amps 600+ 1u +4.5 290 7.5 255 +11.25 155???????

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day 1
amps 600 1u
+5.5 275
+11.5 291
pmps 319 1u

day 2
amps 312 1u
+2 320
+3.5 294
+7 247
+12 233-----------still going down? not enough data, did not shoot
+13.5 285 1u

day 3
amps (+11) 423 1u
+2 340
+3 310
+7 190
+11 136
+12 141-------------again essentially the same # still not ready to shoot
+13 149 chicken shot .25u

today
+11 600+ 1u----help me learn what i can gleen from this? :?:
 
Re: 1/13 tomtom a lev newbie amps 600+

thanks celi...where is my support system angry(2)_cat ?
kidding :-D
 
Re: 1/13 tomtom a lev newbie amps 600+

Good morning Lori.
One thing to do when you are not comfortable shooting is to only wait 15 minutes before retesting and don't feed. That way you will not get too far off schedule.

Testing at +11 and posting is a good idea so you can get some input.

Tom could be bouncing from a lower number last night. I know it is hard for you to do nightime testing but that could be the reason for such a high number now even though you shot a reduced dose.
 
Re: 1/13 tomtom a lev newbie amps 600+

i was kinda thinking i shot too little and he just continued he ascent to the stars...
i also have trouble with air bubbles and in my teeny tiny .25u i could barely tell if it was insulin or an air bubble.
pzi is cloudy so i could always see it clearly....this lev is clear as air!
 
Re: 1/13 tomtom a lev newbie amps 600+

I'm posting from work so I only have a minute. It looks like the combination of late and reduced shots is depleting Tom's shed (which probably wasn't even full to begin with, since he is so new on Lev). My recommendation would be to drop his dose back a little bit (0.75u would be good) so you can ease in to shooting lower. I totally understand, I started on PZI too and it took a while before I understood why it was ok to shoot 140 when the same dose dropped her a lot from 300s. Drop the dose back to a level that will allow you to shoot consistently at +12, work on gathering as much data as you can, then we'll work from there. Does that make sense?

Each time you delay a shot or shoot a reduced one, that does a number on his shed and can lead to higher numbers. It's better to reduce the dose and be consistent.

I think another thing we learned is that 0.25 is definitely not enough, at least for now.
 
Re: 1/13 tomtom a lev newbie amps 600+

yes libby it does but i would like to add one of tom's unusual quirks which may make a difference in how we handle him. i would like to go on a 13 hour day 11 hour night schedule becuase tom has a long history of his amps being a couple of hundred points higher than his pmps.
so if i shot him at 8:30 in the morning but at 9:30 or even 10 at night his dose may have more effectiveness....unless i'm just being totally dense on the way it works...but in my head this looks like a good plan. this way i could shoot 1u in the morning to a typically higher amps and a .75 n the evening to a typically lower pmps.
tom btw has been this way since he was very first dx'd.
thoughts.
i know it's different, but tom is a unique fellow.
 
Re: 1/13 tomtom a lev newbie amps 600+

Hi Lori and TomTom!

Stopping by to see what's going on.

No real advice as I know you've read all the stickies and such, so you already have a good idea how the insulin is supposed to work within the shed.

I would most likely give it a week or two on the protocol to see what happens and lay in the baseline for decisions and variances.

But it is up to you. ;-)
 
Re: 1/13 tomtom a lev newbie amps 600+

Since Levemir works so differently than what you have used thus far, I would suggest going with 0.75u on a 12/12 schedule for a little while (2 weeks at least) and see how he evens out. It may be that he doesn't do that kind of lop-sided thing with this type of insulin. Going on a 13/11 schedule is constantly depleeting and overfilling the shed - you probably will not get a nice even pattern out of it like you could with a 12/12 schedule.
 
Re: 1/13 tomtom a lev newbie amps 600+

Lori I think you have to erase all of the old PZI data from your mind so you can now start to learn how Lev works. I am sure it is very hard to relearn a new insulin as I have not had to do that and I know I would have a very hard time.

