Dosing advice, please!

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Re: Blood Glucose HIGH but Fructosamine LOW

This make it impossible to go on vacation, but it's a deal I made with Lucy, I don't go away, you stay happy, not sick.
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Mariko, you are the best mommabean any cat could wish for. This made me cry, that you love Lucy so much to take care of her so well. I bet she gets the best hugs in the world. If I die and come back as a cat, I would want you as my mommabean.

Lantus can last 15-18 hours or more in a cat. We make use of the overlap effect between the two shots to keep the BG's at the correct levels.

You might want to go over to the Lantus Tight Regulation forum to read the Stickies over there about Lantus. They are at the beginning of the list of topics, have a star icon next to them and a little lock symbol. The best ones are New to the Group and Tight Regulation Protocol. Read all of the stickies when you have some time. You might want to read Shooting and Handling Low Numbers also.

On your understanding of the depot, good, very good.
#1 You got it.
#2 Small correction. Some of the excess insulin from an early shot will go to storage, but some will be used by the body. You may see some lower numbers with an early shot.
#3 yes, minimum of 6 cycles (12 hrs in a cycle) to hold a dose, UNLESS you get a BG under 50. That is an automatic reduction is dose.
Hold this 0.25 dose for 3 more cycles and then we will reevaluate.

Mariko, You are really getting the hang of managing diabetes with Lucy and learning so much. I equate this process to a crash course, graduate college level in managing the diabetes. It's tough, stressful emotionally, spiritually, physically. You get an A so far. Be sure to take some time for yourself to relax and enjoy life.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Oops, I forgot to include some suggestions for a testing schedule to fit your work/life obligations better and not keep you up at night all the time. I'm not giving you exact times but more general observations that others have made and suggestions based on those observations. ECID so your cat Lucy may not follow this pattern.

1. Pre-shot. You always want to get a pre-shot number. Always. So you know the number is not too low to give insulin. We start new members at a shoot/no shoot number of 200. Then as time progresses and we get more test data, we lower that number.

2. +2 One good number to get in the evening is a +2. Here is why, some basic rules of thumb to base decisions on:
A. If +2 is a lot more than pre-shot, it's probably going to be an inactive cycle. Not much change in the numbers, ok to get a night's sleep without worrying about getting up for testing.
B. If +2 is similar to pre-shot, it's likely to be an Active Lantus cycle. You want to get at least one more test before bed to see which direction Lucy is headed.
C. If +2 is much less (50 points or more) than pre-shot, it's likely to be a very active cycle. You may see some low numbers that require you to test in the middle of the night and support with lc food and then maybe some HC food and syrup.

3. Before bed test. This will show you how Lucy has done since that +2. It's more important to get that before bed test if +2 is that similar to pre-shot or much less than pre-shot.

You already are getting those pre-shot tests in the morning. Please continue to do that.

I want you to be able to feel that you can keep doing your volunteering on Fridays. I think that you have a better understanding of the depot and overlap, you can feel confident in doing that and adjusting your insulin schedule.

If she has another pancreatitis flare, do not be surprised if the BG numbers spike higher. The pain with the pancreatitis can affect the BG numbers as can inflammation (think UTI's) or infection ( think gums and teeth). Just be prepared and be sure to mention it in your post if you think Mariko is having a pancreatitis flare.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you, Deb and BJM. I am glad to know that I'm making a progress....

I will always test AMPS and PMPS. On weekdays, I may not be able to do any additional tests between AMPS and PMPS unless AMPS number worries me, but I will do +2 and before bedtime tests. On weekends, I will do some more between AMPS and PMPS. On Fridays, I will see if I can get away with just giving her a late evening shot. If it affects her numbers too much, then I will try the time adjusting method Wendy suggested.

I have updated the SS with today's numbers so far. I tested a little less often last night & today - wanted to give Lucy and myself a break. I will test +2 and before bedtime later today. I really wanted to create Lucy's profile to introduce Lucy better to you this weekend, but I couldn't! So much to learn and so much information to read through.... I will try to do it next weekend. My cats are complaining that I've been spending too much time on computer reading stuff these days, and I am getting a bit overwhelmed too, so tonight I'd like to have a good cuddly time with Lucy & Ginger.
I realize that you must be spending a lot of time on computer helping me and other people on FDMB. I can't thank you enough. So again, thank you so much.

