9/17 need help with Toby's Dosing

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Peg and Toby

Peg and Toby

Member Since 2014
Don't understand He is a completly different cat this morning. He Posted hi today but legs act strong. Got me up at 4.30
wanting to go out in his pen. Jumped up on seat standing on back legs digging on window. Don't know how low he got last night. Thought he had been through enough yesterday so just checked on him in the night. Now I wish I would have checked him. Guess I'd better get some r insulin. To keep his numbers down will pick some up at wal-mart today. You said I don't need a perscription for this. Will have to know how much to give at a time. Will also check into ketone meter. Thanks for your information. Peg and Toby
 
Re: 9/17 Toby,s AMS=Hi

Hi Peg!

Can you make sure to grab a few tests for ketones today since Toby is so high?

Sandy mentioned the R insulin. We found it incredibly helpful with Cobb as well.

As for how much to give, we can't tell you exactly because we don't know how Toby will react to it. When you first start giving R, you don't want to give too much initially. Some cats it takes a drop or two for their BG to fall. Some cats it takes several units. You want to start with a small dose until you see how Toby reacts. Most people start with a drop -- but since Toby is dealing with moderate ketones, you might not start that small. I'll let Julie and Sandy speak to that, as I've never had to deal with ketones in Cobb.

Once you know how Toby reacts, you'll want to develop a R scale. The R scale sounds harder than it is. You'll be able to see how Toby reacts to the Lantus and R combined. The scale may change frequently or infrequently, depending on Toby's response to it. I've pretty much stuck to my scale, although I may change it on a whim depending on how Cobb's overall week is looking. Depending on what the BG is determines how much R Cobb gets. At one point I was shooting R 3x a day -- 2, sometimes 3 units. Since Toby is flirting with ketones, you might have to be more aggressive in your dosing, as long as you are around to monitor him. Again, I'll defer to Julie and Sandy on that.

R can be frustrating though. You can't always see that it is working. Sometimes R "works" by holding the BG steady instead of allowing it to climb higher. That happened several times with Cobb. If that happens, don't despair. It doesn't mean the insulin isn't "working." It just means the dose wasn't high enough to pull the BG down at that particular time.

You're going to have lots of questions about the R, and that's fine. We all did. Ask away! :smile:

~Suzanne
 
Re: 9/17 Toby,s AMS=Hi +5=385 +8=352

Went and got the R insulin when I got It home I opened it up and the top was full of air bubbles. I put it in the fridge like it said
didn't think I bounced it around that much. Will it be alright and settle down. Or did I ruin it? At plus eight Toby was 352.
will check again at preshot. The R insulin was $25.00 at Wal-Mart . Didn't get a ketone meter yet. Will keep monitoring with sticks until I do. Now tonight if Toby is high will someone tell me how to use it. Do I give it with the other insulin or do I give it
separately? How do we determine how much to give? I think He will be high because he was high at +8. Don't know if I should go up on my levermir dose or not if I am using this. Julie thought last night that I should go up another .25 . Do I still do that?
Full of Questions. Peg and Toby
 
Re: 9/17 Toby,s AMS=Hi +5=385 +8=352

Hi Peg,

What time do you shoot? There should be people here to help you figure out what to shoot. And yes, you can give it with the Lev and at the same time as an increase. The R is a short acting insulin. It is in and out of the body within about 4 hours. So how it works is...you shoot it with your Lev dose. The R works to bring the BG down over the course of a few hours. That way, when the Lev starts working, it is starting (theoretically) at a lower BG than the one the R started with. Does that make sense?

The R is pretty much indestructible. It's not fragile like the Lantus. I've left mine out of the refrigerator several times and it still works.

~Suzanne
 
Hi Peg, I'd hold this dose a bit yet. Unfortunately that fur shot messes with the cycle count. Here is a post on Counting Cycles. With blue nadirs, you want at least 6 cycles in a row of that dose before increasing.
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
Click to expand...
On the cycle where you did that fur shot, would it be possible to add something like FS or furshot to the Units column of Toby's spreadsheet? That way's it's immediately obvious when looking at the spreadsheet.

