General Insulin question

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Michele and Esse

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So, all you peeps, I have a question.

I was wondering: how do you decide the dose?

Do you base it on nadir (lowest point in cycle)? A specific time in the cycle? Highest number in the cycle? AM/PM time?

Just wondering...

Best-
Michele
 
I do a little bit of both nadir number and pre-shot number. Motska has been on the same insulin for two years now, so I have a pretty good idea of how her body reacts to it. I'm fortunate that her numbers are reasonably consistent unless I've gotten a fur-shot (very rare) or she has gotten into my roommate's cat's dry food (also very rare).

For the most part, I try to base it upon her usual nadir number. But if her pre-shot number is really low, then I drop her dose a bit so she doesn't end up in a hypo. And if her pre-shot number is pretty high, then I increase her dose -- just a tiny bit.

But I'm very fortunate -- Motska is on of those cats who doesn't get really extreme swings (knock on wood!). Lately she's been having her pre-shot numbers around 200-ish, and I've only got her on .2u (or sometimes .1u).

Not sure if that helps, since Motska seems to have it a little easier than many other sugarcats....
 
I really, really like the German TR Protocol - it makes so much sense to me and I've seen so many success stories.
 
Dose is determined by the lowest BG since yo do not want to go too low. People generally start at 1 unit twice daily (BID) and work up or down depending up results of measuring BG every two hours or so (a curve). Increases are generally in 1/4 unit increments but decreases can be larger if BG is really going low at minimum BG. Some people will vary dose just by preshot BGs. However, this is based on experience and depends upon the insulin.

The import thing to know is how YOUR cat responds to insulin since different cats respond differently to one dose of insulin.
 
Good question, this could be a great discussion.

While we were using ProZinc, I decided dose primarily by nadir. Even though other PZIers encouraged me to adjust dose based on PS#, I never did it that way, I kept looking at the nadir. I shot the same dose on 160 as on 400s, and it worked great for us. By using consistent dosing, I avoided NDW and the wasted time that came with it. I would stall if necessary and shoot late rather than decrease dose on a low PS, or shoot early to head off a bounce. When we were going down the dosing scale, I was encouraged to reduce based on PS # being too low, but I would wait for a low nadir to decrease. There was a little scratching of heads, particularly because I was so new....still am, in many people's eyes! But, to everyone's surprise, it worked extremely well for us. I'm a bit of a maverick, what can I say. :mrgreen:

I'm still figuring out my strategy with Lantus. The protocol is great to have, it's a tremendous help as a general guideline, but I'm seeing a need to adapt it. IMHO, that is what everyone needs to do though, take the protocol and use it, and then try different adaptations to make it work better for you. Any protocol should not be viewed as the only way to do things, it's a starting point. One size does not fit all! That is also the beauty of this board, it allows people to share their experiences in order to help others find a path that works for them.
 
Nadir is only 1 part of the equation. You have to look at the whole cycle. If your cat is going from 300s to double digits, that's producing a nice nadir, but the blood glucose is unstable and the cat isn't going to feel well. Gandalf did not achieve long enough duration from PZI, so that is what happened for him and after 2 1/2 yrs he was tuckered out.

Switching to Levemir created a more level curve and within 2 weeks of beginning it he was outside catching mice.

See the graph in Levemir ISG Sticky: viewtopic.php?f=10&t=682

To determine dose it helps to begin low enough that you have curves revealing what not enough insulin shows. Increasing slowly is the key and then comparing resulting curves. The ideal or optimum dose is the one which produces the most level curve, with the least amount of swing between preshots and nadir values.

Sounds simple, yes. But we all know ECID.
 
Great responses. Thanks.

See, I've got the two FDs, and have to do different things with them according to their numbers. Eeyore, for example, tends to not fluctuate much anymore, since coming off the high dose (for him) that he was on. Esse, OTOH, still fluctuates a lot.

