Sienne and Gabby said:If you are following the Tight Regulation Protocol for Lantus and Levemir,
- doses are typically held 3 to 5 days and
- "The cat should be monitored closely on the first 3 days on Lantus/Levemir: do curves between the AM and PM-doses, e.g. AM pre-shot, +3 hours, +6 hours, +9 hours, PM pre-shot."
From your SS, it looks like you've increased the dose from 1.0 to 2.0 units after 48 hours and you have virtually no mid-cycle checks. There is no way to know whether your AMPS is a bounce
Bounce? Rebound?
If each previous PS is higher then then the next, which has been the case, his curve would look like a straight line up and the Nadir being the previous PS. from a lower BG level earlier in the cycle.
There have been no lower BG Values since we started this. I fear that I am underdosing severely.
Also, and again based on the dosing protocol, doses are raised in increments of 0.25 to 0.50 based on the nadir. Just to reiterate what members have mentioned previously, the longer acting insulins like Lantus and Levemir do not act the same way nor are they dosed in the same manner as their shorter acting cousins.
Gayle and Shadoe said:I don't know anything about the other insulin you were using but the number you get when you test just before shots is NOT the most important number when you are using Lantus.
The best way I can describe it is this. You could be giving too much insulin, too fast, and here is a visual for you.
Take a tennis ball in your hand and hold it above your head (this height can represent your high pink and red BG number).
Now, as hard as you can, I want you to POUND that ball into the ground.
What happens??? BOING! Right up high, even higher!!
So you have tested before the bounce, and then you test again when that ball is sky high and say HOLY MOLY, NEED MORE INSULIN!
nope, wrong.
Finally I see what you all have been saying here. Thanks, Some background here, today is the first day I am home all day and can run a curve. I understand the importance of seeing what happens mid cycle.
That's why it's so very very important to see what's happening in the middle of Frankie's cycle. That Lantus does not start to kick in till a couple hours after the shot, then it's a slow downward movement for a few hours, and then the Lantus wears off and Frankie's numbers start to go back up again. If you measure just at shot times, you miss the middle important info, you miss if there is a HUGE bounce or not.
Please click on the link to my Shadoe's ss in my signature.
Take a look at the week days, when I am at work and I can't see squat.
I test when I leave for work and again when I get home.
As you can see, it's an incomplete picture.
Next, look at what I can see when I test more frequently on the weekends and even some evenings. I see stuff! I see what the insulin is doing and NOW I can decide if it's time to increase her dose.
Don't forget about that shed, that reservoir of insulin that MUST be filled before you will see some action, some change in Frankies numbers.
I don't drive but think of a spare gas tank that you keep for your car.
Imagine that you need to fill that tank before you can put gas in your car's tank and drive the car.
Now, it can take up to 6 cycles, 6 shots, 3 days, for Frankie's spare tank to fill up.
Once it's filled up and you give that 7th shot, Frankie's body says Whup, the spare's filled so you can use that Lantus on that 7th shot to bring Frankie's numbers down.
I hope you are good so far with the above.
Now, when you increase a dose with Lantus, you need to 'top up' that spare tank. That's just the way it is. That spare tank MUST hold an amount equal to your shot size.
So a dose increase means we have to fill 'er up again.
You had Frankie on the dose of 1uLantus for a short time and I suspect that his spare tank was not filled yet, so the Lantus was not being used to bring down his numbers at all.
When you increased too soon to a bigger dose of 2u Lantus, you are back to filling up that spare tank again.
For the above reason, you MUST hold that dose for the 6 shots to give Frankie a chance to fill his spare tank and then what shots follow will be put to use to bring his numbers down.
The more data you can collect and put onto your ss, the better you will know how Frankie is reacting to the insulin. It is vital that you know how LOW Frankie is going in the middle of the cycles because you do NOT want him going so low that he can't recover.
Not wanting to scare you, but some kitties go VERY low and then bounce right back up. It is important to know what your kitty does and treat those lows if they are happening.
Start low, go slow. It works.
If you want to see him drop, you have to check at the right times, and that's at mid cycle.
Think of the letters "U" or "V"; looking at the two ends won't tell you a thing.
I think once you start to test as you can in time alllowed, even +3 +6 +9, or whatever you can get, you will start to see that Frankie is INDEED going much lower, but his dose may be too high or he is bouncing back up to the higher numbers.
Seriously, I know where you're coming from and have gone through high numbers that just don't want to go down, so I and everyone else here know how you are feeling.
