6/30-shakes-AMPS 413
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Dyana
Member Since 2009
Good luck with the new dose.
Are you around to test today? Sometimes it takes a day or two for the new dose to take affect. So, it may be tomorrow, before you see some lower numbers, fingers crossed.
Here is your link to yesterday's thread: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=74059
btb for a few for me
Are you around to test today? Sometimes it takes a day or two for the new dose to take affect. So, it may be tomorrow, before you see some lower numbers, fingers crossed.
Here is your link to yesterday's thread: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=74059
btb for a few for me
Ann & Tess GA
Member Since 2010
Paws crossed that Shakespeare starts working this dose soon. Come on down, to the nice cool blues, OK?
dmartini4
Member Since 2010
Re: 6/30-shakes-AMPS 413 - +6=452
Hi Dyana
He isnot doing well,
I need to get his numbers down but it appears they keep going up
I KNOW I did not give a fur shot today an the other day
even though it looks like I did,
I always smell him all over to ensure that there was not a fur shot
he hasbeen kinda lethargic but I know that is because his sugars are so high
I updated his SS if anyone want to take a look
Thanks
Hi Dyana
He isnot doing well,
I need to get his numbers down but it appears they keep going up
I KNOW I did not give a fur shot today an the other day
even though it looks like I did,
I always smell him all over to ensure that there was not a fur shot
he hasbeen kinda lethargic but I know that is because his sugars are so high
I updated his SS if anyone want to take a look
Thanks
C
Carl & Polly & Bob (GA)
Hiya Denise!
I'm going to take a stab at this, and I am hoping that the good people who've been advising so far will make corrections to anything I say that isn't quite right, but here's my take on Shakes since you switched.
If I look back on his SS, it looks to me like the doses you were at the last time that Shakes really showed decent mid-cycle numbers on Prozinc were in the range of 3.5 to 4.0 units. I know that we thought at that time that he was bouncing a lot from the blues and occasional greens, so the consensus was for you to reduce the dose to make the bouncing go away. But as you reduced the dose, although some of the preshots were lower, he didn't get much of a "kick" from the lower doses during the cycles.
So, when you switched, you started at 1u, and that was somewhat based upon what your latest doses of Prozinc had been. But they weren't his last "good doses" of Prozinc. Just before you switched, Prozinc wasn't doing all that much for him on the lowered doses.
So, I think you probably started too low on Lev. Since then, you've followed the protocol, leaving the dose the same for a few days, then upped in logical increments just like you're supposed too. Still no great results, but you're doing what you are supposed to do. Shakes just hasn't reached his "breakthrough dose" yet. But he will.
In another thread, there has been discussion of a logical starting dose when switching from one insulin to another, and the figure I have seen is that the starting dose should be around 70% of what he had been getting.
Well, my theory with Shakes is that since the last "good" dose he seemed to have on Prozinc was in the 3.5 to 4.0 range, then 70% of that would put him in the 2.5 to 3.0 u range on Lev? So what I'm thinking is that you could be close to his "breakthrough dose" soon.
My other theory involves "patience pants". From what I have seen with the "L" insulins, it seems that the beans need to wear larger pairs of patience pants. (Not "larger" really so don't take that to mean anything, ladies! :lol
. What I mean is that with the L's, whether you are following the TR or the SLGS protocol, you need to "wait" longer than you do with a P insulin -
First you have the "shed" to consider, and waiting for it to be established.
Then you have generally a longer time frame for a dose to "settle".
Then the protocol states that you should wait for "X" number of days before making a dose adjustment.
Bounces can take longer to clear with L's than with P's.
So, it really requires that you be more patient, as hard as that is for you or anyone to do. Dose adjustments don't show results quickly like they often do with Prozinc. But that's why there are protocols to serve as guidelines for dosing. To me, that's the "bright side" in this. The protocols lay out the steps for you. Wait X days, and increase by X amount based on the data you collect. In a way, it is "easier" in the long run, because you don't have to spend as much time 2nd guessing your decisions. In a way, I think that is easier.
Bottom line, I think Shakes will eventually show improvement, but at a higher dose than he's been on so far. The hard part, for you, is being patient until that happens. But I think it will happen! So, "patience grasshopper"...
Carl
I'm going to take a stab at this, and I am hoping that the good people who've been advising so far will make corrections to anything I say that isn't quite right, but here's my take on Shakes since you switched.
If I look back on his SS, it looks to me like the doses you were at the last time that Shakes really showed decent mid-cycle numbers on Prozinc were in the range of 3.5 to 4.0 units. I know that we thought at that time that he was bouncing a lot from the blues and occasional greens, so the consensus was for you to reduce the dose to make the bouncing go away. But as you reduced the dose, although some of the preshots were lower, he didn't get much of a "kick" from the lower doses during the cycles.
So, when you switched, you started at 1u, and that was somewhat based upon what your latest doses of Prozinc had been. But they weren't his last "good doses" of Prozinc. Just before you switched, Prozinc wasn't doing all that much for him on the lowered doses.
So, I think you probably started too low on Lev. Since then, you've followed the protocol, leaving the dose the same for a few days, then upped in logical increments just like you're supposed too. Still no great results, but you're doing what you are supposed to do. Shakes just hasn't reached his "breakthrough dose" yet. But he will.