Lev does work best on a 12/12 schedule and changing the shot times and shooting different doses for am and pm is not really advisable. AMPS in most cats are usually higher than PMPS.
Remember you are not basing your dose on ps....you are basing it on nadir which may be very different than the way PZI is dosed.

I am sure when Libby has a chance she will be back to answer all of your questions.

It is a learning process which takes patience....another thing I am not good at. ;-)
 
Re: 1/13 tomtom a lev newbie amps 600+

I've got to agree with the feedback you're getting. Until you have data on how Tom is responding to Lev, the best and safest route is to follow the protocol. All of what you know about how Tom reacts to PZI no longer applies.
 
Re: 1/13 tomtom a lev newbie amps 600+

personally, if you are not comfy shooting the 1u on the numbers you are getting, then drop to skinny 1 (.75). you should get higher numbers and be more comfy shooting then. can always raise later. lev is best used on a 12/12 schedule. others shoot those weird times due to work constraints and have no choice. Tom is responding nicely BUT YA GOTTA ERASE YOU"RE PZI learning. Been there done that. we really do not care what PS's are. everything is based on nadir. if Tom is nadiring at + 12 right now. and you have been collecting data and you know that within the hour he is going up, then it is safe to shoot at the lower number at +12. It takes at least 3 hours before it starts working. I know it is hard to grasp.
each time you change dose or times, it is like starting over (not quite but almost) cause you are either depleting the shed shooting later or decreasing before need to) and if shooting early then it is like giving an increase. there is also something called NDW where after an increase they can run higher for a few cycles until cat adjusts. weird but this is a normal thing. when ya drop a dose, if no response (if numbers start going back up after a couple cycles, then go back to original dose. I know all this sounds confusing but you will be a pro in no time
 
Re: 1/13 tomtom a lev newbie amps 600+

I agree with dian.

Drop the dose if you feel you must, that is totally OK until you figure out how TomTom is going to respond. And you start to get comfy with Lev.
 
Re: 1/13 tomtom a lev newbie amps 600+

thanks guys,...ok i understand.
than for right now based on this morning we are on 9/9
he does seem to rise soooo slowly but i will not factor that into my thinking. literally only can up 13 points in 3 hours after +11 nadir. but we will do the deed. i'd like to stick with the one u based on his nadir but am will to go skinny u on your experience. i do agree tom shows potential for doing great on this insulin if mommy bean can get it right.
 
Re: 1/13 tom amps 600+ 1u +4.5 490

if you feel comfy with the 1u, then that is fine. at night. at least get a before bed test if nothing else. you can, for a while, til you see when he starts to rise check every 15 min after +12 and then shoot on the first rising number. this way you will be sure (satisfied) that he dose rise sometime after +12 and it will be safe to shoot the lower +12.
this is a very easy insulin to use once you understand it and how your cat responds. no different than when you first started using PZI. It all has a learning curve. the difficult part is unlearning the old insulin.
hang in there. you are doing a great job
 
Re: amps 600+ 1u +4.5 290 7.5 255

well it's +7.5 and we've lost 350 points (or more as 600+ could mean anything)
please note that when tom is high it is absolutely routine for him to drop 300 points. he has done this even with no insulin. i tested once to see how he would respond to no insulin for and hour or 2. tom has an opposite reaction when eatting food. his#'s go down i believe from pancreas stimulation.
 
looks like tom is making a habit of +12 or higher nadir. these are my only scary moments.
testing again in 45 minutes. if he's still going down i'll either shoot skinny u after what happened last nite/this morning.....or wait 15 minutes to test and make sure he is going up.

only question...is it imperitive to shoot past the nadir. what if tom's nadir is +13 or something. is it ok to shoot prior to his lowest number of the day? his data thus far indicates he tends to lose 100 or so points in the first 2 hours post shot.
 
that was very kind Karrie, thank you.
any help out there.
testing in 15 minutes. potential for no nadir yet at pmps...read my last post above please
 
Lori,
You have received some fabulous thoughts today.
As I mentioned last night, whatever you were going to shoot...however late, was going to be a learning experience.
After shooting a .25 last night, Tom ended up in the 600+ range this a.m. You are in the same situation tonight. Do you want to do anything differently?

