Little-Levemir-Ugh

[Lisa and little]

Just want some confirmation that I’m doing the right thing and not missing something. Following TR except for the last dose at 2:5. I left her there a bit longer as she tended to take longer to react/adjust to dose changes on Lantus. She also had a lime on that dose. Overall I’ve seen sprinklings of green an blue on all doses so I guess I’m confused. I’m hating her numbers. Yes, my patience pants are on. Would just like someone to take a peek at her SS and let me know if you think I missed something. Perhaps since ECID, I didn’t leave her on a particular dose long enough for HER body and we skipped tight over what might have been a good dose? Worried that what I am seeing could be too much insulin rather than not enough? She’s bouncing a lot being that her lows really aren’t that low and then there are days where it seems the insulin has no effect at all. Again if someone could peek at her SS I would so appreciate it it.
@Wendy&Neko @Marje and Gracie Confused confused confused.

 

[Sienne and Gabby (GA)]

To my eyes, what you're seeing are bounces.

Please try to remember that with a long term diabetic kitty, numbers under 40 require a dose reduction. You didn't reduce Little's dose on 5/5. Likewise, with nadirs that are under 200, you hold the dose for 5 days/10 cycles. Given that initially, you were seeing nadirs in the 50s (or below), I would have held the dose, as well. Then you started to see higher nadirs. I would have likely increase the dose a bit sooner than you have.

My kitty was prone to dives and bounces. What I learned (from another, very experienced member, Jill/Alex) was to do what I could to maximize the insulin dose. For example, on 5/29, when you tested and got the 55 at +4, try to avoid a drop in numbers that would warrant a dose reduction. You do everything you can to avoid reducing the dose. At some point, you're cat will demand a dose reduction but the overall idea is to try to get Little into blues and greens for longer and longer periods of time. By steering the cycle more with food, you may also prevent some of the bouncing -- no guarantees on that count, though.

You don't want to leave Little at a given dose overly long. My impression is that holding the dose too long doesn't decrease the bouncing. Instead, you run the risk of glucose toxicity developing which in the long run, adds to the bouncing since your kitty treats higher numbers as the new "normal." You want to get Little into lower ranges so her body acclimates.

 

[tiffmaxee]

Max was a bouncer as well, for over a year. I learned to guide the curve with food. I eventually got him tightly regulated.

 

[Lisa and little]

To my eyes, what you're seeing are bounces.

Please try to remember that with a long term diabetic kitty, numbers under 40 require a dose reduction. You didn't reduce Little's dose on 5/5. Likewise, with nadirs that are under 200, you hold the dose for 5 days/10 cycles. Given that initially, you were seeing nadirs in the 50s (or below), I would have held the dose, as well. Then you started to see higher nadirs. I would have likely increase the dose a bit sooner than you have.

My kitty was prone to dives and bounces. What I learned (from another, very experienced member, Jill/Alex) was to do what I could to maximize the insulin dose. For example, on 5/29, when you tested and got the 55 at +4, try to avoid a drop in numbers that would warrant a dose reduction. You do everything you can to avoid reducing the dose. At some point, you're cat will demand a dose reduction but the overall idea is to try to get Little into blues and greens for longer and longer periods of time. By steering the cycle more with food, you may also prevent some of the bouncing -- no guarantees on that count, though.

You don't want to leave Little at a given dose overly long. My impression is that holding the dose too long doesn't decrease the bouncing. Instead, you run the risk of glucose toxicity developing which in the long run, adds to the bouncing since your kitty treats higher numbers as the new "normal." You want to get Little into lower ranges so her body acclimates.

Thanks for the quick reply. I understand about 5/5 but I had already decided to make the switch to Levemir and ordered it by then. At this point I am only looking at the Levemir numbers which start 5/15. She had a random 51 on 5/17 followed by 3 days of solid yellow and pink at 1.75 on 5/20 another random 53 also at 1.75. Her next drop to the 50s was 5/29 with a 48 that day as well on 2.5. Maybe I am thick as I am not sure I understand what I should do at this point. I did not reduce the 48 as per long term protocol. I have not taken any reductions. Just increases since starting Levemir. Are you suggesting I missed something? My interpretation is reduce long term only under 40 which hasn’t happened on Levemir so I keep going up.

 

[Wendy&Neko]

My first comment is to keep on those patience pants. Levemir is a new hormone (insulin), and Little has to learn how to work with it properly. It can take a month or three, before a cats body really starts to do well on a new insulin. In the mean time, Little is bouncy, and you are also seeing some New Dose Wonkiness (last night). Also, don't assume that because Little did something on Lantus that she'll do the same on Levemir. Start by following the protocol, and changing things like holding doses longer when the data tells you to. I found the first month and a bit very frustrating after the switch to Levemir - it was like learning Neko all over again.

Some Levemir kitties drop hard at onset, for example, you had a 180 point drop in a couple hours from +1 to +3 today. 5/29 was another example. Fast drops can also cause bounces. As the others have said, experiment with food so she has fresh carbs on board 1/2 hour before the drop so she doesn't drop as hard.

