8/8 Foster Bastian Curve Day

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Venita

Member Since 2009
Yesterday's Condo

I've got Sebastian Purrbox's spreadsheet link in my signature line now. I am going to curve him this am cycle.

AMPS 372 .75U Levemir
+1 391
+3 230 <---a new color!!
+5 167 <---yet another new color!!
+6 181 <---have we reached nadir?? Still to be seen, but I won't test again for 2 hours.
+8 353 <---yup, we reached nadir.
+12 PMPS 418 .75U

Bastian is an interesting cat. He seems detached at times, but he's just getting over the Bupe (pain med) he was getting for his extractions. I slept with him last night, and he was much more active in seeking affection from me. He slept on the bed, not under it as he did Wednesday night, the only other night I slept in his room so far.

Jim and I were wondering whether there might be something going on with his hearing because of his lack of response to us talking to him. However, he can clearly hear a spoon hit a cat food plate. He might just still be overwhelmed with the change in location from Stefani's. I also have to keep in mind that he is a 10YO cat, and he is going to be a little less active than my younger cats.

Libby and Carolyn, thanks for the comments yesterday. I was unsure about the amount of Clindamycin because Stefani brought me two bottles. 2 weeks sounds about right because it would take about that long to get through one bottle.

I worried quite a bit during the night about his duration. Tested him at +8 (4am) and found him higher than I would like (284). Hence the curve to see what kind of room I have. I also was thinking about doing a split shot. Is there anyone here currently doing that and, if so, who so I can check out how it's working for their cat? I don't know the details of the split shot method, but I know that way back, Cheri was using it on Patriot. Maybe she wrote it up as a case study on the wiki. I'll look.
 
Good luck with the curve Venita.


Not sure about split shot question, maybe someone else can shed some light on that.
 
Venita:

Do you have any other test info you can add to Bastian's SS? It's very hard to evaluate duration based on what's there.

In the time that I've been here, I don't know of anyone that has used a split shot. I tend to think you need to get this kitty well established on Lev and give it a fair chance to work before you decide that the protocol isn't applicable. This will take a matter of a few months not a few days. It's helpful to remember that this is a gentle, long-acting insulin. Lantus nor Lev need time to lower the overall cycle at which point it grabs on to lower numbers and flattens the cycle.
 
Sienne and Gabby said:
Venita:

Do you have any other test info you can add to Bastian's SS? It's very hard to evaluate duration based on what's there.
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No, not on Levemir. He was switched from Lantus to Lev on Wednesday evening. There are handwritten notes on his tests on Lantus, but they are not completely readable.
 
From Patriot's wiki case study---

Patriot was 4YO when DX diabetic. He was on PZI from 10/05 to 5/06. Put on Levemir 5/06, regulated 6/06, remission 7/06.

Levemir has a slow 3-4 hour onset. Patriot had a difficult time keeping duration. To combat this problem he began a split dose regimen. One half of his dose was given at preshot time and the other half was given 1 to 2 hours after preshot. TID was attempted when I had a week off and resulted in remission.

Patriot was also prone to a rebound reaction due to steep drops or normal non-diabetic numbers being reached. When his numbers were in the high 400's to 500's at preshot time, typically due to rebound or lack of duration, he might get a .1u or .2u dose of Humulin R to bring the number down in the first four hours before the Levemir kicked in. One goal was to get him in a 60 - 150 range so I could get his body used to normal numbers again in the hopes we could overcome the rebound tendency that is holding him back.
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Month 8: We are on Levemir, and Patriot's two big problem areas are still lack of duration and steep drops that incite a rebound response. We began using a split dose routine in an effort to extend duration and soften lows and it worked! Over this month glucose went to negative on the urine dipstick. By the end of the month Patriot was tightly regulated between 60 and 150.

Month 9: On July 6th, after six days of TID, the last two days of which the numbers were so low he had to go back to BID, Patriot received his last shot in the morning. He is off insulin but ranging a bit higher than I like so I don't know if the remission will stick. July 15th update: Still in remission and numbers are in 80's and lower.
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That's really remarkable! I was able to read Patriot's profile on the old Board. Incredible response to Lev. I can only imagine that the state of the knowledge about both Lantus and Lev for feline use was pretty much in it's infancy. How different was the dosing protocol then -- if there even was one -- from what it is now? I imagine that it was night and day. Four years in medicine/veterinary medicine is a lifetime! The Tight Regulation Protocol has even changed in the year or so since I've been on the Board.

There are certainly one or two people I can think of who are currently using TID dosing. I suspect you are familiar with Michelle and Doodle. It's my understanding that Jojo worked with Michelle to set up a TID schedule after they spent a long time trying to get Doodle regulated on BID dosing.

I can't think of anyone who has successfully used split dosing recently. My understanding is that with the longer acting types of insulin, it takes time to be able to use the overlap between doses to your advantage so you get the kind of duration you're looking for. No doubt, this is going to mean getting Bastian's dose into a range where he's responding well to the Lev.

