1/29 Chip AMPS 445 +6 361 +9 328 PMPS 316 +6 282

[Dale 'n' Chip]

The high didn't break much, but I increased to 3.0U.

The NDW might be kicking in from that soon?

He is still slightly "under the weather" but maybe that is from the numbers?

He is playing a little bit and still eating well.

But these numbers are about the worst he's ever had.

Chip's 1/28

 

[Marje and Gracie]

Re: 1/29 Chip AMPS 445

There has to be something going on. Let me get some other eyes on his SS too so our collective thoughts might help.

He's peeing,pooing ok? Drinking water? Ketones negative?

 

[Dale 'n' Chip]

Re: 1/29 Chip AMPS 445

Peeing and pooing are normal.

He's eating well, not really drinking but he usually doesn't on wet food.

I need to get some new ketone strips but I'm going to go pick up the clavamox first.

He's not dehydrated or lethargic but I can give him SubQ on a moments notice.

 

[Marje and Gracie]

Re: 1/29 Chip AMPS 445

That's good that you can give him squids if you need to. It's also good that he's at least eating, peeing, pooing.

He's got to be brewing something for numbers to do this so quickly. Have you checked his mouth?

 

[Libby and Lucy]

Re: 1/29 Chip AMPS 445

Dale, I can help with R if you can get it today for PMPS. The only thing is that I won't be available to help tomorrow at all, and I don't know about Thursday. I think once you get started, though, you'll catch on quickly and won't need me to help.

The numbers do look like something is wrong, so I think he needs to see a vet if possible. Is the clavamox for a specific reason? Sorry if I'm asking something you have already answered, but I haven't read back through your recent condos yet.

What time is your PMPS?

 

[Dale 'n' Chip]

Re: 1/29 Chip AMPS 445

The clavamox is just an inexpensive treatment/preventive for possible uti. His teeth and gums look fine to me.

I just saw the vet and he said to do the clavamox, it sure can't hurt anything at this dose.

PMPS will be around 10PM central, I'm confident I can handle the R the way Jill is shooting it.

The big question is, do I need to shoot this down with R? Are we sure it's not bounce, or over dose?

I already have a full vial of NPH. I shot and tested NPH with Chip for months before Lantus. I know onset, nadir,and dose with NPH. And of course I already shot "drops" of NPH when he was OTJ the second time a year ago, I'm pretty familiar with the action for Chip. And I'm good at bringing up his numbers if needed with carbs and karo.

I really should be good to go if *nudging* these numbers down is the next course of action. I'm watching him close in case this "bounce" clears.

And I certainly know how to test every hour or half hour. ;-)

 

[Libby and Lucy]

Re: 1/29 Chip AMPS 445 +6 361

It's not over dose, there are no signs that he might be dipping anywhere that you are missing. It *could* be a bounce, but again, if he's bouncing it is off 90s and that's just not Chip's style. I don't suppose there is a chance he is getting contraband somehow? Though it doesn't really look like that either. Ruling those things out, and the fact that you say he's not quite acting like himself, make me think something is wrong. Hopefully the Clavamox will help.

About using a bolus: no, you don't *have* to shoot these numbers down. You can, though, if you want to. You're an advanced Lev user and have the experience to understand how to use a bolus safely. Your cat is in a high/flat pattern (I wouldn't try a bolus with a bouncer). Now that you are giving an antibiotic, he might start to come down on his own. Hopefully that will start to clear out whatever is going on with him soon.

I have never used N as a bolus. I know there used to be people here who did, though most of them were before my time. In theory, it should work well with Levemir in a late nadir cat. R is easier to use because it is quick in/quick out, and if you make a mistake you don't have to live with it for quite as long. ;-)

How long would you say N lasted for Chip when you were using it? When was his nadir? And when is his typical Lev onset and nadir?

When you are using a bolus, the idea is that you need to know Chip's typical curve (onset/nadir/duration) on each insulin, then lay those curves on top of each other to determine when you can safely use the bolus. For example, you wouldn't want the N to nadir right when the Lev's onset is beginning (or vice versa), because then you could have both insulins having strong action at the same time. It's better to have the bolus just starting to wear off when the basal insulin starts to work.

 

[Dale 'n' Chip]

Re: 1/29 Chip AMPS 445 +6 361

There is a good example of a typical N curve on the first line of his spreadsheet 5/20/12.

N onset: +2-3 N nadir: +3.5-6 and it's all gone by +8. Some good nadirs at +3.5 some at 5 or 6.

As for Chip's nadir on Levemir, I'd say +8 to +12. However most lows for reduction have occurred at +3 from shooting a falling number. I would call that more like +15 from the cycle before. His usual Levemir peak glucose is generally +3 +4.

What I'm thinking is perhaps shoot sk0.25U N before PS at +8 or +10?