Tom is possibly bouncing from these blues and soaring up into the high numbers. Looks like he may be clearing the bounces very quickly, tho.

As others have said, you need to shoot a consistent dose on a 12/12 schedule for a while THEN re evaluate. At the very least, people will be able to offer you more feedback. Random schedules and doses makes it hard for other to give feedback. If that dose is less than 1 u, then so be it for now.

If you feel more comfortable waiting for a rise, then thats what you need to do until you see this as a pattern.

If you ask for help around shot time on the board, could you post follow up numbers. I waited around last night after asking if you could get a +11.5, but only saw a quick reply to another person unrelated to numbers. It was not until this a.m. I saw you were also posting on health, but no follow up numbers in the post on lantus. Also, if you are posting for help in multiple forums, it might be good to post links to these. There are a lot of them going around, and maybe its just me but Im having a hard time following each day. Not that anything I have to say is going to enlighten you, but it does make it harder for anyone who could.

You will catch on. Its confusing enough as a first time user, but to switch insulins and frame of mind...Blech! Its good to see you giving it a go. Looks like Tom approves as well!

Best of luck to you tonight. In not likely able to stick around.
 
Hi, Lori.. it looks urgent based on the subject line.. I have not read the post since I last posted & am not an expert.. but I want to say.. again.. shoot the same dose on a 12/12 schedule & forget PZI. You are not shooting the preshot #, but what the # will be. Breathe. Hugs. Tom Tom is Good & so are you.
 
carolyn i will keep a steady diary of what goes on here. if i post on health it will not interfer in my answers here on this board from today on k?
my main question is, once again, is it normal, ok, cool, acceptable to shoot when you have NOT reached a nadir. this question is based on the ever steady streams of 'we shoot based on the nadir' so if it is ok..yes i will shoot, i don't know how common/uncommon it is for a cat to not nadir out by +12.
 
Also.. I am sure you have heard.. but when you have time.. study our spreadsheets.... they really are helpful... although each kitty is different.. it gives you an idea of what we all go through.. a similar experience in some instances ;-)

**Edited to add.. we do not know what Tom Tom's nadair is yet.. heck.. if you ever really exactly know.. because they change..you have to follow protocol & make best decisions on your collected data.
For now you just have to trust in the expertise of gained knowledge/experience (((Lori))) it is so safe & so awesome when you let go & let the experts guide you.
 
Nicole maybe i'm just not cut out for this group. You are totally a sweetheart. I do know that Tom is NOT at his low point until after +12. This would be nadir right? the low point of his day? So I do know when his nadir is right?
I shot .6 at 15 minutes (god forbid) past +12 so I could see his first rising #. It was 161.
I feel like my one and only question is simple yet I just keep getting told to forget pzi. I HAVE forgotten pzi,,,,just have this one and only nadir question.
 
Ok.. yes, you are made for this group..no acceptance rules.. Tom Tom is on Lev & this is home.. I wish I had concrete answers for you.. but I hesitate because I am not an expert.. with your particular shooting.. but yes, you are correct.. nadair is the lowest point of they cycle.. I just ask.. Nicely.. how do you know his nadiar on Lev yet.. we don't have the data...hopefully someone can drop thru.. hang in there.. you are dong fabulous! I want you to ALWAYS feel welcome.. I enjoy hearing about Tom Tom & you :YMHUG: heck.. look at Baby's spreadsheet today & the day before .. her nadair was +12
 
Nicole I did just look at your SS. I see you have that late low number too. My question after looking at your SS tho' is....when do you sleep :lol:
 
Lori,
Im not sure if its possible to say Tom's nadir is +12 or after at this point. There are a lot of variables going on with early/late shots, reduced doses, short amount of time to build shed, etc. This is why most folks are suggesting a period of time (7-10 days) at a consistent dose and shot time, along with regular testing. It may end up being he has a later nadir, which is common with Lev. Its just hard to say without consistency. And due to the lack of consistency, folks are encouraging you to let go of the pzi brain (because as I understand it you have more freedom to shoot at different times/doses/etc).

I hope this makes sense. Im sorry if it doesnt. Im not sure how better to say it. Maybe I should leave it up to those more elequant with words in the future... :?

