6/14 Bogey AMPS = 264 ** Dosing Question **

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ajouteast

ajouteast

Member Since 2011
Hi All,

Bogey has been at 9 units BID for about 4 days now. He's going back and forth between the yellow and pinks. Mostly in the yellows though. I was wondering if I should keep him at 9 for a while, or move him up to 9.5 or 10 units? I'd love to seem him in yellows and blues!

Thanks for any thoughts!

Amy
 
Amy
Altho I say I'm no expert with the Lantus/Lev - however being an acro - and being so high yet - and being on this dose so long already - I would definitely increase your dose. WHAT do you feel comfortable with? bogey is not your typical diabetic so I do think you could increase one unit but YOU have to feel comfortable too! And how often can you test? If you aren't comfortable enough with this then just go with the 0.5 unit increase. But an increase for sure is in order. JMHO :)

I hope this helps you a little.... :cool:
 
Thanks Patti,

I am comfortable with a one unit increase to 10 units BID. I just wasn't sure if four days is long enough at 9 units to be moving on? I test as often as I can when I'm home (and awake). :-D
 
And here's the other side of the coin -- I know Lantus but not acros!!

Given that Lantus' action is cumulative, I don't know that I would increase by a unit. I would like to have Libby take a look since she is is managing an acro kitty and really understands Lantus well. What I've seen her typically recommend is that you follow the dosing in the Tight Regulation sticky. So, for a cat that has nadirs int he yellows, you would increase by 0.25u.
 
Hi Amy, I'm like Sienne, I have experience with Lantus dosing, but not acro experience, so I will defer to Libby, since she has experience with both.

How long until PMPS?
 
amy, is there any chance you were able to grab a mid-cycle spot check today? there haven't been any the last 3 cycles... 4 if you weren't able to get one today. since lantus and levemir dosing is based on nadir, we like to see how low the dose is taking kitty before increasing the dose.

that said, when kitties get up to this dose range and we have a confirmed diagnosis of a high dose condition, we generally recommend either increasing by 0.5u after every four cycles or increasing by 1u after every six cycles when nadirs remain consistently over 200.
 
thanks, Jill, those were my thoughts exactly.

FYI, for Jazzy most of the time I have decided I was more comfortable with 0.5 unit increases every 4 cycles. I work during the week, so I usually feel better about being a bit more conservative. If I was home during the day to monitor, I might have chosen to go with 1 unit increases, but then holding the dose 6-8 cycles before the next increase.
 
Unfortunately, I work a pretty long day, so no ability to get mid cycle readings unless it's the weekend or a day off. His PMPS tonight was 292. I gave him a dose of 9.5 and will set the alarm clock to get a +6 reading tonight. I'll report back tomorrow if I can. Just to be sure by cycles you mean one 12 hours period?

Thanks, everyone!

Amy
 
A cycle is a 12-hour period.

I would get as many checks in during the PM cycle as you can since you have long work days. Remember, the nadir is not necessarily at +6 -- it's not a fixed point.
 
Just wishing you good luck, Amy, on whatever you decide to do!! Great minds on your condo today with good suggestions.
 
Dear Amy
I know it's hard to test often when you work long days. Just try to do whatever is possible for you and still maintain your own health. In an ideal world - yes it would be great if we could test all the time but if it's only on the w/e and your off days you can test the most often - then GREAT! I remember when I was learning the ins/outs of Merlin's doings - and Danielle who helped me alot always said that each test taught us something eventually - gave us info to put together for the puzzle. You are doing a great job. Give your bogey lots of lovins!!!!!
 
Thanks for all the advice. I've been trying to sneak in as many tests as possible. Bogey is such a good boy. He hears me open and close the test strip tube and comes and jumps right up on the testing chair. Then patiently lets me prick his ear (sometimes 2 or 3 times if I miss, or can't get enough sample), take the sample and then so graciously gobbles his treat! (Dehydrated chicken)

I've been trying to figure out when his nadir is. I don't think I've gotten it figured out. I was also wondering if food affects it? Like if I give him a little extra later in the evening if he's really begging? Or if when I leave a frozen can out for him to work through? Can anyone tell by my chart so far when his nadir is? Can this change? On Sunday I did tests at +5, +6, +7 to see if I could get a better idea on it. I can see that I don't have many tests at +7 or +8. I'll have to see if I can get more of those. I don't know. But, if anyone can tell me anything from the short time I've been testing I'd certainly appreciate it.

Thanks so much again for all the help! And Bogey thanks you too!
 
i can't tell where the nadir is, amy, and sometimes it does move around. i sympathize with the difficulty getting tests. how much time do you have in the morning between testing/shooting and when you leave for work? could you get a test right as you leave for work?

yes, food can definitely affect BG if they eat within 2 hours of you testing - so i usually test, then feed - like i give punkin the rest of his breakfast/dinner at +3 right after i've tested him.

if you give straight meat, like some boiled chicken, my understanding is it doesn't affect BG much because it's little/no carbs. but i'm just repeating what i've read, i haven't tested that on punkin.
 
For now, I'm having a hard time knowing where Bogey's nadir is, as well. He has a very flat cycle, which can be very characteristic of Lantus. Given that there can be up to a 20% variance due to the meter, the cycles are pretty flat.
 
I think sadly the ECID comes in here again - every cat is different. But I know for Merlin - we never really saw any food affect his BG's and there are many other acro's that will say the same thing. BUT then there are some that definitely do see a change when their cats have eaten. Boy do I sound wishy/washy. Sorry for that.

I did see on your SS that Bogey is always starving - THAT I can say is TYPICAL of an acrocat = I think most of us who have one can say that our cats are like that - no matter how much we feed them - they are still hungry - still wanting more. Merlin would hover by the refrigerator at times - and we couldn't keep food on the counter - any kind.

I know that's not what you asked - but have to agree with the others re: the nadir - can't really tell yet - to me it just looks like you still need more insulin which you are working on - slowly building up after so many cycles.
 
ajouteast said:
I've been trying to figure out when his nadir is. I don't think I've gotten it figured out. I was also wondering if food affects it? Like if I give him a little extra later in the evening if he's really begging? Or if when I leave a frozen can out for him to work through? Can anyone tell by my chart so far when his nadir is? Can this change? On Sunday I did tests at +5, +6, +7 to see if I could get a better idea on it. I can see that I don't have many tests at +7 or +8. I'll have to see if I can get more of those. I don't know. But, if anyone can tell me anything from the short time I've been testing I'd certainly appreciate it.
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you're not alone! it's not always easy to figure out when a kitty reaches nadir when there isn't a whole lot of movement. from the recent data on your spreadsheet, it looks like nadir may be around +6 or +7. nadirs can and do change... which can make dosing with the Ls a little more challenging. since dosing with lantus and levemir is based on nadirs, you may elect to hold doses a little bit longer than suggested until your schedule allows you to get those mid-cycle checks.

see the thing is, you always want to know how low the current dose is taking your kitty before you add more insulin into the mix. this is true for all diabetic cats on lantus or levemir... not just acro kitties. if you don't know how low the dose is taking your cat before you increase the dose you risk the possibility of a hypoglycemic episode. make sense?

yes, when you feed can effect a cycle. when i feed alex right before her nadir she won't drop quite so low. however, ECID. some kitties can be free-fed throughout the day with little or no effect on their numbers. one way which might help you figure things out is to test before feeding during a cycle and then test about an hour later to see if the food had an impact. there's really a whole lot of trial and error involved when you're learning how your kitty responds to food and insulin. what works for my cat may not work for bogey and vice versa. keeping good notes has helped me over the years with alex.

hope this helps a little...
 
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