9/18 Toby's PMS 449 +2=404+3=337+7=399

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Peg and Toby

Peg and Toby

Member Since 2014
Toby' is 381 this morning high but a lot better than hi. I am going to be out part of the day so dh will be checking on him. He
does.t do bg checks or give any shots yet. He can make sure he's alright . He knows what to do in a hypo and he can call me home if needed. Toby seems to be fine this morning out in his pen bird watching. It's a little cool here this morning but I guess
he doesn't care. Peg and Toby
 
Re: 9/18 Toby's AMS 381

A much better AMPS, Charlie! And no ketones?? Even better!!!

The 381 is a high enough number that I would feel comfortable leaving my cat by himself without any supervision. Heck, I had to leave Cobb at 106 this morning. But it's great that your DH knows what to look out for -- symptom-wise. Matt (my DH) can test and shoot Cobb, but he doesn't like doing it. He used to do it under great protest. Now he just sighs and grabs the glucometer. Cobb doesn't cooperate as much for him as he does for me. But it's always good to have another person who can do it so you can get a break if you need it.

Enjoy the day pass that Toby has given you! :lol:

~Suzanne
 
Re: 9/18 Toby's PMS 449 Need help dosing

Toby's back up to 449 again tonight . Do I give the R insulin again? How much would you give tonight ? last night with a drop he went down 85 points. Do I give the same amount or more. Will give shot at 6.15 Pm. Peg and Toby
 
Re: 9/18 Toby's AMS 381

Another cheer for neg ketones!! :-D

Here is the link to yesteday's condo where you first used R. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=125443 It's helpful to add a link to the last post so people can follow what was recommended before.

It took me quite a while to convince DH to test. He would shoot from the early days but for some reason was reluctant to test. No problem now and it sure does provide me ease of mind. For what it's worth, Neko got her first below 50 number when she started the day out at 412 and once got a reduction starting at 455. :shock: I've seen kitties get reductions starting in the blacks. As for hypo symptoms, they don't always show them. Neko's been in the 30's a few times and didn't look any different.
 
Re: 9/18 Toby's PMS 449 Need help dosing

Didn't know what to do so I did the same thing I did last night . 4.25 units levermir and 0.1 r insulin. Will have to test to see how we do. Last night I tested for first four hours. See how it goes. Peg and Toby
 
Re: 9/18 Toby's PMS 449 Need help dosing

That's a good plan, Peg. I'm running out right now but will be back within a couple of hours and will look in on you.
 
Re: 9/18 Toby's PMS 449 Need help dosing

Hi Peg

I'm just getting caught up after a trip and see you started using R with the levemir. I've used R and levemir with Gracie for about 1.5 years now but I do use it sporadically because she doesn't need it that often. And that is a really important point I'd like to mention. If a cat is not a high dose cat (e.g. IAA or acro) or doesn't have DKA, if you are having to use R a lot, then the basal insulin dose needs to be increased. I know Toby has thrown ketones and thats a big concern. But what I'd like to see, and I do think the other ladies will agree with me, is staying on top of his dose increases of the levemir and judicious use of R.

One of the things that some of us have noticed with shooting R is that you might see a little more action the cycle after you use it. So I not only watch Gracie closely the cycle I use it but the one after as well. If you are using it to stop the bounce before it gets out of hand (in other words, use it as the bounce starts to curb it), then you can get varying results from it just flattening out the BG and the bounce stops to a quick drop. If you get a drop, then the lev takes hold, it's like the R has opened a door and the lev grabs that opportunity to do it's thing. I have concerns that there were no tests today at all because Toby could possibly have come down and then shot right back up. I've seen it happen; in fact, I've had it happen and if I didn't have those mid cycle tests....or some tests during the day, I wouldn't have known the numbers got low and then went right back up.

The other thing that concerns me with someone new using levemir and R is that you don't know his patterns yet. Although today might not be a good example, let me try and explain the scenario of a high before a break. Let's look at Toby's SS on 9/9 where he got into blue on the PM cycle. He wasn't used to blue and so he bounced the entire day on 9/10 and the night of 9/10, it looked like he might be coming down a bit. But then his AMPS on 9/11 was 361. And by +6, he was in green. That 361 was the high before the break. I know you weren't shooting R yet but if you had shot R that morning, you'd had an ugly cycle on your hands. So you have to be able to know when it's really safe to shoot the R and know it is not a high before a break. If you look on Gracie's SS on 9/4, I thought she was starting a bounce at PMPS so I shot one drop of R and she came right back down on me. And I'm an experienced R user. I encourage you to study her SS because you can see how careful one has to be with using R. I know Gracie's patterns but even she will occasionally throw me a curve with the R. The important thing is to test, test, test when you are using R that cycle and the next. I always test past R+4 when she's coming down because Gracie rarely even gets into pink so there is a lot of opportunity for her to keep coming down lower. For Toby being at 357 at +4, there was no reason for you to test after R+4. But because levemir nadirs later in the cycle, I probably would have checked him at +10 just to see what the effect was.

I don't want to come across as discouraging because R and levemir can be a great combo. But I'm worried you started using R without really understanding his levemir patterns. No member should use R (unless it is for treating DKA) until they know their cat's onset, nadir, and duration.
 
Re: 9/18 Toby's PMS 449 Need help dosing

I'll admit I don't know what I'm doing. Just went on the advise of other members. They said where he had ketones I should try
and get his bg down so he wouldn't get DKA . Do you think I should increase the levermir? He has been neg. on the ketones .
Getting kind of discouraged because I don't know what to do. Seems like this is a complicated insulin. His + 2 tonight is 404
about the same as last night. waited to test + 2 because His ears are getting sore. Peg and Toby
 
Re: 9/18 Toby's PMS 449 Need help dosing

I don't think Marje meant to discourage you. She, like everyone here, just wants to keep Toby safe! This is such a frustrating dance. So much to learn in such a short time. We've all been there so we understand how you feel! Hang in there!
 
