NOt sure to shoot or wait?

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Marci and Buddy

Marci and Buddy

Member Since 2009
Buddys pmps 118 :-D ....is it better to shoot (how much less than his usual F1.25?),
or better to wait till pm +1 or +2 , and shot same amt?? Last night he was same , waited to +14 to shoot,any other ideas?
thanks very much.
 
Just to be clear, you said you shot full dose yesterday at +2, yes? That would mean that your shot times will all be 2 hrs later.
Was this 118 at his new +10 or at his new pmps time?

If you are using Levemir, it's best to stick to the 12/12 schedule and it may be fine to delay a shot by 2 hrs but then all the following shots must be adjusted.

What time locally did you give the late shot last nite, what time was the am shot and what time was the 118 BG taken?
 
good point-yes,need to clarify--last night shot was at +1.5, and this mornings
shot was at +11 after that...tonights bg 118 was at the +12,update..shot reg.dose at +13 ,bg 198.
guess i need to understand that if it is best to stick to 12/12 ,
and his pm bg is his nadir(seems to have been the case lately, very strange turn)...
then do i reduce the dose, and if so, by how much?
thanks very much.
 
See that's the thing... you need to stick to that 12/12 and if you shoot late, mark the times on your ss in the comment column.
The time you shoot, the clock starts over.
If your shots are 6am/6pm and you give a shot at 8am, the pm shot on that day needs to be at 8pm. If you shoot early, you are in effect giving a dose increase.
If you shoot late, you can start to move backwards, to get back to your 6am/6pm in 15min or at most 30min early each shot.

So, if you shot late at 8am, that nite, your shot should not be any earlier than 730pm, the next morn could be 7am, and the next nite could be 630pm. And finally, you will be back on track with the next shot at 6am.

What you could do on your ss, so it's clear to all - put in the time you give the shot in the same field as you put the dose.
That field will show as "f1.25 630am" and when you ask what should be given for the next dose, others will be able to see what you had done for the last few shots, and you will get good suggestions.

When you move away from that 12/12, you have the shed filling and draining and Buddy's body saying HUH?
Now that you have cleared up the times, and once you can put that info onto your ss, I am sure you will get some good directions for the next shot!
 
I don't think it needs to be that complicated.

First, you do want to stay with 12/12 "as close as possible" and make adjustments as you need to (for a late evening, etc. - hey, life happens). I really don't think their bodies can tell 12/12 as close as we can looking at a clock and I don't even worry about 30-45 mins one way or the other - unless the nadir is at a fairly low number that really can't go lower. Then I would want data showing that it wouldn't drop him further if the shot was early. And I wouldn't be always shooting a half hour early at every cycle.

Second, it is not unusual for them to nadir at +12, or even later. What you know now is that he starts climbing after +12 so it would be safe to shoot the full dose then. That is how lev is supposed to work - get them low and keep them there. I can do that with Jeddie, but couldn't with Beau most of the time. If you are concerned make sure it will be when you can get some spot checks in.

On your SS, I don't understand the #3 (or another number), in the second box, but it looks like he has some wiggle room anyway. Even the 86 has some wiggle room. Numbers down to low 40s, and probably mid 30s, are safe on this insulin.

There are ways to move the shot time by a couple of hours backwards and forwards. It's called split dosing. Let's say you are going out after work and will be 2 hrs late. You can shoot half his dose in the am at +12 and half at +14, then shoot the full dose 12 hrs after that second half. Then you can move him back in the same fashion - shoot half the dose at +10 and half at +12 from the last full dose and the next shot is +12 from the first half. I have not tried this myself, but Vicky does it all the time to accommodate her work schedule. I would want to try it first when I could be there to get spot checks - especially the moving it up by 2 hrs.

You can always shoot a little less if you are uncomfortable with shooting the full dose. You are at the helm and have to be comfortable with what you are doing. I have shot less and had it be too little, but I have also shot a full dose and had it be too much, but that was with Beau going into remission and it indicated he needed another dose reduction.

At this point I would hold the dose and get some spot checks in the later half of the cycle - and maybe a few +1 or +2 so you can see that he continued to climb after +12.
 
ok thanks you guys make alot of sence, very helpful. Don't thin k i need to split dose tho', as long as i know that he climbs at +12,right? oh, the #'s in the box (#3, etc) is when i start a new dose amt, i indicate the cycles, 1-6.
Have agood night,y'all!
 
