? dose question 6/30 Murphy 184 pmps 180 +1.5 69 +4 64 +6 67

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Murphy's looking pretty good and hope he gives you some nice low blues again soon. There has been times when Doodles gives a nadir at what appears to be +2 or +3 but in actuality is +14 or +15. It's hard to wrap you head around that but because Levemir is a late nadir insulin it does happen. Hope you're happy with the results so far!
 
Right Bobbie - I love orange and blue I'm figuring what I see this week is just his depot filling, and of course, if I was still using AT2 those blues would be yellow - but I'm not even double checking with my alpha trak2 anymore!! But yes, I am happy I switched to Levemir from Prozinc. Shoulda done it months ago. Thanks for the explanation about possible nadirs at +14 and +15, Karen, it really helps as I try to learn this insulin
have a nice day everyone - in Chicago it's beautiful sunshine, very low humidity, and highs in the high 70s!! Perfect!
 
So it looks like the late nadir is finally starting - his +10 was 184 - I'm anticipating that it will be below 200 for his pmps that is coming up - assuming it is ~ 180, or as low as 150, should I give him the whole 1 unit?- I'm a little confused with what to do

I'm doing the go slow method
 
Carol this is from the stickie of SLGS Hope this helps.


A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
Bobbie - I have read that many times, - even posted it to other people's questions, but that is why I am asking for advice
To be honest, it is not very clear and Cara is also having a tough time figuring out what to do with ps lower than 200

Is the reduced dose for values 150-200 really only 10% of the usual dose - I'd be tempted to just subtract 0.25 - and then my understanding is that it is for that dose only, and resume the normal dose (1 unit) at the next cycle. would the reduced dose and then the subsequent resumption of the normal dose trigger a brand new 7 day cycle? I would imagine (hope) that normal preshots would gradually decline - at what point could I just shoot the normal dose? This was easier with prozinc because the dose was based on the preshot value, but I thought that was not the case for the depot insulins
 
Carol & Murphy said:
Bobbie - I have read that many times, - even posted it to other people's questions, but that is why I am asking for advice
To be honest, it is not very clear and Cara is also having a tough time figuring out what to do with ps lower than 200

Is the reduced dose for values 150-200 really only 10% of the usual dose - I'd be tempted to just subtract 0.25 - and then my understanding is that it is for that dose only, and resume the normal dose (1 unit) at the next cycle. would the reduced dose and then the subsequent resumption of the normal dose trigger a brand new 7 day cycle? I would imagine (hope) that normal preshots would gradually decline - at what point could I just shoot the normal dose? This was easier with prozinc because the dose was based on the preshot value, but I thought that was not the case for the depot insulins
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Hi Carol,

Those guidelines are for newbies. Although you are new to Levemir you are not new to FD. My suggestion is to get a +11 and post it in the title. With Levemir's late nadirs even with SLGS you'll need to be comfortable shooting low numbers. When ever you shoot a lower number getting a +1 &+2 is needed and maybe even more...could turn into an active cycle. You'll need to have all the tools...i.e. enough strips, HC food etc. If it were me...was able to monitor and had the tools I'd shoot anything over 90 at the full dose. Sure you've read this sticky http://www.felinediabetes.com/FDMB/...regulation-shooting-handling-low-numbers.147/ . Even though it's written for TR, how to handle is the same for SLGS.

ETA: Since you're following SLGS, if a preshot is below 90 then you would likely stall, see if he's rising and then shoot the reduced dose - meaning less by .25

Does this make sense?
 
Yes, thanks very much makes a ton of sense his pmps was 180 I can do a +1 but I'm going out to dinner and can't do a +2 - should I give him 0.75 or go for the full 1 unit?
 
Carol & Murphy said:
Yes, thanks very much makes a ton of sense his pmps was 180 I can do a +1 but I'm going out to dinner and can't do a +2 -I'll give him a 0.75 -
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Giving him .75 will not make a difference for this cycle since it's a depot insulin. I'd shoot the full 1 unit and then get the +1 test. If he dropped significantly feed him a little more before going to dinner. I assume you'll be back in a few hours?
 
He's been flat for the past 5 hours so think you're fine but do get that +1, if needed leave some food out and then test again when you get back. Assuming you're not going to be out all night ;)
 
He's been essentially flat or surfing the last couple of hours. I agree with Karen that this is safe to shoot. How long will you be gone?

Getting +1's every once in a while is a good thing, as it'll give you an idea what rise he gets out of a food spike. That's a very useful bit of knowledge when you are faced with lower preshots than you are used to.
 
