4-13 Jeddie was 159 am and 399 pm!

[Sheila & Beau GA & Jeddie GA]

:shock: I was surprised by the 159, so shot .4u this am. So was .4u, instead of .5u not enough? Or did he rebound from some low over night last night?

When I can home tonight he ran out past me and down the hallway. I asked him where he was going, but I didn't get an answer. So I walked (limped) all the way down the hall to scoop him up and carry him back, opened the door and Beau ran out. ohmygod_smile He, at least, came right back in when I told him to.

Silly boys.

 

[Vicky & Gandalf (GA) & Murrlin]

It's hard to tell isn't it? Most likely not enough insulin but that is quite a bounce....it seems they can react unexpectedly when less insulin is given. I think I'm seeing it with Gandalf because reducing dose doesn't get us out of 300s. Earlier shots does, which makes me think he needs more.

When reducing dose you actually change two things - less insulin to deal with blood sugar and a dose change, so the effect multiplies.

Or he simply bounced....I guess the only thing to be done is next time you get a 150 or so preshot, give full dose and see what happens.

 

[Sheila & Beau GA & Jeddie GA]

More bad numbers....

At 5:15 I moved and bumped him and rolled over to apologize. I put my hand on him and he didn't chirp like he normally does, so I jiggled him - no response. I put my hand on his side and he was totally still, so I freaked out and turned on the light to make sure he was breathing. He was, but he was rather unresponsive until I shook him a little and he still just lay there, so I tested him just in case. It was +9 and he was 303 already (or still). 3 hours later, at PS time he was 374.

Now here's the thing - yeah seems like he needs more insulin, but he keeps needing more insulin. When I first had him on insulin again it was a small dose (smaller) and he was dropping below 100 - even to 60s one or twice. Then his numbers all started to climb and I have been increasing the dose slowly.

And why would .5u bring him to a nice 159 PS one time and then with just a 20% drop in dose for one shot he is soaring higher than he has ever been before?

 

[Vicky & Gandalf (GA) & Murrlin]

More bad numbers....

At 5:15 I moved and bumped him and rolled over to apologize. I put my hand on him and he didn't chirp like he normally does, so I jiggled him - no response. I put my hand on his side and he was totally still, so I freaked out and turned on the light to make sure he was breathing. He was, but he was rather unresponsive until I shook him a little and he still just lay there, so I tested him just in case. It was +9 and he was 303 already (or still). 3 hours later, at PS time he was 374.

Now here's the thing - yeah seems like he needs more insulin, but he keeps needing more insulin. When I first had him on insulin again it was a small dose (smaller) and he was dropping below 100 - even to 60s one or twice. Then his numbers all started to climb and I have been increasing the dose slowly.

And why would .5u bring him to a nice 159 PS one time and then with just a 20% drop in dose for one shot he is soaring higher than he has ever been before?

Because it's a 20% drop is why. 1/5th. That's a lot on such a small dose.

I'm sorry he feels crumby. Did you go back to .5U? Maybe he did so well on the miniscule doses before because he was getting some pancreas action, probably just from his diet change. Now he's not, so he needs more insulin. Make sense?

 

[Sheila & Beau GA & Jeddie GA]

Well, I understand what you are saying, but it doesn't make sense that his pancreas would stop working on a good diet.

He was 219 at +13 tonight (I had a board meeting). That is making me wonder about rebound. I re-read the petdiabeteswiki page on rebound and he fits the pattern to a great degree - not 100%, but a lot.

I feel bad that I can't seem to get him under control, and, therefore, feeling better.

 

[Melissa&Paul-Kyle]

I am sorry you are having trouble getting Jeddie Spageddi's BG's to calm....I know it is frustrating and I know you only want what's best for the kitteh. (((hugs)))


FWIW, I see alot of bouncing around with doses in the last few weeks...doses changed in less than 5 days without a full curve to see the whole picture, and dose changes within a few days or even within the same day as if you are using a short action insulin and the effect would be immediate in the same cycle.

I have written here more times than I care to think of, that it doesn't make sense to me that several here dose Lev as if it can change curves on a dime like the short duration's do.

