7/6 Boo Radley

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Jessica & Boo Radley

Jessica & Boo Radley

Member Since 2011
A lot going on here over the past few days. We started a cycle of Clavamox last Sunday for a suspected UTI. Boo wasn't eating - which is wildly uncharacteristic for him. He had mild leukocytosis on the urine strip, enough for the Vet and I to warrant AB therapy (he is FIV positive and has a hx of UTI's and DKA). So....since I have been stalking the LB and monitoring vigilantly for ketones and have had Trace readings for past few days. I have increased fluids, increased food and used R on the 4th. The strip is looking lighter and lighter on each test, so I'm feeling optimistic that we're on top of this. Since beginning AB therapy, Boo's been back to his old self, eating, playing (biting :cool: :cool: ), etc.

In lieu of all of this, it may be the "wrong time" to consider dose changes....but it looks to be that I should revisit that idea of his dose being somewhere between 1.0 and 1.25. It doesn't look like he needs an increase per say , because he's getting some good numbers mixed in there, it's just the repeated preshots in the pink and red. I'd love to hear your thoughts!

I'm working the next few days, so let me say thank you in advance for the advice!
 
It does seem Boo has a steep dip into the blues mostly- at least a 300pt drop to a nice nadir- the other side is to keep the PS looking decent, too.

Maybe increase by .25u to a 1.5u dose for a week to see how that effects the ends? Even though Lev is supposed to be dosed on the nadir and they look nice- his total BG needs to be under the renal thresh-hold and currently it isn't. And he's got some wild swings if he goes down 300+pts in a cycle.

We've got to keep in mind that when he hits the greens his body dumps in glucose to raise him, so that could also be why he has the reds for a cycle or three afterwards. I don't see anything that looks like an inverse curve to show that Boo is getting too much insulin but others can look at it and see and chime in.
 
Jessica & Boo Radley said:
A lot going on here over the past few days. We started a cycle of Clavamox last Sunday for a suspected UTI. Boo wasn't eating - which is wildly uncharacteristic for him. He had mild leukocytosis on the urine strip, enough for the Vet and I to warrant AB therapy (he is FIV positive and has a hx of UTI's and DKA). So....since I have been stalking the LB and monitoring vigilantly for ketones and have had Trace readings for past few days. I have increased fluids, increased food and used R on the 4th. The strip is looking lighter and lighter on each test, so I'm feeling optimistic that we're on top of this. Since beginning AB therapy, Boo's been back to his old self, eating, playing (biting :cool: :cool: ), etc.

In lieu of all of this, it may be the "wrong time" to consider dose changes....but it looks to be that I should revisit that idea of his dose being somewhere between 1.0 and 1.25. It doesn't look like he needs an increase per say , because he's getting some good numbers mixed in there, it's just the repeated preshots in the pink and red. I'd love to hear your thoughts!
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Great job staying on top of thedose, the ketones and UTIs! Sounds like you're doing exceptionally well!

I understand your concern about the preshots. I'm still not completely clear on what's desirable for the curve in Lev. I mean, I know what I've been told, I know what I've seen, but yesterday, Dr. Timian from CSU e-mailed that she had checked out Grayson's SS, and that his curves looked good. Now, don't get me wrong, compared to his 50-100 point range in ProZinc, seeing a 200+ point movement is better than great! ... but he is still getting some red preshots too... and this didn't seem like a concern for her. Meanwhile I interpret that the curve in Lev is not "gentler" as I expected... but then again, after only 5 weeks on Lev, he's not built up the resistance that he had done w/ ProZinc. Some things, I guess, only time will tell.
 
hmjohnston said:
We've got to keep in mind that when he hits the greens his body dumps in glucose to raise him, so that could also be why he has the reds for a cycle or three afterwards. I don't see anything that looks like an inverse curve to show that Boo is getting too much insulin but others can look at it and see and chime in.
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Coming from Tight Regulation, my mindset always was more insulin, more insulin, more insulin and those bounces were just that, bounces that would clear in a few days and could be combatted with more insulin. The increases eventually lead to a toppling down the dosing ladder because the high doses of insulin, eventually won out over the body's defensive response.

With the Levemir "mindset", it makes sense to me that that those high preshot numbers are a result of what Boo's body is viewing as too low during the day, so naturally a decrease of some sort, would make sense.

