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Re: Hi, y'all... We're Beth and Bud

Hi, and welcome.
I am new to Levemir. We started in Feb. We switched from Prozinc. This is quite a different experience to me. Not as flexible as the Prozinc.
Sheila and Vicky made an amazing shot schedule for me, as I work a wacky schedule. Check it out sometime it's incredible! I still can't wrap my head around how they did it. :mrgreen:
Good luck to you and Bud.
 
Re: Hi, y'all... We're Beth and Bud

hey beth,,, welcome to lev!
 
Re: Hi, y'all... We're Beth and Bud

Welcome Beth and Bud! Is she a dilute tortie? I have two of those, 3 years old (just). They are real characters.

When was Bud diagnosed? Was that in Dec 2010? Just wondering how long she was on PZI. Glad you started lev at .5u as it looks like she was doing some rebounding at the end on PZI.
 
Re: Hi, y'all... We're Beth and Bud

sheila she already moved her dose to 1unit tonight. i told her to stick with it if she is gonna use it. the 1u. she is gonna have the hard time i did with not switching doses. it's ingrained in us. i really want to work with her.. we go back to her early days here. i think i know the basics now...tho' you might not like 'everything' in my ss, it's not a bad looking piece of work is it??? :-D
 
Re: Hi, y'all... We're Beth and Bud

Hi Beth,
Welcome to the wonder that is Levemir. May I ask why you switched from PZI? And how did you get your vet to agree to the switch? That is something we have new members struggle with sometimes, so it's good to know how others accomplished it.

Since you are just starting out I would like for you to look at 2 spreadsheets. The first is Peggy and Mickey's: http://spreadsheets.google.com/pub?key= ... vYkE&gid=0

Please notice that she holds each dose for several days. Also notice how even the colors are, going from pink at smaller doses, to yellow, then finally we are seeing a couple blues.

Now look at Klinger's spreadsheet: https://spreadsheets.google.com/pub?key ... 0S2c&hl=en

Notice how every few days there is a dose change. The colors are all over the place. And yes, there are plenty of greens but then immediately pinks and reds as the liver counters with extra blood glucose in the process called glycogenolysis, which you can read more about here: http://petdiabetes.wikia.com/wiki/Glycogenolysis

It's that process you have to counter with only the right amount of insulin. The way to do that is hold the dose for several more days to try to keep the liver from panicking, as we call it. Unless you give the liver time to straighten itself out, it's back and forth between insulin and glycogen. And it's very difficult to tell whether the dose is too much or too little with all this bouncing between the two going on.

Marcy, my apologies for using Klinger's spreadsheet as the example. Hopefully this is helpful for you too. Klinger may not be the best example because he is a late nadir kitty which also complicates things as you're dealing with longer overlap than others might, but his spreadsheet seems to show the liver response to green numbers fairly well.

Back to Bud. Since you've already moved up to 1U the best thing to do is stay there and see how her BGs pan out after a few days. Hopefully we can get rid of those black numbers, as those are never good.

I noticed the title of your spreadsheet. One of my nicknames for Gandalf is Bud Bud. Too cute.
 
Re: Hi, y'all... We're Beth and Bud

dearest beth,,,i think this change, especially after a period of time on pzi is terrifically hard on our brains. and just when i think...ok, yeah, i'm totally ok with it i will find myself responding to a number at amps or pmps. a number that truly does NOT need my responding too. as opposed to a really low number.
i think this is why we test so much at first...we simply cannot believe our dose is gonna do what they tell us it's gonna do.
this morning i shot tom's 94 with his full dose. 2 hours later he is 88. i am verra confident that today will go well yet i will want a +4 or 5 just to be extra certain.
just as in pzi i think some of the peeps here will think i push the envelope as i am now stuck on 1.25 rather then the 1unit that the wonderful, knowledgable sheila reccomends. it must be hard on them dealing with me as i'm sure i frustrate them no end.
i read the bood 'blink' not too long back and am even more convinced than i was before to follow my gut.
still i love the input.
hugs,
lori
and tomtom too!
 
Re: Hi, y'all... We're Beth and Bud

eeraby said:
Vicky & Gandalf,

I see what you mean with the SSs you suggested. I know you have to keep a dose consistant for several days for it to build up a shed. Vet wants to do 7 days of the same dose once we get past the 1st days.

Now.... I'm so used to making 0.2u changes with PZI it will be VERY VERY hard to overcome the *need* to want to do it with Lev. :o In my head, I know NOT too, but there's a conditioned response to do micro moves in dosage. I will fight the need and try, really hard, to let the dosage ride for a reasonable time.