Hi Marci,

My PK is a late nadir kitty...his lowest number in the cycle is right before I feed/shoot....as SOON as he eats- he skyrockets, no matter how much/little food or insulin...it's just him.

If I delay feeding, he continues to drop! I joke that if I never fed him he'd stay in the greens all day! ( of course, that isn't possible)

As far as shooting the low number- you have two tests that show he will rise after the PS +12 check ( is this b/c you feed then?)....IMO, you can be fairly confident he will go up after his shot, but to be sure you want to get a few spot checks after.

Right now the nadir and PS are one in the same, regardless w/lev we gauge shot amount by the lowest number in the cycle.

So, once Buddy achieves a nadir that is too low for you to be comfortable to shoot, then l would lower the insulin a teensy smidge.

Things are looking good for you guys! (knockwood,antijinx)
 
Split dosing is not a great option for long lasting insulins; I am not sure why that method would be suggested. Moving a dose 1/2hr earlier each shot is much simpler than split dosing, and there is no disruption to nadirs by shooting early.
 
Gayle and Shadoe said:
Split dosing is not a great option for long lasting insulins; I am not sure why that method would be suggested. Moving a dose 1/2hr earlier each shot is much simpler than split dosing, and there is no disruption to nadirs by shooting early.
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Split dosing is suggested here because some of us have made it work. Anyone who is a diligent tester can do it. Moving shot times in half hour increments is not practical for some of us.

In my experienced opinion split dosing, as I use it to extend duration for a later shot the next cycle, works exceptionally well with Levemir in my cat. If others would try it when the need arises, such as needing a late evening shot, I think they would be surprised.

If needing an earlier shot, the dose should be lowered by 15%. I do earlier shots as much as 2 hours earlier than the previous shot, which was also reduced (so reduce the prior cycle as well as the cycle which is 2 hours early) to accommodate shooting in to nadir.

Sometimes we have to think outside the box for the good of our cat. They don't read rule books anyway.
 
Thank you, Vicky for lending a voice of experience on the split dosing. It is a tool that does work, that is why I suggested it.

Frankly, now that I am on my second diabetic, and have experience with two insulins as well, I can say that there really is no need to stress yourself out over "exacts" and "absolutes". You can have a well regulated kitty without all that pressure. And life happens. Most of us can't realistically be on a perfect 12/12 schedule with all the other things that would be required to make this an exact science such as feeding the exact same food in the exact same amounts and making sure our cat gets the exact same amount of exercise, cuddles, etc. every day.

As we always say on this board, ECID (Every Cat Is Different) and I think every cat is different every day. This only inspires creativity and ingenuity in working with the insulin and the things that life throws us - such as using split doses to accommodate a changing work schedule. This does take learning about the insulin, paying attention to how your cat reacts, and having data to back it up.

Marci, thanks for explaining those "odd" numbers!
 
Sheila & Beau & Jeddie said:
Most of us can't realistically be on a perfect 12/12 schedule with all the other things that would be required to make this an exact science such as feeding the exact same food in the exact same amounts and making sure our cat gets the exact same amount of exercise, cuddles, etc. every day.
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I am in complete agreement with you Sheila, except for the food part. If it were possible for the owner of a diabetic cat to feed the exact same amount, type of food and when, it would make things so much easier and predictable. But with multiple cats in most households this is near impossible.

But even so, with Tigger being the only cat in my home, and with me trying to keep the food variables as close to everyday as possible, it is not like his numbers are the same everyday and he will wander off track now and then for no apparent reason that I can easily identify.

Sheila & Beau & Jeddie said:
Frankly, now that I am on my second diabetic, and have experience with two insulins as well, I can say that there really is no need to stress yourself out over "exacts" and "absolutes". You can have a well regulated kitty without all that pressure.
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Well said and so true. :)
 
Thinking outside the box is the normal routine in life with an acro. Throw in a second acro and you have alot of thinking outside the box.

Lev works best with regularity, yes? If you remove that regularity, toss in split dosing and make the split dose times irregular as well, you are begging for trouble. When shot times are at +13.5, then +11, then +14, I wonder how you would make that split dosing work.
When nothing is predictable, and everything changing except the insulin, split dosing is not the better method.