Now, Im really off to bed....
 
:lol: :lol: :lol: Sleep? Off to go get 2 hours now.. so I can get up and shoot Baby in 2.5 hours.. you are doing fabulous with Tom Tom... heck just a week ago you were hunting for the RX & now look at you! It gets easier & I want you to keep posting & asking.. we all get our feelings stepped on sometimes.. it is because we all our sensitive to our furbabies, just remember we are all here for each other & in this together! I hope you had a nice day at work today... I-) good night
 
Hey Lori....I've been in Phoenix all day; got back late; did Gracie's thing and just chillin' with Mike tonight before he heads back to work....and monitoring Gracie.

You're doing great...I know it's repetitive but with lev and lantus, the word is consistency. In my novice eye, I don't see enough data yet to know exactly what his nadir is and to tell you the truth, there are many times looking at Gracie's SS that I can't tell what hers is....she moves around; typically it's around +6 but not always. You'll get the hang of it cause you are one smart girl!! And you got all of us. :lol: :lol:
 
+10 554. this is not too much insulin at the wrong times it is too little insulin.
my frustration comes not from not understanding what folks are telling me but from folks not understanding what i am telling THEM and helping me work with my unique cat.
if anyone would like to (not dose advise) but talk to me via phone about what i see verses what you see i would really appreciate it. seems like my thoughts are irrelevent. i just want to have a 2 way dialogue so someone can see what i am seeing and correct me if i am seeing it wrong? or perhaps they also will see what i see. it that possible?
pm me if you would like to help...
lori
 
As I mentioned previously, conversations off the board are not the norm here. We can't prevent it but don't be disappointed if the beans who have the most experience here gracefully overlook your request for a phone call. If you can outline your concerns in a point-by-point fashion in your condo, I'm sure people will be happy to respond or try to better understand what you're seeing and your concerns.

My best hunch is that there are some key concepts in working with Lev that you're struggling with (e.g., shed, overlap, etc.). You also need to be consistent with one dose in order to have a clearer picture of when Lev onset and nadir is and what the duration of the insulin is. Tom may indeed need more insulin but you'll need to be comfortable shooting lower than 200. But, these are all assumptions on my part since it's what most people who switch insulin struggle with and I'll be happy to be wrong.
 
what are you seeing? I don't understand what you mean by what you are seeing that is different? and what is unique about tom that makes him different?

just think about it for a while, get your thoughts together, and write it out for everyone? maybe that's the problem, what is "different" or "unique" is not clear to others?

everything you know about tom and diabetes and insulin up to this week, is useless. seriously. i'm guessing that what you are considering "unique" is your statements about his high amps' and lower pmps' before and his drops for no reason, etc?? that isn't unique. that's your experience on pzi and it was a bit out of control for awhile now in all honesty. all of that though goes out the window now though. none of it applies now.

is that what you mean by "unique"? that's what i've gathered from your posts this week but see, to everyone else, that's pzi and that's part of what they've all been trying to say, that that stuff doesn't matter now. so i think some of the problem may be communication problems thru the typed word.

and lori, i'm not being mean ok. i'm thinking some of the frustration is due to the typed word and i'd rather cut to the chase and get things cleared up, even if it can be read as blunt ok. be patient with me too? :-)

crazy day i've got today trying to wrap things up for the week but i'll try to check in a few times k
 
Hi Lori,

I know getting used to this group is very, very tough. And I know you have observed the dynamics here for quite some time, made comments even about our BOS at shot times.

Right now everyone is hearing what you are saying...really we are.

What we're all trying to tell you or get you to understand ...is we don't have enough baseline data to say your strategy is :-Q :thumbup .

What we are trying to communicate is that Levimir and Lantus don't usually work well with the kind of strategy you want to use. The shed simply doesn't work the way you seem to want.

The shed is a limiting factor, it simply is what it is. How it functions won't change.

STICKY: LANTUS & LEVEMIR - INSULIN DEPOT -AKA- STORAGE SHED

I want to direct you Atlas' spreadsheet. I am doing this with the caveat that how I am handling Atlas is based on a lot of collected data! I cannot tell you to do this with Tom, we don't have any data, but you might end up here.

