3/14 Hank-AMPS 359, +4.5-309,+7:45-273,+10.50-288 PMPS-302

Discussion in 'Lantus / Levemir / Biosimilars' started by bettyandhank, Mar 14, 2010.

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  1. bettyandhank

    bettyandhank Well-Known Member

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    +http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=9045

    Good Morning. High numbers today. Shot late and lower dose last nght due to low numbers/postpone/retest. First time to adjust dose due to low..skipped 3 other times. Only 10 days in with numbers all over the place.
    Initially uncertain but felt good about the ultimate lower dose decision. I just hate changing anything or rocking boat so early in. With his lows and subsequent skips, have not had the opportunity for consistency to establsih a pattern and see where he really is.

    I was tending toward the suggestion of lowering his dose a tad, perhaps to ,75 since he has had several 'lows' with me then in a tailspin not knowing what to do, postponing, making us late, and messing up our schedule. It becomes a long drawn out ordeal by the time we come up here and type for advice, dleay, retest, and so on. Our regular time was already on the late side, but works if all goes well. Lately w/ all the mishaps, our schedule is totally off, we are up til all hours of the night dealing with this.
    I want to try and get things better in check. Because of his AMPS number, I did NOT shoot the reduced dose I planned to try out today. May have shot on the skinny side of 1U,..& there's always the bubble I can't seem to conquer. Just didn't feel right to lower the dose w/ that number.

    With the 1:15 hr. late shot last nite (from our regular time) combined now w/ DST, we are 2+ HOURS OFF schedule. What can we do tonight to move it up some??? 11:15 last night is 12:15 tonight...TOO LATE. We shot at 11:07 AM this morning.

    He is not as cheerful as he was the last couple days..& is really tiring of the 'every day' aspect of the ear pricks & shots. He is resistant now when it's 'time', which is not like him. He is very sweet natured & typically compliant. When this started and he was sick, he surrendered more to it. He is not liking this as a routine. His purr is off. I need to make this easier for us both.

    Since we are operating with out a net right now, and punting as we go (vet/homeless at the moment as you recall- scary being so new & clueless) I have to really make sure he is oK and make careful choices. We have no one to call...I am simply not sure enough yet what to do most of the time.

    Last night when i re-tested before bed (+2:15) and his number was yet 20 pts lower even having eaten twice, I wasn't sure what to do, if anything. I had MC/HC food, but not clear if this was something that called for that. No one was on board, so we punted and i coaxed a couple bites of LC and went to sleep.
    I literally just had to guess having no reference point for this particular situation. We'd not done this one before. Every day is different. i guess seeing his number this morning, that was a good decision, but at the time I had no idea. it wasn't made logically, I just punted.

    So how can we try to close some of our schedule gap tonight?? Any wisdom on the rest? (ie: altering dose w/this data)




    One more caveat: Starting Wed aft., I will be away from home many hours at a time for the 1st time since he was diagnosed. I will also have a few nights where i will need to be late for his PM shot later in the week.
    I do want to take that into consideration as I consider dose and/or schedule altering. Why is it all catty-wompus at the same time???
    I got to keep him in one piece during all this, especially until we find a new home.

    Plus I want to get his purr back.

    :) thnx- B & H ( i need to get his photo up...ya'll haven't really met the boo-boo)
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank AMPS 359

    Here's whatever wisdom I can offer (FWIW)!

    I understand you're wanting to shoot the full dose given Hank's AMPS. That number is probably a bounce from his being in the blues yesterday. The numbers will come down. I can't urge you strongly enough to pick a dose -- 0.5 or whatever -- that you can shoot consistently and allows you to feel comfortable leaving Hank at home especially since you have guests arriving this week. Every time you bounce between doses, it's likely that Hank's numbers will be wonky due to the inconsistent amount of insulin that is being put in his shed.

    I suspect you missed Libby's note last night. I believe she suggested that you post Hank's numbers at +10.5 or thereabouts. When you have a high number like this, it's possible to shoot an hour early in order to get back on schedule. I would have probably encouraged you to shoot the 0.5u since an early shot is like a dose increase (and we're wanting you to be shooting a dose that you can live with twice a day. So, please post at +10 or +10.5 tonight. Let's see if we can adjust Hank's shot time so it's not so problematic for your schedule.

    A 147 at +4 is probably a safe number to go to sleep on. However, you do not know that for sure and will not know until you start getting more spot checks during the day. This is why we are so insistent on gathering data. At this point, you don't have any idea when Hank's nadir is and that is very important information. Can you get checks in at +3, +6, and +9 today? A mini curve will help to start filling in the gaps. Dosing is not based on the pre-shot numbers. It's based on the nadir (low point) of the cycle which is somewhere in the middle (but not always). We look at pre-shot info for the purpose of safety, not overall dosing decisions.
     