He's feeling ok. Pretty active/playful and actually eating a lot. For him that would usually be associated with low/falling numbers and plenty of insulin. Normally when he is Hi or on a lower dose he isn't as hungry. Hearing a little rumble in his tummy which is normal with clavamox. He will have softer poo for a day or two on starting clavamox then it should be back to normal.

Besides these terrible numbers he's otherwise generally normal. :smile:

ETA: When I say lows have happened "shooting" a falling number, the shooting (Levemir) likely had nothing little to do with it. It was the *falling* at PS that kept going, most likely would have shot or no shot.

 

[Libby and Lucy]

Re: 1/29 Chip AMPS 445 +6 361

He's feeling ok. Pretty active/playful and actually eating a lot. For him that would usually be associated with low/falling numbers and plenty of insulin. Normally when he is Hi or on a lower dose he isn't as hungry. Hearing a little rumble in his tummy which is normal with clavamox. He will have softer poo for a day or two on starting clavamox then it should be back to normal.

Besides these terrible numbers he's otherwise generally normal. :smile:

This is all good news (well, not the softer poo).

I would try to draw some charts like this (we'll see if I can make these fit the format of the board and still be legible):

Lev alone (assume +8 nadir)
+8.............+9.............+10..............+11..............+12..................+1
Lev nadir.....rising.........rising............rising.............rising (give Lev)..rise

N alone
+1..............+2............+3................+4................+5...................+6
Give N........rising.........N onset.........dropping.........dropping...........N nadir

Lev and N together
+8.............+9..............+10.............+11...............+12.................+1
Lev nadir.....rising.........drop/surf.......drop/surf........drop/surf..........rise


OR


Lev alone (assume +12 nadir)
+8.............+9..............+10..............+11...............+12...............+1
drop...........drop...........drop..............drop..............Lev nadir........rise

N alone
+1..............+2............+3................+4................+5...................+6
Give N........rising.........N onset.........dropping.........dropping...........N nadir

Lev and N together
+8..............+9.............+10..............+11..............+12.................+1
drop...........rise/surf.......drop............drop..............drop................rise

Based on this scenario, N at +8 might not be a good idea if his Lev nadir is +12. Lev nadir of +8 would be better. You might have both insulins pulling at the same time. Of course if he is super high (400s and flat), then Lev nadir is not very relevant. I believe Jill was using R at various times because she knew that under the circumstances, Alex didn't even HAVE a Lev curve. That is another consideration. Really that is probably the only situation in which you would want to use a bolus for Chip anyway.

It does look like Chip is at least trying to drop today. Maybe he is trying to help out.

 

[Dale 'n' Chip]

Re: 1/29 Chip AMPS 445 +6 361

...Based on this scenario, N at +8 might not be a good idea if his Lev nadir is +12. Lev nadir of +8 would be better. You might have both insulins pulling at the same time. Of course if he is super high (400s and flat), then Lev nadir is not very relevant. I believe Jill was using R at various times because she knew that under the circumstances, Alex didn't even HAVE a Lev curve. That is another consideration. Really that is probably the only situation in which you would want to use a bolus for Chip anyway.

It does seem less urgent at this point. Perhaps I will sleep off this bounce (check in as often as the decay of the curve requires) and bolus NPH during the daytime.

So assuming a lev curve, you think N at +10 is better? What do you think about dose for N?

I can try tomorrow and handle the shooting and testing and testing and testing myself.

Thanks so much for weighing in on this. I was just wondering if this was some kind of counter regulatory response to the dose itself. But it really behaves more like too little insulin for the circumstances.

 

[Sienne and Gabby (GA)]

Re: 1/29 Chip AMPS 445 +6 361 +9 328

I thought I'd raise this question although I'm sure you considered it. Any chance the insulin is bad?

 

[Libby and Lucy]

Re: 1/29 Chip AMPS 445 +6 361 +9 328

I think waiting until tomorrow is a good plan. Maybe he will keep coming down tonight and this whole discussion will be moot. Let's hope so.

I do think +10 sounds like a better plan, or even PS. I really can't suggest a dose for N as a bolus, not having used it. I did use N for Lucy, but that was when I was still in the blind shooting 1 unit twice a day stage. With R, I usually suggest 0.1u to start, but I think N is less potent. Either 0.1u to be ultra conservative, or 0.25 to maybe actually see some action. The safest thing to do is start low. There's no depot, so you can increase the dose the very next cycle if the first dose does nothing.

I really think that given Chip's usual beautiful numbers, even if you do end up using a bolus, you probably won't need it more than once or twice. The idea is to help him over the hump until he can get back to his usual lovely surfing.

 

[Dale 'n' Chip]

Re: 1/29 Chip AMPS 445 +6 361 +9 328 PMPS 316

Thanks all. We'll see where he is at +10 and maybe shoot 0.25U N.

At least he isn't going up yet. :thumbup

As for the potency of the FlexPen, seems like we are always asking that question with Levemir.

The pen was apparently good a week ago and nothing has changed. Not left out, not frozen, digital thermometer always next to insulin in fridge.