Newbie - akane

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dosgatos

dosgatos

Member Since 2010
Hi everyone. I moved here from the main board..

Sheila, thank you so much for taking time to explain me! I still think that drop to 25 was irregular and exceptional caused by the hot water bottle.. He never dropped to that low when he was given more amount.. :roll:

Also, when he was on 0.25 before, he climbed to 450 at +12 so I got an idea that 0.25 was not enough for him. I may be wrong but I fear seeing him being in highs like that and have not had courage to reduce the dose.

I tried to see his patterns. (I wrote this around mid Dec.)
1) When he drops modestly? at his nadir, he will rise back to where he was before the shot by +9 and will rise further until +12. (with a little drop just before the dosing time.) Sometimes he manages to last until +12 but I think about 80% he is back to where he was 12 hours earlier at +9. (<--So I thought he cannot get duration and tried +10 dosing once.)

2) When he has a rebound from low numbers, he will rise horribly to above 350 to 450 at +12. Again sometimes he manages until +12 and does not go very high but most of the time, he is very high at +12.

3) And when he does not drop much and makes a flattish curve, his numbers at +12 is lower than 12 hours earlier.
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And I thought pattern 3) may be something I need to pay attention and thought it may take him to lower and lower gradually. And I am trying to find a dose that will make a flattish curve, lower on the right hand end.
Am I trying something worth, or is my direction wrong? :?:

Sheila & Beau & Jeddie said:
In my experience with Beau, he would range from 60-170. Anything higher, or lower, than that indicated rebound to me and I reduced his dose again.
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This is very interesting..

Any thoughts or education appreciated!
 
dosgatos said:
Hi everyone. I moved here from the main board..

I tried to see his patterns. (I wrote this around mid Dec.)
1) When he drops modestly? at his nadir, he will rise back to where he was before the shot by +9 and will rise further until +12. (with a little drop just before the dosing time.) Sometimes he manages to last until +12 but I think about 80% he is back to where he was 12 hours earlier at +9. (<--So I thought he cannot get duration and tried +10 dosing once.)

2) When he has a rebound from low numbers, he will rise horribly to above 350 to 450 at +12. Again sometimes he manages until +12 and does not go very high but most of the time, he is very high at +12.

3) And when he does not drop much and makes a flattish curve, his numbers at +12 is lower than 12 hours earlier.
Click to expand...

And I thought pattern 3) may be something I need to pay attention and thought it may take him to lower and lower gradually. And I am trying to find a dose that will make a flattish curve, lower on the right hand end.
Am I trying something worth, or is my direction wrong? :?:



Any thoughts or education appreciated!
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On #1, can you give some examples of what dose you used when this happened and how many cycles or days prior it had been since you saw #2 happen.

#2, that is a perfect example of rebound, usually the numbers will get in the 350 to 450 range.

#3 Yes, #3 is what you want! But here's the problem - on the way to lower numbers a close but too high dose will give you a result like this, but then you end up with either #1 or #2 happening.

As small as his dose is now, you certainly would not cause a problem to try .15U. Because of the way Levemir builds in the system it is easier to go from too small of dose to the right dose, than it is to go from too much insulin to a lower dose to find the right dose. A too large dose creates too much overlap and that's why you get the rebounds.

Very very simple explanation, but it's also why even on the too high dose you will see cycles such as #3 and even double digit numbers with good preshots. The insulin hadn't built up enough overlap to cause a rebound.

Another thing to keep in mind, each time after there's a rebound episode, it's like starting over because the body has dumped glucagon as well as stimulants such as cortisol. All that increasing uses up what insulin has been stored, so you have to create the build-up again.

Getting the right dose is actually finding the balance between how much insulin you inject each shot and how much is still waiting in the wings to be used. Too much insulin at each shot will eventually break the dam which results in rebound. So you then have to fill up the lake again, but you may overflow it!
 
Vicky & Gandalf said:
#3 Yes, #3 is what you want! But here's the problem - on the way to lower numbers a close but too high dose will give you a result like this, but then you end up with either #1 or #2 happening.
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Yes, so I am beating my head! When he did great and his BG read mid 100's at +12 (happened 3 times), I reduced the dose a bit to the lower numbers but it did not give good results and had to start over again from the next day.. will try 0.15u but sooo afraid of him staying high..... :sad: I will pick his data for #1 and post again.
 
If you decrease the dose just because you got 100s on preshot you may loose the momentum/overlap/shed which has built up.

And it's better to wait at least 3 to 5 days before making a dose change decision, because you have to give the balance time to work itself out.

Even higher but steady numbers are better than going from 300s to double digits every day. Sometimes you have to sit on your hands to see how a dose works.

drinking11

That icon looks like they're sitting on their hands, doesn't it??
 
:lol:
OK, so it is better to reduce the amount to 0.15 later, not tonight?

