9/22 Martha 144
- Thread starter Hosanna
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rhiannon and shadow (GA)
Member Since 2012
I can understand that.
Are you home today or working?
Nice start for Martha.
Are you testing again soon to see where she is at?
Happy Caturday!!
Are you home today or working?
Nice start for Martha.
Are you testing again soon to see where she is at?
Happy Caturday!!
Morning!
This would have been a safe number to shoot the full dose if you were going to be able to even grab a +2 and midcycle test. Because of the cumulative nature of lantus where one dose builds upon the preceding dose, her cycle is most likely going to play out the same way as if you had shot the full dose. You will see the effects of the BCS on a later cycle.
If you can post when you get a number like this, we can walk you through it. Martha is starting to look really good and she is not a diver which is great. The other thing is lantus responds best to consistency so you want to have a dose you can shoot safely twice a day...the same dose. Smoke of her wonkiness is probably due to all the different doses she's received lately.
There is a link to dealing with low preshots in my signature block...it would be a good one to print and have handy.
And please get a +2 and post
if her +2 is much lower than her PS, you have a very active cycle coming your way.
Have a great day.
This would have been a safe number to shoot the full dose if you were going to be able to even grab a +2 and midcycle test. Because of the cumulative nature of lantus where one dose builds upon the preceding dose, her cycle is most likely going to play out the same way as if you had shot the full dose. You will see the effects of the BCS on a later cycle.
If you can post when you get a number like this, we can walk you through it. Martha is starting to look really good and she is not a diver which is great. The other thing is lantus responds best to consistency so you want to have a dose you can shoot safely twice a day...the same dose. Smoke of her wonkiness is probably due to all the different doses she's received lately.
There is a link to dealing with low preshots in my signature block...it would be a good one to print and have handy.
And please get a +2 and post
if her +2 is much lower than her PS, you have a very active cycle coming your way.Have a great day.
Angela & Blackie & 3 Others
Member Since 2010
I have to agree with Marje. It is best to have the same consistent amount of insulin for a period of time before the next increase or decrease is suggested. You'll see better results that way over time, and providing you'll be home time to test, too with each new dose.
Remember how I pointed out that what can appear to be a difference in numbers really isn't due to meter variance? You shot your full dose with a pre-shot of 166. If you add 20% (i.e., 28 points) to your pre-shot test from this morning, you would have a number very close to the 166 you comfortably shot.
If your goal is to get Martha into remission or more tightly regulated, it helps to get more comfortable with shooting progressively lower numbers.
If your goal is to get Martha into remission or more tightly regulated, it helps to get more comfortable with shooting progressively lower numbers.
Hosanna
Member Since 2012
I realize I'm dense, but I just can't figure this out about the 20%--because it could also be 20% the other way, down.
Too, I have noticed some people shoot when the number is below normal. That would scare me to death and I just can't fathom the reason for it. I'm not questioning you guys, just these principles. Hope that makes sense?
Too, I have noticed some people shoot when the number is below normal. That would scare me to death and I just can't fathom the reason for it. I'm not questioning you guys, just these principles. Hope that makes sense?
You're correct -- the 20% is a range and it goes in both directions.
The reason is that the insulin is doing the job we want it to do. The entire purpose of giving insulin is to get your cat to spend as much time as possible in normal numbers. If you don't shoot, number go up. Take a look at Jean Luc's SS. On the evening of 9/20, Shannan skipped Jean Luc's shot. You can see what happened to his numbers. Take a look at at Rhiannon's Shadow's SS. Rhiannon has been shooting low for quite some time. Shadow's numbers are beautiful. That's what we're aiming for. And finally, if you look at Dale and Max's SS, you'll see that Max hit a good dose and his numbers snapped into place. Dale then was reducing the dose and Max is now on an OTJ trial.
I'd pose a question: Why do you think the cat is in normal numbers?Hosanna said:
The reason is that the insulin is doing the job we want it to do. The entire purpose of giving insulin is to get your cat to spend as much time as possible in normal numbers. If you don't shoot, number go up. Take a look at Jean Luc's SS. On the evening of 9/20, Shannan skipped Jean Luc's shot. You can see what happened to his numbers. Take a look at at Rhiannon's Shadow's SS. Rhiannon has been shooting low for quite some time. Shadow's numbers are beautiful. That's what we're aiming for. And finally, if you look at Dale and Max's SS, you'll see that Max hit a good dose and his numbers snapped into place. Dale then was reducing the dose and Max is now on an OTJ trial.
