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Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD 4/19 AMPS 137 +12.5 115 +13 170
You may not be near to dropping the dose yet. We don't worry about it until you see nadirs below 50, or very low preshots and you are getting closer to that, however, you are sabotaging the results if I'm reading your spreadsheet correctly.
I am concerned about the AM shot times the past few days. The way I read the sheet says you tested at +12, but did not give shot. Tested at +13, had a higher number so gave shot at +13. Is that correct? The PM shots are given on time, +12, because they are over 200. *See below, because I have a question about PM shot times too.
Levemir needs consistent +12/+12 shot cycles, especially in the beginning. It is better to lower the dose a little bit if you're uncomfortable to give the shot on numbers below 150, but still not ideal.
By delaying shots, the shed continues to drain and even though your dose remains the same it has more catching up to do, which is evident in the fact that every PM BG she has is over 200.
This note from your vet: "wait to see if BG is increasing before giving insulin if preshot bg is less than 180)" is not necessary and counter-productive to how Lev works. So many vets see hypo cases that when using a longer acting insulin they are overly cautious. Notice she said, "now we just have to watch she doesn't go too low." I don't worry about needing to see a rising number unless preshot BG is below 80. Yes, double digit 80. But that's also because I have data to show that's about the point I need to be cautious.
Bud Bud is doing very well at 1.25U. Those blue AM numbers you're getting is what you want to see. They are perfectly acceptable numbers for giving a dose. You have the data that every time you skip the shot at +12 she continues to rise, except this AM, but a late nadir is acceptable and could indicate a dose reduction in her future. Don't worry about that right now.
You need to see those rising numbers to feel more comfortable giving a shot at those lower preshots. You also need to give a shot at those numbers and continue testing to again have the evidence to show the slight rise and leveling off.
Her responses are almost textbook to the rise in doses. We need more nadir evidence at +9, +10, +11. Those numbers at those times will also help you feel more comfortable giving a shot at lower preshot values and will determine where you should go with dose.
*One more question - is your PM shot at +12 to when you gave the AM shot or is it at the +12 time it would be to the intended AM shot time? In other words - if your normal AM shot time is 8AM and you delayed till 9AM, is her PM shot at 8PM or 9PM? So then is her next AM shot intended at 8AM (+11 if you shot at 9PM) and you got a lower number so you didn't shoot till 9AM?
Just needing to clarify that. Yes an hour can make a difference. Perhaps indicate the actual shot times in the notes column to the far right to help us out.
I have to leave by 10AM central time tomorrow, but can help you out in the AM before that. I forget what time zone you're in. I hope Sheila or Kelly check in to see how well Bud Bud's doing! We've missed her updates.
And to answer your question about lowering dose, you mean .1U, right? That's 1 tenth of 1U. You are correct that lowering gradually is better than say going from 1.25U to 1U. Some would call a dose a little greater than 1U a fat 1U.
Have you seen these pictures: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982 Although those are for doses below 1U, the divisions would be the same between any 2 unit marks on the syringe. Hope that helps.
Sorry so long.
You may not be near to dropping the dose yet. We don't worry about it until you see nadirs below 50, or very low preshots and you are getting closer to that, however, you are sabotaging the results if I'm reading your spreadsheet correctly.
I am concerned about the AM shot times the past few days. The way I read the sheet says you tested at +12, but did not give shot. Tested at +13, had a higher number so gave shot at +13. Is that correct? The PM shots are given on time, +12, because they are over 200. *See below, because I have a question about PM shot times too.
Levemir needs consistent +12/+12 shot cycles, especially in the beginning. It is better to lower the dose a little bit if you're uncomfortable to give the shot on numbers below 150, but still not ideal.
By delaying shots, the shed continues to drain and even though your dose remains the same it has more catching up to do, which is evident in the fact that every PM BG she has is over 200.
This note from your vet: "wait to see if BG is increasing before giving insulin if preshot bg is less than 180)" is not necessary and counter-productive to how Lev works. So many vets see hypo cases that when using a longer acting insulin they are overly cautious. Notice she said, "now we just have to watch she doesn't go too low." I don't worry about needing to see a rising number unless preshot BG is below 80. Yes, double digit 80. But that's also because I have data to show that's about the point I need to be cautious.