  3. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank AMPS 359

    Hi. Our 147 last night was +2:45 after the shot. I have to figure out how to make that clearer on ou SS. We tested PS, got the 174, didn;t, shoot, tested again about hour later, THEN, shot about 30 minutes after that...(after we'd come up to post for advice, get it together, fed him)
    I just put our shot in the 'shot' square on the SS. How should I alter that to make the chronology clearer?

    At any rate, no one was on board, and I wasn't sure, so punted w/ the LC and went to sleep. Seemed he was still going doen to me, and then I'd done the reduced dose, so wasn't sure. The day before when he skipped dose all together, he still had a yellow the next morning 24 hrs+ later.
    i can't figure it out.

    Aside form his low number this morning, I'm thinking if I am potentially going tobe gone for hours at a time several straight days, it may not be the best time to alter dosing as I couldn't be here to see how he is handling it and trouble shoot anything. I can do some spot checks today and may go try to right now.

    i did see Libby's message, but we were up SO late and were so zonked, when my other kitty (civvie- got the lingo!) Elvis woke me up early, we roused a bit, then fell back asleep. Clocks not yet changed, and by the time we stirred, that's how it worked out. Got the test in about + 11:30-11.45.


    let me see if I can catch him not sleeping and get an update.

    & we will also try to check here earlier tonight w/ hope for an upward adjustment depending on numbers. He better not have any more wonky one's...we need some rest.
     
  4. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank AMPS 359 +4:10- 309- not happy

    spot check +4.10 - 309 - Not happy. :(
    It's possible he may have eaten some in the last bit, but not sure. He's been sleeping & I've been up here. There was leftover from breakfast still down. he hadn't eaten much & hasn't had much of an appetite this whole time.

    This is not a good mid-day report...especially in light of our last few days. I'm glad i didn't lighten the dose. Will try to check him again in a few hours so perhaps ya'll can better guide us. I hope he isn't feeling as pink as this looks. 4 1/2 hours in, this can't be good.


    I also noticed not only bruises and sores, but the hair is coming off his ears. Is this normal? he is just hating this now..and i hate doing it to him. I wished we could get regulated & not need to prick so much.

    ok, that's the update.

    Hope everyone's having a good Sunday.


    b&H
     
  5. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    Re: 3/14 Hank AMPS 359 +4.5- 309 Not Happy :(

    Hi Betty, I'm sorry I can't give you dosing advice (I am still a newbie on dosing). But I might be able to help you with Hank's ears. First warm the ear with a warm washcloth in a plastic bag or a sock with rice in it that has been warmed in the microwave for 30 seconds. Then put a dab of vaseline near the edge of the ear so that the blood drop will bead up and be easier to get onto the test strip. When you are ready to do the poke, hold a gauze square on the other side of the ear to cushion the poke and to keep from sticking your finger. After you get the blood drop and have put it into the meter, gently fold the gauze square over the ear where it was bleeding and apply gentle pressure for about 10 seconds. This stops any bleeding and also keeps the ear from getting bruised. Finally, apply a dab of Neosporin creme with pain killer (cream, not ointment).

    I don't know what to tell you about the loss of hair on Hank's ears. Perhaps he is scratching them.
    Hang in there and you will find everything will get easier. All of this is new for both you and Hank. It really will take a while before you will see any kind of consistency in his numbers. Just bear in mind that Hank is healing. There will be trying times, but there will be rewarding times, too. You are making it possible for Hank to have a good life. Relax and do the best you can. It will get easier when you are able to establish a routine that works for you.

    Ella
     
  6. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    Ok Sienne-
    i got the interim checks today you mentioned. Not good numbers for Hank. 1st one just over +4, and now another at just under +7:45. Am still hoping to be able to move up time at least some for tonight...otherwise we are after midnite new time.


    i can check back here closer to the +10-10 1/2 you & Libby mentioned for advice. That already would be 30 minutes past our 'normal' old non-DST time.
    That's just a couple hours form now. Is that enough time before a re-test for getting helpful information to gauge a game plan..time & dose?
    Will you be here?

    Otherwise, we are still 4 hours away from shot time if we go by last night. Worried if i can mke it that late again...I'm already fading.


    Ella, thanks for all the adice. I do ALL those things. rice socks in the micro, which i think smells like burnt popcorn, tissue, treats, folding the tissue over the ear and pressing afterward, ....all the above. I've used just regular neosporin, not the cream or w/ pain killer. He is jsut getting beat up w/ all this, & the little hair is coming off in a couple places. Hurts me to hurt him. But he does love the treat part.