I forgot to mention yesterday that giving an insulin shot on her bumbum and sub-Q fluid on her scruff on the other side worked!! Her number stayed stable after the sub-Q fluid, so I am very happy about that. Thank you again for the advice.

Tomorrow's AM shot is her 6th cycle on 0.25u.
I will ask for your opinion on dosing sometime tomorrow evening, so please please check back on us!

Thank you! - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Nice blue numbers and seems to be holding the dose.

The testing plan sounds good to me. Maybe an occasional mid cycle test at night maybe +5 to +7 sometime just to check for lows. Her numbers look so good I wouldnt be surprised to see some greens soon at night. And rememeber if she drops below 50 she gets another dose decrease to 0.1IU so its worth it to get up at night for 5 minutes!

I prefer the time shifting plan to skipping a shot. she is getting really nice numbers and we dont want to lose momentum since she is doing so well.

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you, Wendy, for your advice.

No no, I will not skip a shot on Fridays.
But I'd like to try giving a delayed shot on Friday without shifting the timing of previous shots first.
So single 1 - 1.5 hr delayed shot on Friday evening.
And it it does not work, I will do your time shifting.
Time shifting plan is a better idea, I can see, but as I mentioned in my previous post, feeding Lucy is very tricky.
I am worried that letting her beg for food on Friday morning for a long time by shifting may throw her appetite off.
Feeding her late is OK. But it seems letting her beg for long is not so good. Maybe as soon as she expects food, he stomach prepares for food, and if it doesn't get food, she gets too much stomach acid? Or maybe it's just because she gets mad?

I wanted to ask you, Wendy, about syringes since you also live in Canada.
The only syringes with half unit marking I can find is BD Ultra-Fine II. Is it the same for you?
I got a few bags from the nearby Shoppers recently, and the bag I opened had contaminated products.
What happened was that I opened a bag and took a syringe and pushed the plunge before drawing the insulin, and a small amount of clear liquid came out from the tip of the needle. I took another syringe, and the same thing happened.
I brought the bags back to the Shoppers, the pharmacist tested another syringe, and the same thing happened.
I returned all bags as they came from the same box.
I bought some bags from other store, and they seem OK, but if I can get a different brand, I'd prefer that.
I didn't see any re-call announcement of BD syringes, I though this was a serious health hazard, to have some contaminated syringes in the market.
If I can buy 1/2 marking syringes other than BD in Canada, please let me know!.

Thank you - Mariko & Lucy.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Ah ok so you are going to shoot an hour or two late at night? Then what do you do the next morning? Its going to be off by that much too and you will have to time shift it back.

I use the BD Ultra-Fine II 3/10 cc short. The clear liquid might be extra lubricant - they use lubricant to make the plunger easier to move up and down. I have never seen any come from mine though and I always empty first - I have been using 4 syringes a day for over a year. Could be a bad batch box issue and you were unlucky. I have never looked for another brand.

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

I am getting a bit overwhelmed too, so tonight I'd like to have a good cuddly time with Lucy & Ginger.
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Yes, we have to keep the mommabean happy and healthy too. Please, take an occasional break, some down time for yourself. You need to relax and refresh yourself so that you will be ready to take care of Lucy and Ginger better.

I like a piece of chocolate to treat myself.

Don't stress on not being able to do the profile yet. We have some key information in your signature and that helps a lot. When you get to the profile, remember that we like to see pictures, of both cats, not only Lucy.

When you are ready to post tomorrow, remember to go back to your first post, change the subject and change the radio button from None to ? That will help to alert us that you have a question that needs answering.
 
Hello!

I have given Lucy 0.25u for the past 7 shots including today's PM shot.
Could you please look at the spreadsheet, and let me know if I should change the dose back to 0.5u (maybe skinny) or keep 0.25u?

Thank you always - Lucy & Mariko
 
The nadirs are high enough that you could increase, maybe just by fattening, rather than going to 0.5 units. Perhaps start that in the morning?
 
I don't think Lucy got too low on .5u so I'd probably go back up to that provided you can test and monitor.

