12/2 Tommy amps 222 - Dose Question

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Nora & John & Tommy

Nora & John & Tommy

Member Since 2010
Good morning,

Tommy's bg has been high and to date unmanagable. Yesteday we began R boosters. The boosters were shot in the 300's, and were followed by a drop of about 80, the nadir coming 2-4 hours after the shot.

The evening shots (3.5u Lantus, 0.3u R, 300-350 bg) were followed by a surprise: bg dropped about 200 to the blue numbers, and seemed in no hurry to go up again (unlike the other R doses). Tommy feels great, and everyone else is sleep deprived :-D

What does it mean? Possibilities:

1. The old Lantus was weak, and the new jug, started 11/30, began to be effective last night?

2. Tommy had "glucose toxicity" (http://petdiabetes.wikia.com/wiki/Glucose_toxicity), and the R caused a breakthrough (Steve once wrote about this scenario)?

Either answer suggests a Lantus dose decrease (and of course no R for now)...

Advice appreciated...

Yesterday: viewtopic.php?f=9&t=31071

Thanks!
 
Good morning.
I do not know enough about R to give you any advice about the dosing. As far as the Lantus my first thought would be to stop using the R and see how Tommy does just with Lantus. He did not technically earn a dose decrease of Lantus. If you lower the dose and stop using the R at the same time and his numbers get higher you will not know if it was from the insulin decrease of the lack of R. That is just my opinion but I say that with very limited knowledge of R.

Let me see if I can get somebody more familiar with R to help you.
 
Good morning guys! I don't have any advice on using R to get numbers down but I will say this is a nice amps .. low enough to see some blue today! Have a great day guys!
 
Nora & John & Tommy said:
What does it mean? Possibilities:

1. The old Lantus was weak, and the new jug, started 11/30, began to be effective last night?

2. Tommy had "glucose toxicity" (http://petdiabetes.wikia.com/wiki/Glucose_toxicity), and the R caused a breakthrough (Steve once wrote about this scenario)?

Either answer suggests a Lantus dose decrease (and of course no R for now)...

Advice appreciated...
Click to expand...

Or

3. Tommy had his R onset and his Lantus onset at the same time last night (about +2 from the R dose, and about +3 from the Lantus dose). Picture a ball rolling down a hill. Just as it's starting to pick up speed, somebody gives it a push and makes it go even faster. That ball will go faster and harder and farther than it would have without the extra push. Right?

That is why Sharyn and others have cautioned you to be mindful of WHEN you shoot R. You have to know your cat's onset/nadir/duration for Lantus, and you have to know your cat's onset/nadir/duration for R, and then you have to basically lay those curves on top of each other and determine when you can and cannot give R. You don't want the two insulins to have onset at the same time, you don't want the two insulins to have nadir at the same time, and you don't want to give R at the same time a bounce is about to clear.

Also, remember that you are not looking for R to drop his numbers very far. Most of the time the goal is to help keep him flat, or to drop him maybe 50 points, so the Lantus has a better place to work from. Causing them to drop faster than that will set them up to bounce to even higher numbers. Looking at Tommy's numbers from yesterday, I would say that 0.1u is about the most R you should give Tommy at this point. *Maybe* he would be able to handle a little more (0.25 units) if given after nadir. 0.25 units before nadir is obviously too much (he dropped 80 points yesterday afternoon and over 100 points last night). That is normal. It is rare for a cat that doesn't have a high dose condition to be able to handle more than 0.25 units of R. Even my acro cat gets too big a drop if I give her more than that.

Bear in mind that I'm just starting to study R use in depth for my own cat. I have some links saved on my home computer, but unfortunately I'm at work and I don't have them saved here. I am only qualified to help if you are using the R protocol that is used here in Lantus Land. I am not aware of anyone in the Lantus ISG for the last several years who has used any other protocol.

About the Lantus dose, I would recommend changing your R schedule before changing your Lantus dose.
 