In another thread, there has been discussion of a logical starting dose when switching from one insulin to another, and the figure I have seen is that the starting dose should be around 70% of what he had been getting.
Well, my theory with Shakes is that since the last "good" dose he seemed to have on Prozinc was in the 3.5 to 4.0 range, then 70% of that would put him in the 2.5 to 3.0 u range on Lev? So what I'm thinking is that you could be close to his "breakthrough dose" soon.
My other theory involves "patience pants". From what I have seen with the "L" insulins, it seems that the beans need to wear larger pairs of patience pants. (Not "larger" really so don't take that to mean anything, ladies! :lol
. What I mean is that with the L's, whether you are following the TR or the SLGS protocol, you need to "wait" longer than you do with a P insulin - First you have the "shed" to consider, and waiting for it to be established.
Then you have generally a longer time frame for a dose to "settle".
Then the protocol states that you should wait for "X" number of days before making a dose adjustment.
Bounces can take longer to clear with L's than with P's.
So, it really requires that you be more patient, as hard as that is for you or anyone to do. Dose adjustments don't show results quickly like they often do with Prozinc. But that's why there are protocols to serve as guidelines for dosing. To me, that's the "bright side" in this. The protocols lay out the steps for you. Wait X days, and increase by X amount based on the data you collect. In a way, it is "easier" in the long run, because you don't have to spend as much time 2nd guessing your decisions. In a way, I think that is easier.
Bottom line, I think Shakes will eventually show improvement, but at a higher dose than he's been on so far. The hard part, for you, is being patient until that happens. But I think it will happen! So, "patience grasshopper"...
Carl
Dyana
Member Since 2009
Hi Denise,
One thing you want to keep on top of when you Shakes is in the higher numbers, and especially if he's acting lethargic, is to get ketone tests whenever you can. It's even more important should he become inappetant at all. Do you have the ketone test strips, and have you been testing for ketones?
I'm hoping you see some better numbers off of this latest dose increase tonight or sometime tomorrow.
Please keep letting us know how Shakes is feeling, (the five Ps: peeing pooping preening purring and playing) and hopefully soon, he will be back to feeling much better.
One thing you want to keep on top of when you Shakes is in the higher numbers, and especially if he's acting lethargic, is to get ketone tests whenever you can. It's even more important should he become inappetant at all. Do you have the ketone test strips, and have you been testing for ketones?
I'm hoping you see some better numbers off of this latest dose increase tonight or sometime tomorrow.
Please keep letting us know how Shakes is feeling, (the five Ps: peeing pooping preening purring and playing) and hopefully soon, he will be back to feeling much better.
Carl's point is very much on target. Starting back at 1.0u put you all the way back in the starting blocks. That would frustrate the heck out of me, as well.
There are a couple of options. If you look at the TR protocol closely, when a cat has a nadir that's above 300, you can either increase the dose by a larger amount (i.e., by 0.5u vs. 0.25u) or you can increase every 4 cycles (vs. every 6 cycles). However, and this is the crux of being aggressive, you need to be able to get tests in to insure that Shakes will be safe.
While you're seeing nadirs above 300, I'd encourage you to get ketone tests when you can. I'm not suspecting that anything is wrong -- its an 'ounce of prevention' sort of thing.
Hang in there, Denise.
There are a couple of options. If you look at the TR protocol closely, when a cat has a nadir that's above 300, you can either increase the dose by a larger amount (i.e., by 0.5u vs. 0.25u) or you can increase every 4 cycles (vs. every 6 cycles). However, and this is the crux of being aggressive, you need to be able to get tests in to insure that Shakes will be safe.
While you're seeing nadirs above 300, I'd encourage you to get ketone tests when you can. I'm not suspecting that anything is wrong -- its an 'ounce of prevention' sort of thing.
Hang in there, Denise.
(((Denise)))
I'm sorry Shakes isn't feeling well. You are doing a really good job of testing and I agree with Sienne that, if you can keep testing like this, I'd be more aggressive with his dosing in one of the two ways she has suggested.
And I also agree that Carl makes the great point that switching insulins is like starting over. It is. And I started her lower than the dose she was on with lantus when we switched. Jill told me that with switching insulins it could take weeks to see any progress and it did. If you have the time and the inclination, take a peek at Gracie's SS and you'll see I had to put on patience pants as well but we did get to a breakthrough dose for her. I also took her up pretty aggressively.
He'll get there. Levemir is a great insulin. We've all worn those darn patience pants....in fact, in lantus TR, we have the Sisterhood of the Travelling Patience Pants....we're with you!!!
I'm sorry Shakes isn't feeling well. You are doing a really good job of testing and I agree with Sienne that, if you can keep testing like this, I'd be more aggressive with his dosing in one of the two ways she has suggested.
And I also agree that Carl makes the great point that switching insulins is like starting over. It is. And I started her lower than the dose she was on with lantus when we switched. Jill told me that with switching insulins it could take weeks to see any progress and it did. If you have the time and the inclination, take a peek at Gracie's SS and you'll see I had to put on patience pants as well but we did get to a breakthrough dose for her. I also took her up pretty aggressively.
He'll get there. Levemir is a great insulin. We've all worn those darn patience pants....in fact, in lantus TR, we have the Sisterhood of the Travelling Patience Pants....we're with you!!!
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