You must go slow because Frankie's organs need to learn that the lower numbers are the right numbers. Some kitties learn quickly; others, not so quickly.
His body, I think at this point (its been 4 1/2 years of testing, running curves, with PZIVet) knows what lower numbers are. Its numbers like this 300 and now 500) that both he and I are not accustomed to. (More background)
Last, the numbers are NOT the most important or only thing to consider.
You need to focus on the WHOLE CAT and see how Frankie is acting. Watch him as time passes after each shot. You will see how he changes. Watch his habits and his appetite. Look for the old Frankie to come back; things he used to do before but just stopped. Watch for those things to return. Watch his appetite and how it changes. Watch and listen for how he carries himself, how he purrs and when.
No cat is just a number, so watch all of Frankie.
And remember this: Nobody rushes a cat. The cat will progress when the cat is good and ready, so you just get yourself comfy and wait it out.
Frankie's in charge now, always has been, and always will be. :lol:
Sienne and Gabby said:Perhaps looking at another SS would help. Take a look at Mousie/Cindy's SS. Cindy was a very long term PZI user who recently made the switch to Lantus. She works a crazy schedule which makes mid-cycle checks impossible during the work week. But, take a look at the good things that are happening for Mousie. After holding that 5 day settling in period where the shed is being built, Mousie is beginning to see some numbers in the green. Mousie's SS
I;ve been there when he was dx'd. and I'd rather not nor have the luxury of time (it took over 2 months, when he was dxd by holding an ineffective dose)
We're really trying to not torture you or Frankie!
I know, none here are trying to do anyhting but help us. ECID though.
Who better then you, after a long time dealing with managment of your cat's diabetes would know from you gut and experience, could make a judgement call.
Really! What we don't want to see happen is for you to keep raising his dose out of frustration with high numbers and once the shed is filled, you have a hypo crisis on your hands. We really don't want to see Frankie in high numbers for longer than is warranted but we are trying to balance his safety in light of the big picture. The protocol, while seemingly slow and plodding, really does work for the vast majority of cats.
Jay said:Its not from frustration, that I have raised the dose, Its to get a dose, that will do what insulin is supposed to do, That is to bring his BG level down, slowly to a Nadir, then get some duration, so I can play with the overlap, and keep him within a range that is neither too detrimental (over 300 consistently is, isnt it) nor one that would do him any harm. IE Hypo Incident.
Jill & Alex said:hi jay. i've merged both your threads into one to keep all the info together for today. please continue posting on this thread today. tomorrow... start another thread.
i'm also going to do something i don't like to do and that is... post and run. i have to leave the house in a couple minutes and won't be back til late tonight. lantus (and levemir, too) are different than pzi. lantus has a cumulative effect.... meaning one dose builds upon the next and can effect the next 3-5 days. dose-hopping does not work well. increasing the dose in increments of 0.25u or 0.5u is the way to go. when you increase in increments of 1u, it's like shooting yourself in the foot. by the time lantus has accumulated enough to do anything... you'll be over dose. you know what happens when a kitty is over dose. too much insulin can cause the numbers to rise and then plummet unexpectedly... or stay high.
look at alex's lantus spreadsheet from 2006 (link in my signature). this was back in the days when we didn't know how to use lantus as effectively as we do now. i floundered about for quite awhile before it all came together. then take a look at alex's 2009 levemir spreadsheet (link in signature). levemir works in a similar fashion to lantus. we use the same protocol. her 2009 levemir spreadsheet is a good example of fast tracking kitty into normal numbers by an experienced user. this is the technique i suggest you follow since you are not new to feline diabetes. please study the spreadsheet. notice how even one drop of insulin can and does make a difference. i also want you to notice how the numbers got worse before they got better. THIS IS NORMAL.
please, forget everything you ever knew about pzi. instead, concentrate on the dosing protocols used for lantus and levemir found here: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.
I checked your ss's, both. Didnt see what your ending dose of Lantus was prior to your switch to Levemir, and was looking to comapre what your ending dose of one insulin was to your starting dose of Levemir (that looked liked a 1/2 unit). Based on your use of Lantus, I was looking to see what baseline dose you had used upon making the switch. I had Frankie at 3 units Bid of PZI Vet, (yes lantus and PZIVet are 2 different insulins). Thats a relatively high dose and we were ok with what was happening as far as his BG Levels were concerned. I dropped him when starting Lantus (the other day) down to 1 unit. I had no idea at that point whether it would be too high of a dose or too low to start to be effective to some degree, let alone at all.