What I find is that with Eeyore, I can "safely" skip a dose, if needed, to balance him out. With Esse, though, I either reduce or delay. Both of those decisions are not made solely on nadir, but rather what they are at preshot times and what dose they're on, how long they've been on it, if they have a "big" cycle, et cetera. Now, maybe I can skip Eeyore because he's on a minimal dose right now and Esse isn't; or maybe it's because they're different cats with different needs. Esse seems to have a three-day "big" cycle, meaning a low number, than a day of increasing numbers, a day at those numbers, and then one that comes down. Depending on where she is in the cycle is something I account for, as well; if it's early in the cycle, probably a full dose or a delayed full dose...mid cycle, probably a slightly reduced or big delay; and at the end of that cycle, probably not much of a change other than perhaps a shaved dose to prevent the low that's coming so the rebound doesn't come. Her "big" cycles are evening out a bit lately; I was looking at overall patterns, and noticing how they seem to have shrunk both in apex of numbers as well as number of days, so I'll change with her changing.

Eeyore, however, is completely different (as you can see by his ss).

And my question also comes from both the year+ of Esse and the 6 months of Eeyore, and not being able to consistently get a nadir on either of them on a regular basis. School/hospital schedule just won't allow it, unless I get up at midnight, and I've not been able to do that successfully. LOL.

I think that protocols are a good jumping off point, but modification is also needed, if the situation arises, as someone above mentioned.

It's just something I was curious about, and wondering how other people made those decisions...

Best-
Michele
 
Jen & Squeak said:
sounds like a pretty good example of ECID ;-)
Click to expand...
Eggzakly!

For tonight, for example, Eeyore is 102. Esse is a nice solid 161. She got the full dose, he got his normal full dose. But...had he been under 100, he probably would've gotten shaved. As long as she was over 100, I wouldn't have changed hers. But then again, I did manage to get semi-nadirs today for both, so that's good.

I will admit that I have a hard time deciding if Eeyore needs emptying or not sometimes...

Best-
Michele
 
Michele and Esse said:
I was wondering: how do you decide the dose?

Do you base it on nadir (lowest point in cycle)? A specific time in the cycle? Highest number in the cycle? AM/PM time?
Click to expand...

This is a good question, and I'd love to explain some of the wonky things I do in response to the numbers I get.

First Ennis. He's been diabetic 4.25 years, and on Levemir almost 4 years. He's a lowish dose, fairly level cat. Sometimes he needs two doses a day, sometimes only one. I pretty much time his shot based on PS, meaning---->if it's been more than 12 hours and he's over, say, 90, I will give him .5U.

.5U is what he normally gets. However, if he's been needing BID shooting and been getting PS numbers above 150, I may "punch" him to .75U on one shot. With that single move, he usually comes back down to a nice 120 PS, or maybe even trends back to SID.

Second Bastian. He is Stefani's foster who spent about 7 weeks with me. We switched him from Lantus to Levemir when he was here, and his first shot of 1U Levemir took him from a PS of 338 to 35 at +6. So we found out that just as he was overly sensitive to Lantus, he was overly sensitive to Levemir. His follow-up PS would be in the 300s or 400s, whether from bounce or lack of duration.

I finally found a timing/dosing pattern that seemed to work for him. I gave his .75U in two shots. I played around trying to find the best pattern. Sometimes I would dose at PS and at +2; other times at PS and +3. Sometimes the first shot would be .5U with the second shot .25U. Sometimes it would be the other way around. My decisions on timing and amount on any particular cycle would be based on the current BG level, keeping in mind that I knew his overall pattern from several curves and that he was never symptomatic on low numbers. Every cycle seemed to call for the death of several thousand of my brain cells as I thought about what the best time to give the shot and whether to start him on the .5U or the .25U.

It's been too long ago to remember how Maxwell was on BCP PZI, but I do know that the change to wet food played a huge factor in getting him into regulation and then remission.
 
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