Q about interpreting #'s

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Marci and Buddy

Marci and Buddy

Member Since 2009
How do we know if it's rebound or the insulin just plain wore off after 12 hours?
Is it that if the dose is right, the shed never empties out, so when the insulin wears off, there is still some in the shed which should keep him regulated?
 
Marci and Buddy said:
How do we know if it's rebound or the insulin just plain wore off after 12 hours?
Is it that if the dose is right, the shed never empties out, so when the insulin wears off, there is still some in the shed which should keep him regulated?
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Yes to your second question.

Generally if there is little to no drop during 12 hours, it's not enough. It's not really correct that Levemir "wears out" at 12 hours, it's not like PZI or Caninsulin which don't have sheds and can't build a foundation upon which to layer the next dose. There is probably still some action at 12 hours with Levemir, but just not enough to have an effect unless it meets up with the following dose.

Probably not explaining that very well. The best way to recognize rebound is to see the fast or low drop with resulting rise. Check out Gandalf's SS for yesterday and today. We could have factors at play because of the steroid (prednisolone) but he had a good drop yesterday and overnight numbers sure look like rebound to me, but I wanted to confirm today by testing and sure enough, he dropped even more rapidly this time, as a result of the shed!
 
I don't really buy the idea of a "shed," but that's a different discussion. I don't see any rebound in your spreadsheet. What I do see is a cat who has been unregulated for a long time. That means the issue is how to retrain his body to use insulin efficiently. When it does, you get overlap (or what others call the shed)--or one dose working when it's time for the next one. Looking at your spreadsheet, Buddy has never had enough overlap for his body to re-learn how to use the insulin.

Since it's been months of this yoyoing, I think you need to be very systematic in managing dose increases. If you don't see a good drop at peak for 5 days, up the dosage .1 unit. Regularity is the key. If you get good peaks but are still getting high preshots, you may need to shoot TID for a couple of weeks (or try the split dose technique).

I know you don't know me so it's ok if you choose to ignore this.
 
Thank you both for the clarity. i do see rebound in Gandalf's ss but like you say for good reason.
Lucy-TID is 3 times daily? why is that better..i guess more continuity? i have not heard that here so far-is thta what you found to work?
i did up his dose by a smudge today -from a 1.25 to 1.30 (a fat 1.25)i'll keep this for 5 days.
I 've been trying to regulate him for 2 years now and i feel like i'm doing a lousy job, poor guy. but i dont know what i'm doing wrong. Could it be possible some cats are not regulateable?
 
Marci and Buddy said:
Thank you both for the clarity. i do see rebound in Gandalf's ss but like you say for good reason.
Lucy-TID is 3 times daily? why is that better..i guess more continuity? i have not heard that here so far-is thta what you found to work?
i did up his dose by a smudge today -from a 1.25 to 1.30 (a fat 1.25)i'll keep this for 5 days.
I 've been trying to regulate him for 2 years now and i feel like i'm doing a lousy job, poor guy. but i dont know what i'm doing wrong. Could it be possible some cats are not regulateable?
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I don't think you've done a bad job. It's really hard and you're probably balancing many other responsibilities.

Yes, TID is 3 times daily. It's not that it's better, it's just one of many tools you have available to you. If the tools/strategies you've used so far don't work, why not try something else? But I am not recommending TID or split doses right now. I think the best choice for you is to be systematic for 4-5 weeks, upping the dose by .1 every 5 days until you see if you can get him low enough at peak to build up some overlap.
 
Hey there, Terri. Thanks for your input for Marci. Just want to say I gave up on fighting the whole "shed" thing. It's just semantics I guess. My difficulty with using a term like "shed" is that to anyone else, such as vets, they don't mean anything. At least "overlap" has a meaning which someone not familiar with FDMB lingo can understand in this context. Using "shed' is not my favorite term, but it's pretty much how everyone understands the longer acting insulins on the board now, so I gave in. But we'll know what you mean if you say overlap, quite fine by me. ;-)

Marci, sorry to hijack your thread for a nitpick Terri & I both have about lingo.

I agree that being methodical on dosing can be the key for Lev kitties, shed/overlap or whatnot. It's very easy to let preshots get the better of us and raise/lower doses on them or even seeing one low-ish number.

Also, just an FYI, Terri is one of the members who informed me about split dosing, so she knows her stuff on that and TID in conjunction with Lev and probably other insulins as well. TID can be used to break through insulin resistance, for example. But someone has to be on top of testing to do that successfully.
 
Hi Vicky! My problem with the term "shed" is that it gives the impression that its a magic repository caregivers are aiming to control even though they can't see or measure it. But overlap isn't magic and it can be measured with a little bit of understanding. So to me, I think overlap is a more empowering term. And the more we empower, the faster kitties are going to get healthy.
 
Terri and Lucy said:
Hi Vicky! My problem with the term "shed" is that it gives the impression that its a magic repository caregivers are aiming to control even though they can't see or measure it. But overlap isn't magic and it can be measured with a little bit of understanding. So to me, I think overlap is a more empowering term. And the more we empower, the faster kitties are going to get healthy.
Click to expand...

That's exactly what we try to do here. Help people help their cats. It's not just about telling people what dose to give or whether they should increase or decrease (although, yes, we do that), it's about helping them understand what happens when they make those changes, so they feel more confident to make dose decisions themselves. I believe that is what each of us who helps here have accomplished for our own cats. By here, I mean Lev ISG specifically. I can't speak for other ISG sections.

Terri, interesting take on "shed" vs. "overlap." Yes, it is a tool. A shed is where you keep your tools :lol:

Again, sorry Marci for hijacking your thread...
 
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