? HELP. After +6 (47), +6.5 (68) shot time (419), +4 (185)!

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Silvina

Silvina

Member Since 2015
Hello girls!!

Hope you can help me with this. Hope those of you that followed me yesterday with Markies low number after which he earned a reduction to 1.75, can help me again.

I decided to give a last 2u dose since he bounced after low number. Shot time rised to 419 and now, at +4 he is 185, so he drop a lot!!

I fed him, his pupils are dilated. He is weird, but not bad, just weird. Im concerned if I go to sleep (didn´t go to sleep yet, here in Argentina it´s 5.33 AM) he will reach nadir and keep dropping.

Any recomendations? I will reduce dose to 1.75 next shot that will be 1PM, which is 7.5 hours ahead. Nadir is usually between +6-+8 hours, usually closer to +8.

Silvi

PS; this is the previous thread
http://www.felinediabetes.com/FDMB/threads/6-gc-47-and-we-are-still-not-at-nadir.147145/
 
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Hi Silvi.

I wasn't one of the people that helped you yesterday, but I'm here now. Looking at Markies' spreadsheet, it's too early to see a real pattern, but if I had to guess I'd say he's been nadiring between +6 and +8, as you said, so he's probably going to go lower. If you fed him within the last hour, you can probably test him now and see what he's doing. Depending on how much/fast he's dropping you could probably take a nap and get up to test again if needed. Can you test him soon and post the number?
 
thank you Tricia!! I fed him with canned whiskas and tested 1 hour later. He kept dropping even he ate whiskas. he is now +5 (147) so he will keep going down probably.

I may stay little longer.
 
How are you at napping? He's not dropping that fast and you could probably go to sleep now and get up in 60-90 minutes to test and he'll be okay. It's up to you, of course. I'll be around for a while longer if you need help.
 
Thank you dear.. I will go to bed, Im totally exhausted.

Thank you so much!! I will put the alarm in three hours, it will be +8.
 
Okay. I'll be asleep by then, but there will be others online to help you as it will be morning on the East Coast. I would leave some food out for him. Good luck.
 
Thank you Tricia.

Markies GC bounced again. I fed him many times with canned whiskas. He didn´t go too low. At +8 he was 173 so went up but reached 419 at shot time.

Im now reducing his dose to 1.5 instead of 2 units.

Question: Can the reduction needed be bigger, I mean for example 0.5 of reduction instead of 0.25?

Silvi
 
If you need sleep and want him safe while you do, that is an option. It will let the depot/shed drain a bit more quickly. You may need to go back up the 0.25 units later.
And remember, it can take a good 3-5 days for a changed Lantus dose to stabilize.
 
Thank you BJM. We use Levemir, but I guess its the same as in Lantus to stabilize.

I didn´t understand about letting the deposit drain and what for going to back up the 0.25. Sorry, it´s just that language barrier doesn´t help me.
I already dose 1.75 after he earned a reduction. We are up now, no sleeping. It´s 2PM now.

I will try to test many times today.

Silvi
 
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Silvina - there are much smarter people here than me on these depot insulins - think of it as you're filling a glass in the morning and there is a slow leak in the glass (insulin getting consumed) so in 12 hours you have to fill up the glass again. It's not an exact analogy but it might help. We generally reduce in .25 unit amounts rather than .5 unit amounts. Just take the time to get to know your cat. They are all different and react differently. I know it is frustrating and a little scary at times - you will get this figured out.
 
ctmorris said:
Silvina - there are much smarter people here than me on these depot insulins - think of it as you're filling a glass in the morning and there is a slow leak in the glass (insulin getting consumed) so in 12 hours you have to fill up the glass again. It's not an exact analogy but it might help. We generally reduce in .25 unit amounts rather than .5 unit amounts. Just take the time to get to know your cat. They are all different and react differently. I know it is frustrating and a little scary at times - you will get this figured out.
Click to expand...

Perfect analogy ctmorris!!
 
There are sticky posts about Lantus at the top of this forum section for Lantus and Levemir. They explain how to use and store Lantus, and understand how Lantus works in cats.
 
I would stick with your 1.75u dose unless you have some reason that you need to give less, like if you can't be home to monitor after you've shot, and you're worried about low numbers.

Let me take a shot at explaining a little more about the depot. When you shoot a depot insulin (Lantus or Levemir) some goes to work lowering the blood sugar right away. Some builds up in the body. Lantus and Levemir build up differently. There is a good description of that here. As it builds in the body, it forms a depot. The depot gives out over the following hours - think of it like a timed release medicine.

The important thing for you to know when adjusting the dose is that the depot size is in relationship, in an equilibrium, with the size of the dose. A larger dose = a larger depot. Smaller dose = smaller depot.

When a dose is reduced, the depot is still at the larger dose's amount and it will gradually reduce as well, over the next 6 cycles or so. With a 2.0u dose, Markies has a depot that fits with the 2.0u. Reducing the dose to 1.75u means that the depot now has to reduce to fit the new 1.75u dose. It can take as many as 6 cycles to accomplish that.

In your case, you reduced the dose because Markies dropped below the reduction point. If he drops below 50 again in the first few cycles after you reduce the dose, we'd probably "blame" the low numbers on the residual action of the 2.0u depot and suggest you continue to hold the 1.75u dose. If it was in cycle 4 or later, then it might mean that he really did need another dose reduction. This is one of those situations that can vary, depending on the cat, especially on how long it's been since diagnosis.

Similar situation when you increase the dose. Let's say you were going up the dosing scale and increased to 2.0u. The depot that had developed to "fit" 1.75u now wouldn't be big enough for the 2.0u dose. To know what the dose + the depot can really do, you hold the dose for a few cycles to allow the depot to build. That's why we don't suggest increasing too quickly. You want the depot to "catch up" to whatever dose action you're taking.

So you can also see why changing doses too frequently can create wonky cycles and then it can be difficult to see what dose is doing what.

The reason I'm suggesting you stick with the 1.75u dose is to let that depot reduce and see if Markies can still get into green nadirs with it. Then you'll be able to tell what the dose can really do.

Do you have this post yet, "Where Can I Find?" It'll help you navigate around.
 
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