9/25 Ebby Start Bolus Insulin?

[MelissaEbby]

Yesterday's condo

I've been thinking it is time to try a Bolus insulin with Ebby, but do need some guidance.

I have given this a lot of thought, and studied her SS, and feel it is fairly safe to try. I also witness the problems associated with her sitting in these high numbers and just want to help her feel as comfortable as possible. I cleaned up a lot of pee....puddles....on the floor from this last bounce. I don't personally care if she pees on our floor, but I feel bad if she's having a hard time holding it. I have considered a switch to Levemir, but if her nadir happened to fall at +8 or +10, this would really not work well with my work schedule. Her bounces typically last at least 2 cycles, so I think there is room to try a bolus insulin.

Her bounces did flatten a bit when she was on a 1 unit dose, and she was doing really well, but she was diving on most days, and I was faced with bringing her out of the 40's on a lot of these days. So, the 1 unit worked well to control the bouncing, but to continue at the 1 unit would not be safe because of these low drops. I do not expect perfection with her numbers, but just want to take the edge off. By using a Bolus insulin, I would be aiming to keep her bounce below the renal threshold whenever possible, or at least limit the time that she was above 300. I would not be using it an effort to drop her numbers to blue or green on every cycle.

So my questions are:
1. I know of two Bolus insulins that are referred to as "R" and "N." I think I've read the N might be more gentle and slightly longer duration. I feel Ebby is fairly sensitive to her insulins, so thinking a gentler one might be better. Any suggestions as to which is preferred?

2. Am I correct that the "R" stands for Humulin R, and "N" stands for Novolin N?


Any other thoughts are welcomed and I appreciate any feedback.

 

[Wendy&Tiggy(GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Maybe add a ? icon by your post.

I wonder if the experienced guys can take a look at your SS. You have only been on lantus a few months and these numbers dont look too bad to me..typically bouncy.. In fact I wonder why you didnt decrease when you got the 47 on the 21st?

Wendy

 

[Dale 'n' Chip]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

I'm using N as a bolus with Levemir. The dose is so small (practically molecules) I feel it's easy enough to counter (at least for Chip) if I ever needed to. But I had a lot of data before I added the N. Chip has always been relatively easy to feed and steer. I never shoot a bolus if I'm not around to monitor for the duration.

What the bolus is good for is taking the edge off the bounces, not as a substitute for getting the correct dose of Lantus or Levemir. Too much (or improperly timed) bolus may cause wild swings and worse bouncing.

In looking at Ebby I think I might be more inclined to flatten the highs with slighly more Lantus and steer the lows as needed? But I see a few places where a bolus might help some with bounces. It's no miracle fix but I sure wouldn't want to be without it with Levemir.

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Hi Wendy,
Thanks for the response.

In fact I wonder why you didnt decrease when you got the 47 on the 21st?

I am treating Ebby as a long term diabetic. She was diagnosed last year and then went OTJ. So, as far as reductions go, I'm only reducing on 3 times below 50 or once below 40.

I realize that the bounces are typical, but if there is more I can do to keep her in better numbers than I think I should try it. When Ebby bounces, all her symptoms come back and she obviously feels lousy.

Dale n Chip,
Thanks for the info...

Too much (or improperly timed) bolus may cause wild swings and worse bouncing.

Yeah, I thought about that...especially since she can be sensitive to just a little bit of insulin. She bounced really bad on ProZinc, so I wouldn't want it to produce even worse swings. I would never use it later in a bounce, just maybe as the bounce started. And, of course, would never use it when I couldn't be around to monitor.

In looking at Ebby I think I might be more inclined to flatten the highs with slighly more Lantus and steer the lows as needed?

I really liked her on the 1 unit dose because she cleared bounces quicker, and the bounces were a little lower. She kept going below 50 though, so reduced back down. I guess I could start using more MC or HC to keep her up, but I'm reluctant to start feeding too much HC.

Thanks for the feedback!

 

[julie & punkin (ga)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

i used Humulin R on punkin as well as Lantus. punkin had acromegaly and was on significantly higher doses.

I'd like to get some other eyes on Ebby's ss before commenting.

 

[Dale 'n' Chip]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

...I really liked her on the 1 unit dose because she cleared bounces quicker, and the bounces were a little lower. She kept going below 50 though, so reduced back down. I guess I could start using more MC or HC to keep her up, but I'm reluctant to start feeding too much HC.