I am having trouble finding #1 but found this. From 17 Nov to 19 Nov when I dosed him 0.3u, he marked over 350 on the #4 cycle from a rebound. And from 8 Jan to 10 Jan when I dosed him 0.3u skinny, he marked above 350 on the #4 cycle from a rebound again.. interesting..

Edited
On 10 Jan, I dosed him a bit less insulin (0.25 - I missed that) to a lower number so 350 may not have been a rebound..
 
I think Vicky gave you a lot of good info about your different scenarios.

The thing that I have learned about rebound is that it is very, very hard to tell the difference between rebound and not enough insulin. It is also very, very hard (harder!) to tell the difference between rebound from a slightly too high dose and rebound from a slightly higher too high dose.

What I mean by that is like this: I had Beau of .5u and I thought it was too much (he had a few lows) so I reduced him to .4u and his numbers went up. It turns out he was rebounding on BOTH doses, but the .5u was enough higher to sort of take the top off the bounce (he didn't go as high and he definitely went low. On .4u all he seemed to do was go high. If you look at Beau's SS for July 13th 2009 he was on .5u, then he had a couple of 300s and I thought that was rebound so I reduced him to .4u on 26th after a low PS - and he got even MORE 300s! So I went back to .5u on Aug 4th and he immediately dropped to 33. So I reduced him to .3u and his numbers got better. And I kept reducing if he dropped to around 50 or lower. His numbers continued to get better.

When I look at Beau's SS now and see the 300s and 400 on June 24th - 26th, I can see those were rebound highs and I should have reduced the dose instead of raising it. And I bet that last month of vetsulin at .8u to 1.2u was also rebound.
 
Thanks! Beau's journey explains a lot to me. Akane seems to have a cold and has been sneezing. I will give him 0.15u tonight.

Vicky & Gandalf said:
If you decrease the dose just because you got 100s on preshot you may loose the momentum/overlap/shed which has built up.
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But when 0.3 or 0.3 skinny is suspected as too much for him, isn't it safer to decrease the dose, or not? :?:
 
Sorry no one was here to give an answer to you. I wonder what the time difference between you and most of us is? As I post this, it is 12:45 pm (just after noon) in Chicago....

Trying to answer your questions:

I think that .3u is too much - hence the drop to 25 the other day. Because he is getting too much insulin, his body is releasing stored glucose and the adrenal hormone cortisol to fight the excess insulin by raising the blood sugar. This process can continue for a while, but eventually the body can't fight it anymore and his BG bottoms out. It is the dose of too much insulin that is keep him high, not the lack of insulin. Does that make sense?

The drop to 25 warranted a decrease.

He may not go up to 400 on a decrease to .15u, but if he does it will be the first or second PS after you start the decrease. All you do is wait it out and let him settle. The increase in PS number at this time is from the rebound hormones still in his system causing an elevated sugar level. They will fade out, but it can take a few days. That is why you let the dose settle for 3-5 days before assessing it.

Remember that dose changes should be made based on the nadir number, not the PS number.
 
Mami, please check out Marci and Buddy's SS. Here is a link to a thread so you can access the SS: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=33606

He was on a too high dose and as she decreased it his numbers get better. Look at Dec 23 (you have to scroll down) where he was on .75u. She decreased him to .5u on the 26th. There are a lot of "pink" numbers (in the 300s) there because the decrease let the rebound hormones through more - sorry that's the best way I can describe it. She held that dose for 6 days and he finally started to get better numbers. Over the next three days his numbers came down more and he dropped to 39 so he earned another decrease. Notice all the blues and greens and no 300s (pinks) anymore. I bet in another 3-5 days he will need another decrease.

That's a pretty good "picture" of what rebound looks like and what can happen as the dose is decreased. I hope that helps you understand what I am trying to explain. :-D
 
It is now 7:00 am on Wednesday ~O) It is 15 hours ahead of most of you..?

Thank you so much, Shiela. I had occasionally visited here before I posted and I spotted Buddy and Jeddie's progress. Wow! It was amazing and very interesting so I wanted to learn "less is more potent" theory and came here... :smile:

I still could not rule out the thought that the drop to 25 the other day was an irregular response from heat (hot water bottle) with 0.3u. I needed to decrease so I lowered it to 0.3u skinny. And 0.3u skinny did not seem bad to my eyes so I tried one more time. He was 291 this morning at +12, not as bad as the other day when he was up to 350 with reduced amount (0.25u) so I thought of dosing him 0.3u skinny again but I dosed him 0.15u - or 3.5 drops less than 0.5u line.

It may sound funny but I decided to dose him .15 because when I tried to test Akane, I noticed he did not want it. His ears were refusing to be tested. I notice this often since we have changed insulin to Levemir. When he was on BCP-PZI and receiving as needed dosing, he was happy to be tested when he was high and he even came to call me as if he wanted to tell me it was time to dose. And when his BG was not high enough, he bended his ears as if he wanted to tell me it was not high yet, and if I tested, he was right! Hope he likes the reduced amount..
 
