2/20 Oscar pmps 68 +2 54 +4 38 +4.5 66 +5 65

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Kelly & Oscar

Kelly & Oscar

Member Since 2010
I don't have all of the numbers in front of me since I am on my phone. The DH is at home taking care of Oscar right now and sending me updates.

Today is our 3rd day of Levemir and we are 2 weeks away from Oscar being on insulin for a year. Tonight will be the third dose reduction on Levemir in 3 days. He was on 2.75u of lantus. We dropped him to 1.5u of levemir last night since he hit 33 during the day yesterday. Now on that dose he has hit 35. Obviously the dose needs to be dropped tonight, but has anyone else had their cat react like this?

He gets about an ounce of homemade raw food (dr lisa's recipe) at each meal time and when ever he starts going too low. Our feeding schedule today was at am shot time, +4, +6, and +8.

The spreadsheet should be updated as the dh tests today.
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

there's no limit on the # of dose reductions... no waiting period like there is for dose increases. You have to keep Oscar safe! You can ALWAYS go back up the dose scale if his numbers indicate he needs a bump in dose, but keep him safe!

An idea that you might want to talk over with others with more experience...
what about emptying out his shed and then starting with the new dose? just a thought to see if you and DH can get ahead of Oscar!!
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

We had to do that on lantus when he first started surfing the greens for like 20 hours at a time. The result of skipping shots was him shooting back up to 200s for an extended period of time- like for weeks. I don't know if he will react the same with the levemir though. His body seems to work off of momentum with the lantus and we lost too much momentum when skipping shots. I am sorry I cannot give you a date to reference on the spreadsheet since I am on my phone. We might consider skipping only one shot. ...My main concern is obviously to keep him safe.
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

What about cutting the raw food with some higher carb canned food throughout the cycle? I too use a Dr. Lisa recipe, but if Willie has a low PS number, I've started using a 50/50 mix of raw and Natural Balance Venison/Pea formula. Perhaps cutting with a MC food would help Oscar not bottom out so low?

Just a thought!
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

Hi Kelley, we went through the same thing when we switched Tess last month, on the 23rd I think. The first few days were a real roller coaster for Tess too. We had to skip a couple of shots, reduce 3 times in the first week and then gradually up the dose. What is happening is that you are adding a new insulin on top of the Lantus shed, which is still there although gradually draining. So oscar is getting 2 insulins at once. The shed isn't a place where insulin is stored but an accumulation in the system. Since the 2 don't interact you actually have 2 sheds going at once. You should be approaching the end of the Lantus shed and the Levemir shed is still building. I found this video helped me understand the shed a lot http://www.novonordisk.com/images/diabetes/levemir_mode_of_action/levimir_movie.html
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

also usually when a cat decides to start hanging out in blue/green 24/7, the pancreas can start to heal quickly and they head down the dosing scale fast. Sometimes TOO fast. It's a balance - keep going the way you are, or skip something to empty the shed and start over? Either way has risks. With Lucy I skipped shots a few times to drain the shed. Sometimes it worked, at least one time it didn't work and she lost momentum.

For Oscar, I would probably lean toward just taking the earned reduction to 1.25 and continuing to shoot. If he continues earning reductions this quickly, then skipping a shot might be a good idea. I really can't explain why I feel like I would keep shooting now, though. Gut instinct maybe, or the fact that I am known to be afraid of dose reductions. :lol: I'm always afraid reductions won't hold. You've been doing this a while and you know Oscar the best, so I would go with whatever your gut tells you.
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

In addition to Libby's suggestion re. dose, I think you may need to look at food, as well. You're seeing the drops late in the cycle, you may want to think about feeding at pre-shot and +4 and then maybe feeding the remainder either at +6 and +7 or all at +6. If you're using raw when numbers are running low, you may want to add some Karo to bump up the carbs.
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

Sienne and Gabby said:
In addition to Libby's suggestion re. dose, I think you may need to look at food, as well. You're seeing the drops late in the cycle, you may want to think about feeding at pre-shot and +4 and then maybe feeding the remainder either at +6 and +7 or all at +6. If you're using raw when numbers are running low, you may want to add some Karo to bump up the carbs.
Click to expand...

This is our usual feeding schedule. At shot time, +3 or +4, and again at +6 or +7. I am thinking that the second meal probably needs to be bumped to +4 or +5 and the third meal to at least +7. Today he spiked up from that 35 to an 85 an hour later on the raw food alone. He is very carb sensitive, but maybe adding a small teaspoon of MC to the +6/+7 feeding will keep him out of dangerous territory. My gut tells me to not skip a shot too.... I am just lucky the DH is unemployed right now and can monitor when I am not home.
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

Ann & Tess said:
Hi Kelley, we went through the same thing when we switched Tess last month, on the 23rd I think. The first few days were a real roller coaster for Tess too. We had to skip a couple of shots, reduce 3 times in the first week and then gradually up the dose. What is happening is that you are adding a new insulin on top of the Lantus shed, which is still there although gradually draining. So oscar is getting 2 insulins at once. The shed isn't a place where insulin is stored but an accumulation in the system. Since the 2 don't interact you actually have 2 sheds going at once. You should be approaching the end of the Lantus shed and the Levemir shed is still building. I found this video helped me understand the shed a lot http://www.novonordisk.com/images/diabetes/levemir_mode_of_action/levimir_movie.html
Click to expand...