Suzanne can answer most of your questions on R. I didn't use it, there are a lot more people around now to help than when we started out. You usually shoot the R on the other side from the Levemir. One thing you might want to do today is take a used syringe and try practicing to see if you can get a one drop measurement consistently. Colored water or juice can help. I'll see if I can get additional experienced R folks to chime in.
 
R isn't as fragile as Lantus. I wouldn't worry about it having been bounced around.

Like Suzanne indicated, with R, you want to start low and go slow. It'a a very potent and short-acting type of insulin whereas Lantus is gentle and long-acting. Usually, most people start with 0.1u. You may want to practice drawing up that tiny amount with a used syringe and a colored liquid.

Once you give a dose of R, you'll want to run a curve. In other words you'll want to test every hour for the first 4 hours. (Four hours is about the active time of R.) This is important since you do NOT want the nadir from R and the nadir from Lev to overlap. This could result in Toby's numbers dropping into a range where you don't want them to be. Ideally, the R will pull down Toby's numbers and allow the Lev to grab on and bring them down even further.

I also agree with Wendy. I'd hold the current dose. I'll be interested to see where Toby's PMPS is given there was a good sized drop during the AM cycle.
 
I test at 6.00 am and 6.00 pm feed and give the shot about 6.15 to 6.20. Do I give both insulins in the same needle? Or two different ones. Don't know if I can Just do a drop. How can you just get one drop? Do you squirt it out on a plate or some thing
and then pick it up? Have a hard time to do .25 have to have magnifying glass to see that. Will test at 5.45 Tonight so you will have a chance to look at it before I give the shot. Peg and Toby
 
What time and time zone are you shooting tonight?

We usually start with the smallest dose of R. It might not do much, but it's safer to start there and work up.

You can measure out one drop of R by pushing in hard on the plunger of the syringe, inserting the needle into the insulin, and releasing the plunger. The vacuum created by pushing in the plunger will draw up one small drop. Can you practice doing that so you feel confident about it being one drop? Squirt it into the air to make sure you're drawing up some. Don't worry about wasting some - the stuff lasts forever and you aren't very likely to use up even one bottle.

It looks like his nadir is not before +6. R typically is gone by 4 hours after you gave the shot.

Choose a time that you'd like to give it, probably with a shot for the first time. You'll want to test him once an hour for the following 4 hours so we can see what it does. Let's make sure someone can check in with you for the 4 hours, however.

The next time you have an opportunity to try, if the 0.1u (one drop) didn't do much or anything, we'll try 0.25u. There are pictures of that dose on the New to the Group sticky.
 
hahaha i must take forever to post. Both Sienne and you, Peg, have posted since i started writing.

What time zone are you in?

edited to add: Nevermind - i see Maine. So 15 minutes from now? is that right? You're going to use 2 syringes.
 
ok - if you're up for once per hour testing for the next 4 hours, go ahead and prepare the second syringe with the one drop. i'm gonna guess this will be a non-event, but you never know. cats all have their own styles.

i can commit to being here to check in with you every hour for the next 4 hours. I'll check back with you in an hour.

Put this in his spreadsheet like this:

dose.........pmps +1

4.25u ........442 regular test data goes in each + column
0.1uR

Does that make sense?
 
If you put the 4.25u in the dose column, then give a couple of spaces, it will wrap around and go on the second line, but will still be in the same cell.
 
yay! yes, you got it! you want to take out one zero though - it's one tenth of a unit, not one 100th. so it would be 0.1R.

I'll be looking for you about :15 after each hour - is that about right?
 
Hi there :cool:

Glad to hear ketones are negative today :-D
Glad you got some R - for a kitty flirting with ketones is can be a literal life saver.

Below are some important basics of R use:

• you never want the nadirs of the basal and bolus insulin to coincide.