...I was taught that Lev and Lantus have a buildup (shed) and that this mornings dose effects tomorrow mornings dose or after -The shed needs a few cycles to build or deplete to lower or raise numbers.

So, I am not comfortable offering dosing advice other than to offer the reminders that Lev is not a short duration insulin and that BEFORE doses are changed, a curve needs to be done to justify the change- the only caveat being if the cat reaches numbers so low as to be unsafe, then the dose is lowered directly and that a dose should be held for a full 3 to 5 days with the preference being 5 days to allow settle time and "the bigger picture" with a curve AFTER settle time and BEFORE another dose change.

I think, for those that work traditional work weeks, that Weekends are great for running curves, Mondays start a dose change justified by curve data, the new dose is allowed to adjust through the work week with spot checks where possible, then the curve again on the weekend to evaluate present dose.

That's all I got....

 

[Vicky & Gandalf (GA) & Murrlin]

I agree that we need a more complete picture of how Jeddie is doing on one particular dose. I go through the same thing with Gandalf since I can't get nadir numbers on him that are reliable very often. By reliable I mean ones not affected by split doses and ones not affected by the stress of having acupuncture. That leaves me essentially 1 day every other week! In the between he's either going to run high or swing like crazy which again may make for an unreliable curve on the one day I can get it.

Not that I'm making excuses for either of us, we both understand that Levemir is said to not like changes, but the reality is a lot of times you have to go with your gut and do the best you can on what limited info you have. Sheila's very gun shy about raising dose because of what happened with Beau. I don't mean to be critical about that because caution should be used when raising doses more so than when lowering. With lowering dose you really only have to worry about ketones. Raising dose can cause bounces, making the limited number of higher BGs we get very difficult to discern - are they because of bounce or because of not enough insulin???

Sheila, how are his teeth? I wonder if there's not something else going on which might overtax his pancreas. (no pun intended since it's tax day!) And he's peeing in inappropriate places....I'm loathe to mention UTI, but it does happen, especially with boys.

Melissa, thank you for taking the time to look at the evidence and provide an unbiased observation. We need your input here, don't be a stranger.

 

[Sheila & Beau GA & Jeddie GA]

Yeah, I know - I need the reminder though.

My experience with Beau, and I think with Jeddie to some degree, is a more immediate response to dose changes, but maybe I am wrong about Jeddie.

To be honest, I know that is what is said about long acting insulins, but it was so not my experience with Beau, and it doesn't seem to be working with other cats here or on LL. I did relearn about how Lev worked versus vetsulin with Beau. Now it's going to act a totally different way with Jed?

I am very frustrated. I am at the same frustrated "I want to give up" stage I was with Beau when nothing worked. Right after that I started lowering his dose.....

Now, this morning, Jed is all off schedule from my late night last night so that is messing with things. I shot less last night so I could shoot .5u this morning at +10 (he was 341), but I had a bunch of bubbles in the syringe I couldn't get rid of so I think it was only .4u.

 

[pamela and tigger]

I can see where a curve might be useful in some instances, but getting a lot of spot checks on different days, to me, gives much clearer information. I think they might be useful when deciding whether or not to change your insulin, and when just starting out with a new insulin to see how it is working. I don't think it makes a difference if it is a long or short insulin it would still be useful info. And also if you are suspecting chronic rebound then they would be useful too, but it seems that if you are following Tilly you should not have this problem. High flat numbers can just mean not enough insulin (yet).

So I do have mixed feelings about them - it seems to me the problem with curves is it is just one day out of many and variables do change, especially a cat like Gandalf who has multiple outside factors that come into play everyday.

With Tigger since I am home more often I am able to get spot checks everyday at different times. I can pretty much see trends this way and how he is acting to a particular dose. I don't believe a curve on a particular day would give me anything more useful that I could use.

"...I was taught that Lev and Lantus have a buildup (shed) and that this mornings dose effects tomorrow mornings dose or after -The shed needs a few cycles to build or deplete to lower or raise numbers."

Maybe with a lot of cats this is the case (newly diagnosed?), but not in my experience (for the most part) with Tigger.

In a perfect world all the variables that occur with cats all the time would be exactly the same everyday and a lot of this stuff would be so much easier to figure out.

Thank you Melissa for bringing it up again.....always good to think about.