3/24 Charlie +12 151 PMPS 192 +2 249 +4 176 +6 156 +8 179

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charliesmom

charliesmom

Member Since 2012
Hi everyone,

It seems the increase to .75 has started to move us in the right direction. Charlie's PMBG is quite low though. We're going to feed her now. Would like some advice to decide if we should shoot or not though. Thanks in advance.

As we're new to levemir, also just don't want to make any mistakes with the new nadirs, overlaps, and everything else.

Jill

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=91637
 
3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +12.25 178

+12 = 151
Fed. Stalled 15 minutes.

+12.25 = 178

Stalling.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 Shoot or sta

oh crud. i'm no help with shooting low for you; .. but i can bump you up.
Your numbers are rising.. how comfortable are you with shooting a number like this?
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 Shoot or sta

Looks like Charlie's on the rise. If he were my cat, I'd go ahead and shoot. FYI, stalling acts like a decrease, so if you were to shoot now, the effect would be that of a reduction.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 Shoot or sta

Thanks Courtney. It's +13 so we'll test once more right now and then likely shoot.

We were following the protocol that says:

"Below 150, don't give insulin. Between 150-200, you have 3 options: a) give nothing. b) give a token dose 10-25% of the usual dose. c) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200, but below the cat's normal preshot value, a reduced dose might be wise."

We currently fed, have stalled, and will test again now to make a call.

We have strips, maple syrup, LC.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 Shoot or sta

i'm sorry, i'm on the run and can't get back here for another few hours, but spotted your dilemma...

charlie's numbers are on the rise. the onset of lev is typically around +4. that means numbers will only continue to rise until onset occurs.

because this is the lowest lev preshot number you've had so far, i'd start with a spot check at +3.

if you're prepared to steer the curve (if necessary)... shooooooooooooooooooooooooooot!
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 Shoot or sta

Always better to err on the side of caution :) Good luck! I hope Charlie has a good cycle :)
 
3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192

Hi Jill. Little bit confused by what you wrote. Are you saying:

- wait until +3, test and then shoot if the numbers are higher?

or

- shoot now and just be ready to test at +3 and +4 to give maple syrup, etc. to steer the curve if necessary?

Charlie's # at +13 is: 192
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

It looks like Jill signed off, I think she meant to shoot now if you feel prepared and make sure to check at +3, and was telling you that lev typically onsets at +4.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

Thanks all.

Thanks for the bump, thanks for the responsiveness, and thanks all for the feedback.

We shot!
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192

charliesmom said:
Hi Jill. Little bit confused by what you wrote. Are you saying:

- wait until +3, test and then shoot if the numbers are higher?

or

- shoot now and just be ready to test at +3 and +4 to give maple syrup, etc. to steer the curve if necessary?

Charlie's # at +13 is: 192
Click to expand...

i meant for you to shoot at +12 if you were prepared to steer the curve (if necessary).

numbers were rising at +12... and would continue to rise.

the typical onset of levemir is at +4. that means the numbers will only continue to rise until the lev "kicks in" (onset). in essence the insulin wouldn't "start" working for 4 hours from the time you shoot so shooting a rising preshot number (over 50) at +12 was perfectly safe.

please get a +3...
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

:-D

Wonderful! So Jill suggested you get a spot check at +3 to see where Charlie is, and then at +4 when you can expect the onset (lower numbers to start.) If you'd feel more comfortable checking sooner, maybe get a +2?
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

I will test at +3 for sure. Probably already before then.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

The instructions regarding not shooting below 150 are for newbies. You're not a newbie -- you know how to steer the cycle with food. Like Jill pointed out, the onset (and nadir) with Lev are typically later than with Lantus. As a result, numbers will typically rise until onset begins. In addition, you're feeding which also causes a rise in numbers. Shooting sooner rather than later was a good plan.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

Thanks for reinforcing that for my confidence. I still feel like a newbie in so many ways. Still haven't found the perfect foods. Still can't seem to get charlie stabilized, etc.
Will hope for the best tonight.

The challenge of steering the cycle is always that it's hard to do in the middle of the night. It's 10pm here now and Charlie's +4 will come at midnight tonight. If it's trending low, that means another all nighter. Know you all know how that feels.

Let's hope this is not one of those nights.

In any case, do you think there are certain times when I should wake up to test?
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

Hi Jill,

Given that you're new to Lev and this is the lowest ps you've seen from Charlie, I understand your caution and hesitation. From what I know of Lev, it tends to produce flatter curves and onsets much later than lantus. Bearing this in mind, I think it is wise to keep a close eye on Charlie around his mid cycle. Def get a +3 and +4, and depending on where he is, decide when to check. Marje uses Lev, so maybe you can take a peek at Gracie's SS to get a feel for what a Lev cycle looks like.

Since you delayed an hour, I wouldn't imagine that you have much to worry about, but I could be wrong. More data will tell.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

+2 = 249

I wonder if she's starting a bounce? Maybe she went low earlier today? Or else her system just isn't used to the blues anymore?
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

Like I said, a delayed shot acts like a reduction. That +2 could very well be a bounce after the insulin started to wear off. They say that if you're considerably higher at +2 than you are at your PS value, you can typically expect a quiet cycle. It will be intersting to see what the + 4 looks like once the insulin onsets.

FYI, if you ever choose to stall, don't feed. Feeding can cause a spike and then you won't have a very accurate reading for the PS #.
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

charliesmom said:
+2 = 249

I wonder if she's starting a bounce? Maybe she went low earlier today? Or else her system just isn't used to the blues anymore?
Click to expand...
it's too early to tell. you could still be seeing a food spike at +2... or it could be lost overlap from the late shot... or the beginnings of a bounce... or a combination of any of these factors.
time will tell. :mrgreen:

Courtney and Kismet said:
They say that if you're considerably higher at +2 than you are at your PS value, you can typically expect a quiet cycle.
Click to expand...
courtney is correct... if you were using lantus.

since you're using levemir, if your +4 is considerably higher than the preshot number, you can *usually* expect a non-eventful cycle.
onset and nadirs are usually later than what you were accustomed to seeing when you used lantus.

i have years worth of levemir data linked in my signature if you'd like to take a peek...
 
Re: 3/24 Charlie AMPS 220 +5 203 +9 139 +12 151 +13 192 Shoo

D'oh! I meant to include that's the rule of thumb for Lantus :lol: That's why I wrote to get the +4. :oops: My brain is blergh today. Thanks for catching that, Jill. TBH, I really don't know too much about Levemir.
 
3/24 Charlie +12 151 PMPS 192 +2 249 +4 176

Looks like it's not a bounce afterall. She has dropped down to 176 from 249 just 2 hours ago.

Since it's 12:30am here and I will need to wake up to test, can someone give me advice on what times I should test tonight?

Thanks,
Jill
 
Re: 3/24 Charlie +12 151 PMPS 192 +2 249 +4 176

Do you know when he nadirs on Lev? I think most lev cats nadir between +7 and +8, but admittedly, I don't know much about it. Maybe get a +6, and a +8?

If you're worried, you can feed some LC for him.
 
Re: 3/24 Charlie +12 151 PMPS 192 +2 249 +4 176 +6 156

Riding out this cycle smoothly. Been awhile since we had one of these.

Right now Charlie is cleaning herself on her favorite chair. I really hope this levemir is going to be the key that will finally unlock some better numbers and stability.
 
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