Agree with Libby. I use R and have been for a good year. I still don't know enough about it to recommend what another cat needs. I DO know what it's NOT supposed to do. As Libby said, huge drops will only set Tommy up for higher bounces...and I know about high bounces. Alex's nickname is "Yo-Yo boy". R is only supposed to give the Lantus a better place to start working from...not supposed to bring kitty down so much by itself. One day is not enough data to know what did what. And it does look like there could have been some simultaneous action there.

I'd say just stop the R today and see what happens. He may bounce from the huge drop, so be prepared and don't panic. That was my biggest mistake when I started using R and i had Alex bouncing all over the place. :-|
 
peterdevonmocha,

Yep, what a relief to see some lower numbers for a change.


Libby,

That makes sense, about overlapping nadirs. A problem has been, Tommy has never had nadirs (or onsets or durations) that can be correlated with Lantus. His BG has meandered all over the place, seemingly oblivious to insulin. To use your picture, prior to last night, at any given time, the ball could be rolling up, down, or across the hill. Last night was the first time you could see a roughly 12 hour curve with a nadir.

Also, if the Lantus nadir is at +6, the nadir from yesterday morning's +4 R would have coincided closely, yet the impact was shorter and more subdued than the evening.

All of which is why we were wondering about the possibility of Lantus weakness and glucose toxicity.

Perhaps going forward we can use last night's curve as a rough estimate for Lantus, taking into account that it got a "kick" from the R.

Thanks for the insights.


mybuddybinks,

Nothing has really made sense yet, but glad you find it educational :-D


Caryl,

Agreed - we'll wait and see what happens with Lantus. Thanks for the pointers. And a big bounce probably won't be much worse than the past couple weeks.
 
I was wondering the same thing that Sienne just posted!

Here is the link to yesterday's condo for you Nora: viewtopic.php?f=9&t=31071

ETA: new Lantus started on 1/30 according to your SS, is that correct? How long had you been using the previous vial/pen of Lantus?
 
Pat and Sienne,

The old Lantus was prescribed 9/19/10. There's about 15% left. It says to discard after 28 days, though we've read that it can last 6 months refrigerated. Granted it's a long shot, but we thought it was worth pursuing because it did not look like raising or lowering doses had an effect on BG.
 
Nora & John & Tommy said:
Pat and Sienne,

The old Lantus was prescribed 9/19/10. There's about 15% left. It says to discard after 28 days, though we've read that it can last 6 months refrigerated. Granted it's a long shot, but we thought it was worth pursuing because it did not look like raising or lowering doses had an effect on BG.
Click to expand...

When I used Lantus for Alex I don't think I ever got decent numbers after 35 days..just sayin'..... :?
 
You're seeing a bounce from the low numbers. I don't know that there's enough information on your SS yet to know how long Tommy will take to clear the bounce. If you look at Libby's note, she cautions that you don't want to give a bolus dose of R if a bounce is clearing.

I wonder if you would be open to posting the back channel advice you're getting from Steve, Sharyn, and Dr. Lisa? The strategy you're using, as I've mentioned, is not one that is typically used here and it would be informative to everyone if we knew more about how Steve recommends R be used. Likewise, it's hard to offer support and/or suggestions if we don't know what information you're being given off the Board. I suspect that no one here would want to add to confusion or create a problematic situation and having all of the information up front makes it much easier to avoid any potential problems of this kind. The general approach here is to keep all recommendations on the Board so there is peer-to-peer discussion and any good information is shared and problems are spotted by as many eyes as possible.
 
Nora & John & Tommy said:
35 days, huh...

BG is now 450 (+7). Considering a small R booster at +8 if still high. Thoughts?
Click to expand...

yeah 35 days..but usually not even that long.

If it were me, and not knowing what advice you're getting other than on the boards, I would have held off until PS, and I would have only given it because Alex gets ketones so easily. It would be nice to see if Tommy clears this bounce on his own and if the Lantus brought him down before or just the R. And of course there's the chance of another bounce....
 
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