Atlas bounced like crazy, would give me half-hour heart-pounding freefall hypo recoveries (these were not real nadirs), and everything I thought I knew about Smogyi effect, rebound, insulin OD....was wrong on Lantus. So we laid in the baseline data. How did he react at this dose, that dose, this feeding time, that feeding....look at my SS...it took a long time. Longer because I was being a bit stubborn, longer because I couldn't grasp some of what I was being told and how it fit into what I was seeing in his SS.

Look at the note in my comments section from 1/2/11...now that's frustration.

Pay attention to Attie's +9,10,11 readings. Often he gives me a DROP at those times. Nadir or false nadir depending on your POV. In stage 3 of the Roomp protocol it give you 3 options to deal with those kind of PS issues. We tried several for a while...which didn't work. I had to find my BOS and put them on...now that I had the data...

Recently I started following the last option in stage 3 ...feed and shoot as long as the number is above 50 and be available to monitor for signs of hypo. Lantus and Levimir are designed to be dosed in the over lap. This article explains what I mean.
Insulin Depot

Edit to stress this point: In the perfect scenario, there are no high peaks. The consistency of the dose is what makes that happen.


You haven't even made it through stage one... don't give-up on a great support network just yet.
 
Here is what I think Lori is trying to ask:

She thinks Tom is nadiring at +12. Is that ok/normal? She got a 141, 2nd cycle 1/12/11 and because she did not have the numbers yet to shoot the full dose, she stalled which is correct to do AND then she did not feel comfortable shooting a full dose so she shot a reduced dose...that's absolutely fine for a newbie without enough data to do. Because she shot a reduced dose, Tom did not have enough insulin and jumped up to 600 the next day.

Libby said:
Each time you delay a shot or shoot a reduced one, that does a number on his shed and can lead to higher numbers. It's better to reduce the dose and be consistent.
I think another thing we learned is that 0.25 is definitely not enough, at least for now.
Click to expand...

So it looks to me like what Libby is saying is that Tom didn't bounce but what resulted in the higher number was he didn't have enough juice from .25u.
I think everyone has been great about explaining why a 12/12 schedule is important for consistency and I think Lori understands that. What she has been asking is if
Tom is nadiring at +12 and is that normal. My thoughts, as a newbie, is that ECID...he could be and she will be collecting more data to fully determine that. If he is, like
Attie and others do, then she'll have to learn how to shoot that number and monitor it. So the answer is YES...it could be he is nadiring at +12 and monitoring will tell her.
 
thank you marjorie for clarifying what i am doing. and perchance that what i did was ok, acceptable, even the right thing to do. both the stalling and my 2 time dose redux. i know more now based on data.
i am not comfy with the fly by advice. marjorie took a few minutes to really look at my ss, think, and see it's logic.
again thank you
 
fwiw, i think everyone has looked at it and at 4 days, there is no logic yet to a spreadsheet, not when someone is trying to find their way.

i see what you have done and understand the logic that goes on in one's head and makes one take the actions one does and that's totally understandable so early in this, thus reduced doses, etc....

buttttttttttttt, then why are you asking about shooting more insulin? that is what is confusing to me. and probably to others. the high numbers you are getting in the mornings are because you're reducing in the evening's, timewise and dose amount. what everyone is saying is that right now he doesn't need more insulin, he needs consistency.

if you were open to monitoring at night, a little, yes, i would have told you to yes, shoot the 1 unit at the +12 both on the 12th and the 13th simply because you have enough experience with testing and handling hypo's i personally think you could have handled it. but without the evening monitoring, you have no choice to change things up, i.e. reduce, delay, etc....which in all honesty, messes things up and every time that happens, you have to start over. it happens. the key is to not overreact.

for instance, i will be "starting over" with Mousie tonight most likely. as i said, work is crazy still and her pmps last night was at +15.5. she was 168. this morning we had to get up early and head to work due to a bad accident on the freeway so i had to test and consider shooting her at +8.5. i went into it thinking if she was over 100 i'd go ahead and shoot as i knew she would be eating and going up. well, she was only 92. at +8.5. what to do? well, raul took long enough in the shower that i was able to get another test at +9 and she was up to 132 after eating. still, what to do? i decided to go with 1/2 a unit.