C
Carl & Polly & Bob (GA)
Hi Hosana,
I'll try not to be too long-winded, but that's almost impossible for me :lol:
1 - The inconsistency of the doses. "Typical" only happens when things are kept constant as much as possible. When you really think about it, there are only two things that you have control over in this dance. One is the amount and timing of food you give her. The other is the amount of insulin you give her. Beyond that, there's all sorts of things that her body is going to do with those two once you add them to her system. Those things, for the most part, you have no control over. When you alter the doses, you are affecting one of the "constants" and turning it into a variable. So that affects the "insulin depot" that Lantus works by, and keeps things in flux, so your curves will look atypical.
2 - You can see in the "typical curve" description that +3 is normally when the onset of Lantus will occur. It could be that the onset is just not happening at the exact same time each day. That isn't really surprising. The timing of things, like onset, nadir, etc can change even when all things remain constant. Just because they're cats ;-) But seriously, just "because". They are living organisms, nothing is precisely constant. Like I said, you have very little control over anything "internal" once you put the food and the insulin "in".
It wasn't until I "learned" by reading and asking lots of questions of long-time Lantus users that I was able to wrap my head around the "shoot low to stay low" concept. I think that the only way to "get it" is to watch it happen. When someone is just staring out with Lantus, they will see curves that look like the "typical curve". And they will see preshot numbers that are pink or red, and they'll see nadirs that are yellow, blue or green. A "smiley shape" curve. And they will be advised to not shoot lower than 200 preshot numbers until they are "data ready". You have to be able to see and know what a dose does, and that will give you the confidence to start giving shots when you see lower preshot numbers. While you are getting to that point, the Lantus has begun to work the way it is supposed to work with your cat. The curves have begun to start to lose that "smiley" shape, and will have become more "flat". Because that is the way the insulin works. It is supposed to work 24 hours a day, and it is supposed to make the BG numbers more consistent. It has stopped acting like an "if this, then that" insulin, less like a "drug" as we understand medicine.
The best thing to look at is the spreadsheets of people who are either going through OTJ trials, or soon will be. Here are a couple of great examples -
Dale's boy Max:
https://docs.google.com/spreadsheet/pub?key=0AorpXuifiGH7dGdENnVhTXp0UFNYTUsxa1hMUWs0bGc&output=html
And Anne's Muffin:
https://spreadsheets.google.com/pub?key=0Aj2DL9Xz4IstdENaYld0T0xYN2JUQzRDanh4aXJqb1E&output=html
Both kitties are currently going through "OTJ Trials". If you look at them, you can see the progression. The old data will show you every color of the "SS Rainbow". Scroll down, and you will see the gradual improvement, and the lower you go, the more you will see them shooting "normal" doses into "normal numbers". You'll see the curves become flat, and even when they shoot what you and I would consider "scary amounts" of insulin into "scary low numbers", you will see how the kitties responded to them. You will see some numbers that would shock you, like 30s and 40s, and you'll see what they did to raise those numbers up into the 50s and 60s by using food to do it, and keep the kitties safe from hypos. But the closer you get to the bottom, the less difference you will see between the preshot numbers and the nadir numbers. That's because the doses are lower (but kept constant from cycle to cycle), and because the insulin was working exactly the way it was supposed to. Flat cycles and gradually lower numbers.
There are three things going on there -
1 - the cats are responding to the insulin and the way it is designed to work.
2 - the caregivers are confident in doing what they are doing, because they have mountains of data to back them up.
3 - As each one of the "scary" things happened, they have gotten overwhelming amounts of help and advice and hand-holding from the amazing people who are on this board around the clock - those who know how this works, and have "been there, done that"
Lastly, "meter variance".
What Sienne was pointing out is the similarity between the two numbers. On the 166, you shot a full dose. On the 144, you shot a significantly lower dose. But the numbers are pretty much the same. Only 22 points apart. These meters we use, let's face it... they aren't laboratory instruments. Some of them cost less than $10 to buy, and probably cost $3 to manufacture. What they are is a tool so that people can monitor their blood glucose at home, and use insulin safely. The FDA allows them to only be accurate within 20%, sort of "close enough for government work" We have found them to be a priceless tool in managing feline diabetes safely. But we also all understand that they are "close enough", not exactly right. We manage the disease, and the daily numbers we collect, not so much to know exactly what kitty's BG is, but to measure and record the "trends" on a day-to-day basis. Fortunately, what we believe to be true is that the lower the numbers, the more accurate the meters are. So when we get down to numbers in the 50s, 40s, or even 30s, we take what we get on the meter as "right on the money", and we act accordingly to ensure the safety of our kitties. That 42 somebody sees is "right", and we feed them LC or HC food to get them up to the safer 50-70 range and keep them there as long as possible, because the longer the lower numbers are there, the more kitty is healing. Where we emphasize the "20% factor" is when we look at the higher values, when we are looking at the "trends". If Kitty is at 250 at preshot one day, and 220 the next preshot, that's not really that much of a difference. You're going to dose the same on either number, and you are going to expect pretty much the same results day to day. If the numbers don't get much better, and you don't see lower numbers at nadir over a few days, you increase the dose. If during that 4-5 day period, you all of a sudden see a positive response, and you get a much lower number at nadir, then the "trend" has been broken, and you reduce the dose accordingly. And when you look across 12 or 24 hours of data, and you don't really see much fluctuation, you can look at the numbers and say "wow, all those numbers are within 10% or 20% of each other, so not much is happening at all because the meter is only accurate within 20%"
OK, my attempt to be brief and concise has once again failed, but I hope this helps!