I just got home and was able to play this video - it is quite helpful in understanding the shed principle and why there still may be some lantus hanging around in his system. I took a look at your spreadsheet too - man do you have an insulin sensitive kitty! :o
 
Re: 2/20 Oscar amps 181 +6 54 +8 35 - he keeps bottoming out

He hit 38 tonight at pm +4 @-) That number is probably more from the am 1.5u dose than this pm's 1.25u dose. Should I go ahead and reduce to 1u tomorrow morning, or stay the course at 1.25u again and see if he evens out?

With 30s this early in the cycle, he got a small teaspoon of FF MC food on top of his homemade raw food. Hopefully this will push his numbers up enough for him to safely get through the nadir on this dose. I'll check him again in an hour since I know this will push him up a fair amount. Tonight he got food at shot time, and again at pm +2.
 
Re: 2/20 Oscar amps 181 +8 35 pmps 68 +2 54 +4 38

With that low of a +4, I'd be much more comfortable if you checked at +4.5. Maybe I'm being overly cautious but I'd rather err on the side of safety.

Unless you really have to struggle to keep Oscar's numbers up, I'd stick with the 1.25u since, as you noted, this is probably left over shed action.
 
Re: 2/20 Oscar amps 181 +8 35 pmps 68 +2 54 +4 38

From what I've read over in the Lev forum a late nadir is not that unusual. Have you checked out the Lev stickies and posted there at all?
 
Re: 2/20 Oscar amps 181 +8 35 pmps 68 +2 54 +4 38

Ann & Tess said:
From what I've read over in the Lev forum a late nadir is not that unusual. Have you checked out the Lev stickies and posted there at all?
Click to expand...

I haven't posted over there yet, since a lot of Levemir users seem to post over here too. I have read the stickies several times in prep for this switch though.
 
Re: 2/20 Oscar amps 181 +8 35 pmps 68 +2 54 +4 38

This is info I got from Monique. She had originally put it in Shadow's condo.
by Monique & Spooky » Fri Feb 04, 2011 2:14 a
Looks good to me!!!!!!!!!!!!
Could this be the info you were looking for?
“Re: 5/27 Shadow AMPS=117,+2=36,+3=39, +5=67
by Monique & Spooky » Thu May 27, 2010 9:36 am
Jock's typical curve on Levemir appears to be pretty typical.
  • Blood sugar tends to continue going up for the first 2 hours after shot.
    By about 3-4 hours it's down past preshot.
    By about 7 hours it's having some serious effect, which tends to gradually descend to a nadir around 10-12 hours.
    Somewhere between +11 and +14, just after peak, blood sugar starts rising again, and rises very fast.
This may help with your own observations.
But note: Levemir's action is sensitive to two things:
  • Dosage. If you're giving a bit less than optimal, peak time will be shortened. Too much, and peak time will be later.
    Previous doses. Levemir leaves a "storage shed" of previous doses which keep blood sugar lower, so if previous doses were inadequate, current dose will be less effective.

The tendency for the nadir to be later and the largest drop occurring between +7 and the nadir at approx. +10 (even more so than with Lantus) and following the nadir a slow rise and frequently I have noticed a "dip" again at Preshot. So the +10 is Nadir then a slight rise and a little drop to just above or almost the same as nadir (double nadir?) then a rise continuing about +3 to +4 into the next cycle.

This is of course when the dose is just right. When it's to low then the nadir comes sooner and is not as low and the rise begins earlier and is higher, leading to a much higher following preshot.

When the dose is to high the peak will come later often after +12 (which would be +1 to +3 in the next cycle) this is what you are seeing today. The previous few days on this dose (when it was just right) you had nice flat numbers with late nadirs and the "dip" at preshot.
I'll try at some point to pick some examples of this out of the spreadsheet. ”

Here's the thread http://www.felinediabetes.com/FDMB/...56206&hilit=Shadow+nadir+dose+Levemir#p156206 (sorry the smilies and links, quote etc. functions are not working today :S)
Click to expand...
 
+5 is 65. Since he didn't go way up, I will definitely be testing again in an hour. His poor little ears.....

Thanks for that info Ann! That seems to pretty much describe what Oscar is doing. Do I dare say that my boy is responding ....by....the....book.....? :shock:
 
I dunno about responding "by the book." If that 38 isn't a nadir and you're waiting for +7, I'd put a big pot of coffee on. I also think this forum is a lot busier than the Lev forum. If you need a hand, you'll get help sooner.
 
Well..... he was responding more by the book before tonight's cycle. He has to make sure I don't get too used to seeing a pattern ya know ;-)

I agree that this forum is busier, which is why I headed here with these ultra low numbers. I have class really early in the morning, so the DH will probably take over testing for the evening after midnight.
 
+6 is 48. Gonna give him another small teaspoon of MC food and transfer off to the hubby for the night. Based off his numbers so far, we'll go again with the 1.25u tomorrow morning.
 
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