why? because a full unit would have been too much because some of that 132 was food and she would have went too low and rebounded. 1/2 a unit was at least something for the shed but not enough to keep it full i know. so tonight i'm fully expecting a number 250 or higher. will i shoot her usual skinny 1 unit? or will i freak out at the higher number and shoot more? i will shoot her usual dose and work on refilling the shed. that's all i can do without hurting her. if i overreact to the higher number, in a day or two, i'll have a hypo on my hands.

that to me is the worst part about this. on these insulins that "build up" the hypo doesn't happen today, it happens 2 days from now. one shot works on the next works on the next works on the next. overreacting to higher numbers takes it's toll tomorrow, not today. remember that.

sooooooooooooo, are we over the "needing more insulin" thing and more on "is what i'm doing ok for now?" if so, for the most part, yes :-)
 
I think Lori gets what everyone is trying to say and so I think it is best for us to move forward and let her get some data.

Lori: if I could make a suggestion please: I think it would be awesome if you could open a daily condo like the rest of us do and that way we
can see what is going on and track it better. I also think that is where the most help comes as there are folks in LL going through the condos
each day and checking on how things are progressing. If they think a suggestion is needed, they can pop into your condo and leave it for you.
I really think it works best for everyone that way if you want to hang with us in LL :lol: :lol: There is alot of help here.

I think a few things we all need to keep in mind:
1. written words can get misinterpreted; sometimes we don't understand the question or understand the answer thus
2. patience with each other :-D
3. taking just a few seconds to reread a post before hitting "submit" so we can make sure it isn't coming off as too harsh even though we didn't mean it to be. I am so guilty of saying something just to be quick and then submitting. When I read it back I think, wow...I really didn't mean it to sound like it sounds. We're all here to help each
other and be kind to each other...that is the LL way :-D

Hugs to all!! We're in this together.
 
i'm glad the post i just wrote to cindy poofed and did not make it too the board.
marjorie you are the ambassador of good will and quite a negotiator!
i will be shooting 12/12 with exceptions due to a weekly fri. nite commitment at my place of worship.
i am gone for 6-10 so yep, he'll get either a +13.5 .......in time perhaps i can factor that into my schedule to keep more regular.
not tonight tho'
unfortunatly.
i am shooting 1u as i personally do not think he is rebounding but underdosed at night. take that up with your congressperson if you have a problem with that. i am doing more spot checks at night hopefully to see if this is appropriate as both .25 and .6 were not appropriate. and cindy...there are no 'butttttssss' there is what i did and what i did'nt do and i would have been up all night with your method whereas i slept like a baby with mine. slow and go...collecting data,
apologies to anyone offended.
 
lori and tom said:
i will be shooting 12/12 with exceptions due to a weekly fri. nite commitment at my place of worship.
i am gone for 6-10 so yep, he'll get either a +13.5 .......in time perhaps i can factor that into my schedule to keep more regular.
i am shooting 1u as i personally do not think he is rebounding but underdosed at night. i am doing more spot checks at night hopefully to see if this is appropriate as both .25 and .6 were not appropriate. and cindy...there are no 'butttttssss' there is what i did and what i did'nt do and i would have been up all night with your method whereas i slept like a baby with mine. slow and go...collecting data,
apologies to anyone offended.
Click to expand...

:-)
1. sounds like a plan is in place. good
2. i agree, not rebounding so much as being underdosed in the evenings
3. possibly. until it happens, no one can say for sure what would have happened. butttttt :smile: if sleep is the priority, then you work the diabetes around it and if it means reducing doses or having higher amps' then that's what we're going to get and just remember not to get upset with the higher amps'.
 
Marjorie and Gracie said:
Here is what I think Lori is trying to ask:

She thinks Tom is nadiring at +12. Is that ok/normal? She got a 141, 2nd cycle 1/12/11 and because she did not have the numbers yet to shoot the full dose, she stalled which is correct to do AND then she did not feel comfortable shooting a full dose so she shot a reduced dose...that's absolutely fine for a newbie without enough data to do. Because she shot a reduced dose, Tom did not have enough insulin and jumped up to 600 the next day.

