pmps 448; +2 480; +8 380

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Wendy and Boo (GA)

Wendy and Boo (GA)

Member Since 2009
hi everybody-

sorry I haven't had a chance to respond to all your questions. Hopefully I'll get a chance tonight.

Boo was 421 this a.m. shot 1.25 and at +2 he had dropped a 100 points to 321. While I was happy to see a number in the lower 300's, I had a feeling it may have been too steep of a drop. Sure enough, at +9 he was 448! I couldn't test any earlier due to work, but I can test tonight.

He's pooping fine-no constipation issues.

Edited to add updated numbers
 
Re: dropped too low?

Wendy, I suspect that you saw the 100 point drop off his shot from last night - i.e., he was still dropping. That is one of the biggest - and hardest to get used to - differences between the "Ls" and faster acting insulins. It is very unusual to see a fast drop (+2) on lev. Some cats show a nadir at +12 or even later. It'll take a while to figure out how Boo is reacting to lev.

Will you be able to do a curve this weekend? That might give a lot of good data on how the dose is working, when his nadir is, etc.

I just have to add that I see his PS BG's seem to be going up and that can be an indication of too much insulin. It's probably too soon to tell, but be aware that on this insulin rebound can be high, flat numbers with occasional deep drops to very low numbers, followed by a climb back to high, flat numbers. Beau did this and it took me forever to figure it out because I was coming from 2+ years of using vetsulin. I found this page on petdiabeteswiki helpful:

http://petdiabetes.wikia.com/wiki/Somogyi_rebound
 
Re: dropped too low?

try to get some midpoints, wendy. curious to know how low he got around +5.
i wouldn't be too concerned about the dose just yet. he may be adjusting to it. looked at a few of your posts today and at your spreadsheet you went from 0.5 to 1 to 1.25 pretty quickly, so he might just have reacted strongly. lev and lantus tend to work better with more consistent dosing. til we see more midpoints i'd stick with the 1.25u dose for a bit and see how he levels out.
glad he's on lev. :)
 
Re: dropped too low?

Thanks Sheila and Chris :)

My +2 tonight is terrible. 424.

After reading everyone's comments, I'm going to start tomorrow at the very lowest dose I can easily measure- .25 and will work up from there (slowly). His numbers couldn't get any worse so how can it hurt? He's eating and doesn't have an infection, so I'm not too concerned about ketones at this point, but will continue to monitor him.

I can get one more check in tonight and then will get more spot checks tomorrow pm after re-starting at a low dose in the am.

-Wendy
 
Re: dropped too low?

Wendy, you may want to stay with 1.25u and get some spot checks on that. As Chris said, changing the dose too often doesn't work very well with lev (or lantus, I suppose). I would be more interested in seeing if he is getting any drop at all, i.e. any sort of curve, or just a flat line. If you change the dose, it will take up to 3 days for things to settle out. Sometimes longer. Again, it's not like the faster insulins that leave their system entirely one shot to the next.

Read Illka's comment to Michele (& Molly) about the ocean liner (or maybe it was a tanker): Changing doses on the L's is like changing course on an ocean liner, it takes forever to start turning and then forever to stop turning. So any reaction/change you see is not from the last shot, but from one or two, or more, shot ago.

Are you testing for ketones while he is in these higher numbers for so long? I would be. And if you start over at .25u, be sure to test for ketones.
 
he may have later onset with lev, or it could just be one number reacting to a stressor or something, so don't sweat that 480 at +2.
i think a curve on sunday is a great idea, coz it would give him 3 full days on the 1.25u.

if you continue to see higher numbers during the day, i'd suggest you go up to 1.5u Sunday night. (you could actually go up by 0.5u instead of 0.25u based on the numbers we've seen, but i think because of the dose changes it would be good to plan to do the 0.25u increase next. if, however, you don't see anything lower than 300 tomorrow [edited to add: or sunday after the first insulin shot], i'd suggest the 0.5u increase to 1.75. don't want to encourage insulin resistance.)
 
Hi Wendy, I won't add to the dosing suggestions for further confusion at this point...I just wanted to give you a for instance of late nadir kitty.

You can look at our spread sheet and though it is no tup to date, it basically is b/c PK does not change.

at AM test/shot/feed, PK is the lowest he will be through the whole cycle. If I did not feed him, he would continue to drop. Thus PK's nadir/peak is generally +12

within a short time after her eats- even no carb or extreme low carb food, he spikes like crazy, zipping into the 300's. Doesn't matter what dose, doesn't matter or little or much I feed, doesn't matter the timing ( see ss where we did multiple experiments)- as soon as the boy eats- up he zooms.

He rides that food spike for about 3 or 5 hours, steadily dropping- slowly- until he settles into 50- 100 at PM test/shot/feed


Another thing PK does- b/c this is long duration insulin he tends to react TOMORROW to what I gave him today....so a Friday night PS may not be a direct result of Friday mornings dose exactly...it could be as far back as Thursday mornings dose his body is reacting/adjusting to.

One reason to go slow, holding dose for 5 days really....3 days is not enough IMO.

