Guess this is rebound...change to .50U?

Status
Not open for further replies.
Marci and Buddy

Marci and Buddy

Member Since 2009
knew this was coming...Buddy responds to same dose amt with below 40, now i give him a drop less, and hope he'll get back to blues.
poor boy, he's exausted.
maybe this is the time to drop to .50??
 
Was there anything else difference about his day? Food, exercise, etc?

If not, and he was my cat, I would start at fat 1u tomorrow morning. His PS tonight is rebound from the 38 and he may still be a tad higher tomorrow am. He was getting some lowish numbers on the fat 1u in Nov. I wonder about the second cycles on the 22nd and 23rd, where his next PS was lower and he had the +9 of 92, then suddenly 3 hrs later he is in the 300s. That 306 looks like a rebound number to me. Where did he go over night? (how low?) After that he has more 300s and some 400s as you raised the dose to 1.25u. To me, that indicates that he was possible rebounding.

By fat 1u, I mean about 1.1u 0 that would maybe be where the top edge of the stopper is up against the bottom edge of the 1u line (needle facing up).
 
NO,nothing at all different..this is what he does -there is no precitability past 6 months, which is why i am frustrated,
and discouraged at the thought of his chance for remission.
Fat 1 u sounds good to me starting tonight,thanks.
 
Oh, yeah, I know about frustration. Jeddie is doing the same thing. Perfect numbers one day and then lousy numbers the rest of the week - on the same dose. With Beau I was so frustrated after I switched him to lev that I seriously thought about switching back to vetsulin (!) because I knew it and knew what he would do with it. Glad I stuck with the lev.

BTW, I was doing so "calculations" today and I think the top of the stopper against the bottom of the 1u line would be 1.15u - so just a mote more that 1.1u. Laugh, but it does make a difference.
 
yes , i do know it makes a differnce , esp. in Buddy-his body is sooo sensitve,
to everything- noise, sight, meds. the tiniest sound makes him react, even in his sleep. he responds to just 1 drop of insulin. took me all this time to figure out Tilly's .25 unit adjustments are way too much for him, he maybe needs 1/4 of that.
so we are on a fat 1 u now, aloth' i measured it where the top of float hits the top of the 1u mark, not sure why you wrote the bottom? :?
 
I always have the needle facing up - so top of stopper even with top of 1u line = 1u. Move the stopper down so the top is even with the bottom of the 1u line = 1.15 (approx). Does that make sense? I could take a photo of it....

As long as you are clear with your own dosing it doesn't matter too much. You are shooting less that 1.25u and more than 1u so.... it just matters that YOU can draw the same dose using your own methods.

Beau was very sensitive to insulin as well. And also a jumpy sort. He has cardiomyopthay so I am always worried a loud noise could startle him TOO much. And there was no way I could make dose adjustments in .25u increments, let alone .5u. I actually think a lot of cats are like that and go from too little to too much and enter a rebound situation and the dose just keeps getting raised. It's one of the problems I have with that protocol. Some of us think more in terms of percentages of change, so the lower the dose the smaller the fraction of a unit the change would be. Beau was actually on .05u for a couple of weeks - and would drop to the 30s on that if I shot below about 140.
 
Hi Marci,
Sorry I haven't been on the board much. Buddy's spreadsheet looks to me like he needs some dose fine tuning. That means going back to a dose a little lower than present, such as 1U, staying with that dose for at least 6 to 8 cycles to establish a nadir. Then if nadir hasn't dropped in to the 100s, increase dose perhaps .1U. And you hold and check nadir again, until you reach the dose which stabilizes the BG. Stabilization is what's important, not necessarily the lowest number.

When at doses below 2U it's best to think in percentage changes rather than units. I can see from your spreadsheet that you understand that as you are using fats and I see a 1.3U in there as well. So a .1U change from 1U is a 10% change. Changing from 1.1U to 1.2U is a 9% change and from 1.2U to 1.U is an 8% change. I have even done .05 increment changes which is less than 5%.