I looked at Marcy's and Klinger's SS and I see what you mean. Thank you. I have some questions about Klinger's SS:

1. 02/07: PS was 102 shot 1.0u. Would you have shot 2.75 as on the previous day? With PZI I probably wouldn't even have shot! See the problem us PZI users have? I would have been freaked shooting a 120 with 1.0 much less the 2.75u that was shot!

2. 2/9 PS 82 no shot. Would you have continued with the 2.50u? I woulda been getting out the high carb, waiting for a hypo. Now, having not shot, I would have definitly shot @ +15 BG157 with a reduced does, probably 1.0u, even though I would throw off my 12 hr schedule (see Bud's SS 3/23) to try to avoid a bounce.

3. 2/16 PMPS 98 shot 2.0u. Would you have shot 2.25 as on the previous days? (HARD for a PZI user to shoot anything on a 98!!!!!)

4. 2/17 I would have probably shot 2.25 on both AM and PM. Would you?

Looking at this SS and discussing it with you will really help, I think, with me getting my head screwed on to a Lev mindset... sooooo very different than PZI. ohmygod_smile

I have made the committment to change to Lev because I feel it is what is best for Bud. NOT what's best for me. I know it's going to be hard to get my mind around it. Please keep in mind that we've been so conditioned to NOT shoot a green and to make micro dosage changes and bear with me when those times arise that ya'll will be telling me to shoot, dragging me by the heels, kicking and screaming, "But Noooooo!" nailbite_smile

Thank you again for taking the time to point this out to me and help me *see* what I'm going to have to learn to do.


Pretty much all 4 of the incidents you cite deal with the same issue - shooting on a lower than normal preshot. Not sure if you've also read the stickies in the Lantus ISG or not, but they have one called "data ready to shoot low numbers" or something like that. Check that one out.

Another reason we like to remain at one dose for a while is because then the data you have for that dose is reliable - you can see what happens with, say 1U, 2 hours after the shot, etc. So when you start getting lower preshots you have more confidence in shooting the full dose because you've seen the rise which normally happens 2 or 3 hours after the shot. Levemir is slow to ramp up, but given time it is a power house and that's how it achieves its ability to hold blood glucose within near normal ranges throughout a cycle, which we call surfing.

By constantly reacting to preshots by skipping doses or changing doses, you are only gathering unreliable data because the response is governed not by the shot you just gave, but by shed or overlap from 2 even 3 shots before.

In Klinger's case, he is a late nadir cat, meaning he doesn't peak until at or even after it's time for his next shot. So there are going to be more times when he has a low preshot. IMO, dose should be lowered in order to achieve preshot numbers which owner feels comfortable shooting. But that's not the case all the time because not all cats have such late nadirs.

I wish Melissa were around, but she's busy right now, because her Paul-Kyle is a late nadir cat and I think she's on a very low dose for him now.

I have comfortably shot 70s. But only when I'm confident in the dose and the results it's going to present.

You bring up an interesting point about dose changes in small increments. That is exactly what we recommend. I think you meant it in terms of dropping or raising the dose by .2U if the preshot was too low or numbers running higher, is that correct? You really shouldn't make abrupt changes to Levemir dosing based on preshots, but when it's time for an increase, it's better to increase in small amounts like that, especially if your current dose is low like 1U. So if you are used to trying to determine .2U changes on your syringe, you're ahead of the game!

Hope this helps.
 
Re: Hi, y'all... We're Beth and Bud

eeraby said:
Vicky & Gandalf,

I see what you mean with the SSs you suggested. I know you have to keep a dose consistant for several days for it to build up a shed. Vet wants to do 7 days of the same dose once we get past the 1st days.

Now.... I'm so used to making 0.2u changes with PZI it will be VERY VERY hard to overcome the *need* to want to do it with Lev. :o In my head, I know NOT too, but there's a conditioned response to do micro moves in dosage. I will fight the need and try, really hard, to let the dosage ride for a reasonable time.

I looked at Marcy's and Klinger's SS and I see what you mean. Thank you. I have some questions about Klinger's SS:

1. 02/07: PS was 102 shot 1.0u. Would you have shot 2.75 as on the previous day? With PZI I probably wouldn't even have shot! See the problem us PZI users have? I would have been freaked shooting a 120 with 1.0 much less the 2.75u that was shot!

