I can not find the dose

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Gurkan&Raffy

Gurkan&Raffy

Member Since 2017
Hello everyone, my name is Gurkan. My cat Rafy is 8 year old . We ve leart his diabetic 3 mounths ago at periodic whole blood check.His BG was around 450.
After that we ve started to feed him with Bozita wet food (carb ratio is %1,5) and our Vet started with Humalin N. With 3 dose twice a day his nadir was around 50 buy 12 hours later it was again 400-475.
Since last mounth we ve been using Levemir. Started with 3 dose twice a day( every 12 hours) but his nadir is around 350-375 ; and before the AM or PM shots it is again around 470's...
Then we reduce the dose step by step (0,5 every 3 days) to 2 units but nothing had changed...
I need your adviceses.
 
Do you test his blood glucose at home?

What country are you in?
Never mind, now showing in your profile.

Welcome to the board! It is a great place to get information.
 
When it drops that much from the starting number it causes a bounce... The cats pancreas releases stored glucose to keep itself safe. You need to significantly reduce your dose. I'd go back to 1 unit.
 
Rafy's BG level before AM shot is 457. +4 450, +6 400, +9 411, before PM shot again 455. These are today's data....
 
Gurkan said:
Right now , our dose 3,5 unit. Is it safe to reduce it directly to 1 unit?
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You don't have to wean off of insulin. I thought you said you reduced to 2? If he hypoed at 3, why did you raise the dose? That's not safe.
 
We have started with 3, but the BG levels were too high, that's why i reduced the dose till 2 units step by step, to find out if 3 units were overdose or not?
 
Hi Gurkan, and welcome. You have come to the right place to get help for your Rafy.

I can tell that you have been reading the stickies, since you are using terms like "nadir"! Good work! How often are you testing each day? If you can get your spreadsheet set up, it will really help us see what is going on with Rafy's numbers. With just the info you have given us so far, it's hard to say if Rafy is getting too much or too little insulin. Putting the numbers in the spreadsheet gives us a visual that makes patterns and trends become obvious. I see Janet has already given you a link to the instructions for setting up the sheet. Since you are in Turkey and using a pet meter, you will use the World Spreadsheet for Pet Meters. If you need help getting started, please let us know. We have several people here that are very good with it and can get it set up for you quickly.

Also, here is a link to a post that we put together to help new members learn more about using this Board: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

Keep reading the info here - there is a lot of it! Keep asking questions - we love to help.
 
Tricia Cinco(GA) & Harvey said:
Hi Gurkan, and welcome. You have come to the right place to get help for your Rafy.

I can tell that you have been reading the stickies, since you are using terms like "nadir"! Good work! How often are you testing each day? If you can get your spreadsheet set up, it will really help us see what is going on with Rafy's numbers. With just the info you have given us so far, it's hard to say if Rafy is getting too much or too little insulin. Putting the numbers in the spreadsheet gives us a visual that makes patterns and trends become obvious. I see Janet has already given you a link to the instructions for setting up the sheet. Since you are in Turkey and using a pet meter, you will use the World Spreadsheet for Pet Meters. If you need help getting started, please let us know. We have several people here that are very good with it and can get it set up for you quickly.

Also, here is a link to a post that we put together to help new members learn more about using this Board: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

Keep reading the info here - there is a lot of it! Keep asking questions - we love to help.
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I think I ve done it...
 
Gurkan said:
I think I ve done it...
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Good job!!

You might want to add some more information to your Signature too....it keeps us from having to ask the same questions over and over again. Stuff like:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues? and a general location

If you look below any of our comments, you'll see we all have that information there
 
Gurkan said:
First 3 BG datas... as usual again,
Any idea?
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I suggest you continue at this dose for a few more days and get as many tests as you can to build up the picture better. Your dose might be too high but there's isn't enough information yet to know.
 
A
Kris & Teasel said:
I suggest you continue at this dose for a few more days and get as many tests as you can to build up the picture better. Your dose might be too high but there's isn't enough information yet to know.
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Actually i ve been giving this dose for 4 or 5 days. And all the values were around 380- 450.
I used to try 2/ 2,5/ 3 as well and they were again around 400s
 
Gurkan said:
A

Actually i ve been giving this dose for 4 or 5 days. And all the values were around 380- 450.
I used to try 2/ 2,5/ 3 as well and they were again around 400s
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If you could go back and add all this data to your spreadsheet it would be helpful.
 