• you have to be very careful to not give R at a time in the cycle when the nadirs for R and lantus/levemir might overlap, OR when both insulins are working hard at the same time. if you have R pulling him down at the same time the lantus or levemir joins in and starts pulling down even harder, then you can get into a situation where it is hard to control the drop.

• Be very careful about using R for bounces; you have to catch it on the way up. If Tobey is coming out of a bounce when you shoot R you could be faced with a hard to control drop.

• start with a tiny dose of R. we suggest no more than 0.1 unit. it won't take long to find out if Toby requires more than 0.1u R.

• test every hour for the first 4 - 5 hours after giving R. you'll want to learn when onset and nadir occur as well as how much duration Toby gets from R. this data will will eventually help you develop a sliding scale for R (if necessary).

• all we're looking for is a drop of 50 - 100 points from a shot of R. anything more than that will usually set up a bounce... not what we want to happen.

Here is an example of tracking R curve on the ss:

and one method of documenting R doses:


Peg and Toby said:
Don't know how low he got last night.
Click to expand...
Since L dosing is based on nadir, it's very important to know how low a dose takes him. The goal is to find the L dose that will do the job.
 

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Do you think Its working he ate and it only went up 15 points? If you go 20% he may not have gone up at all right. Peg
 
It's hard to know. Often with this small of a dose you don't see much change. On the other hand, you never know so it's best to start low and work your way up.
 
I see your 357 at +5. It looks like the total is about 85 points down from his preshot! that's great. The Lev is probably just onsetting around now, so he may continue going down, but he's not dropping too fast, which is good.

from Sandy's post above:
all we're looking for is a drop of 50 - 100 points from a shot of R. anything more than that will usually set up a bounce... not what we want to happen.
Click to expand...

to have any response at all to 0.1u is great. And as Suzanne said, you may have kept him from going higher.

I can't stay with you tomorrow morning if you want to try a 0.25u dose, but perhaps someone else could. You could repeat the 0.1u if you're able to monitor again like you did tonight. I probably could again tomorrow night, though. You want to monitor hourly until you develop confidence in how he'll respond to it.

Another thing, too, is that i found that the following cycle showed the most effects from using R. When you start the L insulin from a lower blood sugar number, you can get a much better cycle. In other words, Lantus & Lev work best when they are shot into 200 or 100 instead of 400. They just aren't as effective at high numbers - but that is one of the qualities that makes it so great for lower numbers. It's a gentler insulin, compared to the older insulins, or an insulin like R.

This might've been too small of a dose to make much difference in tomorrow's cycle, but you never know. We'll find out tomorrow!

I'm off to my quilting group. Great job of checking in - thank you. See you tomorrow.
 
I have to be out for a few hours tomorrow during the day. So probably I shouldn't give again til tomorrow night right? Hope he's down in the morning. Thanks for all your help everyone don't know what i'd do with out you. Peg
 
Hi there :cool:

If you can swing it a PM +10 or +11 would be good.

It's not possible to know what may have been had you not shot the R. The important thing is that he floated both down and gently from PMPS to +4

Proceed with caution, one shot at a time. R is powerful stuff and that power can be seductive - take care not to fall into the 'see an ugly number and shoot it down' trap.
As important as it is to learn when to use R under the current circumstances, it's equally important to learn when not to use R.
It is a double edged sword.

On the topic of syringes -
When preparing syringes to shoot L and R at PS time your mind must be fully focused on what you are doing.

I had a system using sticky notes, which you can see on the counter behind BK:

For many months I prepared 3 syringes for each PS time - 2 for L (as his dose headed north of 10u fur shots became more frequent so I split the L dose into 2 syringes, which was more manageable for my shaky hands) and 1 for R. Each of those sticky notes had the insulin and the dose written on them and as I prepared the syringes I put them on the corresponding sticky 'placeholder'. That was my cross-check

The last thing you want is to be on autopilot or get distracted, accidentally pull 4.25u R and .01uL, only to realize it after you shoot.
And yes, it has happened here in LL, more than once.
 

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