Pelle day 3, low numbers low pmps

[Charlotte & Prop]

Hey everybody

Pelles numbers yesterday were higher than normal, but we knew that could happen since was only day two after the dosechange from 0,6-0,8 units.

Todays numbers are really good and he were at 137 at +6. At pmps he was at 139, so shooting a full dose of 0.8 units seem a bit to much. So I have guided Pelles parents to shoot 0,4 units and then test him every two hours until his number begin to rise.
Last time he went low they gave him 0,2 unit and that small dose pretty much burned of within 2 hours and didnt do anything.



Pellle is finally beginnig to gain weight so today is a very good day
So any advise or are we doing ok?

Thanks.
Charlotte

 

[Charlotte & Prop]

Hmmmm 211 at +2, so I guess the 0,4 unit was to small a dose afterall eventhough his pmps was a lot lower than normal.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Charlotte,
That was a very good preshot. I'm afraid what they are going to find with shooting only half a dose is that his numbers will climb and result in a higher PMPS and probably higher tomorrow as well.

The problem with reducing dose when numbers get in the normal range is that the lower dose can't maintain the built up insulin reserve (depot or shed). So the reserve has to be tapped in to, resulting in higher numbers later since the lesser amount of insulin can't keep up.

Doses should be lowered based on nadir only, not preshots. We still don't really know how low .8U would take Pelle's BG. It may have brought him only to the 60s or 70s, even after the lower preshot. That is how Levemir is designed to work.

Experience is teaching you and them however, as you said the .2U given one time on a lower preshot hardly did anything. So giving .4U is OK, no harm done. At least they gave something.

Have you read this thread from our Think tank section? http://felinediabetes.com/FDMB/viewtopic.php?f=22&t=9070 Steve is the first owner to have used Levemir for a cat. I think some of the same points can be made about reducing dose on lower preshots, especially if the cat's appetite is fine.

 

[Charlotte & Prop]

Thanks Vicky
I dont think i really understand the nadir thing. Right now after the dose change nadir are in the yellows one day, blue the next and maybe today in the green. Unfortunately they had to go out so we dont have nadir for today. But how can we deside the dose when nadir are so different?
Do you think it would have been ok to give .8 tonight since his numbers have been rising pretty much since the shot?
When Prop was on caninsulin it was so different and the amps and pmps desided the dose. This is a bit more difficult
Thanks.
Charlotte

 

[Vicky & Gandalf (GA) & Murrlin]

If he rose so much after the .4U, then .8U should be OK.

Using nadir numbers to adjust insulin dose is probably the hardest thing for people who switch from shorter acting insulins to longer acting ones to get used to. Since it can change, that's one of the reasons it's best to give a new dose 4 or 5 days before deciding if a change is needed.

 

[Charlotte & Prop]

And then when you have found the right dose after the 4-5 days just stick with that dose even if the amps or pmps is low?

 

[Vicky & Gandalf (GA) & Murrlin]

And then when you have found the right dose after the 4-5 days just stick with that dose even if the amps or pmps is low?

Yes, unless you get a reading below 50 at any time in the cycle or the preshot value is unusually low. A dose reduction should be considered in either case. An unusually low preshot would be if the cat usually has BGs in the 100s at preshot, but suddenly there is a preshot below 70.

 

[Sheila & Beau GA & Jeddie GA]

Thesea re the difficult times when he is starting to respond to the insulin, but you don't have the data to show what will happen if they do shoot a full dose on a lower PS - so you are learning - and gathering data for the future.

Giving the full dose probably would have been fine, but I would have wanted them to get some spot checks in, especially around his nadir time, so that would have meant getting up during the night to test.

I have reduced the dose on a lower PS when I knew I could not test and was not sure of what would happen. But the next time I got the same number for a PS and would be home to test, i shot the full dose. With Jeddie, it has been fine - no sudden drops to very low numbers. Beau was another story. He would drop low so I learned to set a "do not shoot" number" (it was about 150), but he was heading off insulin and wasn't following the rules so I don't think he is a good example.

Next time, they can try .6u, assuming he is still at .8u, and see how that holds him - or a full dose if they will be home (and awake) to test.