I don't think we've ever been in a place where we've had good preshot numbers. They've almost always been above the renal threshold and it hasn't matter if we were on 3.5 units or 1.25 units. The interesting thing is is that on either dose, we can get greens and blues, but we also get steep drops. The lower dose seems to hold the good numbers longer and the higher dose seems to hold the bounce longer.

Still not so sure what to do :oops: :oops: I begin to question whether what I "see" is the right move!

Lu - Thanks for the info on your vet.....maybe our guys just need a little more time to settle? I do think my curve on Levemir is much gentler than it was on Lantus - we're still dropping, but he can hold it much better and for much longer. We used to hit a 50 and within 10 minutes he was climbing and generally didn't stop for days!
 
Jessica & Boo Radley said:
...Still not so sure what to do :oops: :oops: I begin to question whether what I "see" is the right move!

Lu - Thanks for the info on your vet.....maybe our guys just need a little more time to settle? I do think my curve on Levemir is much gentler than it was on Lantus - we're still dropping, but he can hold it much better and for much longer. We used to hit a 50 and within 10 minutes he was climbing and generally didn't stop for days!
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Those greens on 1.25 are less severe. So my hunch would be to hold 1.25 for perhaps much longer, but I'd like to see an expert weigh in on that. :-D

Just seems like with ketones possibly on the doorstep is not the time to go down... unless of course the *bounce* is contributing to those? What happens if you bump it with a much smaller dose of R? Just bump it to pink?

If you want to see confusing take a look at this. Still on Lantus for the time being, and still on the low dose of clavamox. That is 21 days at that dose. I believe in Chip's case it must be too high since the pattern seems to repeat. At least his bouncing appears to be settling down some (anti-jinx) and we hope to start Detemir as early as next week.

That will be 0.5 units, hold as long as possible initially.
 
Dale 'n' Chip said:
Just seems like with ketones possibly on the doorstep is not the time to go down... unless of course the *bounce* is contributing to those? What happens if you bump it with a much smaller dose of R? Just bump it to pink?

If you want to see confusing take a look at this. Still on Lantus for the time being, and still on the low dose of clavamox. That is 21 days at that dose. I believe in Chip's case it must be too high since the pattern seems to repeat. At least his bouncing appears to be settling down some (anti-jinx) and we hope to start Detemir as early as next week.

That will be 0.5 units, hold as long as possible initially.
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Wow does your spreadsheet on Lantus look a lot like how mine looked . I'd get a big drop again followed by days of highs. Here's hoping Levemir will bring you some smoother, longer, better days ;-) ;-)

I'm in agreement with not reducing right now, especially with an active infection. Holding the dose longer probably makes even more sense in light of this as I can't be confident that his numbers for the past week aren't being influenced by whatever is going on systemically.
 
One of the things I've been told, is that the preshots are not as important in the L's. Dosing is based on nadirs... but ultimately, with any insulin, the length of time spent below the renal threshold is more important. So if the preshots are red, but they get and surf at reasonable numbers for, say, 5 hours... that's a good run.

I know it's a totally different ballgame for Acros, but when I FINALLY got below the renal threshold - even for just one cycle - I was ecstatic!!! Now I'm starting to expect it!!!
 
Grayson & Lu said:
One of the things I've been told, is that the preshots are not as important in the L's. Dosing is based on nadirs... but ultimately, with any insulin, the length of time spent below the renal threshold is more important. So if the preshots are red, but they get and surf at reasonable numbers for, say, 5 hours... that's a good run.

I know it's a totally different ballgame for Acros, but when I FINALLY got below the renal threshold - even for just one cycle - I was ecstatic!!! Now I'm starting to expect it!!!
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Lu - that's an excellent point that I think is often overlooked! Thanks for the reminder - sometimes it's the simple things that make the light bulb go on ;-) ;-)

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I generally think that bounces are due to too much insulin - even if it's only .1u too much. But for now, with his trace ketones, I would hold the dose and see if he can even things out. I know you have been at 1.25u for a while, but those nadirs and the surf time are good -and what matters most.
 
Dale 'n' Chip said:
... but I'd like to see an expert weigh in on that. :-D
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Dale, let's not use the term "expert" as none of us are vets and we don't want liabilities for Rebecca. "Those with more experience" works just fine and is a "safer" term. OK?
 
Sheila & Beau & Jeddie (GA) said:
...OK?
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Absolutely.

That was worded poorly. I really didn't mean to point the finger at anyone in particular. Just wanted to make sure the finger wasn't pointing at me. :mrgreen:
 
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