Libby said:
Each time you delay a shot or shoot a reduced one, that does a number on his shed and can lead to higher numbers. It's better to reduce the dose and be consistent.
I think another thing we learned is that 0.25 is definitely not enough, at least for now.
Click to expand...

So it looks to me like what Libby is saying is that Tom didn't bounce but what resulted in the higher number was he didn't have enough juice from .25u.
I think everyone has been great about explaining why a 12/12 schedule is important for consistency and I think Lori understands that. What she has been asking is if
Tom is nadiring at +12 and is that normal. My thoughts, as a newbie, is that ECID...he could be and she will be collecting more data to fully determine that. If he is, like
Attie and others do, then she'll have to learn how to shoot that number and monitor it. So the answer is YES...it could be he is nadiring at +12 and monitoring will tell her.
Click to expand...

Yes, he could have a +12 nadir, some cats do and yes, it's ok if that's the case...you will need to learn to shoot low and do the appropriate monitoring, but it's not an insurmountable problem....in fact, it may be to your advantage if he is a late nadir cat! But as others have said, you don't have enough data to say when his nadir is yet.

I want to reiterate the other part of what Libby said that Marjorie quoted....reducing the dose so that you can shoot consistently on a 12/12 schedule. Yes, it's probably too little insulin, but you need to start lower so that you can shoot the same dose without having to reduce at night because he is lower than you are comfortable shooting. I would do as Libby suggested, try 0.75u rather than 1.0u so that you can try to shoot that dose consistently. Reducing a little is a good way to gather data and ease into shooting lower numbers. It's hard to say what a good dose is for Tom at this point because you haven't been able to shoot consistently, but so far the 1.0u has been too high for you to be comfortable shooting both cycles.

As Marjorie said, it's fine when you get a lower PS than you have the data to shoot to stall and/or reduce the dose....however, we often recommend reducing the dose after that so you don't end up in the same situation again. Again, the goal is to shoot a consistent dose on a 12/12 schedule.

I know how hard it is to adjust to the Ls, one thing that took me a while was the shed....I read and reread that sticky, probably a hundred times! It's a tough thing to get your head around. Keep asking questions, there's a lot of help here for the asking.
 
Hi Laura,
I shot .6 last night and as I tested it 3 times that dose did nothing at all for him. he actually rose all night. tonight i'm putting on my bos (oh god i'm talkin the talk) and unless i see something bizaar in his pmps i'm shooting a u.
i'll test him too.
 
Lori, as long as you are aware that he may go low and you may need to stay up late and test to keep him safe, that's fine. You hold the syringe.

If he were my cat, I would reduce and gather some data before you start shooting low. Start low, go slow. It's a lot easier and safer to work your way up than start too high and have to deal with low numbers and trying to go down the ladder....especially if you are not able to monitor at night. There is always more than one way to do things, but you need to take your circumstances into account...I would err on the side of caution because of your sleep disorder.

Your instincts about not shooting the full dose on the lower PS were good, IMO. Once you get more data, maybe, but not now.

It's absolutely your choice though.
 
laurie was not the 2 nights i shot low enough data gathering? he went way up on those 2 nights. should i gather yet more low dose data?
 
lori and tom said:
laurie was not the 2 nights i shot low enough data gathering? he went way up on those 2 nights. should i gather yet more low dose data?
Click to expand...

Those were also two nights that he had a huge drop in numbers during the day. Just food for thought.
 
Lori, you're forgetting about the shed....each shot builds on the last, as Cindy said. Getting data on one reduced shot is not the same as getting data on shooting that dose consistently.

I'm thinking about Tom's safety. It's better to have him too high than too low when you are sleeping.

I know you have been dealing with FD for a long time, but you haven't been using Lev, and there's a whole new learning curve. You are making judgements based on PZI thinking. You need to listen to those with experience, just like you urge newbies to listen to you when they first arrive.