Bud Bud is doing very well at 1.25U. Those blue AM numbers you're getting is what you want to see. They are perfectly acceptable numbers for giving a dose. You have the data that every time you skip the shot at +12 she continues to rise, except this AM, but a late nadir is acceptable and could indicate a dose reduction in her future. Don't worry about that right now.
You need to see those rising numbers to feel more comfortable giving a shot at those lower preshots. You also need to give a shot at those numbers and continue testing to again have the evidence to show the slight rise and leveling off.
Her responses are almost textbook to the rise in doses. We need more nadir evidence at +9, +10, +11. Those numbers at those times will also help you feel more comfortable giving a shot at lower preshot values and will determine where you should go with dose.
*One more question - is your PM shot at +12 to when you gave the AM shot or is it at the +12 time it would be to the intended AM shot time? In other words - if your normal AM shot time is 8AM and you delayed till 9AM, is her PM shot at 8PM or 9PM? So then is her next AM shot intended at 8AM (+11 if you shot at 9PM) and you got a lower number so you didn't shoot till 9AM?
Just needing to clarify that. Yes an hour can make a difference. Perhaps indicate the actual shot times in the notes column to the far right to help us out.
I have to leave by 10AM central time tomorrow, but can help you out in the AM before that. I forget what time zone you're in. I hope Sheila or Kelly check in to see how well Bud Bud's doing! We've missed her updates.
And to answer your question about lowering dose, you mean .1U, right? That's 1 tenth of 1U. You are correct that lowering gradually is better than say going from 1.25U to 1U. Some would call a dose a little greater than 1U a fat 1U.
Have you seen these pictures: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982 Although those are for doses below 1U, the divisions would be the same between any 2 unit marks on the syringe. Hope that helps.
Sorry so long.
eeraby
Member Since 2010
Re: BUD 4/19 AMPS 137 +12.5 115 +13 170
Thank you very much, Vicky.
Yes, Vicky. That's correct - PM shot given at NORMAL +12 (really +11)
I agree, we need more +9 10 11s (+1 2 3s probably). And I see your point about the 11 hours between shots.
DH tests @5:00am ish and feeds and shoots 15-30 minutes after test. in the evenings, same thing.... tests @5:00pm ish and feeds and shoots 15-30 minutes after test.
The last 2 mornings, he was following vet's instructions. I told him he didn't need to wait an hour - that 15 minutes was better to get the shot as close to amps normal time. Is a bit hard for him while getting ready for work and I'm asleep. That's how I can stay up and get some of the PM +5/6s.
Last night's shot was about 30 minutes later than normal (after being 60 minutes late in the AM). I'll start marking SS with exact times.
He woke me this morning at 5:30.. My fault the shot was delayed as I was still rather asleep.
I'm on eastern time. When we're shooting @ 5.30 you're at 3.30.
I have seen the photos and DH and I have practiced. He'd been doing 2 drops out the the syringe while I've been gone. I have just now printed the photos out for reference as I'll be doing the PM shoots while I'm home.
So, if she's over 80 at PS, go ahead and shoot the regular dose, test every 15 until there are 2 rising numbers?
Off to get her +4. will update SS
Thank you again, Vicky
K... well, +8 is 79/82 tested twice to make sure.
Thank you very much, Vicky.
Vicky & Gandalf said:
Yes, Vicky. That's correct - PM shot given at NORMAL +12 (really +11)
I agree, we need more +9 10 11s (+1 2 3s probably). And I see your point about the 11 hours between shots.
DH tests @5:00am ish and feeds and shoots 15-30 minutes after test. in the evenings, same thing.... tests @5:00pm ish and feeds and shoots 15-30 minutes after test.
The last 2 mornings, he was following vet's instructions. I told him he didn't need to wait an hour - that 15 minutes was better to get the shot as close to amps normal time. Is a bit hard for him while getting ready for work and I'm asleep. That's how I can stay up and get some of the PM +5/6s.
Last night's shot was about 30 minutes later than normal (after being 60 minutes late in the AM). I'll start marking SS with exact times.
He woke me this morning at 5:30.. My fault the shot was delayed as I was still rather asleep.
I'm on eastern time. When we're shooting @ 5.30 you're at 3.30.
I have seen the photos and DH and I have practiced. He'd been doing 2 drops out the the syringe while I've been gone. I have just now printed the photos out for reference as I'll be doing the PM shoots while I'm home.
