First 3 days of data on reduced dose. Keep with it?

[Melissa and Celle]

Hi all - I'm new to the Levemir board.

Please take a look at Celle's spreadsheet for first three days of data on new dose of 0.85 units. I know it can take a while, but things seem to be a little worse if they are different at all. Pre-shot values are mostly over 450, and the drop seems just as fast and steep. I attached a graph of the data, which is how I got used to looking at things and I find a little easier to digest.

One thing positive I can say is that this is the most consistent set of data I've ever had. You can basically discern a curve in there rather than a random scatter plot.

I will be relying on a sitter for doses from Saturday PM through Monday AM. My sitter does not do BG measurements, so I need a dose I can feel comfortable with while we're gone.

Any advice on what to do?

 

[Marcy & Klinger (GA)]

Welcome to the Lev board, Melissa and Celle,

Our more experienced users are out of town for a few days. Although, I think they are trying to check in when they can.
I do like your graph. I see on your ss that you recently switch foods and reduced the dose - which is great! Some kitties will zoom down as soon as their food is switched to a lower carb food.

I'm sure others will be by soon to give you advice on your dose. Hang in there.
It's great that your sitter will shoot insulin! We really need to find someone to do that for Klinger. It would be nice to get away for a weekend.

Again, welcome and keep asking questions. Every cat is different and we all learn from one another.
:smile:
Marcy & Klinger

 

[pamela and tigger]

I will be relying on a sitter for doses from Saturday PM through Monday AM. My sitter does not do BG measurements, so I need a dose I can feel comfortable with while we're gone.

Any advice on what to do?

Welcome Melissa and Celle! Wow, not much time to figure things out. I would go with a nice, easily measured dose for the sitter (not .85) and a 'safe' dose as well that Celle will be fine at. Hard to say but .5 units should be fine and safe for the time being.

Any health concerns that you are aware of? That too would come into play.

Hopefully she will eat well and all will be fine until you get back. How often will your sitter be there to feed and check on her? Are there other cats that might 'steal' her food while your sitter is not there?

Please also leave hypo instructions for your sitter as well and what food to feed should that happen (not likely but just to be safe):

List of hypo symptoms

Treating Hypoglycemic symtoms

Hypo Tool Box

Also, in the meantime we would love to know more about you and especially your Celle. Here is a primer on doing a Profile - it would help a lot:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=36698

 

[Peggy and Mickey (GA)]

Just wanted to say Hi and Welcome

 

[Melissa and Celle]

Any health concerns that you are aware of? That too would come into play.

Hopefully she will eat well and all will be fine until you get back. How often will your sitter be there to feed and check on her? Are there other cats that might 'steal' her food while your sitter is not there?

Other than diabetes, she's healthy. Celle has been on paroxetine (paxil) for years now. It cured her excessive grooming, and we've never tried to wean her off it.

The sitter will be coming twice a day to feed and do insulin. We have three cats, so we've just been leaving out food for free feeding since we made the switch.

 

[eeraby]

I'm looking at Celle's chart.... thinking. Gimme a few minutes

Can you get more BG #s today?

I"m wondering if she's going really low at night and that's what's causing the high AMPSs? Any chance of setting the alarm and getting a pm +6 or +7?

She doesn't seem 'worse off' at 0.85 than she was on 1.0 except in the mornings but there's not a lot of data to go on.

If she's going low at night (she could be because she's probably not eating at night) then the 0.85u is too much. 0.50u would certainly seem safe while you are gone. 0.75 should be safe.
SAFE being no Hypo episodes.

Do you have the syringes with the 0.50u markings or just the 1.0 whole units? If you need the 1/2 unit ones, Walmart has them ... 1/30cc with 1/2" needles, they are easier to do 0.75u

Please try to get as many BGs today and tonight that you can. I'm really wondering how low she actually goes.

 

[Vicky & Gandalf (GA) & Murrlin]

I agree with Pamela on .5U. I know it seems like so little, but since lowering the dose the most noticeable thing is no more 500s! That means lowering dose was the right direction. But still having 400 preshots can mean that the dose is high - we need a few more midcycle tests (I prefer +8 or +9 on Lev) to see exactly how low she's going. I suspect she may be hitting 100s or lower to generate those rebound 400s, especially from the results on .85U with those 200s you've seen after her PM preshots recently, which are really fast dips off the preshots in the mid 400s. Ouch.

You can prepare syringes ahead of time with Levemir since it doesn't need mixing - you can do them for all 3 days and it will be fine, just keep them in fridge and immobile, maybe wrap each one in a paper towel. Standing up might be best so any air left remains at top of syringe.

.5U seems a good dose that won't make her go too low and generate safe enough numbers to shoot even if she were to have a lower preshot. Are you sure sitter can't be shown how to test? Or will they just not do it? This leaves a huge hole in important data, but hey, that's life right?

Even though she's still going pretty high, no more 500s is excellent and what I would expect to happen on the much lower dose. Great job and thanks for posting over here now.

 

[Melissa and Celle]

No chance for BGs during the day, but we'll get up tonight.

You can prepare syringes ahead of time with Levemir since it doesn't need mixing - you can do them for all 3 days and it will be fine, just keep them in fridge and immobile, maybe wrap each one in a paper towel. Standing up might be best so any air left remains at top of syringe.

We have syringes with half unit markings. I never thought to preload them -- great idea! What does it mean to keep them immobile? Just make sure they don't roll around? Why is it important to keep any air at the top of the syringe? Anything else to worry about?

.5U seems a good dose that won't make her go too low and generate safe enough numbers to shoot even if she were to have a lower preshot. Are you sure sitter can't be shown how to test? Or will they just not do it? This leaves a huge hole in important data, but hey, that's life right?

We already ask so much of our sitter, and she said she doesn't do BG readings, so I haven't thought to push it. And honestly, I couldn't teach her how to do it. My husband and I do this as a team. When on my own, it is never clean and easy and makes Celle resist any readings at all.

I also have to honestly say that I'm only very slowly coming around to the idea that testing will be a constant and forever thing. I've been hoping to find a dose that we can be comfortable with not testing all the time, even if she rides higher than needed for remission. I suppose it's because testing is not as easy for us as it probably should be -- and requires both of us to be home at shot time, which often can't happen.

Is the 0.5 recommendation just because we're going away, or because she needs to go down?

 

[eeraby]

those aren't my words, but Vicky and Pamela's.

BG testing is very important as Celle's dosage requirements will change and, to do that effectively, we need to know what's going on at different times in the cycle. Some cats do come off insulin totally. Hard, if not impossible, without knowing how the insulin affects her over the cycle.

Take a look at Bud's SS. there's some testing going on!

If you'd like, I'll be happy to come help ya'll with your testing. Maybe make suggestions that'll make it easier. Show you how I do it. I'll definetly be coming through DC on Saturday, July 16th.

Testing is really the key to managing this, hon.

0.50u to be on the safe side, while you are gone. Yes, just to keep them immobile. To keep the air at the top.

 

[Vicky & Gandalf (GA) & Murrlin]

Thanks Beth, for helping Melissa out

I suggested .5U both to be on the safe side and because I think it's the direction she needs to go, but .7U is a decrease from the .85U so it's the right direction and probably safe enough while you're away.

So this is a sitter with a petsitting business that you usually have? That's awesome. You're very lucky that she can do the shots even, so I understand about not asking her to test.

Testing is something that needs done at least every preshot and a curve where the BG is taken every couple hours at least one day a month once you get at a good dose. Before that at least spot checks in mid cycle are really really important. But you do what you can, I am in the same boat with being gone 10+ hours each workday.