Need urgent dosing advice for Celle again

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Melissa and Celle

Melissa and Celle

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I'm sorry, I haven't been able to download the spreadsheet all week. Google docs says that "We're sorry, your spreadsheet cannot be copied at this time."

After realizing that we were seriously overdosing Celle with 3 units Levemir, we cut back to 1.5 units Saturday evening and then to 1 unit and all wet food (from Purina DM dry) on Sunday (June 12). Here are the readings we have had since then:

12-June
PMPS = 539
+3.25 = 424

13-June
AMPS = 436
PM +3.5 = 332

14-June
AMPS = 490
PMPS = 348
+4 = 209

15-June
AMPS = 445
PMPS = 411
+3.5 = 244

16-June
AMPS = 446
PM +.75 = 447
+3.75 = 324

17-Jun
AMPS = 415
+6.75 = 236
PMPS = 425

18-Jun
AMPS = 335
+2 = 298
+ 6 = 168
+8 = 231
+10 = 447

I thought we were doing better, at least keeping her below 500 and usually below 450. However, now she's on pace to be back up above 500 before her evening shot. Is she still getting too much insulin? I'm totally confused about whether to go up, down, or stay the same. Could someone please give some advice on what to do this evening?

If needed, here is the older data we have for Levemir (since the beginning):

Date Time Hours Post Injection Blood Glucose
27-May 11:10 PM 4.75 336
28-May 9:30 PM 3.25 365
29-May 6:25 AM 0 346
29-May 9:30 AM 3 207
29-May 11:30 AM 5 93
29-May 12:30 PM 6 108
29-May 2:30 PM 8 301
29-May 4:30 PM 10 359
29-May 6:20 PM 11.75 399
30-May 6:20 AM 0 352
30-May 10:15 AM 3.75 338
30-May 12:30 PM 6 239
30-May 3:30 PM 9 262
30-May 6:20 PM 11.75 372
1-Jun 11:35 PM 5 189
3-Jun 12:05 AM 5.5 369
3-Jun 6:05 AM 11.5 427
3-Jun 11:20 PM 4.75 410
4-Jun 6:25 AM 12 409

We then increased to 2.5 units on June 4 (morning).

Date Time Hours Post Injection Blood Glucose
4-Jun 10:45 PM 4.25 374
5-Jun 12:45 PM 6.25 157
5-Jun 2:35 PM 8 159
5-Jun 4:35 PM 10 248
5-Jun 6:20 PM 11.75 389
5-Jun 8:35 PM 14 387
5-Jun 10:30 PM 16 230
5-Jun 6:20 PM 0 389
5-Jun 8:35 PM 2 387
5-Jun 10:30 PM 4 230
7-Jun 6:05 AM 11.5 511
7-Jun 6:25 AM 12 447
7-Jun 11:30 PM 5 300
8-Jun 6:10 AM 11.75 354
8-Jun 11:35 PM 5 131
9-Jun 6:10 AM 11.75 551
9-Jun 7:20 AM 12.75 511
9-Jun 8:40 PM 2.25 380
9-Jun 10:10 PM 3.75 294
9-Jun 11:35 PM 5 179
10-Jun 6:10 AM 11.75 481

And (sorry to say) that we increased to 3 units:

10-Jun 10:15 PM 3.75 216
11-Jun 6:25 AM 12 514
11-Jun 6:25 AM 0 514
11-Jun 8:00 AM 1.5 515
11-Jun 9:35 AM 3 333
11-Jun 2:55 PM 8.5 391
 
Her PMPS = 410 tonight. So that suggests that what we're seeing today with a full curve is similar to what has been going on all week. I'm still confused. Increase, decrease, or hold here for a while longer?
 
i'm not a dosing expert but, i have a question and a thought:

1. this could be a bounce from the 168 you saw today. it's not the lowest she's been, but it's the lowest she's been in a while, which may have triggered a bounce- but this is speculation.

2. my question is what kind of wet food are you feeding?


i'll see if i can find you some info on the google spreadsheet.

my inclination is to stay the course on 1 unit until better eyes can look at the spreadsheet.

have you taken a look at the stickies in the lantus forum? it has the dosing protocol for lantus and lem. it's alot to handle at first, but it will make sense and there are many people there who can help break it down.
 