    Ok, this is the most testing I've done, hopefully there will be helpful data to be gained. I'm not sure this is a truly reflective day. He is high all around.

    let me know what you think

    Please keep and eye out for us in a couple hours...we will need some guidance.


    thanks!
    B & H
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    We're in the same time zone. So you're +10 is around 10:00 PM? No problem - I'm usually awake for a couple of hours past that.
     
  8. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    Oh good...thanks!

    I was thinking toward the latter end of that range (+10:30-45-ish) Want to have enough time gone by for re-test info to be beneficial, plus potentially that is the PMPS. If I re-test at 10:45 (new time) it will be 3 hrs since last test. Maybe that is better?
    I don't intend to try and make up 2+ full hrs tonight, ...just some increment of that...perhaps even an hour or less to work toward a better schdule. I can then bump another 20 minutes in the morning.

    Any thoughts on his numbers so far today. He just never got anywhere really. Haven't done many spot checks but can usually tell by how he acts that he feels better for a strecth. Today not so much. Wonder what the deal is. he didn't rbound when he skipped doses all together the other couple times.

    Anywho....will check back in couple hours. Gonna grab some dinner.


    b& H
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    There are a couple of things that are effecting Hank's numbers. First and foremost, the lower numbers will often cause a bounce into higher numbers. This is due to Hank's liver releasing glucose in response to what it perceives as "dangerous" low numbers (that are, in reality, normal BG numbers). We refer to this as "Liver Training School" (LTS).

    The skipped shot and reduced dose effect what Lantus likes best -- consistency. When the amount of Lantus is inconsistent, it has an impact on the shed. It takes 5 - 7 days to get the shed filled. In that first week, you skipped one shot and skipped 2 more in the following days. All of that has an effect on BG numbers.

    Finally, you have no way of knowing what the mid-cycle numbers were until today. Without those mid-cycle spot checks, there's the possibility that dose reductions are being missed. (This is more of an FYI as to why they are important.)

    So, what time will you be back with a test? 10:30 CDT?
     
  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    If you shot this morning at 11:00, what time did you shoot last night? Midnight?
     
  11. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    Hi. Just coming back up. Haven't tested yet. It is still a bit early relative to last night and this morning.

    last night was somewhere between 11-11:15Pm (OLD TIME) ... With all going on, being late, hurrying, posting, forgot to log it until later then didn't have the exact minute. it was right in there because i tested before, after and posted in between.

    SO, that is 12-12:15 new time.

    We shot at 11:07 OLD time/12:07 NEW time this morning.

    I just don't want to test, then have to re-test in just a short order.....OR shoot too early with anything that has to be worried about or stayed up to test behind.
    We are SO zonked out. If so, I'd instead just postpone another 20-30 THEn do it,....but don't want to lose my Gurus.

    Kind of on fumes here...not thinking so well at the moment. i can tell he is starting to be up and around a bit more, so it must be starting to wear off.

    Would we know hich direction he is heading? I always test, then give him 10 minutes or so to eat while getting the shot together.THEn shoot, so there will be a ltittle lag time. But right now we are still a good 1 1/2 hours early.


    If I test now, will that be enough to make determination? I'm happy to wait another 15 THEn test, report, by then we are almost within an hour window.

    i could then slide him another 20 min tomorrow.


    Let me know. Wait or right now....??
     
  12. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    I'll be up for a while.

    Basically, if Hank's numbers are above 300, you can shoot early. Do not do this again tomorrow. If numbers are high, you can shift the time by an hour but it functions like a dose increase which is why you do not want to do this often. So, I'll be around but if Hank's numbers are in the pinks or even higher, it's fine to shoot as much as an hour early to begin to get back on schedule.

    One of the practical issues of testing is there are times when you will need to test even multiple times in an hour. Look at Gabby's SS. At times when her numbers are low, I test every 15 or 30 min. Hank will adjust to it. He will actually know that you are doing this to help him feel better. If you don't stress, he won't.
     
  13. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5- 309, +7:45-273 Not Happy :(

    Sienne-
    I'm going on down to test now. Getting too sleepy... be right back w/ results and for direction. Hopefully it won't be too early so it won't tell us what we need to know.

    The bean needs to do the easiest version tonight....test, feed, shoot, bed. No drama or staying up for anything.


    Be right back...don't go away...


    tnx

    PS: posts crossed. It's not just that not wanting to stress him, just want to be able to get to bed.
    Am just guessing his counts won't be above 300.. I'll check back before doing anything and let you know.

    Back in a sec
     
  14. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5-309,+7:45-273, +10.50-288 :(

    OK. 9:55/10:55 PM - 288. We are just over and hour early form this AM, slightly more form last night.

    I didn't feed him yet, except his treats.