Thanks for the feedback!

Ebby's fast swings from black to green (and back?) on 1.0U Lantus might be an argument for R instead of N, or even against using a bolus?

But Novolin N is only $25 at Wal Mart no prescription needed. I can't stress enough how small the dose is for either N or R. You need to be confident in your ability to dose carbs if necessary and test frequently to learn the response. I see you are already using Terumos and calipers. However you don't use enough bolus to measure it that way, unless you get diluant.

I think before trying this it might be worth having Libby or Jill take a look.

Libby and Lucy helped me get up to speed on using N as a bolus for Chip to bring his numbers down.

But Jill & Alex was more the one to encourage me to keep at it and use even smaller doses of N.

 

[Sienne and Gabby (GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Melissa:

You mentioned higher carb food. Rather than feeding MC or higher, had you considered feeding something that's higher in carbs but still in the LC range (below 10%). That may be an alternative step to see if it helps to flatten things out.

Using a bolus insulin may be a strategy that will benefit Ebby. I've not used either R or N as a bolus so while I understand the principle, I'd rather have someone who's used this strategy help you think through the approach and the details of use.

 

[Jill & Alex (GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

hi melissa. just a quick note because we didn't want to keep you hanging...
libby and i are aware of your desire to use a bolus, but we're both working. we'll post as soon as we can catch a break between appointments, meetings, etc.

have a good day!

 

[Angela & Blackie & 3 Others]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Hoping that Ebby shows you better #s very soon. Hang in there. Have a good day!

 

[Libby and Lucy]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

hi Melissa,

I've been studying Ebby's spreadsheet, and I do have some thoughts.

Regarding a bolus, I think it could be beneficial for Ebby, but maybe a little tricky to figure out what to do and when to do it. The ONLY thing that is giving me pause is something like 9/14, when she started in 300s and still managed to get to 50s, even though based on her patterns it would have been reasonable to assume that the pink was the start of a bounce. That was on a higher dose, so it might not happen again, but be prepared for times that you might THINK she is bouncing, but she has other plans.

I like that you have been studying your spreadsheet too, and have already started to figure out the times when you should and should not use a bolus. One of the important things to remember is that while others can give you guidelines and help you learn, decisions about when to use the bolus and when not to have to be made on the spot and considering the circumstances at that moment. You have to be able to understand both insulins well enough to make your decisions on the spot. You seem like you are in the right mindframe for that. :smile:

You would want to learn to catch the very beginning of a bounce, since Ebby's bounces don't always last very long. You never want to give R when a bounce is clearing, especially because Ebby seems to clear them fast and dramatically once she decides it's time to let go of a bounce. You don't want to add a fast-acting insulin on top of that! To start, maybe even try giving the R toward the end of a cycle, when she is normally rising, and start with a super low dose (0.1u).

The other thought I had is similar to what some others have mentioned. My cat KK has a similar pattern to Ebby's. He drops fast and hard at the beginning of the cycle, which sets up a bounce, which then clears fast and hard, which sets up another bounce... I have used R with him at the end of the cycle, which works great except I am usually not here at the time he needs it. What did work very well for him was increasing the % carb of his food. Initially I made the food switch because he had stopped eating and the food he would eat was FF Medleys at 12-16%. What I noticed, though, was that those steep drops slowed way down so he didn't bounce as much. I was able to increase his insulin dose a little, which helped even more toward reducing the bounces. Eventually he flattened out and his insulin dose started coming down too. I have now been able to switch back to low carb food and he is on a very small dose. Some cats just do better with more carbs (and it doesn't have to be as high as 12%, like I said, my reasoning for choosing that food was based on appetite, but it worked for him).

I'm working now and have to head into another meeting, but I'll check back in later to see what thoughts you have.

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Thanks so much everyone...

libby and i are aware of your desire to use a bolus, but we're both working. we'll post as soon as we can catch a break between appointments, meetings, etc.

I appreciate you taking a look, and in no way is this a huge hurry, so please don't feel rushed in having to get back to me. Thanks for letting me know. :smile:

You mentioned higher carb food. Rather than feeding MC or higher, had you considered feeding something that's higher in carbs but still in the LC range (below 10%). That may be an alternative step to see if it helps to flatten things out.

