11/17/14 Oz Dosing Question

Status
Not open for further replies.
Ian & Oz

Ian & Oz

Member Since 2014
Hello,
Oz has now been at a dose of 2.5u for six days or twelve cycles.
On the fourteenth, something strange happened & I still don't know if he got two fur shots that day or something else was going on.
From the A.M. shot to the P.M. shot he stayed between 200 & 227 unless there was a number I didn't catch. The P.M. cycle was higher but still stayed in the 200's. Assuming he must have had at least one fur shot that day ( but maybe he didn't?), I wanted to stay with the same dose for a while. The past two days have been better, coming down into the green, but going back up into the 200's at pre shot time. I'm wondering if anyone can make some sense of his recent levels. I'm trying to decide if I should move him up to 2.75u or if he's just now recovering from a bounce & maybe stay with his current 2.5u dose.

P.S.
Oz's Lantus is kept in a zipped up cold pack kind of bag in the refrigerator, on occasion it's been accidentally left out to the point where it was close to room temperature. I've read that it can supposedly handle being left out for 24 hours, his hasn't been left out that long but I'm wondering if anyone knows how durable it is being left out.

Thank You for any help you may have.
Ian
 
Hi Ian

I think he was just bouncing from the long run of normal numbers the day before. Many of us have noticed how this can happen.....higher numbers after a really nice day. the other thing is that absorption can vary up to 50% even from shot to shot. I wouldn't give it too much thought since he came back down.

The question is.....how do you feel about his nadirs? If you want to see a bit more green, you can increase to 2.75u because you test. But it is just fine to leave him here and let the cumulative nature of Lantus work. Take a look at Maxs SS and how long Elise held the +2.5u dose even through the bounces and how Max has pretty much stopped the bounces.

Insofar as the Lantus, several members have left theirs out overnight with no issue. Just keep an eye on numbers and if you see real wonkiness, then we can think about the pen.

Sound good?
 
Hi Marje Great to hear from you!

I'm thinking of giving it a little more time since he's now coming back down, hopefully his pre shot numbers will too.
I just worry now about staying too long on a dose, since it's been mentioned that changing faster is better, maybe?
I would think that if the 2.25 dose was really trying to bring his levels down, then the 2.5 dose would be working even faster to do so, but maybe, it's just the bounce that slowed things down for a bit?
By what you see on his chart would you think that the insulin is still working correctly & not affected by being left out?
I know that may be difficult to actually tell, but I guess I'm referring to when you said, If I see any real wonkiness, I don't think I'd know what to look for.

Thank You Marje!
Ian
 
I just remembered something, I had bought some chicken & cooked it & wasn't paying attention to the fact that it had some fat (dark meat too) & felt a little greasy when cooked. When I do buy them, I always get boneless skinless chicken breasts,except this time ( it's been very stressful recently). So for an evening snack everyone got some chicken for about 3 or 4 nights. Could this be part of why his levels are weird lately, probably some high carbs with the fat?
I'm actually a responsible adult, but keeping up with Oz lately & testing, not getting much sleep along with a few other things that are going on in life, have made it a little tough.

Ian
 
Ian --

There aren't carbs in the fat or dark meat. There may be more calories than in chicken breast but what you're giving as a snack is zero carb. Sometimes, giving food if it's past nadir may cause numbers to bump up since there's less insulin available to offset the effect of food.
 
Ian
I would think that if the 2.25 dose was really trying to bring his levels down, then the 2.5 dose would be working even faster to do so,
Click to expand...

Remember that if the dose isn't his perfect fitting dose, then each time you increase the dose, the depot has to fill to the new dose. Even if you are at a good dose, it can take a bit to get the cumulative nature of lantus really working. Some cats, like Max and even my Gracie at times, are slow responders. I know with Gracie that if I increase her dose and she gets some blue or green, I often have to give her 11-13 cycles before I know whether it is going to be a dose that will work for her. On Tilly's webpage, Kirsten says that on the "holding the dose" phase, it might last a month. Sometimes longer, sometimes less. ECID.

I don't think the insulin is wonky. I think it's fine right now and I doubt you will have issues with it.

So it depends on how aggressive you want to be. If you want to have a little more overall green and you can be there to test, increase the dose. You could even just fatten it a bit. If you want to be patient and see how he does, he's getting good nadirs; it wouldn't be wrong to do that either.
 
Hi & thank you Marje & Sienne,
Good to know about the chicken!

Marje do you have a link for Tilly's web page?
Will holding these doses for a longer time effect the possiblity of getting him into remission?
Last night Oz went down to 50, I started testing him closer together in hopes of catching that 49 for a dose reduction, but a few minutes later he was back up to 54, I was trying to get him there.
Now today it seems either I've managed to give him a fur shot or he's reacting to that 50 from last night. It's really frustrating thinking I'm not doing something right when giving his shot, I do it the same everytime but the more I worry about doing it right, the more difficult it seems. How does missing a shot here & there affect him overall in the process of trying to regulate him & hopefully get him into remission?
Marje I know you told me that you've seen these higher numbers after a good day, so maybe that's what's happening.

Ian
 
Hi. It's weird to see Max referred to as a good example. He's always been a bouncy cat. I saw your most recent numbers. Not sure if yesterday or today but lots of green. Did you increase? If not it sure looks to me like this dose is kicking in nicely. One thing about Max was he would go as much as a week doing really well and then fall off for no apparent reason.
 
Hi Ian!

I think I'd stick at this dose for a little bit longer. What it looks like to me is that he has a few hours in nice green numbers and then he bounces.

One strategy you can do is to feed him a little bit to keep his nadirs up so he can stay at this dose for a little bit longer. You don't want to rush into a dose reduction. You've got a dose right now that's getting great nadirs in between the bounces but you're still having some higher numbers in the bounces. If you can hold this dose a little longer, it might be enough to get rid of the higher numbers. As his body spends more time in green numbers it will settle down and react less.

Asking the question about the dose is great, though. You do want to keep revisiting the question and making the decision again every few cycles. You're right about not sitting on a dose too long that's not getting you where you want to go. At the moment though, in between the bouncing Oz's nadirs are just about perfect. That's why I'd go with holding it a bit longer. I'd re-evaluate it again in about 4 more cycles.
 
Ian

Sorry...vet appt for Gracie today and then we were out.

Here is the phase I was discussing which is mentioned on Tilly's website. The bold is mine.
Phase 3: Holding the dose

Try to keep the cat at a dose where the BGs are in the 50 to 200 mg/dl range for as much of the day as possible. The majority of cats are actually able to achieve consistent BGs in the 50 to <100 mg/dl range with consistent dosing.

Don't let the cat go below 50 mg/dl (N.B. there are some cats that do well with BGs >=40 mg/dl and are difficult to regulate unless the dose is held at BGs in this range, but a cautious approach should be used until you are sure your cat reacts this way). 200 to 220 mg/dl is approximately the renal threshold for glucose and important for renal health and general recovery. This phase may last a long time (many months). Periodic slight adjustments are necessary in many cases.
Click to expand...
 
Thank you Marje, Julie & Tiffmaxee,
I've stayed at the same dose & at least for now I'm glad I did, his levels are coming back down.
Thank you for your help!!

Ian
 
Status
Not open for further replies.
Back
Top