I think that you mentioned that Rafy had nadir of 50 on the other insulin, is that correct? I am wondering if maybe the vial of lantus you have is no longer good. It is possible it is still good, and you cat just needs a bit more time on the new insulin. Some cats need more insulin than others. I am not experienced enough to determine if the high numbers are caused by too much insulin, hoping a more experience member drops by. Keep getting as much tests as you can and maybe a better pattern of his number will help to see what is going on. If you can do a curve (test every 2 hours for 12 hours). That would really help.

Good luck, and keep posting and asking questions :)
 
I saw that value (50) just once with Humalin N.
Because of my duty times , usually it is very hard for me to make tests every 2 hours.
Next Monday , i ll be on my off day, maybe i can do that...
I am planning to increase the dose to 4 today.
Do you think is it going to be reasonsble?
 
Gurkan said:
With these latest datas, current dose is so high or too low?
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I think it's probably going to be too low, but again, we are very data driven here and without Pre-shot tests every cycle, it's really hard to know.

Can you get both AMPS and PMPS tests the next couple of days?

And if at all possible, at least 1 test somewhere mid-cycle on the AM cycle and a "before bed" test on the PM cycle.....you're doing great on getting the "before bed" tests though!
 
Gurkan said:
Since last mounth we ve been using Levemir. Started with 3 dose twice a day( every 12 hours) but his nadir is around 350-375 ; and before the AM or PM shots it is again around 470's...
Then we reduce the dose step by step (0,5 every 3 days) to 2 units but nothing had changed...
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Do you have any of the blood sugar data for those days when you took his dose down to 2.0 units?

As others have said, more data will tell us how he is doing on this dose. Some cats need more insulin, some less and it's hard to tell with what I see so far. Getting a test before each shot is important, as well as some data some where in the middle to end of the cycle. With Levemir, the nadir will be quite a bit later in the cycle than it is with Humulin N. Testing throughout the cycle will tell you when his onset and nadir are. Typical onset is +4 and typical nadir is +8, but my Neko was later with both on Levemir. In fact, her nadir was often the preshot test time.

I would wait another day before increasing to 4 units. Get preshot tests and spot checks in the next two cycles and then post again about increasing.
 
So i ll stay on 3,5 one more day. When were on dose 2, the values were a little bit higher. That's we ve started to increase the dose.
 
Chris & China said:
I think it's probably going to be too low, but again, we are very data driven here and without Pre-shot tests every cycle, it's really hard to know.

Can you get both AMPS and PMPS tests the next couple of days?

And if at all possible, at least 1 test somewhere mid-cycle on the AM cycle and a "before bed" test on the PM cycle.....you're doing great on getting the "before bed" tests though!
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We were again on same dose(3,5) but values are much more better.:)
Can u pls check them on Ss....
 
Yellow is much better. :) Can you test again in a couple of hours to see if he's still coming down?

Since you have seen yellow nadirs, the next increase would be by 0.25 units.
 
Wendy&Neko said:
Yellow is much better. :) Can you test again in a couple of hours to see if he's still coming down?

Since you have seen yellow nadirs, the next increase would be by 0.25 units.
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The last value, which is PMPS is 355.
I gave 3,5 U again.
According to last data, do u think tomarrow morning i shoulg give 3,75U?
 
Good job getting those preshot tests and setting up the spreadsheet. Can you see how that sheet helps us figure out what is going on? It's a great tool.

I would go ahead with the increase to 3.75 tomorrow morning. Will you be able to get any mid-cycle tests in? I'd try for at least a +2 and/or +3 to see where he's heading, then a +7 since that seems to be around nadir for him. Of course, any other tests you can fit in are good, too!
 
Tricia Cinco(GA) & Harvey said:
Good job getting those preshot tests and setting up the spreadsheet. Can you see how that sheet helps us figure out what is going on? It's a great tool.

