Chip's Big Fat Lantus Condo...

[Dale 'n' Chip]

...it just isn't my cup of tea. I find the whole daily condo thing overwhelming.

Me too, me three. I once posted an actual daily condo and no one read it what a waste of time. :smile:

...We have historically seen very similar numbers at both high and low amounts of insulin. Days of flats followed by drops then bounces and it begins again. At one point last year, we kept reducing the dose without much change to the pattern, just the length of flat time changed....it ended in DKA. I guess the long and short of it is, I don't believe it's the rebounds that are causing him DKA problems....I think it's a lack of enough insulin during the flats.

Interestingly enough Chip is actually seeing this now. Only these glucose numbers are correct and double checked. Relion meter and Bayer Contour usb both within 10 points either way in some double spot checks.

Whether 0.5U or 1.5U the range is the same, the pattern is similar, once the dose settles. @-)

Jessica wasn't Boo Radley's DKA more about the fact that the freestyle meter was *off* by more than 300 points at times, so you reduced to far without accurate glucose readings? I don't know for sure if 0.5U Lantus was too little or too much insulin for Chip, but the glucose readings here should be reliable.

So what might this be telling us?

Sheila, Vicky, and everyone jump in here as well.

 

[dmartini4]

The only thing I can add to this is that we had a disater with the freestyle meter
We used ut for the first year and his numbers were great, but they were VERY WRONG!!
I now use the alph track

 

[Sheila & Beau GA & Jeddie GA]

You probably have no choice but to keep systematically raising the dose and see what happens. He has been on lantus such a short time that there are no real patterns evident. Something will happen eventually that will give you some direction. You are starting to get a few more yellow PSs....

 

[Dale 'n' Chip]

I thought those were just more sidewinder Nadirs encroaching AMPS and PMPS.

But I don't see the expected big bounce from the blue PS.

Looks like he may have spent the full 24 hours in the yellow? If so that's progress.

Since he may not be bouncing as bad, I think I will *settle* each increase for 12 cycles.

 

[Jessica & Boo Radley]

Jessica wasn't Boo Radley's DKA more about the fact that the freestyle meter was *off* by more than 300 points at times, so you reduced to far without accurate glucose readings? I don't know for sure if 0.5U Lantus was too little or too much insulin for Chip, but the glucose readings here should be reliable.

Unfortunately....we've been through DKA more than once. :shock: :shock: :shock:
We did on one of the occasions have a problem with the Freestyle meter realizing we were off by hundreds of points.

 

[Dale 'n' Chip]

When I read that I thought it sounded like the patterns I was seeing with Chip.

And just as soon as I post that he completely stops bouncing until... and we have green.

I was thinking about going ahead with the planned increase 1.72U to shoot the bounce.

But then I'm thinking it will be more stable to just hold the dose. :?

 

[Sheila & Beau GA & Jeddie GA]

Hold the dose. If you raise it you will keep the bounce (if there is one) going. You may need more that 6 days of settle time - as evidenced by today's numbers. Things just started changing.

Sometimes Jeddie needed a couple of weeks to settle.

 

[Dale 'n' Chip]

That was kind of a steep drop of more than 300 points but at least it seemed to be a soft landing.

It's interesting that after the blue PMPS on the 20th, this time there was no bounce. So that must be progress.

Tomorrow we see the vet about the other L, but in the meantime we will continue to see where this goes.

At least we should be able to enter the Levemir rapids capable of hitting green, much like Beaumont. dancing_cat

 

[Grayson & Lu]

That was kind of a steep drop of more than 300 points but at least it seemed to be a soft landing.

At least we should be able to enter the Levemir rapids capable of hitting green, much like Beaumont. dancing_cat

Grayson was only getting a 50-100 point range on ProZinc (mostly due to his insulin resistance). However, in the 3.5 weeks we've been on Lev, we've actually seen as much as 300 points of movement AND we've seen blues!!! For the boy that "swam in the sea of pinks" for months, this is huge!

I also went round & round w/ my meters.... sometimes using as many as 3 at each shot time, and even questioning one single meter to the tune of 6 tests at one test time. I have to say, I like my Accu Chek Aviva. I have since stopped the multi-meter testing. It's brought a little bit of sanity to me... although I often saw as much as a 40 point difference from my ReliOn Ultima. AC typically registers the higher number, but seems to be more consistent overall.

It's probably too early for Grayson's resistance to kick in... but that's certainly a possibility. In the meantime, I'm continuing to increase his dose in hopes of even better numbers. Hoping he settles into lower preshots soon!

 

[Sheila & Beau GA & Jeddie GA]

Well, I think "greens" are possible for any cat on lev - it's all in the dosing. What I think you will see is less swinging. 300 points is a lot of change. I think others have seen that they can get the same nice nadirs and avoid the pinks and reds with less insulin on lev. Time will tell.

Looks like Chip takes his time settling on a dose. That is good info to have so you can be patient for a week before changing the dose.

 

[Dale 'n' Chip]

I notice Beau was throwing greens out of the gate on .5u and .4u Levemir after less than spectacular yellows, pinks and a few blues on Vetsulin.