I use a 5% as my main food, and have been trying 9% when I shoot a falling number, or on a bounce clearing day. I got out the 13% last night at +2.5, but am not sure the affect it had on the cycle. I did not use a 9% as my main food when she was on the 1 unit dose, so maybe that would be something to try: Increasing slightly and switching to the 9% at the beginning of the cycle. When looking at her recent numbers on the 1 unit dose, I do NOT feel a bolus would be needed, as the bounces cleared quicker and were not causing her as many clinical symptoms. Just a little tricky trying to get more insulin in her while maintaining a safe dose.

Ebby's fast swings from black to green (and back?) on 1.0U Lantus might be an argument for R instead of N, or even against using a bolus?

Yes, I completely see where you're coming from on this, and thanks for pointing it out. Had I used a bolus in this scenario, it probably would have dropped the numbers way too quick, resulting in an even higher bounce. In this case, there was probably no room for R or N. Ebby's bounces are fairly consistent, but I guess she has cleared a few bounces in one cycle. Maybe that is too much to chance. I do not want to put her in danger, or create worse bouncing. :roll: It's always so hard to know what to do, and the best way to approach treating this.

I can't stress enough how small the dose is for either N or R.

You're dosing 1 drop, right? I'll take another look at your SS. After thinking about all of this, I guess another concern would be that Ebby does get pretty good lows on even a small amount of insulin (.50) So one drop of R might have quite the affect on her, whether that be good or bad.

Again, thanks everyone for the help. I am just beginning to feel like my hands are tied. I try to increase; her bounces get better, but the dose brings her too low. I try to decrease; her bounces get worse, and her symptoms come on pretty strong. I just don't know....I have mixed feeling about the Bolus too. I just want to treat her diabetes, and treat it well, and I cannot ignore the fact that she is still having problems associated with unregulated diabetes. On her bad days, she looks up at me with these very sad eyes, and gives me a pitiful meow...it just breaks my heart.

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Hi Libby, I think you were posting when I was. I'm going to re-read this and comment in a little bit. Got to do a couple things really quick, and but I'll be back soon. Thanks so much!

 

[BJM]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

You're on such a low dose of Lantus, I'd really hesitate to add a bolus insulin.

With the slightly higher carbs you're feeding to steer at the lower glucose levels, maybe it would work better to ease off the Lantus a drop or two and use the low carb only to steer.

About the only other thing I'd suggest is when you've finished the Lantus you have, maybe switching to Levemir would help. It has a later nadir, and a slightly longer overlap, the latter being the most helpful to reduce bouncing.

 

[Libby and Lucy]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

I should add that the downside of increasing carbs and subsequently increasing the insulin dose is that you do have to be really vigilant about making sure the cat eats. If you base the insulin dosing on the fact that she is eating 10% carbs, then she doesn't eat, you might have to work hard to keep her numbers up that cycle. From your spreadsheet, it looks like you are able to be home most days, so possibly that is something you can do fairly easily. I'm not home mid-cycle, but I know KK will eat everything in sight, and I do have an ability to work from home if I have to.

I'm not trying to discourage you at all (I have already pointed out that I deviate from protocol all the time), just trying to be sure you understand what you need to think about.

About the dose amount for bolus insulins, we always suggest starting with a very low dose (around 0.1u) because you never know how a particular cat will respond. That may or may not work, but it's a relatively safe way to gather data until you figure out her response to the R.

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Ok, I'm back...Thanks for all of the thought you've put into this. I'll comment on a few points.

The ONLY thing that is giving me pause is something like 9/14, when she started in 300s and still managed to get to 50s, even though based on her patterns it would have been reasonable to assume that the pink was the start of a bounce.

Yes, I completely agree. I remember that day well, and thought for sure it was going to be her regular type of bounce. If I do decide to use R, I would most likely not use it if I ended up back at the 1 unit dose. On this dose she did clear bounces well, and even if she stayed high, she was near or below the renal threshold most of the time. That's not to say she couldn't pull a similar stunt on the .50 dose, but I tend to think the higher dose is what was causing those bounces to clear so quick.

You would want to learn to catch the very beginning of a bounce, since Ebby's bounces don't always last very long. You never want to give R when a bounce is clearing, especially because Ebby seems to clear them fast and dramatically once she decides it's time to let go of a bounce. You don't want to add a fast-acting insulin on top of that! To start, maybe even try giving the R toward the end of a cycle, when she is normally rising, and start with a super low dose (0.1u).

