Clearly bounced today. Any reason not to decrease now?

[Melissa and Celle]

Reduce to 0.85 or even lower?

I'm not sure how the UTI could be still factoring in at this point. AB were started last Saturday evening. Perhaps her needs are still decreasing due to clearing up the infection.

 

[pamela and tigger]

Reduce to 0.85 or even lower?

I'm not sure how the UTI could be still factoring in at this point. AB were started last Saturday evening. Perhaps her needs are still decreasing due to clearing up the infection.

I am sorry Melissa, I just don't see it. I see there is a slight reaction to the insulin, but not enough to hold her in a good range.

But that is just my opinion. Wait to see what others think.

Thank you for the Monojet link in the other thread. I like that they have .5 unit markings and they are not short needles. Think I will try them when I need to reorder.

 

[Melissa and Celle]

I am sorry Melissa, I just don't see it. I see there is a slight reaction to the insulin, but not enough to hold her in a good range.

But if 1 unit is to little and the high numbers are just from it wearing off, then why are the highs so much higher than on the lower doses? We were generally able to keep her under 400 on the lower doses, especially in the mid-range of the cycle. Her nadir there was at about +6, with a gentle fall and rise. Now we get a really fast drop and fast rise with the nadir at about +2-3. What would explain a +7 value about 100 points higher than we saw on lower doses other than rebound?

Also, if we go with the theory that this curve is an indicator of too little insulin and she just needs more, then our moves from 2 to 2.5 to 3 units were right because those curves were similar in shape -- even though the numbers kept getting worse as we went up. What do you see that's different now? Or would you think that those higher doses were still too low?

I think my basic confusion/question is about how the insulin wears off. I would expect that as you increase it lasts longer and longer (moving from a check-mark shaped curve to a wide u-shaped curve). But we're doing just the opposite.

 

[pamela and tigger]

I am sorry Melissa, I just don't see it. I see there is a slight reaction to the insulin, but not enough to hold her in a good range.

But if 1 unit is to little and the high numbers are just from it wearing off, then why are the highs so much higher than on the lower doses? We were generally able to keep her under 400 on the lower doses, especially in the mid-range of the cycle. Her nadir there was at about +6, with a gentle fall and rise. Now we get a really fast drop and fast rise with the nadir at about +2-3. What would explain a +7 value about 100 points higher than we saw on lower doses other than rebound?

I don't know that you can really say all that since there are a lot of cycles with no spot checks (I know this isn't your fault - not everyone can test multiple times a day).

Also, if we go with the theory that this curve is an indicator of too little insulin and she just needs more, then our moves from 2 to 2.5 to 3 units were right because those curves were similar in shape -- even though the numbers kept getting worse as we went up. What do you see that's different now? Or would you think that those higher doses were still too low?

But isn't that when she was on the Purina DM Dry? If so, I don't think you can even consider those numbers anymore and what they meant. I think you were also treating a UTI at that time too?

I think my basic confusion/question is about how the insulin wears off. I would expect that as you increase it lasts longer and longer (moving from a check-mark shaped curve to a wide u-shaped curve). But we're doing just the opposite.

Remember too that with this recent UTI brewing in the background before you were able to notice it, that the numbers could very well have been erratic from that.

Again, see what others say, but you never gave 1.25 units much of a try. That would be what I would suggest with more spot checks if possible.

Also, when you take her back to the vet for a recheck on the UTI, can you ask her to look at her teeth again and see what she says? Also, ask the vet if possibly the Paxil is hindering her regulation as well. I am just throwing that out there since it is not something you just stop giving all of a sudden, but maybe she would suggest a smaller dosage now?

 

[Vicky & Gandalf (GA) & Murrlin]

Melissa, I posted in your thread about changing back to Lantus on why you should increase the dose rather than change insulins again. I agree with Pamela at this point. Celle's seeming lack of duration could also be because of glucose toxicity by now because of the length of time with high numbers and the only way to combat that is increase the dose, even if you're seeing a brief response from a dose.

Unfortunately we advocated pretty hard with you for lower doses and now you're convinced that that's the only way - she must be getting too much insulin. The crazy thing is that curves on not enough insulin and too much insulin can look very very similar. That's why when less insulin does not work after a period of time we have to conclude that a higher dose is needed.

Look at it this way - you know what didn't work when using Lantus, so if you do it the right way (Tilly) this time around on Levemir, Celle should do much better!

 

[Melissa and Celle]

OK, if nothing else her numbers today have persuaded me to give 1.25 units another go for lack of other options. I'll try not to get freaked out if she goes over 450 again. I just can't figure any of this out. For example, it doesn't make much sense to me that 0.85 units is now less effective than before when she even had the UTI.