12/15 PMPS 521 Need dosing help NOW BG never this high

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Cheryl & Whiskers (GA)

Member Since 2010
Hello

I really concerned I'm about to feed whiskers and give her evening insulin. Her blood glucose has never been this high. Can I go up on her Lantus tonight.
 
Cheryl, I looked at your spreadsheet and it looks like you increased from 1u to 1.25u tonight. I'm not in the position to give dosing advice, but don't fault you for being nervous about that high number. I may have done the same since she'd had quite a few days of the lesser dose. I'll let the dosers chime in on that one. In the meantime, make sure she's eating some and keep getting tests in tonight.
 
Hi,

Ok here is my previous threads/condos? viewtopic.php?f=9&t=32047
viewtopic.php?f=9&t=32174
I did go up to 1.25 units on lantus tonight. We have been at 1 unit for 5 days now and todays numbers, especially the PMPS was just to high.
I've spoken to our vet 3 times in the last day and 1/2. He had a diabetic cat of his own, so I feel pretty comfortable with him. I have emailed him a link to this website because he wanted to look at Whiskers SS. He said he had a passing familiarity with FDMB.
I think that I am following the protocol by staying at 1 unit for 5 days and now going up to 1.25 units tonight because her BG numbers are high. I realize the dosing is based on the nadir. I'll do a curve this weekend.

Thanks everyone.
 
I'm not a dosing expert either but it is possible that the high numbers are from bouncing...you don't have any mid cycle numbers to know how low she is going; she could be going very low and then bouncing back up. If that is the case, increasing the dose might not have been the right thing to do because we don't increase based on preshots; if you shot an increased dose tonight and she already has a full shed, I am hoping you will monitor her closely tonight even if you have to stay up or sleep and get up to test her frequently. If she's bouncing, she might stay high but if you shot a higher dose through the bounce, she might not. Again, if she were my cat, I'd be testing her tonight.
 
You are not wrong about the 5-7 days for the dose to kick in--You already gave him the increased dose--
You must monitor him tonite, with at least +2, +3, and +6 to see where he goes--That's the thing about raising the dose,
You need to be able to be home & awake to monitor--If he does drop, you have high carb food, karo, etc--hypo kit(NOT TO Scare you but you must have this-read newbies sticky)
Yes we get frightened by a high number, but it's just one number one day--It could have been stress, or maybe he got into something to eat
that was incorrect for him??--Just watch him now tonite-OK???
 
What do you do if you cat is bouncing?

I can do +2 maybe a +3, I can not however stay up all night, my sister was murder 2 years to the date today 12/16/10. Whiskers was her cat. I am exhausted. I'm doing my best.
 
cheryl its difficult to tell if a increase is neccessary right now because we like to have more spotchecks in the cycles. i am not seeing enough spotchecks at different times here so its an unknown right now whether yu should increase or perhaps decrease for that matter. bouncing is a result of when a cat goes very low and the liver compensates as a preventive measure by excreting glucose into the system to counter act a low number. its not a bad thing in fact it happens alot.but is difficyult to tell right now .if ytu could get some more spotchecks it would give us a clearer picture as to what is going on. especially since yu just did an increase that dose will have to setttle which will take a few cycles to see what that new dose is doing. in meantime if yu could get some bgs it will help to see the picture better
 
Here is some info that may help you in testing mid cycle:

How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Also, here are the guidelines for the protocol to be handy for you:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


It is hard in the beginning, to see those high ps numbers, but they are not the ones that you need see to decide on your dose changes.
If you think of a tennis ball and you hit it so that it bounces hard on the ground... you know what happens after that - that ball will soar high in the air. Your ps numbers may be those kind of bounces, and maybe not.
By testing at say +3 +6 +9 on a few days, or some other times in between, you will see a couple things: you will see Whiskers going low somewhere in between am and pm shots, OR you may see Whiskers with all high and flat numbers.
Those two different situations would tell you two very different issues, so that's why it's important to see some numbers in the middle. It really is not that safe to say what you should do with the dose when there are few numbers mid cycle.