We scored our script and will be able to jump on the *other* L.

In the meantime is there anything we can be doing to prepare for this?

I assume we'd start at .5u Levemir? Or would we want to try .3u first?

 

[Sheila & Beau GA & Jeddie GA]

I think a half unit is good. Be prepared to be testing for ketones and to step up the dose systematically - but, depending on the numbers you are getting that would be in .25u amounts or less.

Thinking in terms of percentage increases in the 20-25% range works best - so from .5u you may want to go to .6u. Again - it will depend on the numbers.

 

[Pumbaa]

Hold the dose. If you raise it you will keep the bounce (if there is one) going. You may need more that 6 days of settle time - as evidenced by today's numbers. Things just started changing.

Sometimes Jeddie needed a couple of weeks to settle.

OMG! Sheila, I love you! Jeddie needed weeks not 3 days/6 cycles to settle into a dose? I think Pumbaa is the same way!

If you get a spare minute or five, and could take a look at Pumbaa's SS, I would appreciate your advice on what I have done in the past, as well as what I need to do in the future. I am seriously considering switching Pumbaa to Levemir just to see if he responds better, has less drastic dives and bounces, etc.

Suze

 

[Sheila & Beau GA & Jeddie GA]

OMG! Sheila, I love you! Jeddie needed weeks not 3 days/6 cycles to settle into a dose? I think Pumbaa is the same way!

If you get a spare minute or five, and could take a look at Pumbaa's SS, I would appreciate your advice on what I have done in the past, as well as what I need to do in the future. I am seriously considering switching Pumbaa to Levemir just to see if he responds better, has less drastic dives and bounces, etc.

Suze

Pumbaa is definitely a bouncing baby boy! He might do really well on lev with less bouncing. I do see a possible pattern that he is getting too much insulin where he has days of high numbers and then one day of "perfect" numbers followed by high, flat numbers again. The lows don't always have to be "too" low. I wonder if something closer to 1.5u might be better? But it may be that a little reduction AND a gentler insulin is needed. Not sure if he needs more settle time. I generally think that 5 days is a better minimum for settling unless you have a ketone prone cat and need to step up faster. But that can backfire too if you miss the optimal dose because the settle time was too short. This falls into knowing your cat. It took me over a year to figure out that Jeddie needed a long settle time.

 

[Pumbaa]

I do see a possible pattern that he is getting too much insulin where he has days of high numbers and then one day of "perfect" numbers followed by high, flat numbers again. The lows don't always have to be "too" low. I wonder if something closer to 1.5u might be better?

Wow, I never considered that he might be getting too much insulin because he's never stayed down in the blues and greens long enough on any dose. I've been mulling this over in my mind since last night...and studying Pumbaa's SS.

Pumbaa seemed to have more blues and greens when he was on 2.25U, then I decreased him to 2.0U after 10-1/2 because, per "start low go slow"

If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

This is very confusing. Here I was thinking that he needed to be nudged back up to 2.25 slowly, but maybe he needs to be nudged down for better results? He's been high and flat for the last six days and I'm willing to try just about anything!

Suze

 

[Pumbaa]

Dale, sorry to hijack your condo.

Sheila, I've spent a lot of time this morning researching what to do with Pumbaa after your suggestion. Looky at what I found...this is exactly what Pumbaa has been doing, and Beth & Atlas' vet noticed the pattern and had her drop the insulin down by .5U. Atlas has done pretty dang good once his dose was dropped.

Thank you for seeing that pattern in Pumbaa. I will be dropping him down to 1.5U tonight, and praying for the best!

Suze

 

[Dale 'n' Chip]

I guess if Chip and Pumbaa are going to be on the same dose, they can share the same Big Fat Lantus condo? :mrgreen:

That does look a lot like Atlas.

If you are going to do this, hopefully Sheila and Vicky can supervise.

And you should test for ketones when he goes so high for the first 5, 7, or 10 days. nailbite_smile

 

[Pumbaa]

And you should test for ketones when he goes so high for the first 5, 7, or 10 days. nailbite_smile

I've been trying to get urine from him for a couple of days...every time I put him in the litter box he refuses to go. So much for my little guy peeing on demand in the past.

 

[Sheila & Beau GA & Jeddie GA]

Ah, nice to see a vet echo what I keep saying - drop the dose and hold. 3 weeks! Wow. And I thought asking for 5 days was pushing it.

 

[Pumbaa]

Sheila, you were brilliant in your suggestion! I'm serious...I never would have seen that pattern as being anything other than needing a dose increase.

My fingers are crossed, and my patience pants are on. I have to give it more than 5 days because Pumbaa does take a long time to settle into a dose. I found it interesting that the vet recommended holding the dose for 3 weeks as well. I need to do some more research on the Somogyi rebound, in the meantime, and see what other recommendations are for holding a dose to break the pattern.

Suze

 

[Dale 'n' Chip]

Pumbaa and Chip (on the same dose of Lantus) had very similar AM cycles the last few days. Chip's surf may be a little flatter after more than three weeks at this dose.

However that will change shortly, they won't be on the same dose, or even the same L.

For a while anyway? ;-)