I suppose if it works well for you and a few others, that's fine, but it will not work easily for the many.
 
Gayle and Shadoe said:
Thinking outside the box is the normal routine in life with an acro. Throw in a second acro and you have a lot of thinking outside the box.

Lev works best with regularity, yes? If you remove that regularity, toss in split dosing and make the split dose times irregular as well, you are begging for trouble. When shot times are at +13.5, then +11, then +14, I wonder how you would make that split dosing work.
When nothing is predictable, and everything changing except the insulin, split dosing is not the better method.

I suppose if it works well for you and a few others, that's fine, but it will not work easily for the many.
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Gayle, I am not doubting that you have to think outside the box with your acrocats - and I would not presume to give advice on acrocat dosing/management. And, yes, the "Ideal" is 12/12, etc., but that is not realistic 100% of the time for most of us. Hence, dealing with extended/lopsided cycles with techniques that work. That was why I suggested it. It is something to have in your arsenal. I am guessing that you have not tried it, so I wonder at your outright dismissal of it.

Please, I don't want to argue with your about this. There is room for all of us to offer our experience on what works for our cats, or for cats we have read about. That is why we are here. Marci, or any other cat parent, can decide if she wants to try it and then determine if it is workable with her cat. I just want those options out there.
 
Would like to say something on this split /dose issue...I am not comfortable split dosing, even tho' i am not new to treating diabetes(almost 2 yrs now), i don't feel like i have the confidence to do that, nor do i feel it is necessary at this time -
HOWEVER,i love the fact I have another tool in my diabetes toolbox ,
The thing i like most about this site is that it offers options, not orders.
 
Please, I don't want to argue with your about this. There is room for all of us to offer our experience on what works for our cats, or for cats we have read about. That is why we are here. Marci, or any other cat parent, can decide if she wants to try it and then determine if it is workable with her cat. I just want those options out there.
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I would hope that when offering other options, cautions are also provided.
To say, sure try this, but hold back on the cautions, the warnings, is dangerous.
No method is perfect; each has its own unique set of pitfalls, so please state them clearly as people may read the simplistic statement that split dosing has worked well and try it without knowing where to be careful.

I am guessing that you have not tried it, so I wonder at your outright dismissal of it.
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In my own way, I have made use of R to balance out levels, but that's a completely different approach, method. Using R is quick; it's in, it's out, and the Lev takes over.
While I may praise R as being useful in some situations, I will also loudly state that it must be used with extreme caution, and that it must be tried with the guidance of someone experienced with its use. Even my signature on this board offers a warning.

Have I dismissed split dosing outright? No. I looked at it, found that it was a flawed method, and THEN I dismissed it.

But if it works for you, great.
 
Marci, I have not tried it*, really, myself, but I do keep the technique "on file" as a usable method. So far, I have been able to make time changes in other ways - either by just shooting late and then reducing the dose at the next cycle (which is shot at less than +12), or moving the time in increments (which I find exceedingly tedious).

*I tried it with Beau at one point - once - and didn't have a reason to try it again because he went OTJ very fast. I don't consider one attempt a real "trial" of a technique.
 
Gayle and Shadoe said:
Have I dismissed split dosing outright? No. I looked at it, found that it was a flawed method, and THEN I dismissed it.

But if it works for you, great.
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Not sure I understand that. How can something that "works great" for even one cat, be a "flawed method"? Almost everything that is done to manage FD here is great for some cats and terrible for others. For instance, the Tilly protocol did not work for Beau, but I would hardly call that a flawed method. And how I treated Beau did not work for Jeddie, but that doesn't mean that was a flawed method either.
 
Not sure I understand that. How can something that "works great" for even one cat, be a "flawed method"?
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I believe I said IF it works for you..... frankly I don't believe it because earlier you said the following:
Marci, I have not tried it*, really, myself, but I do keep the technique "on file" as a usable method. So far, I have been able to make time changes in other ways - either by just shooting late and then reducing the dose at the next cycle (which is shot at less than +12), or moving the time in increments (which I find exceedingly tedious).

*I tried it with Beau at one point.
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So what is it... you have not tried, or you tried it.

I think a spread sheet with legitimate BG numbers along with doses given would go a long way in proving that the method has been tried and worked, even for that one cat.

As for Tilly not working, I doubt that statement as well, but that's OK. It can be a tedious protocol to some.
 
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