? Need dosing advice.

Once again Wally is throwing me for a loop. He just tested PMPS at 139 and was 143 nadir. I had reduced his dosage from 1.5 units to 1 unit the other day because he was so low AMPS, then upped it to 1.25 in the evening and then back to 1.5 units this morning. What do I dose him tonight? It's 8:21 pm Eastern Daylight time and he gets his insulin at 9 pm. I'm thinking I should reduce it back to 1.25????

 

Ummm I cannot access your spread sheet. I just sent a request...(Didnt know you could do that )

ACK never mind I clicked the wrong link. my bad

 

Lets see @tiffmaxee was just here...click the link in her signature.
Tiff click the link in her signature

 

My bad - I included the link that I thought would work....

 

He is eating now so I know his BG will go up because of the food.

 

Wally hasn't earned a reduction but I also haven't seen you dose this low of a pre-shot so I'd say if you want to be safe you can dose 1.25u.

Could you do us a favor though - your signature and spreadsheet both say Prozinc and Lantus and it makes it look like you're using both. Can you remove Prozinc from your spreadsheet and in your signature do Lantus (formerly Prozinc) so people will know.

Lantus works best when you maintain the dose ... when you reduce randomly you mess with the depot and that affects multiple cycles. You're using SLGS, so reductions under 90 only. Wally earned a reduction on August 6th but you didn't reduce until a couple cycles later. Looks like you also fed a bounce extra insulin on the 13th and upped him early. SLGS has you maintaining the dose for 7 days (14 cycles) unless he earns a reduction. Did you give him 1.5u this morning because his pre-shot was high or?

 

Thanks Elizabeth!

 

Yes - I gave him 1.5 units this a.m. because he had gone so high again. I know that I should try and maintain a consistent dosage, but he's so bouncy and doesn't show signs of hypo so I often only realize how low he is when I test or he's begging for food. That's what scares me about keeping his dosage the same when he's showing such beautiful blue numbers...

 

If you get a PS number under 150 (to start), you should stall, don't feed and test again in 20-30 minutes so you can see if the number goes up without the influence of food. That way you have a better idea if the last shot is really starting to wear off or not. If the number goes up, it's a pretty good indication that you can shoot the scheduled dose as long as you're able to test as long as necessary and have a fully stocked hypo kit.

Eventually, you learn to shoot lower and lower PS numbers.

It's too bad you didn't get a few tests on the PM cycle on 8/15....would have been good information to know if he went lower and the 108 in the AMPS was "on the way back up". Kind of looks like it the way he kept climbing, but you also gave a reduced dose that may have had something to do with it too.

One important thing to remember with Lantus....every time you change the dose, the depot has to "catch up" so you're going to get wonky numbers until it's had a chance to stabilize. That's why we give the same dose both AM and PM and hold it for 7 days unless he earns a reduction by dropping below 90 (on SLGS)

If you're going to be home tonight and have plenty of supplies, I'd suggest you go ahead and give the 1.25 again (although he was on 1.25 for 12 cycles and it didn't seem like it was enough so we may have to revisit the 1.5 dose soon)

 

Thanks, Chris. I'll give him 1.25 tonight and hold it again for 7 days and do another curve.

 

It's really important to remember NOT to feed high numbers. That was a bounce, you have to wait for those numbers to clear. Giving more insulin won't bring it down any faster and you actually encourage more bounces to happen when you do this. Please please remember to hold the dose no matter how high he is until he is due for an increase after 7 days. Every time you change the dose your 7 day-count starts over, so it's really important to keep it the same.

I read in another thread you're doing PMPS shots over an hour before shooting? When you feed an hour before shooting yes, his BG raises from the food but that is a false number you're now shooting. Some cats dip an hour or two before shot-time and then go back up. So if you hadn't fed Wally and tested at ACTUAL PMPS time he may have gone up enough for full dose naturally. We can't tell for sure, but it happens in many cats. Can you start shooting when you test? That way you can stall like Chris recommended when needed.

If you stick to the advice above Wally should start having more consistent good numbers.
And thank you for editing your signature/spreadsheet! Very helpful!

 

Do you post on the L&L forum by chance? If not it would be really wonderful to have you over there. Follow along with Wally's journey.

 

I now test, feed and shoot within 30 minutes. Normally test around 8:30 am/pm, get meals prepared for all the cats and then give his insulin by 9.

 

What is the L&L forum?

 

Lantus, Basaglar and Levemir forum

Everybody uses a depot insulin so you'll get the most experienced eyes there

 

Oh wonderful!

Second the L&L forum, lots of experienced eyes over there specifically for Lantus and Levemir users like you and Wally.

 

He went down to 288 +8 PM but was back up to 511 AMPS! What a roller coaster ride this boy is on....