Yep, totally agree. If ever I missed the window at the beginning, I would just not use it. To start out, I would feel most comfortable using it at +10 or +11 if she was really zooming up. I have practiced measuring drops....to clarify 0.1u is 1 drop, correct? There is about 10 drops in a unit, right?

What did work very well for him was increasing the % carb of his food.

Yes, it might make sense to give this one more try, maybe even before trying the R. She will eat the wellness pouches....one is 9% and one is 13%. KK is looking great! Looks like it worked well for you.

If you base the insulin dosing on the fact that she is eating 10% carbs, then she doesn't eat, you might have to work hard to keep her numbers up that cycle. From your spreadsheet, it looks like you are able to be home most days, so possibly that is something you can do fairly easily.

I am home a lot of days...just work out of the home 3 days, and on those days I'm around until +4, so I can steer the cycle, and abort the cycle if need be on a work day.

I'm not trying to discourage you at all (I have already pointed out that I deviate from protocol all the time), just trying to be sure you understand what you need to think about.

No, not at all. I want to be very careful, and very safe, and I understand this strays from protocol, so I appreciate that you put yourself out there to advise. I want to understand it well, so I can make educated decisions going forward, and your info is very helpful.

You're on such a low dose of Lantus, I'd really hesitate to add a bolus insulin.

Yes, this low dose is one of my main concerns too, but when she bounces and it doesn't clear for two days, she is in need of more than just the .50. On these days she needs a dose more like 1 units, and since we don't dose lantus on a sliding scale, adding the bolus, in my mind, is a close substitute.

With the slightly higher carbs you're feeding to steer at the lower glucose levels, maybe it would work better to ease off the Lantus a drop or two and use the low carb only to steer.

Like lowering even below the .50? Well, I've been tempted to lower her dose to a skinny .50 or even .25, but this is really leaving the protocol, and I worry she will hover in the 200's. I'm almost positive she wouldn't bounce as much, but don't know if her pancreas is quite ready for such a low dose. Are you thinking steering with the HC might be influencing a bounce?

A question about the "R"....is this Novolin R

Thanks Libby and BJM, and everyone else that has been helping. I can't thank you enough for the advise I've gotten today and everyday.

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Oh, and I'm headed to work soon, so won't be around until later tonight. Hope everyone has a good evening!

 

[Jill & Alex (GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

wow! i was prepared to write a lengthy post, but the points i wanted to make have pretty much been covered. :lol:

What the bolus is good for is taking the edge off the bounces, not as a substitute for getting the correct dose of Lantus or Levemir. Too much (or improperly timed) bolus may cause wild swings and worse bouncing.

i can't emphasize dale's point enough. when using a bolus, all you want to do is bring down the numbers by around 50 - 100 points. any more than that and all you do is set kitty up for another bounce. this is why we suggest 0.1u as an initial starting dose of R or N and testing for the first 4 - 5 hours after injection. you may find 0.1u isn't enough, but it's the best place to start. those who start with higher doses of a bolus are often unsuccessful because they end up yanking kitty's nmbers down which only causes more bouncing... which is obviously counterproductive.

Ebby's fast swings from black to green (and back?) on 1.0U Lantus might be an argument for R instead of N, or even against using a bolus?

i agree. if you choose to use a bolus, i do think R is the bolus of choice for ebby. personally, i prefer using R as a bolus because if kitty chooses to "zig" instead of the "zag" you were expecting, the action of R is out of kitty's system before N would be (the duration of R is less than that of N). there are some cases such as a lack of duration with the basal insulin where using N might be appropriate, but imho, ebby is not one of those kitties.

I can't stress enough how small the dose is for either N or R. You need to be confident in your ability to dose carbs if necessary and test frequently to learn the response.

frequent testing is a "must do" until you get a good feel for using a bolus as is the ability/availability to steer the curve with food.
enough said?



re: libby's comments...

i won't waste your time reiterating libby's remarks. she's saved me a lot of typing. lol! what i will say is ditto to everyone of them! libby and i are usually on the same page when discussing treatment options and this time is no different. :mrgreen: please give a lot of thought and consideration to what she's said. manipulating the cycle with food or using a bolus are great tools to use with a bouncy kitty.

fyi: initially, increasing carbs will result in higher numbers. expect it and don't get discouraged. the idea is to raise the nadir which will allow you to raise the basal dose. raising the basal dose will help to squash the bounces. once ebby's body learns not to react so harshly you'll be able to lower the dose as well as the percentage of carbs in the foods fed.


just a general comment...
i'm very, very impressed with the thought you've put into the possibility of using a bolus. i usually don't like to recommend using a bolus with the exception of post-DKA or ketone prone kitties because decisions to shoot a bolus generally have to be made on the spot. there's usually not time to post to ask for opinions or direction. the caregiver must have a good idea of their kitty's response to the insulins used and use that knowledge to make decisions. it's apparent you've spent a good deal of time analyzing ebby's spreadsheet. kudos to you!