One last thing to mention, PK is super sensitive to dose increase and decreases. For the last few months we have been dancing between .5u and .3u....the .5u tends to send him into the 30's and 40's and back to the 300's at food spike where the .3u keeps him between 100- 300 for the most part.

If I could predictable measure .4u, we might have gold here!

Anyway, the point is, sometimes those .25u or .5u increase/decreases don't work b/c of kittys sensitivity. ( See Gandalf's 1.1u and 1.3u doses! ) And you won't know until you have tried everything else, tested yourself silly and broke and are ready to give up in frustration- then the light goes on and ta-da! you find that micro doses work really well.

I sense your frustration already and it has only been 2 weeks, right?

Buckle up, friend! It may take a few months to find a proper dose and just when you do, you'll need a decrease again! ( another reason micro dosing is preferable)

Then again, mayeb your Boo will be one of those lucky kitty's that go OTJ within a month and leave you standing there in battel gear saying- what was that?! :o

Either way- marathon, not sprint...patience grasshopper... OOmmmmm.....OOmmmmmmm.....happy-place...happy-place....

;-)

(((hugs)))
 
Thanks Melissa :-D

I know ya'll want to reach through the computer and slap me for changing doses too quickly! And patience? What's that?

I'm finding it difficult to get out of the PZI mentality of being able to shoot numbers down mid-cycle. Before remission, his PZI dose was 1.2 on a BG above 250. 200-250 was 1 unit and below 200 was .8.

I don't know how many miles he can do in this marathon given his CHF. We may be running a half marathon instead :? I think that's why I keep sprinting...

I wish he didn't eat all the way through the cycle so I could check for food spikes-but he no longer eats like he used to. Now he just grazes all day.

We'll see what tomorrow's curve looks like. I would do it today but I have to work. Blech.
 
no reaching and slapping here...I get what you say about the CHF and it sounds like you are saying without saying that you are in a hurry to get the BG's down b/c the CHF may take him before you can...?

I think in that postion, knowing what I know about Lev, I'd have to slow down that much more. It seems counterintuative, I know.

Another thing about Pauly that may apply here is the ups and downs. I've always beena a big fan of the shallow curve.

That is to say, I'd rather see AMPS 325, +2 398, +7 252, +10 299, PMPS 310 than AMPS 410, +2 398, +7 105, +10 277, PMPS 425

There is an awful steep drop between that 410 and 105 and back to 425...I can't imagne that feeling good at all ( being hypoglycemic myself).

On the other paw, the 325 to 252 and back to 310 is a nice quiet, slow predicatable drop that doesn't shock the body and make it rush to protest with emergency glucose stores and whatnot.

It's my observation with Pauly that providing the shallow curve, even at higher numbers, helps his body to go lower over time ( 3 to 6 weeks). I had PK on some 1.5 or something and got peaks and valleys...on the .3 to .5 I get a nice steady shallow predictable curve.

Even with slightly higher numbers I may not be excited about, he is playful ( annoying the old lady kittys) and keeps himself clean and interactive with others.

When he gets those steep drops and back up to 300's at food spikes, he is lethargic, unkempt and his 3rd eyelids are up. Excepting extreme lows like 20's and 30's, then he chases the old ladies and devils everyone and acts paranoid.

Anyway, the point is, taking things slow and steady over time rather than rushing to beat an invisible clock might offer quality over quantity.

Whatever you do, we do support you and we knwo you are doing the best you can with what you have and we know if you could wave a magic paw and fix it all, you would do it before I could finish writing this.

Hang in there. ;-)
 
if there's an issue with big drops you can learn to feed the drops.
consistency is key, as is data gathering. no getting around that at this point.

just never know what tomorrow will bring (said generically rather than about sunday specifically), so you know about CHF but you compartmentalize and deal with the diabetes to keep him feeling as good as he can. he knows he's lucky to have you and at least you have experience with this so you'll get him where he needs to be. :) (((Hugs)))
 
I think Boo was so excited to see the Giants beat the Phillies last night he threw me a 112 at +4 (either that or it was a bad test ohmygod_smile ) Two hours later he was back up in familiar territory with a +6 363 ( he did munch on some low carb ff after the 112)
 
That +4 is a good piece of data to have. So you know he is getting down to decent numbers, now you have to find his nadir time and number. Looks like he is not one of those mid-cycle nadirers. If he was so much higher at +6, my thoughts are that he nadirs early in the cycle (from the previous shot) and may have gone lower and bounced higher.

I will be interested in his curve today.

Also, I like Chris' point about compartmentalizing. Beau has multiple issues and I just do the best I can for each of them. When he was on insulin, I tried to get his numbers as good as possible to lessen the impact of diabetes on other things, especially his heart issues.
 
It's quite surprising to me to see the difference in him being in the 300's rather than the 400's. While I am sad to see those 300's keep coming up, he does not frequent the water dish nearly as much which I'm sure makes him feel better. He rests most of the time so not getting up to drink or use the lb helps him.

I'll continue the curve tonight past his pmps.
 
hi, wendy
can you put the results of the curve on a new thread for today? tho the levemir forum doesn't move that fast, it would help to have a new thread on this. too much info on one thread over the course of multiple days can get confusing.
thanks.
 
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