Just as you had a few years of experience with dosing, my sense was that dropping a High Dose kitty to a very low dose would prove to be ineffective at dropping his BG level from throughout any part of the cyle. I increased his dose today and as you can see, even though we started at a high BG level, he is dropping, which means that this dose level, is allowing the insulin to do what it is supposed to do. Its the baseline dose that's the issue here. If I start too low, his numbers will be high and go higher.
Again, knowing my cat is a high dose kitty, the initial dose I started him at, could very well have been too low. Would hanging on to a dose thats too low, regardless of how long it takes to settle, ever be effective? I'm not an expert, however, doesnt it stand to reason that that if you give a dose thats too low, no matter how long you wait for that dose to settle it will still be too low and eseentially ineffective?
i'll check back here later. have a good day...
Sienne and Gabby said:I really do understand that you are not new to insulin use or FD. The concern is that how Lantus is used is different than shorter acting insulin due to it's pharmacology. Approaching it like PZI is not recommended. There is a time for an aggressive approach - it's just not now. It is far too easy to miss what may be an optimal dose by what amounts to 4 times the typical increase. You also need to take the shed into consideration.
Going from relatively dealable with numbers (he will never walk away from needing insulin) to this, is not the time to be aggressive?
When is it time then,,,when he falls asleep with his head in his water bowl? When his numbers stay over 300 consistantly, or like the past 3 days and over 400. When would you get aggressive?
What you do is your choice. All we can do is point you to what the research literature informs us and what we have seen from experience. Please take a look at those materials. It may be, as Carolyn suggested, that Lantus is not suited to how you conceptualize insulin use or your lifestyle.
Jill & Alex said:hi jay. i've merged both your threads into one to keep all the info together for today. please continue posting on this thread today. tomorrow... start another thread.
i'm also going to do something i don't like to do and that is... post and run. i have to leave the house in a couple minutes and won't be back til late tonight. lantus (and levemir, too) are different than pzi. lantus has a cumulative effect.... meaning one dose builds upon the next and can effect the next 3-5 days. dose-hopping does not work well. increasing the dose in increments of 0.25u or 0.5u is the way to go. when you increase in increments of 1u, it's like shooting yourself in the foot. by the time lantus has accumulated enough to do anything... you'll be over dose. you know what happens when a kitty is over dose. too much insulin can cause the numbers to rise and then plummet unexpectedly... or stay high.
I have no base line here,. too little insulin will only keep his numbers high and have little effect.
look at alex's lantus spreadsheet from 2006 (link in my signature). this was back in the days when we didn't know how to use lantus as effectively as we do now. i floundered about for quite awhile before it all came together. then take a look at alex's 2009 levemir spreadsheet (link in signature). levemir works in a similar fashion to lantus. we use the same protocol. her 2009 levemir spreadsheet is a good example of fast tracking kitty into normal numbers by an experienced user. this is the technique i suggest you follow since you are not new to feline diabetes. please study the spreadsheet. notice how even one drop of insulin can and does make a difference. i also want you to notice how the numbers got worse before they got better. THIS IS NORMAL.
please, forget everything you ever knew about pzi. instead, concentrate on the dosing protocols used for lantus and levemir found here: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.
i'll check back here later. have a good day...
Ronnie & Luna said:hi there
I just wanted to let u know, your replies are showing up mixed in with other's replies in the quotes, if u could space them out(your own reply) a bit or highlight where u are replying, it makes it a bit easier and quicker to read your own replies.
You could also post your own reply a bit lower, or rather under the quotes so it keeps them separate.
Just trying to help ya so others can view the posts more clearly.
How is Frankie doing today? Behaving like a good kitty?
my cat was OTJ for almost 3 years before i switched to levemir. so there's really no comparison to be made as far as a base line dose.I checked your ss's, both. Didnt see what your ending dose of Lantus was prior to your switch to Levemir, and was looking to comapre what your ending dose of one insulin was to your starting dose of Levemir (that looked liked a 1/2 unit). Based on your use of Lantus, I was looking to see what baseline dose you had used upon making the switch. I had Frankie at 3 units Bid of PZI Vet, (yes lantus and PZIVet are 2 different insulins). Thats a relatively high dose and we were ok with what was happening as far as his BG Levels were concerned. I dropped him when starting Lantus (the other day) down to 1 unit. I had no idea at that point whether it would be too high of a dose or too low to start to be effective to some degree, let alone at all.