 

[BJM]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

There is an option you've not considered.
It isn't used a lot.
It isn't on the regular protocol... but your cat isn't following the protocol, so maybe doing something different could help.

That is to take the 0.5 unit dose of Lantus and split it in half, separating the injection of each half by 2 or 3 hours. This spreads out the effect of the Lantus, generally slightly raises and widens the nadir period with 2 less deep nadirs, one for each half dose.

The biggest issue with that is if you needed to increase, because if you ever needed to combine it back into one dose, the combined amount could be too much at once. There's a fairly recent post in Think Tank about using it for bouncing.


It takes double the syringes, which you would have done using a bolus. It doubles your pre-shot testing. And of course, you may not be able to arrange your schedule to do that.

 

[Sienne and Gabby (GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Splitting doses with Lantus is generally not recommended. You can run into problems with overlapping nadirs which can cause a host of problems that are not easily rectified in a cycle where numbers are precipitously dropping. A short acting insulin like R is a far better option.

 

[Jill & Alex (GA)]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

i agree. split dosing is generally not recommended. there is a possibility of over-lapping nadirs when splitting the dose, but most of all... split dosing is an alternative method that has not worked as well as consistent dosing for bouncy cats. there have been a few successes, but overall the results haven't been that great. however, never say never. if options which are known to be more successful fail... why not try it?

personally, i'd only try split dosing as a third option after giving the options of using food to manipulate the curve and using a bolus insulin a fair shake.



just my thoughts...

 

[MelissaEbby]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Wow! What a wealth of information you have all given me. I'm just so grateful for the time you put into this and the knowledge you share. A very sincere thank you! :YMHUG:

it's apparent you've spent a good deal of time analyzing ebby's spreadsheet. kudos to you!

Aww, thank you Jill! Well, my DH has asked me before in regards to looking at her SS and other kitties SS's, "Why do you stare at these all the time?" :lol:

if you choose to use a bolus, i do think R is the bolus of choice for ebby. personally, i prefer using R as a bolus because if kitty chooses to "zig" instead of the "zag" you were expecting, the action of R is out of kitty's system before N would be (the duration of R is less than that of N).

Just so I have an idea, is the duration around 4 hours for R? We're talking Novolin R right?

frequent testing is a "must do" until you get a good feel for using a bolus as is the ability/availability to steer the curve with food.

Absolutely! No problem.

That is to take the 0.5 unit dose of Lantus and split it in half, separating the injection of each half by 2 or 3 hours. This spreads out the effect of the Lantus, generally slightly raises and widens the nadir period with 2 less deep nadirs, one for each half dose.

I have given this some thought before, but yes, the thought of the overlapping nadirs started to make my head spin. I'm already having to feed at +1, +2, and +3, which makes leaving the house sometimes difficult. Add two nadirs to the list, and well, I might not ever get anything done. Also, Ebby's "bounce clearing days" tend to be very active, and this is where I think the two nadirs might really pose a problem.

I really appreciate this discussion, and feel confident going forward when/if I choose to use R. I am leaning towards first trying the higher carb foods, like Libby mentioned. Controlling the bouncing with food would be the easier, safer, and possibly more effective method. I might go ahead and pick up some R just to have it on hand, but will give the higher carb food a chance first. I don't want anyone to worry....I will use extreme caution if I try it.

 

[Dale 'n' Chip]

Re: 9/25 Ebby AMPS 267 +2.5 248 Start Bolus Insulin?

Yes this thread is amazing, lots of good info here to think about. Bookmark it for future reference, I know I will. :smile:

To answer an earlier question I do measure the drop (practicing several times) for every new syringe when I shoot. I'd rather err on the side of too little bolus rather than too much. I hope to soon get the official diluent (no charge) from the manufacturer to dilute and make the N dosing more precise. If I can't get that for some reason the vet has mixing vials and saline which will also work (shorter term) for diluting N or R for easier dosing.