Good morning!

So, he didn't let you get a number? That's funny. They really do know I think. Jeddie does the same thing, but Beau didn't. With Jeddie, he resists testing, I think, when he has gone low and is not yet back up to "normal" so he thinks he doesn't need anymore of that stinking insulin stuff! :lol:

It will be interesting to see how Akane does on the .15u - mind you, it might not settle for a few days!

FYI, on my syringes, if I place the top of the stopper at the bottom of the zero line, that's about .166u (I just call it .15u). Always check that the zero line is AT zero! Your stopper should not fit above the line at all, so take that into consideration.

BTW, is Akane an orange tabby cat? I red that Akane means "red".....
 
So Jeddie knows, too! I think they are very smart.. Wonderful that you find out akane means red. :smile: Yes, I named him after his colour. He was orangish but now pale brown. Will put his photo later. Yes, 0.15 looked like that. You explained it to me before so it helped me to measure. Thanks! And yes, always checking the zero line as I had a bad experience using inconsistent BD syringes (made in Japan one)!!
 
dosgatos said:
I wonder if Akane is doing all right so far with the reduction..
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I say yes. His numbers are higher, but that's to be expected. We often see that kind of reaction with a dose change either way, up or down. But he responded to the 1.15U as evidenced by the 197 after a high of 357 during the cycle. And the 265 preshot is promising, that is a good number to come down to after 300s, also it shows that Akane may have a late cycle nadir when he's at the optimum dose. A too high dose tends to bring them down earlier, then they bump right back up again which you were seeing on a lot of cycles.

I hope we see some settling on this dose within the next 3 days. That means his numbers will transition lower on average. Does your meter have the ability to show you 7 day, 14 day and /or 30 day averages? I like to use those on my meter to give an overall picture of trend.
 
Thank you, Vicky. I am relieved to read your feedback. Yes, my meter can show 14 day average and it is 246 now. Yesterday I was happy with his result. I did not expect he could stay within that range! Today his numbers were higher and he seemed unhappy so wondered if he wanted a bit more. Slowly but he is still rising at +7. Not very nice to find out before going to bed. :sad: About the pre shot number - like 260 today, he often drops a bit before +12 from higher numbers around +10 but it usually rises back very soon.
 
Mami, it is important to not think about making dose changes based on PS numbers - or a single high number, or slightly higher numbers in the first few cycles after a dose change. Doses need to be consistent. Lev doesn't work well on any type of sliding scale (deciding dose based on each PS number).

As Vicky said slightly higher numbers after a decrease are normal for a few days. Give it time to settle and look at all the numbers, especially the nadir, when thinking about dose changes.
 
Hello. I am looking forward to snow to fall today..

I shot him 7th 0.15u this morning. I would be happy if you could translate his curves for me. When would you try a dose change and based on what evidence you see?? I would like to learn it beforehand so that I can make a decision in case no one is around ? I-)

He has been quiet for the last 2 days and drinking more. Hope it is just temporal and nothing. And the drop around +12 was just a drop and not his nadir, it seems.
Thanks!
 
I would like to see one or 2 more cycles on .15U. Yesterday's curve was promising and his 300s after may be a response to those 100s. Yes, that is possible to have good numbers, followed by not great numbers. We call it a bounce. Sometimes you have to maintain the lower dose to level out the bounces as their system gets used to the lower numbers. Sometimes the liver reacts to numbers falling, not necessarily how low the numbers are.

As for increase, you would go to .2U, not .25U. I would give the .15U another whole day to see if there are more 100s. I hope there will be! I know it's difficult if they are peeing more. 300s will do that. He should have had a good day yesterday? No?
 
Thank you, Vicky! If we see more 100's with 0.15u, great and if we do not see more 100's until next morning (2 more cycles including this one), would go to 0.2u? Or 2 more cycles excluding this one??

I notice that his meow sounds not happy and seems a little lethargic than before and that concerns me a bit..
 
I think you are already on Saturday's day cycle now, correct? So I would wait through tomorrow's AM cycle on .15U so you get 2 daytime cycles and one nighttime cycle before deciding to increase. So yes, 2 more cycles, excluding this one.

The increase is so small that increasing in the evening is fine. You could set an alarm and get a spot check at +6 or so, like you have done. Which is good by the way. Some cats seem to have different PM cycles than AM cycles.
 
If he does not drop to 100's and stays in higher numbers above 250 tonight (on 8th cycle) again, increase to .2u tomorrow morning (1 cycle earlier than your suggestion) would be an option, too?
 
dosgatos said:
If he does not drop to 100's and stays in higher numbers above 250 tonight (on 8th cycle) again, increase to .2u tomorrow morning (1 cycle earlier than your suggestion) would be an option, too?
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Yes, you could go ahead and raise it tomorrow morning because I see he stabilized in the 200s mid cycle on the 15th. Stabilizing is good, but 200s are still too high.
 
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