Hi Melissa,
I'm sorry I don't think I can help with the spreadsheet snafu. If you're very good with computers, you could possibly just start your own spreadsheet, instead of trying to do the copy thing, although that's supposed to be very easy. I wanted custom colors, so I did my own thing, which is why Gandalf's looks a little different from most others.

So Celle's been on 1U for almost a week now? Her numbers are better than before, with no huge drops and not such high numbers. 400s are high, but 500s are worse, so we've calmed that down a bit.

Good for you for getting her on an all canned diet. May I ask what brand and what variety? Even some canned food is higher in carb. If it's still Hill's brand, it's not low enough in carb, even if it's canned.

Back to the dose. Even though she had a good nadir number today with 168, she's still swinging pretty high. It seems her system has become accustomed to a higher set point of BG - meaning she's been high for too long and likes it there! It seems counter-intuitive to lower the dose yet again, but the goal is to even out the BGs and sometimes it takes a lower dose to do that. Although you may still see 300s for her, the idea is to gradually then raise the dose once the BGs level out to get the system used to a new normal of lower BGs.

If you can get more BG spot checks tonight or tomorrow and they show the same pattern, she may achieve steadier numbers on less than 1U, maybe try .75U. My reasoning for the lower dose requirement is this - Celle was on high carb, grain-filled dry food. You've removed that element and gone to canned food (but I'd like to know what type to see the carb content - have you looked at Janet & Binky's food charts to find appropriate foods?), so chances are that her system may not need very much insulin to help out the pancreas that simply got tired from all those carbs flooding it. The doses of each insulin she's been on were probably too high, which is why you've struggled so mightily getting this under control for her. The key was removing the high carb food though, so I promise we will get you there!

It is confusing! And the fact that almost every medication out there takes more to work better makes it even more so. Realize that insulin is a hormone - it's not trying to fight bacteria, it's simply aiding the body do what the pancreas should be doing for itself. And with a low carb load now, a small dose may be exactly enough to get the job done.

Here's the link to the canned food charts, so you can look up the food you're using. http://binkyspage.tripod.com/CanFoodOld.html
http://binkyspage.tripod.com/CanFoodNew.html
You want a food that is LESS THAN 10% kcal from carbs. Even the cheaper brands are fine, as long as they are under 10%.

Hope this helps. I know it's hard to believe that such a tiny amount of insulin can do the job, but we have a cat on the Lev section of the board right now getting .15U and she went in to the 50s last night after having a BG almost 400 that morning! So now this kitty is almost OTJ (off the juice) as it doesn't even need that much insulin to help its pancreas!

I hope someone else can steer you in the right direction with the spreadsheet.
 
I just thought of this. Do you need help with syringes? Dosing less than 1U is easier with syringes that are marked in half units. Like the syringe on the left:
resource.aspx


And here are some close-up pictures to help you determine where .75U or less would be on a syringe of the half-unit marked type. http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

I believe other members get Wal-Mart's Reli-On brand syringes in half unit markings, 3/10cc (holds up to 30U, the smallest size you can get), so that may be the fastest for you. Depending on what state you live in, you may be able to get the syringes without a prescription or may have a limit on the number you can get without a prescription. Here's the link to check state requirements: http://www.isletsofhope.com/diabetes/state-law/state-prescription-laws.html
 
Thank you for the advice! I'm really lost and much appreciate the help.

Celle is eating Wellness chicken/turkey (4% carb). At first she loved it, and I did the switch cold turkey a week ago, but she seems to eat less and less of it every day. I tried some Fancy Feast (the no grain, low carb), and she enthusiastically licked the food but didn't end up ingesting very much. I threw a couple of nuggets of her old Purina DM on top of the Wellness, which got her to eat for a while, but again, the dent in the bowl was inconsequential. I'm worried that she's swinging now because of not eating enough.

