Question? updated ss

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sammy34

Member Since 2012
hi i have question about insulin. Sam has been on levemir for a couple of weeks now, and she has been seeing a lot of greens which she never did on lantus but most times she will drop out with in 4 hours from 300's to 74. is this because she is getting to much insulin? she is bouncing up into the 300's because we never seen greens on lantus. any ideas, i dont have ss up to date, i don't have time. any advice would be greatly appreicated.
she eats raw and evo 95% and fancy feast. 3 units of levemir and she was on lantus 4.5 with no results always high numbers.
 
Re: Question?

Do you have time at least to maybe list out the last few days of readings in a post?

I suspect she is just bouncing off the greens like you said.. which is normal and does not necessarily indicate too much insulin... unless she drops below 50.

She may well drop below 50 though since Levemir usually maxes at +7 or +8 . so I am wondering if you have readings at that time??
 
Re: Question?

Either list 4-5 days of test numbers in a post or update your SS with the last few days of data. It would probably take you less time to update the SS, than to list it here.

5/23 AMPS xxx +2 xxx +6 xxx +8 xxx PMPS xxx +4 xxx+8 xxx
5/24 AMPS xxx +2 xxx +4 xxx +8 xxx PMPS xxx +8 xxx
5/25 AMPS xxx +2 xxx +6 xxx +8 xxx PMPS xxx +8 xxx
5/26 AMPS xxx +2 xxx +6 xxx +8 xxx PMPS xxx + 8 xxx
5/27 AMPS xxx +6 xxx +8 xxx PMPS xxx +8 xxx +10 xxx
5/28 AMPS xxx +2 xxx +6 xxx +8 xxx PMPS xxx +8 xxx
5/29 AMPS xxx +2 xxx +6 xxx +8 xxx PMPS xxx +8 xxx

As far as someone giving you advice on the dosing without those BG numbers and without an updated spreadsheet? Well, I asked folks last night to help out another member. He only had a few pre-shot tests and one day of more tests. Even the most experienced members on here with 10000 to 25000 posts "wouldn't touch it with a ten foot pole" as they say.
 
updated spreadsheet for you. thanks for all the help. sorry i couldn't update sooner today but had to work husband was getting bg for me but he has no idea how to put them in on spreadsheet.
 
FANTASTIC thanks!! Thats really useful!

Why did you lower the dose from the fat 3? Because Sammy went to 4? We usually only reduce when they hit 2.8 for new diabetics.
 
i was worried because sometimes i am not home. scared of her going to low. and then i thought maybe i have to much insulin because it seems like it drops really quick.
 
Ok - well According to the protocol (below) - you hold the dose for a minimum of 3 days (unless Sammy drops below 2.8) and then change dose if need be. So I would hold this dose longer to see how it settles in.. and try and get some more +4 or +5 tests in because her nadir might be around then.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise.
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further. If an attempted reduction fails, go right back up to the last good dose.
.
Click to expand...
 
so should i hold 3 units or fat 3? i was just scared i was missing some really low numbers at night.
 
I personally would hold the three to see how it goes, and if it stops working move to the fat 3. But I would get more tests in. But it must be said I am not that experienced in dosing. Let me see if I can find someone else to advise.
 
Sammy34,

Wendy probably sent a PM to a couple of folks or posted in one of the more active forums to get someone to look at the SS and get you some more advice. Most everyone here works during the day so you may need to wait until the evening for a response.

The boards are busiest first thing in the morning, slow late morning thru early evening and then activity starts to pick back up after working hours and the commute home.

Was there an immediate question you had other than the dose change, 3 or fat3?

There are a lot of newer members on the boards so sometimes it can take some time for a response from our all volunteer members. It all depends how busy their work and family lifes and taking care of their own pets becomes as to how much time they have to reply to questions.

ETA: I do not have much experience with Levimir which is why I'm not commenting on the dose. I do know that Levimir has a much later nadir than Lantus does. You may need to set the alarm to get a late night test, +8 to +10, to gather some more data and see if the lows are happening then.
 
Looking at the spreadsheet, the mid-cycle tests you have gotten on this dose suggest to me that it would be safe to fatten the dose or even go to 3.25 units.

With a human glucometer, < 50 mg/dL earns a decrease ... and you're more than 100 points above that at the mid-cycle tests you've gotten so you've a large margin for safety.
 
yes nice to see greens! thanks for all your help everyone.....i will try the increase on weekend when i am home all day.
 
Bounce from fast drops, large drops, or lower levels than customary may ocurr anytime you increase a dose. Sometimes changes initiate several cycles of "New Dose Wonkiness". These all tend to settle out if you stick with it for a while. For those cats who have spikes at end of cycle after stabilizing on a dose, there are some tactics which may be tried.
 
First, lets be clear what we mean by spiking - a swing of 200 mg/dl (11.1 international) is very common during a cycle, so that isn't spiking. Plus, some cats swing more; some cats swing less. You are getting some green and blue numbers and only going up to magenta numbers - not red, nor black. Starting and ending in red or black with blue and green numbers at nadir is what I think of as spiking at the end of a cycle.

