6/22 Max + 7.25(last night) 481 AMPS 418 Q???

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max&emmasmommie

max&emmasmommie

Member Since 2012
Links to yesterday's posts:
In Health: viewtopic.php?f=28&t=73543
In Relaxed: http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=73595

Link to THIS post in Relaxed: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=73649

Hi, Everyone,

Note: Max was given a rabies shot yesterday. It was after the procedure, I think, to avoid a reaction that prevented the teeth cleaning. (The vet tech said he had to have this because if he bit them during the teeth cleaning, it would be reported to the state, and the state would take him into quarantine and possibly kill him to check his brain.) I know it makes no sense to do it after the procedure, but she said it would keep the state from taking him. So, I agreed.

I am seriously considering starting over at 2.0 units, and that is what I gave him this morning because I have only 9 cycles left before I leave for my trip home.

The factors are these: 1. He has been at 2.5 for 8 cycles and had a To Low to Shoot Number yesterday morning; 2. This bounce is clearing, if it is a bounce; 3. I think 2.0 units makes sense because he never had a good AM or PM test value after 18 cycles at 1.5 units of on time shots; 4. During those 18 cycles of 1.5u he was on antibiotics (Clindamycin) and had good hydration for that period; 5. He had 8 cycles of on time shots at 1.75u right before that 1.5u period which did not give any good numbers either. (All the other data on 1.75 units isn't worth much because I had so much trouble getting him the shot on time.) 6. Additionally, at this time, he's just had the plaque removed from his mouth and is on antibiotics (Clavamox - broader spectrum than Clyndamycin to reach the possible infection in the pancreas) for the next 18 days which should, in theory, help his BG.

So, this is why I'm thinking of trying 2.0 for 3 cycles and then reassessing. Does anyone have any comments? Thank you!
 
Dale

IMHO, no...I would not have reduced him. In fact, it looks to me like his breakthrough dose might be 2.75u.

While 137 might be a number you consider too low to shoot, it is, in fact, a very safe and shootable number if you have strips, food, karo, and can be there to monitor and it looks like you were. I don't think his bounce is clearing; I think he is flat.

I also think you will probably not see much in three cycles. The shed from the higher dose can affect up to six cycles. It doesn't in every cat but it can; typically, I would say you would see effects of a higher dose for at least 3-4 cycles. Having said that, if you want to leave him at 2u because you are getting ready to leave, I can understand that. Some caregivers decrease the dose when they go out of town to ensure the kitty is safe. But, ultimately, I think he will need more insulin.

I'm not a big fan of lowering the dose to "start over" unless the protocol was not followed as increases were given thus risking the chance of being overdosed. I don't see that here. In fact, I think you gave reductions that might not have been warranted but since there are some cycles with little to no data, it's hard to tell how low he went.
 
Thank you, Marjorie!1 I'm really happy to hear that. I was afraid to go up or down with him. He IS really flat now. I checked him at +6 and got 459. Maybe tonight he'll stay in that range, and be quite flat.

That's exciting that you think the "breakthrough" dose was 2.75. I know so little about dosing - it really is a mystery to me. I assume "breakthrough" doesn't mean "correct" or does it? Does it mean the dose that would eventually stop any bouncing?

I am trying to read about it, but I'm not sure I get what you do with a bouncy cat. Without a nadir, I'm lost. Would you mind explaining why you think that's the breakthrough dose in really simple terms? Does it have anything to do with the numbers on April 24, May 6 and 8, May 28, June 3 and 4, and June 14? Do you get numbers too low to shoot when you are "breaking through?" May 28 and June 4 had me so hopeful, but I felt I couldn't get any confirmation that I was on the right track after June 4. Do I need to "shoot through" with a full dose on those low numbers to get any traction?

My vet thinks I may be dealing with overlap, and I was beginning to think so, too. I don't want that to be true. He's talking about giving 3 units once a day. I know that is not advisable from what I've read on this board.

I'm operating on fear mostly. I'm afraid of having him low to shoot frequently. Some days I have to leave the house and be gone sometime between, or all during +4 to +7. Also, I worry I won't wake up at night early enough to catch a hypo. If I simply don't shoot at those times, then, I'll have him yo-yo-ing at lot and going into the blacks as he had been doing on 2.75 before his dental.

If you mean 2.75 is possibly the correct dose that's even more exciting. I will have to put him at 2.5 for the sitter. I won't want anyone to shoot below 150 on him while I'm gone. However, if he would stay in the 200 to 300 range at least, that would be an improvement.

I thought I was not following protocol when I raised his doses because I didn't have enough information. I didn't know when his nadir was occurring, and it seemed he didn't have a nadir half the time. I felt I had to do something. When I raised him from 2.5 to 2.75 I did have enough info, but it didn't seem to help in the long run. Maybe that is because of the BCSs -- Big Chicken Shots? Is that why they are called that?

Oh, any enlightenment would be so appreciated! Thank you.
 
Dale:

You're welcome. I'll see if I can answer your questions. One thing that is important is counting cycles. If you look through the protocol, you'll see references to "consecutive" cycles. Here is an important sticky regarding counting cycles and it can help you a great deal when you're dealing with dosing and stalling, skipping, shooting a BCS, etc. Counting Cycles

A breakthrough dose is the one you work up to, according to the protocol, that finally allows them to start getting into normal numbers. It has nothing to do with bouncing so you might reach the breakthrough dose but Max may still bounce. There's so much data missing that could help but I'm just referring to the fact that on most occasions when you had him on 2.75u, he got into normal numbers.

