Pam and Alley 12/14

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pamela and tigger

pamela and tigger

Member Since 2009
Pam & Alley said:
I must learn patience! My short term goal was to not hit the "red" zone anymore. So much for that! Hit 401 AMPS, staying with the 4 drops for now. Only gave him 2 drops last night, which probably was stupid, he was at 254 PMPS.In the first 3 hours after his shot he usually is dropping 100 pts. I feel he is close at 4 drops right now, will wait to see if it should go to 5 drops by the weekend. If I am brave enough to give him 4 drops tonite, I think his AMPS would be better.
I see that all the midwest is getting hammered. The TODAY show even had a correspondent in Michigan City, IN this morning (our home town) reporting on the lake effect storm. And it may even hit close to 70 today in Denver. Go figure!
Pam
Click to expand...

Pam, I am starting a new thread for you with a copy of your last post from today.

The one thing to remember is that Levemir likes consistency. So that means finding the same dose that you can give comfortably AM and PM. I would hesitate to go to five drops this weekend since you are getting quite a drop on the four drops.

Remember when you skip a dose you are basically starting over and you need to refill the 'shed' or insulin depot. Might help to read this - I think I might have given this to you earlier but here it is again:

viewtopic.php?f=9&t=150

See what others say, but maybe you should try 3 drops consistently for a while. If you get a lower preshot that you aren't comfortable shooting, don't feed but wait for 30 minutes and test again. If he is rising then you will be okay to shoot the 3 drops. Also try to get those late cycle tests in (+10-+11) when you can to see how rapidly he is rising. That should make it easier to make a decision of whether or not to shoot that lower number. Here is another good primer to read:

viewtopic.php?f=9&t=147

Also, from the Levemir 101 Sticky above that Vicky wrote, scroll down to "Maintaining Regulation". Hope this helps.

(I know you tried the 3 drops before but that is also when he got into the gravy so maybe try it again and stick with it for a while).

Awww, temps in the 70's. That would be nice, sigh. :)
 
Hi Pam,

In addition to what Pamela wirtes, I also encourage you to stick with one dose for at least 3 days/6 cycles, however I usually go longer if there are no HUGE reasons ( like hypo or constant reds) not to. If there are hyp numbers, you need to decrease the dose immediately, of course.

I'd second the 4 drops b/c it is where you are getting pretty decent numbers and let his body adjust to it.

Another thing to remember is not to make a dose change based on ONE number....most of the rest of the cycle looks like a cat adjusting to me...the 401 is ONE number- don't panic. ( although the 401 is similar to the 396, etc)

Also, dose changes are based on the LOWEST number in the cycle, not the highest...

If you are testing for ketones and all the 5 P's are in order and his cattitude is good, I see no reason not to let the dose settle for some time.

Each time you switch it up it is like starting over, so that 2 drops you shot a few cycles ago - the next 4 drop dose is where you would start counting fresh to see if the 4 drops is working.

Another reason not to go up is b/c you had to lower the dose a few cycles ago to get in your comfort zone.

lastly, the 4 drops has to be really close to the .25 you gave that bottomed him out...

Just some suggestions, of course...it is up to you how you proceed. ;-)

Sending good numbers vibes! :thumbup
 
Thank you Pamela & Melissa, did not know about the storage shed. Makes sense.
Ok, his + 10 was 137 and his + 11 was 195 and he is eating, so will test in 1 hour preshot. I also have to base this pm shot on his am preshot number don't I? 401 and given his regular, for now, 4 drops, but with the drops he made all day (all good) I don't think I can do anything more than 3 drops tonight, maybe 2, then he is not getting consistent amounts. But I hope to have a decent preshot number in the morning, away from the high 300/low 400's.
Suggestions anyone??????

Sheila said there may be a possibility that I am overdosing him, because of food numbers and possible rebounds. would that make sense then to just skip a day or two altogether and start anew at maybe just 2 drops morning and night. Otherwise to just decrease his dose would send him into rebound unless I let his system clear out.

Another blizzard coming to our mountains tomorrow, so you'll see it by the weekend.

I cannot express my appreciation enough to this forum for all this wonderful advise.

Pam
 
He is dropping to 34, 39, & 46 on three different doses - all within 10 days.

