :cat:

Trying to explain it to Steven
He said he will be getting the Libre put back on again on Wed, right now hr is using a meter
Thanks ladies
 
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Diane Tyler's Mom said:
Let me just double check on how many tests you need to do to follow TR and how many for SLGS. Only because I was a testaholic :cat:
When you get the Libre put back on just be sure to make a note on your SS

@Chris & China (GA)

@Bron and Sheba (GA)

@Bandit's Mom

@Sienne and Gabby (GA)

Hi ladies I totally forgot how many tests you need to do to follow TR and how many for SLGS that's because I am a testaholic :cat:

Trying to explain it to Steven
He said he will be getting the Libre put back on again on Wed, right now hr is using a meter
Thanks ladies
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Oreos at 112 +3
 
Steven Policano said:
Oreo is 56 6+
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PLEASE listen to us. Oreo dropping to 56 is getting very close to "too low" and you should have tested him every 30 minutes for awhile to make sure he didn't drop any more.

Also, his dose needed to stay at .75 but I see you increased it tonight. Lantus craves consistency. You need to hold the same dose for at least 3-7 days unless he earns another reduction.

Tomorrow, please go ahead and start posting in the Levemir forum

We do posts a little differently there due to the large number of cats on Lantus and Levemir so here is the "Making the most of your Lantus/Basaglar and Levemir forum experience" to help guide you.

Please, please don't give more than .75 tomorrow....and if he's below 150 at AMPS, you should Stall, DON'T feed and test again in 20-30 minutes. Use that time to post (and use a good subject line like "STALLING! NEED HELP!"...You can go back and edit it later after you get someone's attention.
 
Steven, with Levemir, you may find that the cycles aren't going to be the same as what caregivers find with their kitties on Lantus. For most kitties on Levemir, onset often happens a little later and the nadir can also be later than +6, to where you may get it at preshot or just before. There are times when you can get a bit more action earlier in the cycle, sometimes due to the previous dose carryover. On Lev my kitty sometimes has had nadirs at +14-15 in the past. I'd be watching for those cycles particularly like on August 12th where Oreo tested 78 at PMPS, but no further tests happened.

I agree that you should hold the 0.75u until you get a better idea of how Levemir is working for Oreo. I also think you may benefit from breaking up Oreo's daily meals so that you feed some snacks during the cycle rather than feeding all of his food just at am and pm with shot.
 
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