With a cat coming out of remission, we tend to recommend you be more aggressive in dosing then you might have been the first time around. Cats are hard to get back into remission but it can be done and she's already looking pretty good.
 
Thank you very much for your help & advice.
I would like to regulate her a little tighter in order to increase her chance of going back in remission, but since I'm not at home to test her much during the AM cycles on weekdays, I'd like to increase her dose back to 0.5u in steps unless you don't think it's a good idea.
What do you think about the below plan?

- Increase her dose to *fat* 0.25u from tomorrow morning first, and keep it for a week or so.
- If the test results indicate it's safe to increase further, increase her dose to *skinny* 0.5u, and keep it for a week or so.
- If she has room for more, increase to 0.5u.

What do you think?
I am guessing that her numbers will not change much at *fat* 0.25u.
I've been practicing measuring *fat* 0.25u this evening, and it's very very hard....can't really tell if it's 0.25u or *fat* 0.25u, so it's entirely possible I'll just be giving her an imaginary fat dose, but at least it will not be less than where I think is 0.25u!
I'd like to plan this so the increase to *skinny* 0.5u will take place during weekend when I can do more tests and monitor her, so maybe from Saturday PM shot?

Please let me know if increasing in steps is a good plan or not, considering I am out at work during days.

Thank you - Mariko & Lucy
 
Lucy looked much better getting 0.5U twice a day. Normal BG numbers in fact.

If you feel more comfortable with only increasing to a Fat 0.25u, yes, I would say start that, and get some evening tests. I think Marje would prefer to see you increase back to the full 0.5U 'provided you can test and monitor'. Since you are working during the week and not around to monitor, it sounds like you do not want to increase back to that full 0.5u all at once?

A slight increase now, would be better than holding that 0.25U. The numbers are going up since you dropped to the 0.25U. The numbers looked much better at 0.5U, normal numbers. We want to get you back to that 0.5U dose level ASAP and Lucy in better numbers as soon as you can test and monitor.

By the time the weekend is here, you will be ready for the 0.5U dose. Maybe by Friday evening or Saturday morning instead of waiting until Saturday evening? I do remember that you work later on Friday's so always have to give a later shot(later = dose reduction) that day. Your next increase for the weekend could be a skinny 0.5U or a full 0.5U at that increase. I see no reason to not give the full 0.5U for the weekend since you will be around to monitor.

Marje did say:
Post by Marje and Gracie » Tue May 28, 2013 12:45 am

I don't think Lucy got too low on .5u so I'd probably go back up to that provided you can test and monitor.

With a cat coming out of remission, we tend to recommend you be more aggressive in dosing then you might have been the first time around. Cats are hard to get back into remission but it can be done and she's already looking pretty good.
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Good morning, and thank you.
I wasn't aware that the dose increase had better be done sooner than later, but if I think about it of course making Lucy better sooner is definitely better than later.

So, after thinking about it again hard, I ended up giving her a full 0.5u shot this morning.
Her BG since yesterday's PMPS has been higher including this morning's AMPS, and besides I wasn't confident if I can give reliable *fat* 0.25u consistently.
I can at least test her AM+2 ish before leaving for work, and if needed I will stay at home.
And I will also try my best to come home early to test her again before the PMPS, somewhere around AM+9.
After submitting this post, I will send an e-mail to my boss asking him permission to leave office early until I know how she does with the increased dose of 0.5u. He will say OK since I can get some work done at home too (that's home I've been testing her in mid-AM cycle since last week).

Does testing at AM+2 and +9ish sounds good enough testing? Unless she goes way lower at AM+2 than AMPS?

Thank you - Mariko & Lucy
 
Yes, Mariko. That sounds like a wonderful plan. Glad you decided to up the dose sooner than later. Lucy's numbers were creeping up there to the higher blue numbers and definitely needed more insulin.

It's nice you have an understanding boss and can do some work from home sometimes.

Would you tell me what time your +2 test will be, stated in your local time is fine? I'll pop back in to check on you.
 
I think that is a good decision and I think the +2 and +9 tests are perfect.