Patience....it's a marathon, remember? You need patience and consistency with the Ls. You won't see overnight results, these insulins do not work like PZI.
 
Hi again Lori,

I tend to agree with Laurie about adjusting the dose down...say for 3 days. Give yourself and Tom a chance to catch-up and fill the shed. I would back off to 0.75u and think of it as filling the shed. You will see some action on the BG, but part of the insulin is kept to fill the shed. Until the shed is full ...you won't see the whole result. And then when you do it could come at the price of a prolonged hypo, which I know make you uncomfortable.

Atties current dose didn't happen in 6 cycles or 10 cycles. I almost increased (I actually did for one full cycle 1/2/11) when I shouldn't have.

( Please see Condo from 1/2/11 viewtopic.php?f=9&t=33430 )

On 1/3/11 you see the result. Low numbers, and bounce.

And then chicken shots and high numbers. (when I found my BOS)

It took another 10 cycles to straighten out one overly aggressive dose.

It took Attie nearly 20 cycles to settle into this dose.

Taking that long to settle on a dose with Ls is unheard of and crazy...but it took Attie that long. I keep referring you to our SS, because it is recent events. Real examples and easy to point out. Actually discernible for almost anybody with a little explanation. I hope it helps.
 
lori and tom said:
laurie was not the 2 nights i shot low enough data gathering? he went way up on those 2 nights. should i gather yet more low dose data?
Click to expand...

Let me try a different way of saying this: You were reducing the dose to accommodate a low number, in case he continued to drop overnight, or dropped as much on the PM shot as on the AM shot because you would not be able to test over night and do not have data to show what might happen.

But we are suggesting lowering the dose to stop the swings - saying the 1u is too much and causing the swings. And hold the lower dose because that is what lev needs in order for the numbers to settle out. One low dose followed by a return to the higher dose will not do it. Data after that scenario does not tell you anything. In fact you have no data other than the next PS. He may very well have continued to drop before climbing. No one knows.

I still maintain that the 600+ the next morning was from a 450 point drop the day before. His body saw that drop and said "Whoa! Red alert! Shields up! Man your battle stations!" and proceeded to dump stored glucose and release cortisol, which takes days to clear the system. In other words, you are seeing numbers that are caused by the dose TWO SHOTS AGO.

Answering your other LL thread post: I am not questioning your previous years experience with other insulins or with FD. Isn't the whole reason you are posting now to learn from those who are more experienced WITH LEV than you? I mean, that is why I started posting in the Lev ISG when I switched Beau from vetsulin. I knew nothing about lev. It was a whole new ball game for me. It was very hard to let go of my old vetsulin thinking. And it was very frustrating. All of us that have switched between very different insulins have been in the same boat. We were not newbies about testing, diet, ketones, etc. but we were newbies about the insulin. Cats respond very differently to lev/lantus that to other insulins.
 
:YMHUG: ok i give. you guys are right. i don't know a thing about this. i'll try my best to let go and do the tried and true method. i'll stop angry(2)_cat fighting it off. you've been pretty darn patient explaining yourselves over and over.
i went into town to drop off a couple of newbie kits at the p.o. and 'breathed' and i realized maybe, just maybe they know what they're talking about. maybe i have been spinning my wheels :dizcat like da dizzy kitty and for what?
tonight i will give tomtom his .75 (please allow me this compromise .6'ers) and will hold the dose for 3 days. i suspect i will wake up to an ugly...but i've done that before. i suspect it won't get much prettier, but you guys think it will.
PLEASE PLEASE PLEASE don't hesitate to change your minds if tom runs terribly high for too long. i hope i am the one who is wrong. if not, please don't let him ride it past your better judgement ok, just give me the go to raise dose.
cat_pet_icon cat_pet_icon i love this little guy so much. and i know you all know exactly how i feel cause you all feel the same way.
here we go.
and i'm going to try my hardest but he may be 1/2 hour late tonight. and that is with me cutting a commitment i do religiously in half just so i can attend part of it. is that ok with you all.
and now that i'm calmed down i want to say thanks for sticking it out. i've been grumpy_cat but am ready to :YMHUG: embrace the knowledge and experience.
thank you.
lori and tomtom
 
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