Humulin R or Novolin R both work the same, whichever is cheaper when/if you buy. For N it would be Novolin N since that is the one Wal Mart has currently for $25. When Chip was originally on N with the vet, Humulin N was the one for $25. Both those are interchangeable as well. The R lasts about 4-5 hours, N perhaps 6-8 depending of course on the cat.

And for the record I agree with Jill about split dosing. I was interested in what Venita did with that, I had almost the exact thoughts Libby had about it when it was originally discussed back when Venita was doing it. I would be open to trying that with some important caveats similar to things Libby mentioned back then. All that said, it's likely simpler and more efficient to use a bolus on the highs and carbs on the lows to tweak individual cycles without disrupting the basal dose and depot in the process.

 

[MelissaEbby]

Re: 9/25 Ebby Start Bolus Insulin?

Thanks for the info Dale!

Yes this thread is amazing, lots of good info here to think about. Bookmark it for future reference, I know I will.

Indeed!

And for the record I agree with Jill about split dosing. I was interested in what Venita did with that, I had almost the exact thoughts Libby had about it when it was originally discussed back when Venita was doing it. I would be open to trying that with some important caveats similar to things Libby mentioned back then. All that said, it's likely simpler and more efficient to use a bolus on the highs and carbs on the lows to tweak individual cycles without disrupting the basal dose and depot in the process.

I'll have to go back and look at the threads on split dosing again. It did intrigue me when I first looked into it. I would never rule it out completely, as I'm willing to try different things within reason, but I agree that it should maybe be one of the last things I try, as it does add complications to the mix. It would also push a nadir later into the cycle, which because of my schedule, I'm trying to avoid.

 

[BJM]

You'd probably see 2 nadirs, separated by the number of hours by which you lag the dose.

Each nadir, by itself, is likely to be higher, because only half of the insulin has reached its peak.

Visualize the normal curve you get on Ebby and when the nadir is.
Now imagine it half as tall, with the nadir shifting a bit earlier, because there is half the insulin (which will have a closer surface area:volume ratio for the volume injected).
Imagine a copy of that curve, moved over the 2 or 3 hours you've separated the shots and superimposed over the first curve.

If nothing goes haywire to lower the glucose further, such as high activity, vomiting, diarrhea, or inappetance, the 2nd nadir will be about the that lag period later.

Its the last statement where the concern is - if something changes to alter the metabolism, intake, or excretion of glucose. The wider the lag, the less likely the nadirs overlap and the more complicated your schedule becomes.


Getting diluent for the R, so you can measure it more accurately, is your best bet, given the low dose Ebby needs. When i tried it with Spitzer, undiluted, with as small a dose as I could see with my crappy vision, it worked pretty well. He was having issues with eating, vomiting, etc, so I couldn't increase the Lantus and had to go with using R to cover when he was able to eat and keep it down.

 

[Sienne and Gabby (GA)]

I agree with Jill's take on things. If Ebby were my kitty, I'd try what people have had better success with and leave the split dosing option as something to consider if none of the above seem to be doing the job.

And yes -- we're talking about Novolin or Humulin R (also called "Regular" insulin).

 

[Libby and Lucy]

FYI, a couple of people have said that they got Novolin R at WalMart for about $25. I wish I had known that before I bought mine! I bought Humulin R at CVS and I think it was $90. ohmygod_smile

 

[Doreen and PeePee]

Hi Melissa, I hope what ever you decide helps you get better numbers. So much info to digest. Great guidance here as usual. One could never get such good info from any vet.

Have a good day!

 

[Ann & Tess GA]

I just found this website http://www.goodrx.com that will get you the local prices for drugs. Just type in the name of your drug and your zip code. I just found out we could have gotten Tess's Lev for $60 less!

Good luck if you decide to try the bolus.

 

[MelissaEbby]

Thanks so much for the help and support. My plan going forward is to start feeding 9%-13% food at the beginning of the cycle. Assuming her BG numbers rise, I will adjust the insulin dose to find the correct lantus dose based on her nadir. Hopefully the higher carb food flattens the cycle, and maybe I can increase the dose enough to counter the bounces. If not, I will start using some R on the higher bounces. I am going to limit the use of R is the beginning until I really get a sense of how it works. Don't worry, I won't go shoot every pink number with R. :lol: Dale, I'm going to study your SS in regards to how you're using N. Looks like you do a great job with this, and have wonderful documentation. I won't rule out an experiment with split dosing, but I think trying the food and R would be the easier option if it works.

