4/28 Charlie PMPS 266 +4 74 +4.75 32 +5 38 +5.5 69

[charliesmom]

Hi Friends,

It would be real helpful to get some more experienced eyes on Charlie's spreadsheet, if anyone has the time. She is progressing on the levemir, and still not stabilised. Tonight she took a nose dive real early in the cycle. I gave maple syrup and food at +4.75 and +5. Now she's starting to come up a bit, but I still feel a bit lost in managing her on levemir and would like some advice on the following:

- Where do you think her nadir is likely hitting?

- Are there specific times I should be testing to give a full picture on her SS for all of you (in order to answer the question above)?

- The last time Charlie hit a low number and earned a reduction, we reduced to .25 and it wasn't enough. Would you advise reducing to .25 or just reducing to a skinny .5 (from a fat .5)? Or start with the .25 and if it's not enough, move up again to a skinny .5?

- Why are Charlie's cycles not more even? Mornings she seems higher most of the time. Has anyone ever given slightly more insulin in the morning and less in the evening (split dose) due to weird cycles like charlie's? (IE: Should I experiment with giving a skinny .5 in the morning and a .25 at night for awhile)?

Thanks in advance for your input. We are leaving for a trip on Tuesday and taking charlie with us, so input tonight or tomorrow is very much appreciated.

Thank you in advance,
Jill

 

[Dyana]

That 32 really means she wants a dosecrease, but I think if it were myself, I would try a slightly fat 0.25 next.

Congratulations on the dose reduction.

I do see that your spreadsheet has a lot of NO SHOT on travel days. I was just wondering if you could still shot and test on some of those days.

Good luck with your next trip. I am glad you are taking Charlie with you. She is becoming quite the traveler

 

[Ann & Tess GA]

Hi, yes Lev is a little different than Lantus. Ususlly it is a much later nadir. My best tool is getting +11 tests so I can see if she is still headed down at shot time. I f she is I know a drop is likely and can be prepared to test earlier and have higher carb food planned to slow things down. For a long tinme 5 % or 6% would be enough to slow her,recently it has been taking more carbs.

I know the protocol calls for a full ,25u reduction, but ECID and for Tess we just shave. I think it works better especially at the lower doses. Think about it, if you are giving .5u, a .25u reduction is half of the dose, that is a big proportion to step down. If you try a reduction several times and it doesn't hold, shaving is a good option.

There are a couple other techniques some people use. Marje has actually upped Gracie's carbs and insulin to stop the bouncing. Sounds counterintuitive but sometimes you need a broader base to work from. Another trick is to use just a touch of R insulin when you see the bounce starting. Talk to Marje or Jill about how to work that out.

 

[Sienne and Gabby (GA)]

I don't think giving a different dose in the AM and PM is a good idea. Lev is also a depot insulin. What you're suggesting is that you change the dose every cycle. The depot would never stabilize and I suspect that numbers will be less than what you'd like. FWIW, many cats experience lower numbers during the PM cycle. I haven't any idea why, though! The other reason you're probably seeing higher numbers in the AM is because Charlie is dropping lower at night and bouncing slightly. The cycles are much flatter but the lower numbers at night (e.g., the 32) may be a contributing factor to some bouncing during the day.

It looks to me like Charlie's nadir is around +5 during the PM cycle. Your data dring the AM cycle isn't as plentiful and I don't have as good of an idea where the AM nadir is falling.

I agree that Charlie is on a small enough dose that I would give serious consideration to shaving the dose. I'd encourage you to do what you can to keep Charlie on insulin as long as you can so her pancreas keeps getting support. Right now, there are still too many numbers outside of the normal range. One other option is to hold the dose for three drops between 40 - 50. A drop below 40 still gets an automatic reduction.

 

[charliesmom]

Thanks for all of your input, everyone. I fell asleep last night just after getting Charlie's numbers up, so I didn't get to this until today. Sorry for the late reply. I do appreciate your quick input very much.

We decreased Charlie's dose today to a slightly fat .25 as we thought that was the way to go as well. We are still having a hard time seeing the micro-doses between .25 and .5 so we go with the "skinny" and "fat" methodology. Sounds funny. Skinny and fat methodology! Man, am I a real Dr.

The only time Charlie received "no shots" on travel days is if we traveled over a weekend. My partner's family is from Denmark, and what we have found is that Charlie will not allow anyone to give insulin (even specialists). We took Charlie away for a weekend with us once, and for the price ($300 each direction) we found that her numbers shot through the roof and were still real high. On the other hand, when we left for just a weekend and gave no shot, her numbers were fairly stable. We try not to go away too much for weekends where Charlie will be left alone with the sitter. It just doesn't work with her dosing and it sets her backwards, so it's not ideal.

This trip is for a bit longer so we decided to bring her with us. Maybe her numbers will not be good this week as a result, but we have to see.

Ann & Sienne:

The +11 test is a great idea, and especially good on days where we are concerned. We tried to shave today to a certain extent (giving a fat .25 instead of a fat .5) but maybe we should have gone with a skinny .5

Time will tell. I just didn't want to have us traveling and put charlie at risk at a time when we couldn't have all our materials prepared to bring her up (while on the plane, in transit, etc). Also this trip will be quite busy and we will not be able to monitor the entire time, so the fat .25 seemed safest as an approach for right now.

I don't know what "R insulin" is, so I will wait on that for the moment. I will post in the coming weeks to show the progress and check back in for advice on next steps after our holiday. I'll be starting a new work project mid-may, so daytime tests will be a challenge after that. Step by step, I guess.

We will not go with different doses in the AM and PM as advised.

Thank you again, friends.

Jill

Sienne and Gabby