So, if she's over 80 at PS, go ahead and shoot the regular dose, test every 15 until there are 2 rising numbers?
Off to get her +4. will update SS
Thank you again, Vicky
K... well, +8 is 79/82 tested twice to make sure.
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD 4/19 AMPS 137 +12.5 115 +13 170
Well, not exactly. That's what I go by because it's my cut off for what a safe preshot shootable number is for Gandalf. It's probably safe for most Lev kitties, but there's that darn manual and ECID.
Right now I'd say 120 is a good cut off for her, where you wait 15 minutes to see if you get a rising number if BG is below that. And the times your DH tests/shoots, that's actually happening anyway so you were right to tell him he didn't need to wait an hour. Isn't the woman always right? :lol:
Unless Bud Bud is not a good eater - ie. sometimes walks away from the food when it's put down - there really isn't a need to wait till they eat to give shot, especially if it would be easier for DH to test and give shot at same time. That's a fast-acting insulin rule. So long as the cat is getting food about the same times each day in relation to the insulin shot, it's not really a big deal either way though. Just thought I'd mention it.
So if you've been giving the PM shot at +11, that's why your AM preshots are lower, not because the dose is too much. Let's see if we can keep the times on 12/12 track and the keep the dose at 1.25U and see what happens. Deal?
Glad we got that straightened out. I was wondering if we were dealing with an earlier shot somewhere. I like it when I'm right :mrgreen:
Well, not exactly. That's what I go by because it's my cut off for what a safe preshot shootable number is for Gandalf. It's probably safe for most Lev kitties, but there's that darn manual and ECID.
Right now I'd say 120 is a good cut off for her, where you wait 15 minutes to see if you get a rising number if BG is below that. And the times your DH tests/shoots, that's actually happening anyway so you were right to tell him he didn't need to wait an hour. Isn't the woman always right? :lol:
Unless Bud Bud is not a good eater - ie. sometimes walks away from the food when it's put down - there really isn't a need to wait till they eat to give shot, especially if it would be easier for DH to test and give shot at same time. That's a fast-acting insulin rule. So long as the cat is getting food about the same times each day in relation to the insulin shot, it's not really a big deal either way though. Just thought I'd mention it.
So if you've been giving the PM shot at +11, that's why your AM preshots are lower, not because the dose is too much. Let's see if we can keep the times on 12/12 track and the keep the dose at 1.25U and see what happens. Deal?
Glad we got that straightened out. I was wondering if we were dealing with an earlier shot somewhere. I like it when I'm right :mrgreen:
eeraby
Member Since 2010
Re: BUD 4/19 AMPS 137 +12.5 115 +13 170
DEAL. thanks.
Vet called. She came in and looked at the SS and this thread. She would rather have the limit of when to wait and test to be set @ 150. Will test 15 min intervals. She knows Bud's history and her reaction to PZI. I think that's a reasonable compromise... 120-150. Especially since Bud does NOT read any of the manuals.
We all concur to keep her @ 1.25u until we see what's she's going to do.
Thanks so much for all your great advice and your time, Vicky. Nice having a great see of eyes keeping one out for us.
~Beth and BudBud
DEAL. thanks.
Vet called. She came in and looked at the SS and this thread. She would rather have the limit of when to wait and test to be set @ 150. Will test 15 min intervals. She knows Bud's history and her reaction to PZI. I think that's a reasonable compromise... 120-150. Especially since Bud does NOT read any of the manuals.
We all concur to keep her @ 1.25u until we see what's she's going to do.
Thanks so much for all your great advice and your time, Vicky. Nice having a great see of eyes keeping one out for us.
~Beth and BudBud
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Re: BUD 4/19 AMPS 137 +12.5 115 +13 170
Hey, a vet that at least is open to suggestion and taking in to account experienced users. That's a keeper!
And 150 is a good compromise. I can live with that. Once you get the 12/12 down you'll see that it will make a difference for the better.
Have you read the sticky over in the Lantus group about being data ready to shoot low numbers? The same applies to Levemir.
Hey, a vet that at least is open to suggestion and taking in to account experienced users. That's a keeper!
And 150 is a good compromise. I can live with that. Once you get the 12/12 down you'll see that it will make a difference for the better.
Have you read the sticky over in the Lantus group about being data ready to shoot low numbers? The same applies to Levemir.
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