I would think that given the success of Lev and Lantus, it may be worth giving the protocol a try for a few months in order to adequately evaluate whether it is working for Bastian. I know with Gabby (although she's on Lantus), I've worked with Jill to tweek dose and use food to manipulate her curve and we're finally seeing this work pay off in dividends. It's just taken time, persistence, and some thoughtful and creative use of the Tilly Protocol.
 
Hey Venita, wha' sup?

Wow, that little guy had some big changes in his life recently. New foster home, teeth extracted, A/B meds, babysitting at your home, new insulin. No wonder his numbers are a little wonky. I see that on day one of Lev @ 1 unit, he went really low. So you know he responds to Lev.

I bet if you give him some time to settle his bounce and the antibiotics and relax, you may see him level out some. Changing to a split dose pattern after so many other changes seems to me to be a little too much. I'd hazard a guess that he will do great with consistent dosing on a 12/12 schedule. So many kitties succeed with it and the ones that need a different plan are pretty rare. But honestly I think it is way to soon to say he needs something different.

Patience, grasshopper, hee, hee! I know with BigMac I didn't see pretty numbers right away. I certainly didn't see green on the first or second dose! I think you are ahead of the game for day 5 on Levemir. :lol:

Your curve results should be interesting today. Good luck!
 
what was Bastian's dose on Lantus, and how was he doing on it? And can you remind me how long he has been diabetic? I see 1.25 on the spreadsheet, was that his normal dose? I ask because he is probably just not up to his Lev dose yet, although it looks like he's doing great already so he might not need to go much higher. Most people would kill to be getting blue so early in the game! I think it is too early to say that he isn't getting enough duration. Lev has a cumulative effect, and it hasn't really had enough time to build up in his system yet. His duration will improve the more time he spends on Lev, and the closer he gets to his good dose.

There are a lot of good signs here. He has already had some green. His bounce from the 41 only lasted two cycles, even with two delayed shots and a reduced dose. He hit blue from the 400's. He just needs some time to settle the bounces down. His numbers are actually pretty low for just having had major surgery and still being on antibiotics. I would hold the course, honestly, obviously I don't have a crystal ball but there is a LOT of promise just in the little bit of data we have here. Try following the protocol to the letter, and giving shots as close to +12 as possible. I think it will pay off.
 
Libby and Lucy said:
what was Bastian's dose on Lantus, and how was he doing on it? And can you remind me how long he has been diabetic? I see 1.25 on the spreadsheet, was that his normal dose? I ask because he is probably just not up to his Lev dose yet, although it looks like he's doing great already so he might not need to go much higher. Most people would kill to be getting blue so early in the game! I think it is too early to say that he isn't getting enough duration. Lev has a cumulative effect, and it hasn't really had enough time to build up in his system yet. His duration will improve the more time he spends on Lev, and the closer he gets to his good dose.

There are a lot of good signs here. He has already had some green. His bounce from the 41 only lasted two cycles, even with two delayed shots and a reduced dose. He hit blue from the 400's. He just needs some time to settle the bounces down. His numbers are actually pretty low for just having had major surgery and still being on antibiotics. I would hold the course, honestly, obviously I don't have a crystal ball but there is a LOT of promise just in the little bit of data we have here. Try following the protocol to the letter, and giving shots as close to +12 as possible. I think it will pay off.
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"Normal" dose on Lantus? Maybe 1U. As I said before, the handwritten records are tough to interpret. But he was getting lower numbers, for sure. But still bouncy. Here's a day where he had alot of tests, 7/18/10.

AMPS 159 +1U
+8 94
+10 76
+11 81
+16 PMPS 359 +1U
+6 39
+7.5 63
+9 AMPS 428 1U

Pretty classic pattern, huh? Great AMPS. Went too long to the PM shot. (You have to understand the Stefani is dealing with her Mom's recent breast cancer DX right now.) Went too low and bounced hard.

Bastian was DX diabetic in July 2009. He was never taken back to the vet after his DX. He was put on N. No home testing. His owner surrendered him to the shelter in June 2010. The rescue pulled him very quickly, and he came to Stefani on 4U of N BID.

The night I got him and started him on Lev, 1U, PMPS of 338 and he hit 35 at +6. (I thought, man, how could I kill Stefani's foster cat on the first night?) I backed off the dose immediately. Seems like maybe he was just overreacting to the stresses of the dental and trip. Maybe 1U is a better place for him to be. I won't be changing the dose tonight because I don't like having to stay up worrying about a hypo cat. I will think about sneaking up to 1U in the morning.

I won't be delaying Bastian's shots anymore to get him on a better cycle. He's at 8:30 now, which works out well for both of us.
 
FWIW, there have been several cats who have switched from Lantus to Lev over the past several months. We've suggested cutting the Lev dose by about 305 at the outset because some have dropped low in the first or second cycle. The dose usually has to come back up but that first day can be, ummmm....., exciting.
 
We've suggested cutting the Lev dose by about 305 at the outset because some have dropped low in the first or second cycle.
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Little typo in the above note. I believe she meant to type 30%.     :-D  Slippery shift key.
 
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