Martha's Curve

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Hosanna

Hosanna

Member Since 2012
Does anyone have any input that might help me? I was finally able to get Martha's curve:
AMPS - 227 (1 unit)
+3 hours - 91
+6 hours - 87
+9 hours - 199
PMPS - 202 (1 unit)
Thank you.
 
Um, your signature says that Martha is OTJ. If you would please update that, and tell us what insulin you are using and what meter, that would be helpful.
 
The numbers on the 1u dose don't look bad at all. In looking back at her SS, it looks like you have a "no shoot line" of around 150? I've never used Lantus, but I've watched a lot of kitties who are on it. And it seems that at some point, everyone ends up lowering the "no shoot" line. Some people even give insulin on numbers that are below 100.

The important thing to keep in mind with Lantus is that it is not the preshot number (although that is important) that determines how well the dose works. It's the nadir number that is most important. The lowest BG of the day helps to figure out the dosage.

That said, a nadir in the 80's, which is what she seemed to have when you ran the curve, is a great number. Not too high, not too low.

I think that right now, I'd stay at 1u. And maybe consider giving her the shot even when your number at shot time is 150. Maybe draw yourself a new "line-in-the-sand" for when you will or won't give a shot?

Overall, her numbers look really good.

Carl
 
Carl, it seems that the purpose of insulin is to make up for what the pancreas can't do. So when the number is 84 or so, I just can't see giving insulin. I still have trouble grasping this nadir business. If I shot on that, say 84, I would not shoot at all. If I shoot on those high 200-numbers, I am comfortable that she will not hypo. I know many people who use 200 as their cut off line. My biggest fear is her hypo-ing.
What kind of insulin do you use?
 
Insulin is used to replace what the pancreas cant produce. But in order to allow the pancreas to heal, especially when using Lantus or Levimer, the longer they are in the good range, the better the pancreas is. If you are going to be around to shot a lower number than say 150, they you should try. You will need to learn to shoot low to stay low. After awhile, the liver will get used to lower numbers and not bounce (which is what the 199 looks like). If you decide to shot low, just test and feed. You can use food to manipulate numbers and keep them going (surfing). I to was afraid to shoot anything below 200 for a long time but I finally got the courage up to shoot low. I tested every 2 hours or so and fed when I saw Doogle's numbers going low early. This allowed the BS to go up and come down gently. I agree stay on the 1u. The nadir is the lowest point in the cycle (12 hours) which is usually around +6-+8 for a typical cycle. Sometimes they can be sooner or later. That is how long it takes for the insulin to be at its fullest potential in the body. Dont be afraid of hypo, I have had Doogle at 29 before and you just be calm and give a little bit of honey/karo if numbers go below 40.
 
When I saw the 227 fall to 91 in the first 3 hours, I thought that was a huge drop and nearly panicked. Isn't it a big large? But if I had given syrup or a high carb food at that time, what would have happened? I would not have gotten that beautiful 87. This is so complicated! Diabetes is a complicated disease! Cats are complicated! How on earth do we ever get it right! I am willing to shoot at 150. Both vets have given that number.
So do I wait till it drops to 40 before giving any recovery food?
 
As someone who shoots low often, the thing to remember with depot insulins like Lantus is that they "release" differently than an in-and-out insulin. Once you find the "right dose" (one that doesn't send them too low or keep them too high during nadir), you want to hold that dose across both shot times, regardless of pre-shot numbers. This is why we don't recommend for new members who don't have much data to shoot less than 200 on the Main Health board (or less than 150 on the Lantus Board) because they're usually not yet at that "right dose."

Lantus lasts around 12-14 hours and it takes about 2-4 hours before the next dose starts kicking in. It's this overlap that is being used when you shoot low. If the pre-shot is low, then that gives very little time for the number to continue rising before the next shot kicks in (which is a good thing). The result is a low, flat curve. If it's the right dose, they don't drop into hypo when you give a shot. If the dose is a little too much, you'll see them flirting with the forties, but not anything you can't prop up with a little bit of their regular food. If the dose is too little, they'll spend more time in the 100s. (This is usually where you'll see doses being fattened or skinnied up.)

If you prefer, you can slowly nudge the "no shoot" number down and give shots first at 140, then 130, then 120, etc... and see how Martha reacts at each lower pre-shot. I learned with Mikey that pretty much any pre-shot over 70 is "shootable" and he won't drop too low, although I might be super nervous and hover over him all cycle long. nailbite_smile And if I'm not going to be home to monitor, then I won't shoot those lower numbers (usually under 100). You're the one holding the syringe so it's what you are comfortable with. ;-)
 
Those are good numbers but I would really try and get a before bed test and more mid cycle tests if you can. Many cats drop lower at night and there is a good chance she is spending more time in green than you think - especially those times she has a blue pre shot. Also she may well be dropping lower than you expect already - and thats good because blues and greens are healing numbers and anything under 50 means an instant dose decrease!

Wendy
 
I am reading that sticky and will probably study it out. Lots of information.
I will also try to get a bedtime reading tonight, which will also be +3.
I want to make this work but I'm still a little confused as to what difference all this will make if she never goes into remission again.
 
I want to make this work but I'm still a little confused as to what difference all this will make if she never goes into remission again
Click to expand...

Well, the ultimate goal in trying to do all this is to get her into remission again. :-D

I've watched a whole lot of Lantus kitties go into remission by following the steps used in the TR protocol. Especially the steps as they get closer and closer to going OTJ. You see a gradual reduction in dose, and a reduction in numbers overall. And the "curve" gets flatter and flatter as things improve. Eventually, nothing but a nice flat sea of green numbers. And they take their time "weaning" the cat off of insulin. Some people even go to .1u doses for a few days, or even "a drop of insulin" for a few days. It seems like when you do things that way, the remission tends to "stick" better. At least that's what I've seen happen dozens of times in the past couple of years.
 
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