i agree with you. dropping to 1u bid of lantus from 3u bid of pzi would be ineffective.Just as you had a few years of experience with dosing, my sense was that dropping a High Dose kitty to a very low dose would prove to be ineffective at dropping his BG level from throughout any part of the cyle. I increased his dose today and as you can see, even though we started at a high BG level, he is dropping, which means that this dose level, is allowing the insulin to do what it is supposed to do. Its the baseline dose that's the issue here. If I start too low, his numbers will be high and go higher.
again, i agree with you. if frankie was getting 3u bid of pzi, the initial starting dose of lantus was set too low. his starting dose probably should have been set at 2u or possibly even 2.5u bid. since you're seeing some action tonight, i would stick with 2u bid for 6 shot cycles (3 days) unless he has a high flat curve. if that happens, i would raise the dose by no more than 0.5u after 4 shot cycles (48 hours).Again, knowing my cat is a high dose kitty, the initial dose I started him at, could very well have been too low. Would hanging on to a dose thats too low, regardless of how long it takes to settle, ever be effective? I'm not an expert, however, doesnt it stand to reason that that if you give a dose thats too low, no matter how long you wait for that dose to settle it will still be too low and eseentially ineffective?
Jill & Alex said:my cat was OTJ for almost 3 years before i switched to levemir. so there's really no comparison to be made as far as a base line dose.I checked your ss's, both. Didnt see what your ending dose of Lantus was prior to your switch to Levemir, and was looking to comapre what your ending dose of one insulin was to your starting dose of Levemir (that looked liked a 1/2 unit). Based on your use of Lantus, I was looking to see what baseline dose you had used upon making the switch. I had Frankie at 3 units Bid of PZI Vet, (yes lantus and PZIVet are 2 different insulins). Thats a relatively high dose and we were ok with what was happening as far as his BG Levels were concerned. I dropped him when starting Lantus (the other day) down to 1 unit. I had no idea at that point whether it would be too high of a dose or too low to start to be effective to some degree, let alone at all.
i agree with you. dropping to 1u bid of lantus from 3u bid of pzi would be ineffective.Just as you had a few years of experience with dosing, my sense was that dropping a High Dose kitty to a very low dose would prove to be ineffective at dropping his BG level from throughout any part of the cyle. I increased his dose today and as you can see, even though we started at a high BG level, he is dropping, which means that this dose level, is allowing the insulin to do what it is supposed to do. Its the baseline dose that's the issue here. If I start too low, his numbers will be high and go higher.
again, i agree with you. if frankie was getting 3u bid of pzi, the initial starting dose of lantus was set too low. his starting dose probably should have been set at 2u or possibly even 2.5u bid. since you're seeing some action tonight, i would stick with 2u bid for 6 shot cycles (3 days) unless he has a high flat curve. if that happens, i would raise the dose by no more than 0.5u after 4 shot cycles (48 hours).Again, knowing my cat is a high dose kitty, the initial dose I started him at, could very well have been too low. Would hanging on to a dose thats too low, regardless of how long it takes to settle, ever be effective? I'm not an expert, however, doesnt it stand to reason that that if you give a dose thats too low, no matter how long you wait for that dose to settle it will still be too low and eseentially ineffective?
you have to remember the "cumulative" effect of lantus. one dose does build on the next. generally speaking, you'll see better results after a few days on a dose. if you don't, it's time to raise the dose.
--- if nadirs are greater than 200, but less than 300 increase by 0.25 unit.
--- if nadirs are greater than 300, increase by 0.5 unit.
--- if nadirs are less than 200, hold the dose for 3-5 days. let that cumulative action build up.
make sense?
whoa! am i understanding you correctly? you shot 2u at +10 and you're planning on giving him another 2u before you go to sleep? i hope i've misunderstood what you said.He should be (nuless the dose totally tanked out on him) around 280 to 300 at which point I will give him another 2 units, and then try to get some sleep
Jill & Alex said:whoa! am i understanding you correctly? you shot 2u at +10 and you're planning on giving him another 2u before you go to sleep? i hope i've misunderstood what you said.He should be (nuless the dose totally tanked out on him) around 280 to 300 at which point I will give him another 2 units, and then try to get some sleep
lantus is a 12/12 insulin. there are some circumstances when you might want to shoot a little earlier than that, but for the most part shoot every 12 hours or as close to it as your schedule allows. please do not give any more insulin tonight (if that's what you meant). your AM shot time is 12 hours from tonight's shot.
remember, lantus dosing is all about nadirs... and lantus likes consistency in dosing and schedule.
