Casey's numbers - now what do I do?

[ohiogal]

Hi everyone,

I'm flummoxed about Casey's numbers. I raised her dose to 2.5, but her numbers haven't gone down. On the contrary, they've started going UP - so what do I do? Up the dose? Take it back down? Or is it possible that no amount of insulin is going to get her numbers down in the low 100s so I should just stick with 2.5u and nadirs in the high 100s, and let it go? I've been trying to get her regulated since January.

Thanks for any suggestions! I really don't know what to do next.

 

[LILandKIT]

Oh Casey, bring those numbers down for us ok? Pretty please?

I personally wouldn't just "let it go"...mostly because I don't think you have to give up just yet If her nadirs are still showing always above 150 then my personal opinion would be raise another 0.25 and see where that takes you. If Casey were my kitty, that's what I would do....try to get away from all those constant high yellows/purples.

Hope you guys are doing well!

 

[Blue]

Hi everyone,

I'm flummoxed about Casey's numbers. I raised her dose to 2.5, but her numbers haven't gone down. On the contrary, they've started going UP - so what do I do? Up the dose? Take it back down? Or is it possible that no amount of insulin is going to get her numbers down in the low 100s so I should just stick with 2.5u and nadirs in the high 100s, and let it go? I've been trying to get her regulated since January.

Thanks for any suggestions! I really don't know what to do next.

I am wondering why you would consider reducing a dose when numbers are in the 300s. The current dose of 2.5u is not high at all, so if Casey needs more insulin, then increase the dose by using the general guidelines most others are following.... you don't need to be a crazy TR tester to follow the general rules and to me, I think you are holding the dose too long.

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.
Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

So to me, you can do another curve if possible and if you are still seeing nadir/lowest number in the 100s, you would be fine to go up by .25u and see how it helps.
I would not hold each dose so long.... if you can do a curve once a week like you have been, it should be good enough to let you know how she's doing....
Increase the dose by .25u and do a curve. Then if you are liking to hold doses till the next weekly curve, that's fine. Unless you get a really low ps, like under 100, I think it looks as if you have room to increase.

Keep in mind that you would not have to worry about reducing your dose unless you are getting numbers under 50 in mid cycle.

 

[ohiogal]

I am wondering why you would consider reducing a dose when numbers are in the 300s.

Because when her dose was at 2u, the numbers were in the 200s/high 100s.

That's what I don't get. If her numbers were in the 200s at 2, at 2.5 they should be lower, right? But they aren't. Since I raised her dosage her numbers have gone up, not down. That's what has me confused.

I'm doing a curve today, and I'll raise her dose tomorrow. But it's kind of discouaging that increasing the dosage doesn't seem to be doing any good.

 

[ohiogal]

Oh Casey, bring those numbers down for us ok? Pretty please?

I personally wouldn't just "let it go"...mostly because I don't think you have to give up just yet If her nadirs are still showing always above 150 then my personal opinion would be raise another 0.25 and see where that takes you. If Casey were my kitty, that's what I would do....try to get away from all those constant high yellows/purples.

Hope you guys are doing well!

Well, we are, except for those numbers, and she still has the neuropathy! But other than making her walking and jumping wobbly, it doesn't seem to bother her much. I'm still giving her Zobaline and hoping it'll kick in at some point...and she's still eating and drinking and pooping...

 

[LILandKIT]

Aw man..but at least Casey's taking it in stride. Kit used to too...I used to be so upset seeing him but he would just wobble around like it was nothing (well, except for jumping, but that didn't seem to phase him). I think you wont see a drastic change until those numbers start coming down though...but I'm crossing my fingers!!