If she's similar on our checks tomorrow, then we'll try the 0.75 units. We have syringes marked with half units, but I can't say I have confidence that we can reliably measure this amount. The pictures do help, but there are also two of us splitting insulin duty, so that's yet another variable.

Could you tell me what numbers I'd hope to see if the dose reduction is the right move? Should the highs go down AND the lows go up? By how much?

Should I move over to the Levemir board or stay here?
 
here is a great page:

http://www.catinfo.org/

we had trouble switching d'art from dry to wet

at first he was all about it, but the shine wore off after a day or two and we had to apply ourselves to getting him interested and fully transitioned to wet

dry food has a very sexy powder coating it that keeps cats hooked- dr lisa explains it better than "very sexy powder"

but there are ways to keep them going on wet. you are getting alot of information at once, but here are a couple things to keep in mind:

1. you are three steps ahead because you are home testing and you are asking questions.

2. this doesn't all happen over night, things take time, and you are asking the right questions so you can be making the right choices.

3. now that you've got the spreadsheet up and running, use the notes section (take a look at mine or others for examples) use this to help you remember how much was eaten of what kind and when.

everyone has a bunch of advice when it comes to food- we've all been there. sometimes it's just a question of laying out a kitty low carb buffet and letting them pick, and sometimes its all about consistency and one food only. really it just depends on the cat. but please be assured as long as you keep trying and making and effort you will get there.
 
You can stay here on Health as long as you like, but we would love to help you in the ISG as well. There are usually more visitors to the Health section and we are a tiny group on Lev. But you would get more responses in the ISG from others who are using Levemir and have had similar troubles, so it might help you feel more confidence to know others struggled too. I think the board is a little quiet this weekend because it's Father's Day tomorrow.

As for what BGs to look for to know if .75U (lower) is the way to go - there should be less of a variance between numbers, and yes the lows won't be as low, but the highs shouldn't be as high either. My estimate would be in the 300 range. That is still above renal threshold, so not ideal, but it stops the swinging from so high to as low. Let me see if I can find a spreadsheet example, but I want to post this reply first.
 
OK, my many thanks to Beth for Bud Bud's excellent spreadsheet example of what happens when dose is too high. https://spreadsheets.google.com/pub...UDRVV1J2WUUwYzJsa1BFdFBtWHc&hl=en&output=html

I believe she's been on Levemir since March. What you should notice first is all the pretty colors! That's not really what we want though. Notice the greens, followed by pinks and even reds. By early April she already had a dose reduction and it sure looked like the .75U wasn't enough, so she went back up to 1U, then to 1.25U even. More pretty colors.

The pattern became that she would have a low then be high for a while. So it probably doesn't seem logical to lower the dose. She stayed at 1U for quite a while but kept having lows and high 400s. Beth was gone for a while and there was a sitter, so that's part of the reason the dose remained there.

Then in June it got interesting. More lows and more tests finally so more lows were caught. It's sometimes hard to catch every time they have a rebound inducing low. Even on these drops of insulin Bud Bud is still wanting to bounce.

That shows you what happens when the dose is too high. Here is Laura and harley's spreadsheet: https://spreadsheets.google.com/pub...oydGoxOWEzMDBRNm5JM09aUlA4cks0SlE&output=html

Harley has a lot of health issues going on, but on his it's pretty easy to see what BGs do on a dose which is low enough that you have something to work with and then what happens as you gradually increase the dose. Laura is going very slowly as he's sensitive to lower numbers and she doesn't really want him going very low. Notice the evenness of the colors and how they gradually change as you scroll down. It's a good example of going from not enough insulin to more insulin, instead of going from too much insulin and trying to get them to level out. You can even tell his breakthrough dose was 1.25U where the reds just stopped! But you have to start below that dose point or it doesn't work.

Hope these examples helped. Once you get a spreadsheet going it will be easier to see the patterns. That's why we like the spreadsheets so much!
 
Melissa,

Hi, I'm Beth. Vicky asked me to come look at Celle's #s to see if I can 'see' anything.