Bouncing is when you have a fast drop, a large drop, or a lower value than generally experienced by the cat; the body compensates by releasing counter-regulatory hormones, the glucose spikes up and may stay elevated for several days, gradually coming back down. I'm not seeing that.

If you aren't already doing so, you might try the least complex option - feeding in mini-meals during the first half of the cycle to distribute the food intake more evenly throughout the cycle. The PetSafe 5 (see our shopping partner Amazon) has been used successfully by many of our members.

Depending on the insulin, some folks have found that testing and shooting every 8 hours (TID) may help reduce spiking by increasing the overlap between shots. This takes the total daily dose, and divides into 3 doses given every 8 hours. It requires more testing supplies and may be difficult to schedule.

Basal + bolus dosing, by adding a 2nd short term insulin to manage known times of spiking has been done, however you need to wait until you have been consistent on the dose and optimized it first before. If you did that too soon, you will find it difficult to get the optimal dose of the longer acting insulin.
 
I think its too early to even think about bolus dosing. Its for experienced users of insulin and even I havent tried it yet and I have been doing this 18months.

For now just increase at the weekend and lets see where that takes him. I think you just havent found the right dose. And the bouncing should stop eventually, or at least he will spend more time in normal numbers which is just as good. We are already seeing more greens which is giving his body a break!

Wendy
 
thanks everybody! i will increase tomorrow morning to fat 3 again and see where that takes her. everyone is a great help. sam is having a little diarrhea today, first ever. could this be something serious, i am not sure. she is not as active as usual but eating fine.
Thanks
Crystal :-D
 
hi everyone, sam still got soft poo today but not as bad. i did buy before grain for her to try as evo is getting really expense for me $50 case here. but i dont know maybe she is getting pancreatitis, could this pass if it is? getting lots of water into her as i am adding it to her food. oh and she only had a little of the bf grain as she did not like it.
 
Some people add about 1 teaspoon to 1 tablespoon of plain canned pumpkin to the food to firm up the stools. You want to get the plain one with no spices in it.

Pumpkin works for constipation also.
 
hi everyone, sam had some bad diarrhea this morning, so i backed off the insulin to 2.75 as i was scared her food was going through her to fast. and then she never had it again today. seems to be doing ok and feeling good. but today i took away her fancy feast liver and chicken could this be the problem? anyone else with a cat that got diarrhea from fancy feast? so she ate raw and evo today. i am a little confused with numbers today as she was at 377 this morning and then at +4 she only came down to 257 and at preshot tonight she was lower then normal at 243. she is usually really high in 300's. could someone explain this. thanks everyone....
 
Tiggy has intermittent soft stool and we blame it on the fancy feast but its not bad enough to merit changing it.

If you think it's teh cause then try cutting it out to see what happens..the evo is canned right?
 
Coming down from a bounce?

Question though, why didnt you stick with the fat 3? You didn't give the levemir a chance to build in her system so you didnt give that dose a chance to work... And she didnt earn a decrease?
 
well she had really bad diarrhea this morning so i was scared she didn't have to much on stomach as it was going right through her. but tonight i shot the fat 3 again, did i make mistake on spreadsheet? i will fix it.
 
Ah that makes sense.. Good call. Try the evo beef then for a few days (maybe 3-5) and see how she does... then slowly reintroduce other foods to see what she reacts to.

I am also wondering if you want to start posting in the tight regulation forum? They are really good at giving dosing advice and will be be able to keep a real close eye on you. Plus it's a great sense of community, I post myself there every day or two... http://felinediabetes.com/FDMB/viewforum.php?f=9
You are welcome to continue to post here, I just think that they might be able to help you more over there.

Heres how to post
Every day ( or as often as you can) you open a new thread/post. We call them "condos"
- The subject has the date/cats name and BG readings ie 06/02 Sammy 450 +2 486 + 8 204. You add a ? icon if you have a question. You can update your subject as you get a reading, or whenever. You wil need to use US readings but just multiply yours by 18.

- The contents of your post have a quick update on how sammy is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today sammy was in a good mood, playing and eating well. But still diarrhea and BG is really high. Should I increase the dose?

For your first post put "newbie" also in your subject so everyone can welcome you!

Wendy
 
Before you go over the one of the tight regulation forums, it would be very useful if you would put some more information in your signature.

Would you please provide us with some more information and put this in your user control panel? It helps us to help you better.

Go to the upper left corner of your screen and click on the words, User Control Panel
On the next screen, a row of tabs is presented. Select the Profile tab
On the next screen, there are a number of choices along the left hand side. Select Edit Profile.
Go down to the location field and enter your country, state/province, and city if you are willing to share that info.
Click on submit to save this change.

Still in the User Control Panel, Profile tab, this time select Edit Signature from the left hand list of options.
A free form text box appears.
We like to see information like your name, your cats name age and sex, the diagnosis date for the diabetes (DX 4/30/13), what meter you are using for testing, what insulin you are using , what you are feeding (wet or dry, what brands/style of food), any complicating health issues your cat may have, any additional medications your cat is receiving.

You already have the link to your spreadsheet in your signature.

Click on submit to save this information. Now, this will appear at the end of every post you make. You can update the info when you need to.

Think of this as having some very useful information at our finger tips for those that are replying to your posts.

Would you please do those updates when you get a chance? Thanks.
 
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