The folks here are doing a great job but if you'd like to come over to the Lantus TR ISG, I think it would be a good time. If your goal is to get her tightly regulated and back into remission, we can give a little more specialized help and there are more of us there to help you. We have a pretty good track of record of getting cats back into remission.

Many of our members work and we take the cues from them....we try to come up with a testing schedule around work...but you've already got the same idea we would have given you.....+2 and +9 tests during the day cycle and a +2 or before bed test at night. Then, if you are up early enough a +10 or +11 in the morning so you know whether she's dropping into AMPS or not.
 
Thank you, Deb & Marje

I will do her +2 test at 8:30am, and after that if the number is good I will have to power-walk to work, huffing & puffing.
I'll wait to hear from you after posting +2.
Please check back on us!

And thank you for inviting me to the Lantus TR forum.
I would definitely like your help getting her back into remission, so I will start posting there tonight / tomorrow.
I thought I might be to early for me to move to the Lantus TR since I seem to be still full of beginner's questions, but I will at least start posting dosing questions there.

Thank you - Mariko & Lucy
 
Mariko,

Marje is one of our most experience members and helps out a lot of people. If she feels it's time for you to go over to the Lantus Tight Regulation Insulin Support Group (ISG), then I would take her up on her offer.

There are two regulation protocols SLGS (start low, go slow) and TR (tight regulation). Since Lucy has fallen out of remission, it sounds like TR is your best method.

She will explain to you how they like people to post. She may or may not suggest to you that you read some of the Stickies over in Lantus TR. This one is always a good one to read: New to the Group?

You can still ask questions over there too, simply remember to use the question mark ? radio button to let people know you are seeking information.

I'll try to pop over now and then to see how you are doing, but you would be in very good hands over in Lantus TR. Many more experience eyes over there to keep a lookout for you.
 
Just tested her +2, it was 122.
Good to go to work?

I will read the stickies in the Lantus TR forum and prepare myself to start posting there tonight.

Thank you - Mariko & Lucy
 
Thank you!
Since today's is the first day on 0.5u, I will try to come home to check on her sooner than +9.
Mariko & Lucy
 
Mario

If you can check on her around +4, it would be good. Her +2 is much less than her AMPS so she might have some green numbers today. Leaving food out is good...maybe some medium carb if you can't get back in a couple hours.

I will watch for you tonight in LL. Deb has given you some great info. We are always happy to answer questions.

Have a good day.
 
Hello!
I rushed home to Lucy after seeing Marje's message from work.
I couldn't make +4, but I just checked +6 and it was 130.
I'll be working from home the rest of the day, so I can check her every two hours or so until PMPS.

I did leave a little food - something neither of them really like, put it where Lucy normally hangs out.
But I would like to manage this without having to leave food if possible because they hate it when they can't go where they usually can go, but if I don't separate them I can't see who eats when. So I'd rather come home when an additional testing is necessary.

I hope there is a way to leave food for Lucy without having to separate them in different rooms....
Maybe I should try to find something Ginger wouldn't touch, but only Lucy would eat.....

Mariko & Lucy
 
We didn't mean to worry you. That +6 of 130 is a good number. She may have gone a bit lower at +4 or +5 but she is certainly in safe numbers.

Cats that feel their BG dropping too low, will often seek out food on their own. One way to provide some food that can be slowly eaten, is to freeze some of the canned food and put out a piece to slowly thaw during the day. You might try that to see if Lucy will eat it but not have Ginger steal it all.
 
I just wanted to say what a beautiful cat Lucy is :-D and her numbers are looking pretty good, too.
 
I just wanted to thank you all one more time for your great advice, patience and education I received here since I first posted this. I could not have learnt so much and taken care of Lucy as well without you.
I am now going to post Lucy's updates over at the Lantus TR as suggested, so please check on Lucy there too!

Dyana, thank you for your nice comment about Lucy.
Lucy and Ginger are my pride and joy!

Mariko & Lucy
 
Your welcome. We could not do all we do without the support from everyone here.

good luck over in TR. They are a great group of people. You'll find lots of help there.

I'll be sure to pop over now and then to see how you are doing.

Be sure to say you are a "newbie" on your first post.

date, cat's name, AMPS number is the format so today would be 5/28 Lucy AMPS 180 new here
 
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