I'm sorry, but I really don't have an answer for you as to what to shoot tonight. Please read the rest of this before you decide what to shoot (if you've not already), but my gut is to decrease just a tad to a really skinny 1.0 or 0.80.
I wouldn't shoot the same. .
It's that the current dose has been held for 14 cycles and you're not getting any improvement on PS #s. You're also getting a 50% drop (if I'm reading your #s right)

I'm no dosing expert. But I'll tell you what's happened with Bud this past 6 weeks:

Bud was on 1.0u and we left for 3 weeks (may 12). She was in good hands with a house sitter that knew how to test, shoot, and treat a hypo.

Vicky's spot on that we had some very pretty numbers :lol: . In retrospect, all those reds sprinkled with a few blues meant 1.0 was probably too much. The house sitter really didn't get many tests in during the day or it would have, maybe, been more apparant to me that it was too high (probably a lot of greens in there between PSs). I wasn't posting much to the board, so I didn't have other eyes looking at it.

Notice the f1.0 starting on the 20th. The little bit of increase gave us a lot more red numbers.
Dropping to 0.80 got rid of the reds and gave us some nice blues.
I was kind of forced into 0.50 on the 6th and it got us some yellows and blues but still pinks.
Forced again on the 10th to drop the dose again - 0.25 and I should have held it instead of shotting 0.40 that pm and next am (made the mistake of looking at the higher number instead of giving the 0.25 a chance to work. Same thing with the 0.15 increase on the 16th PM.

It's *hard*. No doubt about it. It's not an exact science. By posting and getting different thoughts from others that have been there, you are doing to best you can for Celle.

Hang in there, hon.
 
Fantastic!!!!!!

ATTA GIRL! :RAHCAT :RAHCAT :RAHCAT

How's Celle today? What did you shoot PM last night?

good job on the wellness wet. you can also try the Beef & Chicken and the Turkey & Salmon.
 
Celle seems fine today. In general she tolerates high and low BG levels fairly well (as far as I can tell). It's only at under 50 or over 500 that things are clearly not right.

We did 1 unit again last night and this morning in order to get another day's worth of data. If she shoots up over 400 again pre-shot then we'll definitely lower the dose. If not, then I wonder if what we saw today is what we want?

Thank you everyone for the support! This is indeed hard.
 
She does have a nice flat day.

keeping fingures crossed for a non red pmps

Melissa, when a thread gets too long, it's sometimes a bit hard to read. Generally, it helps if you start a new thread every day. The subject something like "Celle 6/20 amps ### shot 1.0u (or, what to shoot?)"

What time do you shoot and and WHERE are you located? This will help us in that someone, hopefully, will try to be here for ya'll near your shoot time. :smile:
 
Celle was 461 at PMPS, so not so flat after all. We reduced the dose this evening. We decided to just try to split the space between the unit and half unit marks, so half is open and half is plunger, which by the photos looks like probably 0.85 units to me. That seemed like a goal that my husband, our sitter, and I could hope to have more consistency on than other possibilities.

We shoot at 6:30 AM and 6:30 PM from Washington DC. I added my location to my profile. Is there somewhere that most people put injection times?

And I'll start a new thread every day from now on. Thanks for the tips.
 
Hi Melissa,
Good call on the dose reduction. One thing to be aware of is that it may take a couple of days for a new dose to settle. The 1U had plenty of time to show what it would do and it's still causing bouncing.

You can put the shot times in the notes column to the right, maybe once in a while and also note any deviations from that schedule. When reporting a mid-cycle BG put it in the column for how many hours from the time shot was given. We don't worry too much about clock time, the important thing is how many hours ago was the shot.

Hope that makes sense.
 
I'm just down 95 from you and right off 64 :smile:

As Vicky said, "it may take a couple of days for a new dose to settle." The tendency is to want to shoot a higher dose when you see a hight PS. I do it all the time. And then kick myself for it.

Give it several days to see if it's going to do anything. Don't raise the dose if you see a red number. Any extra BG tests you can get during the cycle would be helpful. It looks like, from the limited data, that Celle's nadir (peak insulin effect at the time of the lowest blood glucose concentration) is around +5 +6 at this point. Would be interesting to see what her +4 is, if that's possible.

Fingers crossed for a yellow amps!
 
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