The trick is learning how to consistently get those doses on your syringe. If you're confident at doing that, shouldn't be a problem to get him stable. His response to Lev is excellent.

I struggled for a long time trying to get a dose which held Gandalf below renal threshold numbers all day long. It was only through this type of fine tuning that I did it and arrived at 1.3U, which time and again if I move off that dose, his spreadsheet looks likes Buddy's! And not as good as he didn't have as many lows.

My hunch is Buddy's dose is about 1.1 or 1.15U.
 
ok so just to be sure i understand, since this is Buddys 6th cycle,
if by tonight his bg is not around 100, drop his dose from F1 to 1....right?
( I wd. have thought to increase it by .1 or .2, )....i'm worried he's not getting enough insulin, but i know you and others are saying i may be giving him too much , which is why his #'s are so off. Wish i understood that concept more fully....doesnt his shed empy out with less insulin? I agree he needs fine tuning,and i trust you guys....please confirm the dose drop for tonight...thanks so much.
 
I think what Vicky is getting at is to start slightly below the right dose so you don't overshoot it. By trying 1u, if you are giving a tiny bit too much, his numbers will improve on that change, if not then you very slowly increase in very small amounts, hold to let settle, and repeat until you get to the best dose.

As to the shed thing, all I can say is that you would think that on smaller doses the shed would empty sooner - if you can completely go with the shed metaphor. I mean, a shed holds a set amount so putting less into it means it would last less time - but how these insulins work is that they bind and unbind repeatedly to (something, can't remember what) and can only be utilized in the unbound state. The binding state allows some of the molecules to be available much later in time (think time-release action, sorta).

Almost all these cats are producing some insulin, just not enough to go solo, so they may need a lot or a little exogenous insulin available. So it is possible for a cat that needs little exogenous insulin to still have some "shed" available even on a small dose.
 
thanks for this Sheila, i think i have a better understanding now.
i did increase his dose from 1.10 to 1.15 tonight before this post came...i have felt so bad for Buddy past few days , feeling lethargic as his numbers stayed so high.
I believe slight increase will give him some relief,until he goes too low which ususally takes a few days, then i will start at 1u.
does that sound like a plan, or am i thinking too much with my emotional response to his illness, rather than my (ever growing) intellectual one ?
 
Marci, it seems like you are near his dose. The trouble, and confusion, is that it is very hard to tell which way to go. I know, I have been there. If you haven't already, you might want to read this post I made to Pam:

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=32406

It deals me being in the same place with Beau that you are now with Buddy, and Pam is with Alley. Maybe it will help you understand how less is more.

Your decision on the dose is fine. It isn't like you decided to double it or anything that would put him in jeopardy. In fact, it was making that same decision with Beau that lead me to feel sure he was rebounding because he dropped really low by the second cycle. It was clear to me that he needed less. Although, you only increased by about 5% so it may not show a dramatic change either way.

So, keep spot checking and looking for clues in the numbers. And asking questions.
 
Marci,

Sometimes you just have to go with your gut feeling...you feel that Buddy needs a scosh more, so he got it.

I don't know that he will neccessarily go so low again on the .05 increase that you have to back off the dose...if he does get to the greens- that isn't actually a bad thing.

Some folks on the board will leave the cat in the lower greens (50's +) to weed out "panicky liver"...they refer to it as "liver school". They let the bounces happen and hold the dose until the numbers even out. While I don't actually agree with this practice, others on the board do and have been successful with it...maybe those folks can chime in here and offer insight on that?

In any case, remember getting a 50 or so on Lev isn't the same as getting it with N or other short acting insulins...Lev tends to let a cat hang in the lower numbers without plummeting- referred to as a "gentle insulin" b/c of this.

Because I know you are home to test, green doesn't have to mean panic with Lev...you may just test and see if he'll "hang" rather than stuff food in him to get an artificial rise. Of course if you start getting numbers that are going lower than the 50, you'll want to feed.

Watching and rooting for you guys! :RAHCAT
 
Status
Not open for further replies.
Back
Top