There is nothing wrong with bouncing. It shows that the liver is working. Bouncing is caused by either fast drops in BG or the BG going lower than the liver is accustomed to. It doesn't mean the BG is necessarily low ...it can be in the 200s or high 100s....but if the liver is used to numbers in the 400s and 500s, then 200 seems low and so the liver releases counterregulatory hormones and glucagon to bring the BG up to what it believes is "safe". Until a kitty's liver is used to normal numbers, it will most likely cause bounces.

There is not much you can do with a bouncy cat except try to catch and control any steep, fast drops but as far as the liver getting used to lower numbers, a kitty will bounce until it doesn't. If you look at my Gracie's SS, she is fairly tightly regulated but every once in a while, she'll drop quickly (pancreas working?) or throw a really low number, and she bounces.

Lantus likes consistency in dosing and in shooting 12/12. When you skip shots, stall, shoot BCS doses, etc, you affect the insulin depot and so your numbers may get wonky. In LL, we try to teach you to gradually shoot lower and lower numbers (above 50). When we were new, I could never imagine shooting below 150 but the wonderful people here taught us to learn how to shoot lower and handle the numbers. But you simply must have some data. That does not mean that you need to test like I do.....Gracie is different and likes to be low. But always get a PS test. If you have to go to work, always get either a +2 and/or an out the door test. At night, always get a +2 and/or before bed test. The other tests that help are +1 tests when possible....they tell you if Max gets food spikes after you shoot and feed so if you shoot a low number, you know if he'll go up or down. And +10/+11 tests are great because they tell you if Max is dropping or getting a second dip. But I want to stress you do not need to get these tests every cycle. Maybe on weekends....occasionally during the week during a cycle here or there when you can. You just want to build some data for him but you do not have to test test test test.

Your vet's remarks on overlap are interesting. Perhaps he doesn't understand the term. Overlap is a GREAT thing. I am not seeing any overlap in Max's cycles. Again, look at Gracie's SS. She gets overlap most cycles BUT the clearest one for the unsure observer is on 4/29. Remember she is on levemir so her cycles are different than lantus. But overlap allowed her to be in green all day long.....you probably can't pick out when one cycle stopped and the other started can you? Overlap occurs when one shot is waning (losing "strength") and the next one is onsetting so you see very little change in numbers.

We are not proponents of shooting SID, generally. IMHO, I would not shoot Max once a day....I don't think you'd like the most probable results because you'd be filling his shed, draining his shed, filling, draining....every day. That's not the way this insulin works.

We all live in fear of hypos. If someone isn't afraid of a hypo, I would seriously worry about their cat. And you need to have a life and get some rest. I know it might be difficult, but if you could post regularly, and try to follow the protocol, then you might be able to see a difference in Max. In this forum, go to Jinx's condo and look at his SS and the progress he is making because Joe has been working hard to follow the protocol.

I'm not saying you should put him on 2.5u for the sitter. You need to see what he does on it the next six consecutive cycles as you are starting the cycle count over. Get some of those mid cycle day and night tests just so you can see where he is. PS and one test in the morning and the same at night. Then you can reassess and see where he is and if you should drop the dose for the sitter or not. If you get a number you think is too low to shoot, do not feed him, post, and ask for help to walk you through it. The lower you can gradually learn to safely shoot (again...above 50), the better he will do.

BCS doses are what you did last night...shooting a reduced dose. But a BCS dose often doesn't affect that cycle because of the cumulative nature of the insulin. It often affects subsequent ones.

Does that help? ;-)
 
It helps greatly. Thank you. I need to digest it all, and check out the SSs you mentioned, but I really appreciate your long, detailed post!
 
Marje's posts are wonderful! I hope that helps you with respect to dosing. There are only two things I would add.

First, with respect to a "breakthrough" dose. Mr. Kink's spreadsheet is a good example of a breakthrough. All of a sudden, everything goes green.

When you mentioned that at times, you feel like you're operating out of fear. We've all been there. For me, having a protocol that gave me a set of rules I could go back to was an enormous help. Having the people here was even better but having a set of guidelines I could follow along with people who could explain the rationale, took a great deal of the anxiety out of the equation. Let us know how we can help. I'd encourage you to read through the Tight Regulation Protocol or, if you prefer, the Start Low Go Slow approach. Which ever strategy you want to use, begin to work that dosing strategy consistently and evaluate the results. This will help you to understand how Lantus works and, more importantly, how Lantus works for Max.
 
Thank you, Sienne! It is nice to have another member second what the first one said so quickly. I'll look at both of those Stickies. I have been wondering if I might have to use TR for a while just to get him under control.

For everyone: Is it okay to give extra insulin to make up for the draining of the shed from BCS or when you reduce the dose and regret it? If so, how much extra per shot?
 
Dale

I wouldn't give him "extra" insulin. I'd just go back to shooting the dose you were shooting before you gave the BCS....I believe it was 2.5u.
 
Yes, it was 2.5, but only because I was trying out that dose for when the sitter comes. I was doing it early believing that I was probably overdosing him. She will be giving his AM shot on the 27th. If turns out to be that 2.75 is the best dose for him, I would rather not give him less than that until she is here. Or should I go ahead and do a trial of the 2.5? I know I won't want to let the sitter shoot 3.0. So, its going to have to be 2.5 or 2.0.
 
At your next regular shot time, I'd go back to 2.5u and let's see what he does for six consecutive cycles......unless he goes too low to actually shoot. Ok? If you'll check back in with us, we will be able to help you decide what to do with the petsitter there. :-D :-D

After you read everything, if you have any questions, please let us know.
 
Ok, thanks. I gave him 2.5 before I read this because of the timing of the shot getting later. So, we will have 6 consecutive cycles of 2.5 on the morning of the 25th. Have a good night, both of you.
 
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