Carl
I'll try not to be too long-winded, but that's almost impossible for me :lol:
Here is an example of a typical curve. From what I have seen, it is typical until you get to the point where your cat is almost ready to go "OTJ", then it looks a little bit different -
There are a couple of possibilities as to why you are seeing a rise at +3 sometimes, and a drop at other times.
1 - The inconsistency of the doses. "Typical" only happens when things are kept constant as much as possible. When you really think about it, there are only two things that you have control over in this dance. One is the amount and timing of food you give her. The other is the amount of insulin you give her. Beyond that, there's all sorts of things that her body is going to do with those two once you add them to her system. Those things, for the most part, you have no control over. When you alter the doses, you are affecting one of the "constants" and turning it into a variable. So that affects the "insulin depot" that Lantus works by, and keeps things in flux, so your curves will look atypical.
2 - You can see in the "typical curve" description that +3 is normally when the onset of Lantus will occur. It could be that the onset is just not happening at the exact same time each day. That isn't really surprising. The timing of things, like onset, nadir, etc can change even when all things remain constant. Just because they're cats ;-) But seriously, just "because". They are living organisms, nothing is precisely constant. Like I said, you have very little control over anything "internal" once you put the food and the insulin "in".
I didn't use Lantus with Bob, I used PZI. And like you, I couldn't fathom shooting insulin into "normal" BG numbers, and it scared the hell out of me! BUT, it was a question of understanding the difference between how Lantus works and PZI works. I think you think like I used to. PZI is what I call a "if this, then that" insulin. Like a painkiller for instance. If you shoot X, then X will happen. If you take one painkiller, it will do "X". If you take 2 of them, "XX" will happen. If you shoot 1u of PZI, you're going to get a fairly predictable response. If you shoot 2u, then you can expect "more" to happen. If you shoot 1u, you might get a drop of 200 points, so if you see a preshot number of 225, you probably don't want to shoot that much insulin, because you would expect a hypo to happen, right? "If this, then that". So, logic would tell you "reduce the dose for safety". Perfectly logical thinking.
It wasn't until I "learned" by reading and asking lots of questions of long-time Lantus users that I was able to wrap my head around the "shoot low to stay low" concept. I think that the only way to "get it" is to watch it happen. When someone is just staring out with Lantus, they will see curves that look like the "typical curve". And they will see preshot numbers that are pink or red, and they'll see nadirs that are yellow, blue or green. A "smiley shape" curve. And they will be advised to not shoot lower than 200 preshot numbers until they are "data ready". You have to be able to see and know what a dose does, and that will give you the confidence to start giving shots when you see lower preshot numbers. While you are getting to that point, the Lantus has begun to work the way it is supposed to work with your cat. The curves have begun to start to lose that "smiley" shape, and will have become more "flat". Because that is the way the insulin works. It is supposed to work 24 hours a day, and it is supposed to make the BG numbers more consistent. It has stopped acting like an "if this, then that" insulin, less like a "drug" as we understand medicine.
The best thing to look at is the spreadsheets of people who are either going through OTJ trials, or soon will be. Here are a couple of great examples -
Dale's boy Max:
https://docs.google.com/spreadsheet/pub?key=0AorpXuifiGH7dGdENnVhTXp0UFNYTUsxa1hMUWs0bGc&output=html
And Anne's Muffin:
https://spreadsheets.google.com/pub?key=0Aj2DL9Xz4IstdENaYld0T0xYN2JUQzRDanh4aXJqb1E&output=html
Both kitties are currently going through "OTJ Trials". If you look at them, you can see the progression. The old data will show you every color of the "SS Rainbow". Scroll down, and you will see the gradual improvement, and the lower you go, the more you will see them shooting "normal" doses into "normal numbers". You'll see the curves become flat, and even when they shoot what you and I would consider "scary amounts" of insulin into "scary low numbers", you will see how the kitties responded to them. You will see some numbers that would shock you, like 30s and 40s, and you'll see what they did to raise those numbers up into the 50s and 60s by using food to do it, and keep the kitties safe from hypos. But the closer you get to the bottom, the less difference you will see between the preshot numbers and the nadir numbers. That's because the doses are lower (but kept constant from cycle to cycle), and because the insulin was working exactly the way it was supposed to. Flat cycles and gradually lower numbers.
