mars72 said:
Ugh!!!!
Klinger had some nice blues yesterday. This just seems so high to be a bounce from 100s.
Anyone???
He's acting normal. All p's in place, eating normal, playing...
This is his 3rd day on 1.35 and I don't know if I should increase or decrease the dose. I feel stuck.
Marcy, hi,
I guess I answer to "anyone." I would say, you should not feel stuck and forget who is saying what -- just look at Klinger's spreadsheet. Look for the last time when you had lots of blues and greens and very few reds, and then let your eyes float over to the dose column. See the number there. It is not 1.35u. (I have not read back to postings matching the last "good" period, so maybe there was a reason to change a dose that was working -- but whatever it was, it doesn't look like a good idea in hindsight.)
I don't know what the right dose is for Klinger but the last time it worked it was somewhere between 1.5 and 2.25. It is an interesting chart, very intelligible and not hard to read, in my opinion. For what has happened lately, this one day caught my eye: 2/26/2011. On that day, in another ratchet in a series of reductions throughout the month of February, the dose was shaved from 1.5 to 1.35 and, in response, Klinger threw out an amazing string of greens and blues. That should have been a signal, but it was misread. And for sure they look like the numbers we want, they in fact look like those of a cat headed for remission... levels that were naturally interpreted as positive affirmation for the lowered dose. As a result you reduced a little further; but then a couple of days later, it no longer looks good, and the comment line says "Hmmm. What's with the pinks? Bouncing?" It's not that it is the wrong question -- it is that we so easily question the bad news, but forget to question the good news.
On Feb 26, that string of numbers was just accepted -- but it should have been questioned too. In any case, apparently rejecting the message (perhaps on a rebound theory) that Klinger is sending on Feb 28, there is a further reduction. So on 3/4, a week later, barely, there is the inverse of 2/26, now it's all reds, and there is scrambling to explain how that could be.
I think it all makes perfect sense. If you go back to, say, Valentine's day (just to pick a point) there were really nice glucose levels throughout the day, and in the subsequent days a few visits to the 400s but in general acceptable numbers. But for whatever reason, the dose was being lowered and lowered and the basic good results were maintained -- up to a critical point, I think. The good dose had probably been left behind a while back, and Klinger has been dealing with it, but with the 1.35u on 2/26, he received some critical amount less insulin than he needed -- a crisis for him. Instead of showing that in higher numbers, he calls on his own systems to make up the shortfall, thus
masking the problem (a specialty of felines), which shows only later. You could say that the low numbers of Feb 26 are indeed a reaction to the dose reduction, but the reaction was misinterpreted. Interpreting it correctly now is pretty critical to Klinger, I would say. Feb 26 was an emergency, and he responded by calling on reserves, but he can't keep it up because he is diabetic, and the real picture is not visible until some days later, when apparently without reason (but actually for very good reason), the numbers seem to go haywire.
I don't see anything in Klinger's chart, by the way, to suggest that he can't be regulated on Levemir.
Ilkka