Jill & Alex said:He got his dose, thats it for the moment. You misunderstood. I am aggressive yes, but thats a bit too much even for me.
oh good. you scared me for a moment.
I'd love to see 14 to 16 hours of duration, if not longer. Many times with PZI Vet, I had to skip cycles as we tended to get very long durations particularly when I dosed him close to or at the ideal time to catch overlap.
i know it's difficult, but have patience. i know it's even more difficult to have patience when your cat did well on another insulin. you WILL get there. lantus doesn't like to be rushed. you're already ahead of the game because your experience will allow you to be a little more aggressive than the average newbie coming through here.
Although 12/12 would certainly make my life/schedule much easier. We are dealing with cats though, and since when do they make our lives easier? Just fuller with love and affection, but certainly not easy.
lol! how true! although, as soon as you get frankie to an ideal dose, your life will be made easier using lantus.
When we get to that point ( see above) with a dose, then its on cruise control and I have no fear that his Nadir will be too low, or that he will drop way to fast, too early in the cycle. That latter is what we all want to avoid.
yep. we're on the same page.
He hardly ate. In under 24 hours he has eaten far more then he usually does as its been a long time since we dosed at TID ( is that 3x per day?)
he may eat more when his numbers are higher. less as they come down. my alex always did.
yes, TID pertains to shooting 3 times a day.
Again with such little insulin in the syringe, I think I missed and gave him a fur shot yet again. I have to get used to the plunger being so close to the bottom of the syringe with a short slide as opposed to the long slide of the plunger as recently as this past Friday morning.
ddon't worry. you'll get used to it.
By the way. later on today 3/7 can I post a "new topic" or do I have to continue this thread?
you can start a new topic with frankie's AMPS. one thread per day per cat. there's so many kitties in this group. it helps keep things organized.
hope you get some sleep tonight...
Jill & Alex said:my cat was OTJ for almost 3 years before i switched to levemir. so there's really no comparison to be made as far as a base line dose.I checked your ss's, both. Didnt see what your ending dose of Lantus was prior to your switch to Levemir, and was looking to comapre what your ending dose of one insulin was to your starting dose of Levemir (that looked liked a 1/2 unit). Based on your use of Lantus, I was looking to see what baseline dose you had used upon making the switch. I had Frankie at 3 units Bid of PZI Vet, (yes lantus and PZIVet are 2 different insulins). Thats a relatively high dose and we were ok with what was happening as far as his BG Levels were concerned. I dropped him when starting Lantus (the other day) down to 1 unit. I had no idea at that point whether it would be too high of a dose or too low to start to be effective to some degree, let alone at all.
i agree with you. dropping to 1u bid of lantus from 3u bid of pzi would be ineffective.Just as you had a few years of experience with dosing, my sense was that dropping a High Dose kitty to a very low dose would prove to be ineffective at dropping his BG level from throughout any part of the cyle. I increased his dose today and as you can see, even though we started at a high BG level, he is dropping, which means that this dose level, is allowing the insulin to do what it is supposed to do. Its the baseline dose that's the issue here. If I start too low, his numbers will be high and go higher.
again, i agree with you. if frankie was getting 3u bid of pzi, the initial starting dose of lantus was set too low. his starting dose probably should have been set at 2u or possibly even 2.5u bid. since you're seeing some action tonight, i would stick with 2u bid for 6 shot cycles (3 days) unless he has a high flat curve. if that happens, i would raise the dose by no more than 0.5u after 4 shot cycles (48 hours).Again, knowing my cat is a high dose kitty, the initial dose I started him at, could very well have been too low. Would hanging on to a dose thats too low, regardless of how long it takes to settle, ever be effective? I'm not an expert, however, doesnt it stand to reason that that if you give a dose thats too low, no matter how long you wait for that dose to settle it will still be too low and eseentially ineffective?
you have to remember the "cumulative" effect of lantus. one dose does build on the next. generally speaking, you'll see better results after a few days on a dose. if you don't, it's time to raise the dose.
--- if nadirs are greater than 200, but less than 300 increase by 0.25 unit.
--- if nadirs are greater than 300, increase by 0.5 unit.
--- if nadirs are less than 200, hold the dose for 3-5 days. let that cumulative action build up.
make sense?