Now that you have increased, it would be good if you can get a few tests in. If you see that Whiskers is dropping fast in the first few hours, some people give tiny meals every hour and it will sort of slow down the cat's huge fast drop, and by slowing down the early drop, you are going to minimize another mega bounce. Keep in mind that it may take up to 3 days for a bounce to clear, so don't get discouraged if that's what you see when you get the mid cycle numbers.

If, on the other hand, you see all the tests are just flat with little dip downward, let the dose settle and if it does not improve, move up in dose according to the guidelines I put above. That flat curve is likely saying "more insulin please", but you need to let the Lantus shed fill, and some cats take up to 6 shots or more to start to show they got a dose change. My Oliver has taken up to 7 or 8 shots before I see any change, but my Shadoe will show a change in maybe 3 or 4 shots. With more test numbers, you will see what Whiskers is like.

We know it's tough in the beginning, looking for that good dose, but you will find it.
 
Cheryl & Whiskers said:
What do you do if you cat is bouncing?

I can do +2 maybe a +3, I can not however stay up all night, my sister was murder 2 years to the date today 12/16/10. Whiskers was her cat. I am exhausted. I'm doing my best.

Cheryl...Bless your heart..I'm really sorry about your sister. This has got to be a very difficult time for you especially since Whiskers was your sister's sweet kitty.

It great that you are feeding Whiskers the raw diet, testing and shooting. That's alot to learn at the beginning. I wonder if it might be possible for you to set your alarm for at least one spot check at night. At least to see what may be happening. That might just be too much for ya right now...but it may help to provide some data for you regarding your question about the bounces. But you have to do what you are able to do right now.

Just to let you know....I'm thinking about you today....The anniversary of your sister's death.....Lots of hugs for you my dear.
 
Those over than 400 numbers can be unnerving. Take a few deep breaths. First and foremost, unlike Humulin N, Lantus require patience. A lot of patience. Responses to this type of insulin are neither quick nor dramatic. Think more of being the tortoise (i.e., slow and steady) than the hare.

Several people have already given you some very good information about what is most likely happening. Things like needing to have gainful employment definitely get in the way of collecting data about our cat's BG. On the other hand, it's how we pay for strips. You may want to think about your shot schedule and if there's any flexibility around when you shoot and when you can get spot checks. If not, it is what it is and we'll do our best to help you work around your schedule. What is important is getting in at least one test per cycle in addition to your pre-shot tests. Without a little more data you're guessing as to what's happening. It may be an educated guess, but it's still a guess.

As others have noted, there is the possibility that numbers dropped into a lower range and Whiskers bounced. Girlcat gave a great explanation of what happens and why numbers rise into the higher ranges. A bounce can take up to 72 hours to clear.

The other possible explanation is a phenomenon that we refer to as NDW - "New Dose Wonkiness." This happens occasionally when you raise a dose. Rather than seeing what you expect (i.e., the additional insulin will lower BG numbers), for a cycle or two the numbers go up. This is one of those places where you need patience. Levels will come back down.

For now, since you just raised Whiskers' dose, you need to let this dose settle for 2 - 3 days and then evaluate whether it's working the way you want.
 
as far as getting those spotchecks in goes,dont fret yourself with having to think yu have to stay up all night.dont overload yourself.what yu can do is get those spotchecks in during the day right now when yu can. and it doesnt have to be all in one day.i ised to work many times where i couldnt get sptchecks in during the day due to my work schedule. what i did was id get that pmps number, and then get another right before i went to bed. if i happened to wake up during the night i would try to get one if i could. then waking up in the morning get another say an hour or 2 before amps shot. during my day off id do a mini curve as well as during the weekend when i was home. and id take a look after updating the ss to see where the spots were that id have no info on and try to get them done over a period of days. the more u can do now will make it easier for you later on for you will see a pattern in the numbers. new dose wonkiness does play with the numbers till that dose settles after a few cycles.once you see where that nadir is u can check around that time to fine tune where kitty is going.often the nitetime hours in a kitties cycle we see a tendency for the numbers to be lower as opposed during the day.but i understand it very well if it seems overwhelming.right now just do what you can and get those checks in that there is no info for.its going to be ok.
 
CHERYL--Start a new condo every day posting Whiskers numbers so we can see where the cat is going--OK?
She was ok last night??--
 
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