I know its hard, but try not to respond to one PS with a dose change every cycle - lev isn't a fast acting insulin where you would do that. And, as Melissa said, you make dose changes based on the lowest number anyway. Today, he dropped from 401 to about as low as you want him to be (46). The problem is that you don't want him swinging from 400 to 50 and back every 12 hrs. He would feel better if his BG change was from 200s to 80-90 or so. This means you want to take the "edge' off those swings and reducing the dose should do that.

I think if you go to 3 drops, stick with it for 4-5 full days (barring 400s ALL the time or a number below 40), shooting it even on PS as low as 180-ish, you will start to see a better pattern. Or at least what 3 drops is really doing.

Lev works by getting them low and keeping them low, so you don't reduce the dose for a lower PS - unless it is really low and you are really unsure and can't be around to watch him and get spot checks.

And I do still think that he may be getting too much even at 3 drops, but if he were my cat I would drop to 3 drops and hold it until it settled and numbers were stable. I would expect that they would then start to show very low nadirs and higher PS again, so I would reduce the dose to 2 drops and hold that until it settled and wait for low nadirs and/or high, flat rebound numbers, especially PS numbers.
 
Pam sent me a PM, thanking me for what I posted above and I wanted to answer her questions on the board - for "peer review" reasons.

She asked:
He was at 406 this morning, after only 2 drops last night, because of the SWINGS we were afraid he would hypo at night. Then we have to start all over again in the morning. We did give him 4 drops this morning already. May just skip tonight (?) and start fresh at 3 drops for the next several days, or until we notice the low nadirs and higher PS again as you state. Then go to 2 drops.
Click to expand...

I would not skip tonight. It is perfectly safe to make dose reductions at the next shot time. I would probably shoot 3 drops tonight. I think he may need the 3 drops for a while as a "step down" so his body can adjust more slowly. In my experience that works better. This is a process that involves a lot of patience. If you were to skip tonight, he would loose momentum and probably have higher numbers just because that is how is body is responding right now.

Since you gave him 4 drops this am, he may drop very low - and then bounce high again. I would still give 3 drops so you aren't repeating yesterday's overnight cycle again.

We changed to half-unit measure 100U syringes, and they are better, but we found one last night where the line was way off.
Click to expand...

Yeah, that is a problem with these syringes. Mine this morning had a half unit above the zero line! I always check how far above the zero line the stopper goes and take that into account. You will get so that you can eyeball doses if you make a mental note of where the stopper flange's top and/or bottom edge is in relationship to one of the unit/half unit lines as you practice making the drops.
 
I agree that I am losing momentum with his pm shot and a 3 drop would start the lower cycle perfectly. His AM/PM shot is at 7:30 mountain time, 1 hour behind central.
At least this is a plan and I won't worry about upping the dose if he is high. I totally get it that he may need less insulin than more.
BTW, Alley is feeling pretty good these days, in fact, he is sitting right in front of my monitor now and I can barely see.

thanks again
Pam & Alley
 
I just read your post and Jeddie came by to get in my face, chew on the phone cord, swipe at my mouse... I think they get jealous of the attention we pay the computer.

OK - I'll try to stop in around 6:30 my time to see if you have any questions.

ETA: seriously, this cold is making my head fuzzy! Obviously, that would be 8:30 my time. Unfortunately, I have a conference call planned with my two sisters at that time. I'll try to check in, but can't promise anything. I feel so bad about that, but I think you will do fine.

ETA2: just checked your SS and I see he has been high and flat today. It could be rebound. There have been too many changes with the dose and numbers all over to be 100% positive. I think the 3 drops tonight will be good.
 
It helps that his numbers are up even though I also think it is a rebound. Will test and shoot in 15 minutes. Then test again in 3 hours (10:30 mountain time).
Will check on him periodically through the night, although he is back in his habit of sleeping right next to me again, but he snores a little.

Thanks,
Pam

Sheila, I hope you feel better soon! Stay warm.
With today's storm so far we have about 6 additional inches of snow, should reach your area in a day or so.
 
Sheesh! I couldn't see to read your post for Alley being in the way! LOL!

I like the 3drops and stick with it idea...I like the spot checking, too....and not reacting to ONE number...give him time to settle this dose.