I would go ahead with the increase to 3.75 tomorrow morning. Will you be able to get any mid-cycle tests in? I'd try for at least a +2 and/or +3 to see where he's heading, then a +7 since that seems to be around nadir for him. Of course, any other tests you can fit in are good, too!
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We ve started this evening (PMPS 355). Right now, +2hr. 3,5U 434:(
Is it normal?
 
Gurkan said:
We ve started this evening (PMPS 355). Right now, +2hr. 3,5U 434:(
Is it normal?
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Perfectly normal. Levemir typically doesn't onset until around +4, so his numbers will keep going up after preshot until the onset time. I didn't find much value in getting a +2 test when Neko was on Levemir, unless her numbers were still going down at preshot time. And as others have said, he's probably bouncing from that yellow. Good progress today!
 
Chris & China said:
There's something we call New Dose Wonkiness (NDW) that could be in play....for some reason we don't fully understand, the first cycle or two after an increase can make the numbers go up instead of down like we think they would
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You mean ; he might be better tomarrow
 
Welcome to the group!

I don't think the increased dose is a problem. There is a phenomenon called "new dose wonkiness" which occurs when numbers go up after you increase the dose. It will take a few cycles for the numbers to come back down. The other thing to keep in mind is that Levemir works very differently than Humulin N. With "N," it works much more quickly and it drops numbers sharply -- like you saw when Raffy's numbers dropped into the 50s. It also is a shorter acting insulin so it wears off after about 8 hours. Levemir is a depot-type of insulin. You don't see an immediate response to a change in dose. It will take some getting used to not seeing the immediate effect of a dose change. You also base your Levemir dosing on the nadir and to on the pre-shot value. You'll also find that both Lantus and Levemir have a much longer duration than Humulin N.

I suspect that most of the people here will tell you that the hardest thing to get used to is being patient. Raffy's numbers will improve. You need to give it time and be systematic in your dosing.

 
Gizmo had a lot of new dose wonkiness. It used to take the full 6 cycles before I saw lower numbers from a dose. Then they weren't that low, so I would increase again ... just to see his numbers go higher due to new dose wonkiness. It was very frustrating, but finally we got to a better dose and he is seeing more blues and sometimes greens.
 
Gurkan said:
You mean ; he might be better tomarrow
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Yes probably, every time the dose is changed, or skip a dose, it can take up to 6 cycles to tell how the dose is doing because the depo also needs to be adjusted. My cat usually only took about 4 cycles. That why it's important to hold the dose, unless the cat has a BG of 90 or less, where you want to decrease the dose.
 
Raffy may also still be bouncing from the 280, that also can take a few cycles to clear. Once you get closer to a good dose you will see more activity. Lets hope we see some movement next cycle, to keep you and Raffy enouraged :) ... it takes time and patience.... and it keeps them safe
 
Thing are not going well, my neighbour and his dog were on vacation but now they are back... That means unlimited dry dog food for Raffy. Since they'r back we were between 550-480 :(
 
Any chance you can talk to your neighbour about lifting the dry food when the dog is finished eating? It's either that or you'll have to limit Rafy's time out to when you are there to monitor him.
 
Wendy&Neko said:
Any chance you can talk to your neighbour about lifting the dry food when the dog is finished eating? It's either that or you'll have to limit Rafy's time out to when you are there to monitor him.
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I think, it is going to be better to keep Raffy at home as long as possible. He is at the age of 7, and he has been living both indoor and outdoor
all of his life; it wiil be very stressfull for both of us.
 
I ve just loaded the latest datas. :(
when he is more than 450 he is not comfortable.
i think i ve to keep him indoor.
 
I know that in the Mediterranean most cats are normally outdoor cats, but I think it would be safer for Raffy to be indoors. It will be hard, but at least you will be able to monitor what he eats. Indoor cats live longer too :)

I would hold the dose one more day, unless a more experience person thinks it is a good idea to increase at his next hot time.

I would suggest to get more attention to you post that you start a new one with todays date, Cat Name, His BG numbers for today and add Dose advice needed. You will notice we start a new post every day. People may think this is an old one already answered and may not look at it.

You should also add a link to this post in your new one.
 
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