There are three things going on there -
1 - the cats are responding to the insulin and the way it is designed to work.
2 - the caregivers are confident in doing what they are doing, because they have mountains of data to back them up.
3 - As each one of the "scary" things happened, they have gotten overwhelming amounts of help and advice and hand-holding from the amazing people who are on this board around the clock - those who know how this works, and have "been there, done that"
Lastly, "meter variance".
What Sienne was pointing out is the similarity between the two numbers. On the 166, you shot a full dose. On the 144, you shot a significantly lower dose. But the numbers are pretty much the same. Only 22 points apart. These meters we use, let's face it... they aren't laboratory instruments. Some of them cost less than $10 to buy, and probably cost $3 to manufacture. What they are is a tool so that people can monitor their blood glucose at home, and use insulin safely. The FDA allows them to only be accurate within 20%, sort of "close enough for government work"
We have found them to be a priceless tool in managing feline diabetes safely. But we also all understand that they are "close enough", not exactly right. We manage the disease, and the daily numbers we collect, not so much to know exactly what kitty's BG is, but to measure and record the "trends" on a day-to-day basis. Fortunately, what we believe to be true is that the lower the numbers, the more accurate the meters are. So when we get down to numbers in the 50s, 40s, or even 30s, we take what we get on the meter as "right on the money", and we act accordingly to ensure the safety of our kitties. That 42 somebody sees is "right", and we feed them LC or HC food to get them up to the safer 50-70 range and keep them there as long as possible, because the longer the lower numbers are there, the more kitty is healing. Where we emphasize the "20% factor" is when we look at the higher values, when we are looking at the "trends". If Kitty is at 250 at preshot one day, and 220 the next preshot, that's not really that much of a difference. You're going to dose the same on either number, and you are going to expect pretty much the same results day to day. If the numbers don't get much better, and you don't see lower numbers at nadir over a few days, you increase the dose. If during that 4-5 day period, you all of a sudden see a positive response, and you get a much lower number at nadir, then the "trend" has been broken, and you reduce the dose accordingly. And when you look across 12 or 24 hours of data, and you don't really see much fluctuation, you can look at the numbers and say "wow, all those numbers are within 10% or 20% of each other, so not much is happening at all because the meter is only accurate within 20%"OK, my attempt to be brief and concise has once again failed, but I hope this helps!
Carl
Anne & Zener GA
Member Since 2011
Hosanna, I am wondering if you are misunderstanding what normal numbers are because I haven't seen anyone shoot below what is generally considered a normal number around here, which is 50-120. Some vets think those are dangerously low but they are not if you are testing.Hosanna said:
Liz
I agree with Liz. Yes....you will see some of us shooting 50 but that is a normal number. And you might have to learn how to shoot that number. But we will be here to help you. None of us just started out by shooting numbers in the 50s. With help, we learned to shoot lower and lower within the normal range of 50-120.
Angela & Blackie & 3 Others
Member Since 2010
For what it's worth, I was scared to death about shooting lower #s in the beginning, but I got over the fear very quickly because I didn't want to not shoot, or give a lower dose and then have to fight the bouncing all over again. So, I shot a low # one day, and then the next, and now here I am, shooting low #s left and right. Blackie's in the 50-120 healing range now, and has been for quite some time. 2 weeks ago, while she was getting 5.25u, on the 6th cycle (the evening of the 3rd day), she gave me a # below 40 (39 to be exact) which enabled me to decrease her dose by 0.25u. If she maintained being in the healing range of 50-120 for 7 days, she'd get another decrease of 0.25u, and she did. I've given her 0.50u decrease in total over the course of 2 weeks so far simply because her #s were between 50-120, for the most part. Granted there are times she'd dip a bit lower than that, but I'd give her a small amount of her food, and she'd come back up again in 1/2 hour.
You'll do fine here with the people who have been in the exact same spot that you're in now. All you need to do is simply trust them. They will never steer you wrong.
You'll do fine here with the people who have been in the exact same spot that you're in now. All you need to do is simply trust them. They will never steer you wrong.
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