    I guess we can wait 1/2 hour and do it again. I owuldn't have done it again tomorrow, but instead like you suggested for DST. maybe I will try to shave 30 minutes off tonight, @ 11:30-ish new time. then move it up 15-20 minutes tomorrow AM. Same again tomorrow night, another 15 minutes. Then I am getting closer to caught up.

    Ironically, I need the time to be a little later as mentioned by weeks end. it may be that I only do tonight maybe 20-30 mnutes, then a couple more of the incremeantal 15 min. changes, tomorrow & Tues, THEN leave it for the remainder of the week adjusting back to normal after they leave.
    I can use you DST shift chnage as a road map.

    Do you suggest I wait to re-test Hank once more, even if it is only 1/2 hour early in the end....
    At this point, I would be leary to give him his full dose not yet in pink. Correct?
     
  15. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5-309,+7:45-273, +10.50-288 :(

    Shooting 30 min. early is fine. However, you do need to pick a dose and stick with it. If you shoot early, you are still shooting the regular dose. You don't move the tlme and alter the dose - at least not in this context. How much are you planning on shooting?

    If you are going to shift a time tomorrow, I'd suggest moving the PM shot time 15 min early. 15 min will have a minimal effect. There have been too many changes so we want to go gently here so Hank's numbers aren't unduly effected.
     
  16. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5-309,+7:45-273, +10.50-288 :(

    As it has turned out, with all the delays and posting, etc.. I am not that far off. I was planning to use your DST as a guide.
    i actually think we will end up even less than the 30 minutes 'early', ...this may just fall into the 15-20 minute window considered 'on time' by the time he eats and we would shoot.
    I can then do the same tomorrow nite and have then made up 30-40 minutes. repeat on Tuesday.
    With all his blues and a green, we were basically deferred and just getting to our DST bump delayed.


    I should probably do one more test just to be sure, it's been another 1/2+ hour now??? this can be his PMPS.

    I don't know on dose....it had been discussed to potentially reduce his, but with sveral pink numbers still, I;m not so sure. Maybe a 'skinny' 1U??????????
     
  17. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Re: 3/14 Hank-AMPS 359, +4.5-309,+7:45-273, +10.50-288 :(

    another thought. you are saying to pick a dose and stick to it...that is basically what I have done EXCEPT last night for the obvious reasons.

    It may be with all the time changes and other things, this would not then be the best time to alter the dose even downward? Again, i will be gone starting mid week through the weekend, for many hours each day. Would the logic then be to do it now, if we were going to change it, or better to wait leaving it at 1U until the next week.
    I had considered going to 3/4 or somewhere in between, but that was before today. Now with this time issue to make up, it may not be the right time.
     
  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Re: 3/14 Hank-AMPS 359, +4.5-309,+7:45-273, +10.50-288 :(

    Here's my concern. Hank reads your condo. He's a cat. He will, despite the lack of opposable thumbs, throw a monkey wrench into the dosing and/or time plans. If you are concerned about the pinks, shoot 0.75u. I would like to see you on a schedule that let's you sleep as well as have Hank on a dose that let's you both sleep and shoot consistently.

    Changing the dose now will allow it to settle. I think if you continue to shoot the 1.0u, you may get lower numbers than you are comfortable shooting and then we're back to the same no shot/reduced dose merry-go-round. I think the timing is fine.
     
  19. bettyandhank

    bettyandhank Well-Known Member

    Joined:
    Feb 21, 2010
    Well, so much for shooting early and making our way back to a friendlier schedule. By the time we tested and typed about it, and he ate, we hardly gained anything. 10 minutes!

    Our posts crossed. I did one more re-test at 10:39/11:39- PMPS- 302. (still need to update my SS)

    I gave him either a .75 or skinny 1U or somewhere in between. I don't know, it is so tiny i can hardly tell, and there's always the bubble. Not sure how giving LESS keeps us out of the pink.
    He did at least eat a few bites, he has hardly eaten today. He is just not liking all these other canned foods I've introduced. Will still eat is Wellness canned usually, which he ate before all this in his other life, just not daily.

    Since i managed to screw up and gain very little time-wise, and based on the dose above, do you think it would be ok to shift tomorrow in the AM up 15-20 minutes earlier. Tonight's shot was 11:57. Can we do, say 11:40 AM tomorrow? or is there a reason to wait until tomorrow night for that?
    perhaps 11:40 AM/ 11:25 PM? , ditto the next day. I have lots of catching up to do.

    if I don't figure something out, and he has a low PMBG, I have a real problem. i have to get this bumped some. .we're going to crash.

    let me know what you think on the time shift for tomorrow...Thanks Sienne, for all your support tonight

    betty
     
  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Moving the shot 15 min. early tomorrow AM is fine!

    FWIW - I give Gabby her shot when her head is in her food bowl. I don't wait until she's finished. Test, feed, and shoot takes under 10 min.
     
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