Chip and Dale's "Tight Tilly" Relaxed Levemir TownHall

[Dale 'n' Chip]

As is typical, I'm not one to ever stop and ask for directions. I'll drive around aimlessly until I either find it on my own or *conveniently* change my mind about the destination. Can you believe I have no Garmin device of any kind? And no satellite radio either. :mrgreen:

My approach may be relaxed but my dosing protocol is apparently pretty tight. So you ask why not post in Lantus Land? Well I'm using Levemir now and attempting Tight Regulation so kind of homeless since I'm just not comfortable with the conventions in LL but still need to do some Tight Tilly to get results.

Hopefully by posting here Marje, MamaOfMuse, MammaDale, Purple, Lintball, Leanne & Count Chocula, Lindsay Lohan or anyone else may stop by and chime in. I'm looking for all opinions.

The good news: Chip was finally on a roll... nearly solid green for two weeks. The bad news: I suspect I messed up the reductions badly and he apparently went off the rails.

My question is how does one know when a reduction has failed? And how do you promptly return to the last good dose? And for that matter what is the Last Good Dose? Okay Lindsay Lohan doesn't have to answer that last one. :smile:

But I am curious where I should take Chip from here. And what are the odds he will see regulation again after this? Thanks.

BTW I have the Harbor Freight Calipers and Terumo syringes if that makes any difference. ;-)

 

[Julia & Bandit (GA)]

Hi Dale--

Here's what I'm seeing. Considering some of those very low preshots, I don't think it was a bad idea to reduce the dose even though you didn't get below 50. I've done that myself and had the reductions hold just fine, and I think your reductions held fine as well. Some cats just come rocketing down the dosing scale once they start to regulate. If you get a low preshot and you won't be home to test, I think it is safer to take the reduction with a preshot less than 100 rather than shoot. Remember that the Rand protocol does call for a .25u reduction with preshots <100, but some people who can predict how their cat will react to the dose (i.e. they have data to back up their decision on that dose) choose to shoot numbers less than 100.

Where I see the problem is that you got one number higher than 200, but then you did not wait to see if the 1.75u would hold before starting to raise the dose back up. If you had given the dose time to settle, it very well could have held. Or it may have needed to be nudged back up to 2u with some fat/skinny doses. I think that you raised back up to 2.25u without waiting to see if either 1.75 or 2u would hold, and that caused some wonkiness because of the lack of consistent dosing. Things need to settle a bit and you need to get some data to see where to go from here.

I don't think the increases to 2u or 2.25u were earned, and with the preshot you're getting right now, I would reduce to 2u. I don't think you have enough data to hold the 2.25u safely. I would hold the 2u (unless he drops too low) for 5-7 days.

My question is how does one know when a reduction has failed? And how do you promptly return to the last good dose? And for that matter what is the Last Good Dose?

The last good dose is the one that you are able to hold...you're aiming to keep BG between 50-200 for most of the day. It's ok if you see an occasional number or cycle above 200--that's not a reason to immediately raise the dose. You don't know if the cat just got into something, or got stressed out about something, or just was having a wonky day. But if you're seeing consistent numbers over 200 for at least 3-5 days, then that's time to increase the dose. If the numbers are borderline (high 100s, low 200s), you might want to fatten the dose and see what happens over the next 5-7 days rather than raising a full .25u.

And yes, I think it's likely Chip will see regulation! I think this is just a hiccup.

 

[Julia & Bandit (GA)]

The most important lesson I ever learned is patience. You really have to wait with those 200s to see what is going on. Sometimes it just needs to level, and sometimes you need to nudge the dose upwards. But always take more care when a cat is regulating, like chip is right now. In my experience, he is likely to settle eventually around 1u. or less, which is about what most cats need on the right diet and Protocol, if there are no secondary condition.

 

[Dale 'n' Chip]

Thanks Julia.

I did go with 2.0U.

Can't believe the plus 12 was 49. And that was after carbs and karo on the 97. But the steering did work since +12.5 was 56. I had to stall for 4 hours before he was up to 75 and rising so I could shoot. It was a long day and I still need to stay up for the new shot time.

But that very specifically answers my big question as to when a reduction actually fails. That would be great if I can eventually get him down to 1.0U!

And that is a relief I can give those doses a little more time to settle without worrying so much.

 

[Dale 'n' Chip]

Just an update here. I held 2.0 for 7 days and he seemed to get stuck in flat pink, so that apparently didn't hold.

So I walked him back up the ladder 5-7 days each step and he settled down when I got back to 2.75U.

And earning reductions again right away so I tried a reduction of 2.5U (after the 44) but 2.5U also went flat pink in no time.

So I took him promptly back to 2.75U and he settled back down. Guess he's not ready for a reduction yet.

Seems Levemir is so excruciatingly flat, it requires more aggressive dosing perhaps than Lantus.

So much for getting him down to 1.0U (or even 2.0U or 2.5U) in a hurry, but I'm just glad to see him regulated again. :smile:

 

[Pumbaa]

Chippendale's: You have done a tremendous job getting Chip's numbers back to being well regulated! :thumbup

I pray for the day when Pumbaa flattens out on the Levemir again. I was never fond of yo-yo's, and having a yo-yo cat isn't my idea of fun. *LOL*

Suze