Carol & Murphy said:
okay I'll give him the full 1 unit thanks a million Karen I know you have your hands full, and I so appreciate you taking the time
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Anytime. One thing to remember is "can you monitor", do you have all the tools etc. If he dropped significantly at PMPS I would've given different advise..i.e. cancel dinner LOL. The goal is to flatten Mr. Murphy out and shooting consistently is one way to do that. Adjusting the dose often will only cause wacky numbers...the depot gets confused. I'll check on you later...surf safely now Murph and eat a good dinner :)
 
okay great advice - I gave him 1 unit - he is a grazer and only eats about 1/4 his food at mealtime - he'll finish it up by eating 1 tsp or two every hour - I can get +1 and then a +1.5 -- I'll be gone 2.5 hrs max
although he is a little freaked out now - I live in a national register of historic places building - built in 1904 and it's supposed to have ghosts - when I first brought Murphy here, he was freaked out - constantly looking over his shoulder at something and at the walls. He hasn't done it for months but wouldn't you know - just started doing that about 10 minutes ago - great - please send vines for my ghost to encourage Murphy to eat :nailbiting::nailbiting::nailbiting:
 
ugh - he's at 69 at +2.5 he already ate way more wet food and is full now - I did give him some gravy
well, I guess he's earned a reduction I just hope he doesn't continue to drop - I don't know what to expect tonight
 
Congrats on the reduction but sorry on the timing. I hope he works that gravy soon and that this cycle looks like the AM of the 28th where he drops early then drifts back up.
 
Sorry about your dinner but congrats on the reducie. Hopefully the gravy will bump him up and get him surfing. Keep in mind HC can wear off so you'll need to test again even if he's up.

ETA: remember he's still in safe numbers until under 50...just want you to feel less nervous for now.
 
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So he has been surfing in the 60s for the past hour - I guess the gravy didn't so much bring him up as stopped a further drop
Do you think this is the nadir from his am dose or some effect from his pm dose as well?
 
I'm hoping it's his nadir from the previous cycle but it's a little hard to say for sure since there's still little data with Levemir. When do you usually feed him next?
 
I wouldn't go to bed until he's above 90 for 2 hours without food. This is what we call a PJ party, make coffee or start setting alarms to test as long as needed especially if the 60's is gravy influenced.
 
okay - he's 64 @+4 yes, the 60s is definitely gravy influenced - he's just surfing along in the 60s - so should I not feed him anymore? the 64 is +16 from the am dose - is that too late for the am nadir?
 
See what @Wendy&Neko has to say but if it were me I'd try to give him a tbsp. of LC or MC food to keep him surfing. The gravy may be wearing off soon but my crystal ball is certainly broken.
 
+5=69 so he's been in the 60s for the past 3 hours
I'd feel better about this, but I have no idea what to expect from this Levemir
5:15 (his next shot time) will come all too soon - so if his amps >200 I'll give .75 , but if less (maybe way less) should I do a 0.5?
 
It really depends on how the night goes and your ability to monitor tomorrow if you're up all night with him. If possible it's best to shoot the .75 but the depot from 1 unit will be at play. Even if you shoot .5 the depot is still a factor. Many times when they surf these greens either they will bounce or flatten out. The saying "shoot low to stay low" has been proven to work nicely but ECID. It's always best to post and ask in the morning and I'm not up at 3am (5:00am Chicago time). Most would say it's too early to give any options for tomorrow but here are a few things in case no one is around being the holiday weekend.

- If he's low, don't feed, delay, test again in 20-30 min and see if he's rising. If rising it's probably safe to shoot but you'll need to monitor.

- If he's low and you're exhausted (always something to consider for you both) you can do an 18 hour cycle. Meaning if he's too low to shoot and you have to consistently feed him tonight, skip the AM shot and shoot at +18 (or what would be AM+6) then skip tomorrow's PM shot and get back to the 12 hour schedule the next morning. You'll still need to test but probably not as much.

Does that sense? BTW, sometimes I am up around 3am for Doodles second overnight meal but it does vary with my alarm snooze button.
 
Can you also update the title with his current numbers? This helps catch others eyes. You can delete some of the AM cycle numbers to give more room for tonight :)
 
Sorry, I was away doing TFS here then gardening with Neko (she wanted out). Could you update your subject line with the latest numbers? You can remove the AM numbers and just put the PM ones. That way people taking a quick glance at the titles can see what the latest action is with Murphy.

It's also helpful if you mark either on the SS itself, or in the remarks, when you give gravy or extra food. Did you last give him LC or MC? I wouldn't give higher carbs, but rather some low carb food. Gravy lasts a couple of hours and if you go that long, the gravy would have worn off, and if his numbers were still stable, you'd know he was surfing on his own.

I would shoot .75U in the morning. But you can always get a +11.5 and post for help if the number is concerning.
 
Shockingly at +6 he's still at 67
Wendy - I had company during the +1.5 to 4 hour feedings, so I can't really remember what was given when
I'll remember for next time I'm not so sure what is considered medium carb or low carb - Murphy is so limited by the wet foods he can/will eat (no gums or caraggenen) I use only a few brands (Nature's Logic, ZiwiPeak, Nature's Variety), most of which are too new for the catinfo site - I will make a concerted effort to figure it out though (I gave him Only Natural Pets pate turkey which is a brand new wet food) So that's great - the gravy has worn off and he is surfing on his own - I'm going to sleep on the sofa next to him and set alarm
 
The food list on Tanya's site has some of the newer foods, though sadly not Nature's Variety. I hear you on the food selection. I'm trying to avoid gums and carrageenen too, and for Neko it's got to be low carb, low phosphorus, low sodium, preferably novel protein. :rolleyes: Oh, and no shreds.:rolleyes:

Good job surfing Murphy. :D He sure likes the Levemir. :cool:
 
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