(crossing fingers and hoping for GREAT results on dose allowed to settle without changing it up! knockwood, antijinx!)

;-)
 
You can keep the snow in CO! We didn't get much here, but it was on top of freezing rain and I spent about 90 mins today trying to salt it and scrap it off the sidewalks and driveway to our condo building (yep, being the assoc. pres is loads of fun!). Our garbage company won't empty the dumpster if there is a hint of ice or snow on the driveway. They guy's an (_|_), so we have an overflowing dumpster now from Monday when he wouldn't empty it. If he doesn't take it tomorrow I don't know what we will do.

So anyway, about the cats....

Jeddie has taken to sleeping right up by my head lately. He likes to stare adoringly at me and purr with his face about 3" from mine when I first get into bed. Later during the night he is crosswise, on his back with his feet sticking into me. He is a very silly boy. But at least he doesn't snore. :roll:
 
Now I am not alarmed by the 433 this morning PS. Tested him at +3 (282) & +6 (165) last night and he had very good readings. Maybe he went a little low after that and he is rebounding? Should have gotten up and tested him at +8 or +9 but he cuddled in my arms and I was out. Did not think there would be a problem after testing 165 though as his pattern is a slower decline/rise after 6 hours. I think Alley is toying with me. First short term goal is to keep him out of the red for his AMPS numbers. Maybe after the weekend we will have that.
Feel so much more relaxed knowing we do not have to adjust his dosage, to shot at the low number and not the high, and let him get used to the 3 drops.

Can't wait to see what today brings!
Pam
 
Yes - give his body time to catch up and settle down. He may have dropped to 60-75-ish? But that is perfectly safe - his body is just not used to it AND he is primed to respond to a dropping BG by releasing stored glucose and cortisol (stress hormone), both of which send him back to the reds. It isn't just a "hypo" number that causes the rebound it response, it's a rate (or trend) of dropping, a distance of dropping (400 to 150 is a lot more than 250 to 125, for instance).

His body is saying, "Oh no! Here we go again! Man the battle stations!" and it gets all geared up to fight a potential hypo even when everything is going to be OK.

Does that make sense? He will settle down as his body figures out there isn't an immediate danger. He is still getting a noticeable drop - at least 200 points and maybe up to 300 points from that dose last night.

Paws crossed for better numbers today and no more reds!
 
Hi. Even though his shot yesterday morning was 4 drops, his numbers are a bit lower today on the 3 drops. Hopefully, his body will see we are not trying to harm him and will accept the lower doses and stop giving me the red readings! Appetite is very good, and his water consumption is down a little bit. Will test him before bedtime as usual, and possibly during the night.
Think pink!!
Appreciate all the help.
Pam
 
I think that looks good. It can take up to 3 days for rebound hormones to clear, and we are not sure that 3 drops isn't still too much. Give him another day or two.

And I'm going to think blues and greens!
 
He still is not in his rhythm, but at least there are no big drops or really high numbers.
We are all comfortable in this range for now. Alley chased Gidget around the couch and jumped over it tonight to try to get her. He has not done that for more than 2 years! He is splashing in his water dish and singing every night. He feels good. He is making progress on the Lev, it is a relief not to be in the danger zone like he was on N. We are very happy with the results so far.
It's all good.
Pam
 
That's so great that he is playing and feeling good.

When I got Beau regulated on vetsulin, he started acting "like a kitten" again, and his coat got better, but it was nothing compared to the change when I got him on lev. Even when he was having frustrating numbers on lev (first 6 weeks) he was feeling better and acting better. I think this insulin just works so much better than those fast acting insulins like N and vetsulin.
 
Alley had a restless night, in and out of bed, singing, slamming the cupboard doors. Kept me awake, feel like a zombie today. My former boss and his two boys were supposed to visit us today but they just called and United lost their luggage and skis! They are stranded at DIA hotel. Time for a much needed nap. Things just seem to work out, and I know Alley is headed in the right direction. He was a little high (the dreaded red) this morning, but the numbers are almost identical to the 15th, when he was on 4 drops!
Snowing like crazy all night, all day, tomorrow and tomorrow night. Already have about 1 - 2 feet new snow.
And this is your Hippy Dippy weatherman.
Pam
 
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