O'Malley's charts, 5 days after diagnosis

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Aristocats fan, eh? Hello and Welcome to Lantus Land, Sarah and O'Malley!

Catching me on a bad night, my internet down here in Cape Town is being a bit sketchy and I can't access spreadsheets. But for now, just saying Hi, and I'll check in with you tomorrow, ok?

You've come to a great place! We'll help you out.
Hugs
Jane
 
Hi Sarah,

Welcome to LL! I'm wondering if you used Pzi in the past? You are dosing the way you would with PZI but not the way you do with Lantus. With Lantus it is important that the dose stays the same and that you give it at the same time every 12 hours until you change the dose. We change doses by increments of .25u generally, not .50u. You've been switching between 1u and .50u every dose. That does not allow the shelf to build properly. Please read the stickies at the top of this page that explain Lantus protocol whether you decide to use tr (tight regulation) or (go slow, stay low) you need continuity.

Other than that, you have done great, getting a spreadsheet set up, learning to test and getting to the best place to help your fur kid! His numbers are very nice also for a newbie! If handled correctly according to the tr protocol I think he has a good chance for remission, no promises, but my gut feeling. :razz:

I'm not a dosing pro but from looking at his spreadsheet, he probably belongs right in between at .75u 2x a day but one of the pros should look at it and would be better able to tell you. That would be a very small starting dose.

Melanie & Racci
 
Caught a peek at your SS just now, Sarah. Can't stay long right now - but other will be along to pitch in. One thing you need to keep in mind, seeing your SS:

Lantus needs consistent shooting to work best. Switching doses frequently is not a good idea. We're going to help you stick to a safe dose - for now, the 0.5u may work well for another couple of days before we re-assess - and then hopefully, O'Malley will show progress. Dosing in Lantus is based on NADIRS (lowest points in cycles), not pre-shot BGs. And we need to know whow much you are able to monitor and test during days/nights to make sure O'Malley is safe.

You're doing fine since you are HERE and wanting help and committing to being there for your cat! That's GREAT!
Sorry my internet is so wonky. Will be back later or tomorrow.

Jane
 
Well, the thing is, he's actually on Levemir, I'm posting in here on the advice of another. I now know to keep him on a steady dose, and he seems to be responding well. The reason he is on Levemir is because it was actually donated to him, at no cost. Unfortunately, I've no money for anything else as of yet. Thank you all for your help!!
 
Levemir is a very good insulin and works very similarly to lantus. Have you decided to keep him on the .5u for now? The 1u brought him a little too low. He should not go below 50.

You should read the stickies on The TR Protocol and Shooting Low on this page if you haven't done so and save a copy to your computer in case you need them quickly. You should also make sure you have a hypo kit on hand since he is going low easily. It never hurts to be prepared.

Melanie & Racci
 
Thanks for clarifying which insulin you're using. Lantus and Lev are pharmacologically a bit different but they act in much the same way. There are a few basics that it helps to keep in mind.

  • Dosing is twice a day and it seems like you have that in place.
  • Dose changes are based on the lowest point in the cycle, the nadir. Doses are reduced if numbers fall below 50.
  • Generally, dose increases/decreases are made in 0.25u increments.
  • Lantus works best with consistency. It helps if you are as consistent as possible with respect to shot time and dose. Beyond the first 5 - 7 days, the dose is held for 3 days and then increased unless numbers drop below 50 indicating that a reduction is needed.
  • It is important to get tests at your AM and PM pre-shot times and to get at minimum, one test per cycle. You've been doing a fantastic job of testing during the AM cycle. You need to start getting at least one test duirngint (OK, that should have read "during") the PM cycle.
Overall, it looks like O'Malley is doing well. I would encourage you to hold te 0.5u dose for at least 3 more cycles unless his numbers dip below 50.
 
Hi Sarah,

Great to see you over here and very pretty spreadsheet :smile: testing every hour is possibly a little excessive though (not often telling someone to test less :lol: ) there are times when O'Malley gets low that you are going to need to test even more frequently (but probably not for 12 hours straight!) so it might be better to save his ears for then.

Mid-cycle tests are vital for figuring out dosing, as Sienne said these should be done after his PM shot too as you cannot rely on the cycle to be the same/similar to the AM cycle. A lot of people also like to get a +2 as once the shed is full and O'Malley has adjusted to the insulin a big drop at +2 can indicate that the cycle is going to be an active one. +10 and/or +11 are also good to get in case you get a low PS number, then you will know whether it is a still dropping number (which you want to be more careful about shooting) or a second drop (some kitties have a second drop just before the end of the cycle). It is also good to get a curve once a week (testing every two hours throughout the cycle) to help paint the picture of how the insulin is working in O'Malley. Curves are also often performed after a dose increase and you may to do them more frequently for a while so we can see if we can pick when O'Malley has his nadir (lowest point in the cycle) - not all cats are predictable with this but we should be able to get some idea as to whether he nadirs early, late or in the middle.

What we home to see as O'Malley adjusts and we get his dose right is a flattening of the cycle so that there is less of a distinctive dip and his numbers stay in the normal cat range (about 50 to 120) throughout. In this range his pancreas has a chance to heal so the more time he spends there the greater his chances of remission. He does seem to be responding very quickly and well to insulin which is an excellent sign :-D

You've probably had a bit of a peek at the other 'condos' (that's what we call the daily posts for each kitty) here and I would encourage you to do the same as you see others doing. Post a daily thread with the date, O'Malley's name and his numbers in the subject line. You can update the numbers in his subject line as the cycle progresses by editing the subject line in your original post (if you don't do it in the original post it can't be seen from the board view). If you have other new information to add you should reply to your own post rather than edit the original or people will not know there is anything new to see.

If you have a specific question you can add the question mark icon to your original post and please 'bump' yourself up (by replying to your own post) if your question hasn't been answered and you have dropped down the page too far - this sometimes happens at PS times as many people are posting at the same time.

If he doesn't drop below 50 between now and the PM cycle on 8/28 it will then be time to reevaluate his dose. (If he does he will earn an immediate decrease to 0.25U following treatment as per the handling low numbers sticky - it's a good idea to ask for help if that happens when you haven't dealt with it before). It will be a good idea to add 'DOSE QU' to the subject line in your original post severals hours in advance of being due for his PM shot on 8/28 to alert the dosing experts that you need assistance and to allow time for them to have a look at his spreadsheet and respond.

You really are doing such an amazing job (as is O'Malley), I can't believe how quickly you are picking everything up :-D best regards to Nanacat

Serryn
 
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