 

[Lisa and little]

My first comment is to keep on those patience pants. Levemir is a new hormone (insulin), and Little has to learn how to work with it properly. It can take a month or three, before a cats body really starts to do well on a new insulin. In the mean time, Little is bouncy, and you are also seeing some New Dose Wonkiness (last night). Also, don't assume that because Little did something on Lantus that she'll do the same on Levemir. Start by following the protocol, and changing things like holding doses longer when the data tells you to. I found the first month and a bit very frustrating after the switch to Levemir - it was like learning Neko all over again.

Some Levemir kitties drop hard at onset, for example, you had a 180 point drop in a couple hours from +1 to +3 today. 5/29 was another example. Fast drops can also cause bounces. As the others have said, experiment with food so she has fresh carbs on board 1/2 hour before the drop so she doesn't drop as hard.

Thanks Wendy. I guess I was just a bit scared after seeing a 48 to move up again. Approaching 3U is scary for me as I’ve never gone above 2.75 since first diagnosed. I know what happens on other Insulin’s is no indication of what a new insulin will do. Thanks for the advice on the food at onset. It’s worked so far and while I’m working from home that can work. Thanks for all the help and advice from everyone here it is truly appreciated more than you can imagine.

 

[Marje and Gracie]

Just want some confirmation that I’m doing the right thing and not missing something. Following TR except for the last dose at 2:5. I left her there a bit longer as she tended to take longer to react/adjust to dose changes on Lantus. She also had a lime on that dose. Overall I’ve seen sprinklings of green an blue on all doses so I guess I’m confused. I’m hating her numbers. Yes, my patience pants are on. Would just like someone to take a peek at her SS and let me know if you think I missed something. Perhaps since ECID, I didn’t leave her on a particular dose long enough for HER body and we skipped tight over what might have been a good dose? Worried that what I am seeing could be too much insulin rather than not enough? She’s bouncing a lot being that her lows really aren’t that low and then there are days where it seems the insulin has no effect at all. Again if someone could peek at her SS I would so appreciate it it.
@Wendy&Neko @Marje and Gracie Confused confused confused.

I see Wendy and Sienne have commented. I just wanted to add that you would not see her getting overdosed (referencing your comment on too much insulin) for where you started her and how you’ve increased in small increments. Kitties following TR dosing do not get overdosed. It’s the kitties that come in where the vet has been increasing the dose 1u every week based on bounces.

It literally took Gracie a few months before she started looking better on Levemir but Jill told me the would happen. Hang on!!

 

[Lisa and little]

I see Wendy and Sienne have commented. I just wanted to add that you would not see her getting overdosed (referencing your comment on too much insulin) for where you started her and how you’ve increased in small increments. Kitties following TR dosing do not get overdosed. It’s the kitties that come in where the vet has been increasing the dose 1u every week based on bounces.

It literally took Gracie a few months before she started looking better on Levemir but Jill told me the would happen. Hang on!!

Thank you ... holding on. Just scared as I approach 3U! Was hoping Lev would lower her not raise her. Grrrrrrr! Thanks to you and all for all the advice here. Keeps me semi sane. Ok. Last ??? For now- So even with a 48 random reading like I had a week or so ago, it’s recommended to increase if I don’t see steady improvement?

 

[Marje and Gracie]

Thank you ... holding on. Just scared as I approach 3U! Was hoping Lev would lower her not raise her. Grrrrrrr! Thanks to you and all for all the advice here. Keeps me semi sane. Ok. Last ??? For now- So even with a 48 random reading like I had a week or so ago, it’s recommended to increase if I don’t see steady improvement?

She’s a long term diabetic so reductions are earned when she drops below 40. She just fizzled out after that run of green so, yes, I would continue dose increases per the protocol. Because she is seeing blue, you’ll want to hold 2.75u at least ten cycles and then reassess.

I did have to increase Gracie’s dose over what she was on with Lantus.

 

[Lisa and little]

She’s a long term diabetic so reductions are earned when she drops below 40. She just fizzled out after that run of green so, yes, I would continue dose increases per the protocol. Because she is seeing blue, you’ll want to hold 2.75u at least ten cycles and then reassess.

I did have to increase Gracie’s dose over what she was on with Lantus.

Thanks Marje. I have 2 different printouts of TR. I assume one is old. One says for long term diabetics only reduce after 3 times lime . Is that the case or does the first 40 earn a reduction? Again I appreciate all the advice and guidance

 

[tiffmaxee]

For long term diabetics you reduce if three times under 50 or one time under 40.

 

[Lisa and little]

For long term diabetics you reduce if three times under 50 or one time under 40.

Thank you ... would that mean reduce if 3 separate cycles Get an under 50 or would I reduce if I get 3 under 50 readings in the same (one) cycle as well? Sorry I’m a little thick and want to make sure I do this 100% correct

 

[tiffmaxee]

Yes,three separate cycles and there can be time in between. You aren’t a little thick. This is very confusing. Keep asking questions.

 

[Lisa and little]

Yes,three separate cycles and there can be time in between. You aren’t a little thick. This is very confusing. Keep asking questions.

Thank you for your patience. I feel like I should know all this by now but I’m basically starting over with new insulin. And really want to stick to the protocol and get it right. Thank you thank you Hugs back at ya!