2. 2/9 PS 82 no shot. Would you have continued with the 2.50u? I woulda been getting out the high carb, waiting for a hypo. Now, having not shot, I would have definitly shot @ +15 BG157 with a reduced does, probably 1.0u, even though I would throw off my 12 hr schedule (see Bud's SS 3/23) to try to avoid a bounce.

3. 2/16 PMPS 98 shot 2.0u. Would you have shot 2.25 as on the previous days? (HARD for a PZI user to shoot anything on a 98!!!!!)

4. 2/17 I would have probably shot 2.25 on both AM and PM. Would you?

Looking at this SS and discussing it with you will really help, I think, with me getting my head screwed on to a Lev mindset... sooooo very different than PZI. ohmygod_smile

I have made the committment to change to Lev because I feel it is what is best for Bud. NOT what's best for me. I know it's going to be hard to get my mind around it. Please keep in mind that we've been so conditioned to NOT shoot a green and to make micro dosage changes and bear with me when those times arise that ya'll will be telling me to shoot, dragging me by the heels, kicking and screaming, "But Noooooo!" nailbite_smile

Thank you again for taking the time to point this out to me and help me *see* what I'm going to have to learn to do.


Pretty much all 4 of the incidents you cite deal with the same issue - shooting on a lower than normal preshot. Not sure if you've also read the stickies in the Lantus ISG or not, but they have one called "data ready to shoot low numbers" or something like that. Check that one out.

Another reason we like to remain at one dose for a while is because then the data you have for that dose is reliable - you can see what happens with, say 1U, 2 hours after the shot, etc. So when you start getting lower preshots you have more confidence in shooting the full dose because you've seen the rise which normally happens 2 or 3 hours after the shot. Levemir is slow to ramp up, but given time it is a power house and that's how it achieves its ability to hold blood glucose within near normal ranges throughout a cycle, which we call surfing.

By constantly reacting to preshots by skipping doses or changing doses, you are only gathering unreliable data because the response is governed not by the shot you just gave, but by shed or overlap from 2 even 3 shots before.

In Klinger's case, he is a late nadir cat, meaning he doesn't peak until at or even after it's time for his next shot. So there are going to be more times when he has a low preshot. IMO, dose should be lowered in order to achieve preshot numbers which owner feels comfortable shooting. But that's not the case all the time because not all cats have such late nadirs.

I wish Melissa were around, but she's busy right now, because her Paul-Kyle is a late nadir cat and I think she's on a very low dose for him now.

I have comfortably shot 70s. But only when I'm confident in the dose and the results it's going to present.

You bring up an interesting point about dose changes in small increments. That is exactly what we recommend. I think you meant it in terms of dropping or raising the dose by .2U if the preshot was too low or numbers running higher, is that correct? You really shouldn't make abrupt changes to Levemir dosing based on preshots, but when it's time for an increase, it's better to increase in small amounts like that, especially if your current dose is low like 1U. So if you are used to trying to determine .2U changes on your syringe, you're ahead of the game!

Hope this helps.
 
Re: Hi, y'all... We're Beth and Bud

Wow, lots to read on the board tonight. Vicky, I don't mind at all that you pointed Beth to Klinger's ss. We're all hear to learn from one another. :-D
Beth, Vicky is right in answering your questions about Klinger's ss. I wasn't data ready to shoot those lower preshots at the dates you referenced. I just wanted to expand on the 4th question..
4. 2/17 I would have probably shot 2.25 on both AM and PM. Would you?
If you look at the night of 2/16, Klinger did get down to 38, which definitely warranted a decrease.

I still struggle with not reacting to the AMPS and PMPS #'s. The other day I increased Klinger to 2u's and he had a really late nadir in the 60's eventually 70's and finally he got into the 80s and I shot. I only shot because I was home with him and he is a late nadir kitty and he usually goes up 100 points after he eats. I figured that the 2u's may be too much for such a low number at PMPS, so I scaled it back to 1.75u, so I can get a more shootable number.Having the data to be able to shoot on a number like that is very important. Above all, kitties should be kept safe.

So, Vicky, :-D when we first started lev, we were encouraged (here) to follow the protocol and only hold the dose for three cycles. I would hold off for a week because of my vet wanting me to wait and get a full curve and I admit I stopped holding his doses for that long. But, now your saying that holding doses is the way to go. confused_cat Do we need to update our protocol to make this more consistent with how we do things on this ISG? I actually am all for holding doses, but I didn't think it was supported. Or maybe mention that holding doses may be warranted? Maybe it's in there. Sorry, I'm tired tonight.