Well, again, thank you, and Ebby says thank you too! I told Ebby today that we have a lot of very smart people trying to help her.

 

[MelissaEbby]

Great website Ann! It's amazing the price difference between different pharmacies. I'm going to use this to price our own medication too!

 

[Dale 'n' Chip]

...If not, I will start using some R on the higher bounces. I am going to limit the use of R is the beginning until I really get a sense of how it works. Don't worry, I won't go shoot every pink number with R. :lol: Dale, I'm going to study your SS in regards to how you're using N. Looks like you do a great job with this, and have wonderful documentation.

If/when you get to the point of trying R, the SS to look at is Jill's Alex. Go to 2013 and scroll to early June 2013 for some of the best documented and most impressive use of R as a bolus that I can think of. Jill had to miss a few shots of Levemir because she was out, and she strategically used R during the hours she was available to maintain control of those cycles. Notice how she tested every hour for those doses of R. She was able to regain regulation for Alex within a few cycles of the missed shots. Nov/Dec. 2012 when Alex had p'titus is another good example to look at.

The way I'm using N is slightly different, the same drop of N is less potent than R but lasts a little longer. I'm using a very small dose and repeating as often as every 6-12 hours until I know the bounce is clearing. I eventually was able to fit this strategy into my regular testing schedule so I don't use many more test strips than usual. If the N does little, or I don't get the bead in the cat, it's no worse than doing nothing and waiting out the bounce. All I'm out is the extra syringe. A few times I suspect I got too much bolus and it caused bigger bounces. That's why I think small on the dose. I hit Chip with these *molecules* of N nearly every time he goes over 250, and thus far I haven't had any big surprises. When first using R you want to start VERY small and of course test every hour exactly as Jill does.

 

[MelissaEbby]

Wow, Jill's SS is impressive. Oddly, I don't think I've looked at her SS before.

I hit Chip with these *molecules* of N nearly every time he goes over 250, and thus far I haven't had any big surprises.

So I can shoot every pink number....well maybe with a lot of practice! I'll start out slow though.

 

[julie & punkin (ga)]

my favorite time to use R was just past the nadir of a cycle. i found it less nerve-wracking than in the first half of the cycle. the other thing that i would offer is that i noticed that it often affected the next cycle as well. even though R is only "supposed" to last 4ish hours - it definitely changed the next cycle. if you end up using it, it's a good thing to watch for and see if that happens with Ebby as well.

 

[MelissaEbby]

Thanks Julie, that's good to know about the next cycle. Something to look out for. I think past nadir might be good for Ebby too....around +9 ,+10 she's been known to rise over 200 points in an hour.

 

[Jill & Alex (GA)]

Just so I have an idea, is the duration around 4 hours for R? We're talking Novolin R right?

in most kitties, the duration of Novolin R or Humulin R (same insulin, different brands) is about 4 - 5 hours. although, joan's maddie got about 5 - 6 hours duration from R. like everything else, ECID. if or when you use a bolus you'll want to test every hour until you see the numbers rise. that'll give you a good idea of ebby's response.

my favorite time to use R was just past the nadir of a cycle. i found it less nerve-wracking than in the first half of the cycle. the other thing that i would offer is that i noticed that it often affected the next cycle as well. even though R is only "supposed" to last 4ish hours - it definitely changed the next cycle. if you end up using it, it's a good thing to watch for and see if that happens with Ebby as well.

initially, you'll only want to use a bolus at the very beginning of a bounce with ebby.

i have to clarify julie's comment "even though R is only "supposed" to last 4ish hours - it definitely changed the next cycle"....

R is in and out of kitty's system in approximately 4 - 5 hours (with some exceptions like joan's maddie). the change seen in the next cycle is not because the R is still at work. the change in the next cycle is because when using a bolus, you're interrupting the normal course of events. in other words, using a bolus will naturally cause a change going forward. it's "why" we elect to use a bolus. we want to change the current course.

hope that makes sense. it's been a rough week and i'm beat.

 

[MelissaEbby]

hope that makes sense. it's been a rough week and i'm beat.

Thanks Jill... Yes, it absolutely makes sense. Thanks for all your help, and I hope you get some rest and relaxation this weekend.