Re: 9/18 Toby's PMS 449 +2=404+3=337

Suzanne is right. I'm not trying to discourage you. I just want you to use caution and really be sure you understand the action of the two insulins you are using separately and in combo. That's why we are here.....to help you learn it.

I'm not saying the advice to use R to fight the high numbers because of the ketones was not good advice. It came from very experienced members that I trust very, very much. But if you are going to use it, we have to get you up to speed on what you should be looking for on a levemir and R curve.

For example, his +2 is likely high because the levemir usually nadirs anywhere from +8 to +12, typically. And then, typically, it doesn't onset until +4. So you have that space in time where, if the dose isn't enough, you have no duration. Two pluses of these depot insulins are:

Carryover - insulin effects lasting past the insulin's official duration
Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Click to expand...

They sound somewhat alike but they aren't. So if the depot is not quite full enough, you won't get any carryover and lack of duration will result in no overlap. It's those two things which give those nice, long, flat curves we see.

My post is just to keep him safe and encourage you to learn as much as you can as quickly as you can. Suzanne had to do it and it is doable and we are happy to teach. :-D :-D :-D

And, yes. If he does not come down into blue tonight or by AMPS tomorrow, I would increase his dose. I'd like to see what he does tonight and then I can give you an idea of how much if he stays high. I know his ears are sore but a +4/+5 would be helpful because the lev should be onsetting.
 
Re: 9/18 Toby's PMS 449 +2=404+3=337

i'll just add that i appreciate Marje's experience and advice on the R/Lev usage. She's bringing up some really good points - the concern for ketones pushed us to move quickly, but perhaps it's now time to slow down so we don't cause a problem.

the beauty of this forum is that we have many experienced people with different experiences to bring to the table, especially when it comes to helping a kitty that's having a difficult time. It's all about the cat. cat_pet_icon
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

So at +4 he's 339. So when should I test again? Marg said +5 and + 10 right ? Will try and get more tests tonight. Now has the R insulin stopped working ? It's been four hours. Peg and Toby
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

it won't always be this rough! :sad: once you've learned what his patterns and responses are, then things become predictable and you can let up some.

sleep well!
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

His +5 is 393 why is it going up so soon. does that mean the Levermir isn't working? The R insulin must be wearing off. So if he doesn't see blue tonight I will do an increase? Do I do this in the morning or wait until tomorrow night? If in the morning will you post the increase. Well off to bed been a long day. Thanks everyone. Peg and Toby
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

No but I think it means he doesn't have enough levemir.

Normally, I would say to raise him by 0.5u in the morning if he doesn't come down into yellow. But I'm not sure if his nadirs were in the 300s today or 200s. If he got I to the 200s, we'd probably want to only increase by 0.25u.

Since you are headed to bed for a well deserved sleep, we will discuss and leave you a post on what you should shoot in the morning. Rest well. :-D
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

Different cats have different responses to the insulin - it's possible he has a later onset on the Lev than +4. Yes, it looks like the R has worn off. If he has a later onset, that might explain why he rose a little bit just now - the R has worn off and the Lev hasn't kicked in yet.
 
Re: 9/18 Toby's PMS 449 +2=404+3=337+4=339

Hi there :cool:

Peg and Toby said:
I'll admit I don't know what I'm doing. Just went on the advise of other members. They said where he had ketones I should try
and get his bg down so he wouldn't get DKA . Do you think I should increase the levermir? He has been neg. on the ketones .
Getting kind of discouraged because I don't know what to do.
Click to expand...
Being that I'm a night owl (borderline vampire hours truthfully) and I'm not sure if each morning you check for late posts from the previous day, I'm going to copy the recommendation I make regarding your use of R for Toby -

From Tobys 09/16 condo:

Hi there :cool:

I want to make sure you understand what I see as the best use of R for Tobys circumstances at this point in time:

Sandy and Black Kitty said:
It's a tool you should add to your arsenal. We can guide you on how to safely use it.
Fur shots happen but for a kitty battling ketones they can tip the scales in the wrong direction. A bottle of R in the fridge can help reduce the fallout from a fur shot and get a ketone prone kitty safely to the next L shot time.
Click to expand...
After the furshot last night a shot or two of R over the course of the PM cycle could have kept Toby out of the "HI" zone.

You never know when a furshot will happen - I've given plenty - even back to back :roll:
For a kitty that is not flirting with ketones a furshots impact is usually sorted out in the next couple cycles I'd say don't worry, it's just one shot, he'll get back on track.

However Toby is flirting with ketones and a fushot could put him at risk.

If you can manage the cost, it's well worth it just for your peace of mind
Think of it as insurance - you may never use it but it's a good thing to have - just in case.
A $35 investment just may save you a (potential $2k) visit to the ER. (I've been there - twice)
Click to expand...

And from Tobys 09/17 condo:
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.
Click to expand...

As long as you test frequently for ketones and the results are negative, If you give a furshot - use R for that cycle only.
Otherwise - forget you have the R. No need to complicate things (goodness knows it all complicated enough)

Raise your Lev dose accoring to the protocol. The goal is to arrive at an L dose that does the trick - while keeping the ketones away :cool:
 
We must have all been posting at once . Before I got done posting I had two more posts in. Repost Toby's +7 bg is 399 Peg
 
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