Beth, I think you and Bud will do great on lev. The people here are very supportive and you'll recognize a few of the names from pzi. :-D Now who else can we convert :lol: just kidding!! !!! no converting took place.

Have a great night!
 
Re: Hi, y'all... We're Beth and Bud

mars72 said:
So, Vicky, :-D when we first started lev, we were encouraged (here) to follow the protocol and only hold the dose for three cycles. I would hold off for a week because of my vet wanting me to wait and get a full curve and I admit I stopped holding his doses for that long. But, now your saying that holding doses is the way to go. confused_cat Do we need to update our protocol to make this more consistent with how we do things on this ISG? I actually am all for holding doses, but I didn't think it was supported. Or maybe mention that holding doses may be warranted? Maybe it's in there. Sorry, I'm tired tonight.

Beth, I think you and Bud will do great on lev. The people here are very supportive and you'll recognize a few of the names from pzi. :-D Now who else can we convert :lol: just kidding!! !!! no converting took place.

Have a great night!

Yeah, we were quoting the Tilly protocol on the holding dose business for 3 to 5 days. The thing is it works for some cats, but not for others. I remember when I first started Gandalf on Lev I raised him the very next day! But the thing is I immediately saw results. And I knew his PZI dose was not too far off base so I tried not to go higher than that.

When there are spots of lower numbers but still more 300s, even 400s, it's probably a better plan to try to ride it out a few more days than immediately jump to the conclusion that that dose is not enough.
 
Re: Hi, y'all... We're Beth and Bud

that would be my ss. gator managed somehow to put my pzi ss on one page and my lev ss on another page. wish i knew how he did that. if no one here know's how i can call him k?
 
Re: Hi, y'all... We're Beth and Bud

eeraby said:
Thanks, ya'll.

Oh, btw... the first dose of 0.5 was vet's recommendation base on Bud's PZI reaction. after her +8 #, I called and we decided to raise it to 1.0u and hold there.

She's at 494 +5

Question: I saw someone that had a 2nd sheet on their SS. I'd like to do that and move the PZI over to the 2nd sheet. How, please?

Going to bed. will read in the morning.

Thank you, again.

Making a second sheet is pretty easy. Down at the very bottom of the page you will see the title of your sheet. There is a down arrow to the right of that title. Click it and it opens a box with delete, duplicate, etc in it. Select duplicate and it will make a duplicate sheet of your page. Then you can go through and highlight the entire sheet that you duplicated (not the top line which includes the headings for each column though!) or just parts of it you want to remove, click edit from the blue bar near the top of the page and select clear selection. That will erase everything written in the cells, but not the grid. Then you can start filling in with dates. You can remove all the colors in the cells by highlighting the whole sheet again and selecting white from the color box above. Don't forget to rename your sheet also.

I don't know if the formatting for colors and values will remain however. I didn't use the template, I created my own spreadsheet from scratch, which is why I use custom colors, which I have to select each time I put in a value. Under format in the blue bar is the selection change colors with rules. You can set up to 5 rules, you just put in the ranges of BG that you want to show up as what colors.

Your original sheet is fine, you can "lock" it by going back to the bottom title, click the arrow and select protect sheet.

Hope that works for you.
 
Re: Hi, y'all... We're Beth and Bud

hey beth so far it appears that ocean linear is hitting a nadir at pmps...but if you could get a +9 or even a +11 we'd know if he's on his way up....and while that might not seem to matter NOW with those big numbers you will find the nadir info quite handy once the numbers start receding. start looking for his pattern more importantly than what you assume (+6) is his nadir. +6 does not appear to be it.
love Ya!
lori
 
Re: Hi, y'all... We're Beth and Bud

Ya, my fault on the +6. I keep trying to get the +3 +9 but life's interferring.
 
Re: Hi, y'all... We're Beth and Bud

at this point i think the +9 or 10 would be the more interesting beth
 
Re: Hi, y'all... We're Beth and Bud

looking for a nadir. you might be at your low point at pmps?
 
Re: Hi, y'all... We're Beth and Bud

I thin k you will find switching to Lev the right thing to have done, and it's great that your on the site.It's awesome with all the help you could ever want . The kindness and generousity of people here have make all the difference in struggling with FD...Welcome and best of luck to you. (I have a Bud too :smile: ).
 
Re: Hi, y'all... We're Beth and Bud

Marcie... Bud's name was Buddy, given to her by my then 6 or 7 yo daughter. Daughter's on her own now and she's now called BudBud. lol Bud is a she.
 
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