so confused-dose increase or decrease?

[Marci and Buddy]

thinking of going to 1.25U, altho its only been his 4th cycle...or maybe i need to go down?
***the fridge did go below 32 degrees one day for a few hours, but his shot that night gave him bg in 50's ...so I'm thinkning the new vial wasnt ruined.
Buddy (age 14-15) eats 80% raw rabbit, 20% wellness can turkey... nothing else since diagnosis.
i've been freaking out over this inexplicable,unpredicatable #'s past few months.going from bg 23 to 400 with less than .25U difference!!
Not sure if i should go up or down with dose---still confused after 20 months,the diabetes drives me nuts! :roll:
Thoughts, pleeeease!

 

[Melissa&Paul-Kyle]

I'm sorry you are still having such issues with your little sugarcat.

If it were me, I'd hold the dose another few cycles....but then there are tohers here who are more aggressive in their treatment that would push for the increase.

In the end, it really is your call.

If you Increase, I would suggest to wait until you are going to have a day to monitor, maybe. Do you have weekends off? Maybe the weekend would be a good time?

As for food, I guess what I meant was have any ingredients changed? We get so used to giving a food and take for granted the ingredients are the same, then bammo- the company goes and adds banannas or something stupid!

As for the insulin, If it were me, I'd crack open a new cart/vial and try it just to make sure...again, a day when you can monitor in case there is a nasty punch to the new cart.

hang in there!

 

[Marci and Buddy]

thanks...guess i will hang in there with same dose , see whta tommorw brings.
i work at home so i can always monitor.

 

[pamela and tigger]

thinking of going to 1.25U, altho its only been his 4th cycle...or maybe i need to go down?
***the fridge did go below 32 degrees one day for a few hours, but his shot that night gave him bg in 50's ...so I'm thinkning the new vial wasnt ruined.
Buddy (age 14-15) eats 80% raw rabbit, 20% wellness can turkey... nothing else since diagnosis.
i've been freaking out over this inexplicable,unpredicatable #'s past few months.going from bg 23 to 400 with less than .25U difference!!
Not sure if i should go up or down with dose---still confused after 20 months,the diabetes drives me nuts! :roll:
Thoughts, pleeeease!

You don't really have to start a new thread in this forum everyday. It moves more slowly so you can just answer questions in the previous thread, or not, and then start a new one if you want to. We are not too picky here so do what you are comfortable doing.

Usually I am all for increasing to shoot down high numbers. But he goes low at times and then shoots right back up so I am thinking he could be rebounding, but you never said exactly how much and when he is fed throughout the day. Is he having to share his food with other cats? Does he not get enough food at times so that is why he is going lower in those cycles?

Because he seemed like he was handling the fat 1.25 dose okay (but not as well as when he was on much less back in February for whatever reason), plus there are not enough spot checks at night on that dose.

If you want to increase you might have to manage those lows with a little extra food. Are you able to do that?

Also, more spot checks at night would help, like right before you turn in.

Thank you for addressing the type of food. Nice to see he likes the raw rabbit.

 

[Marci and Buddy]

Buddy is the only cat-and i am home with him all day, so whenever he tells me he wants to eat, i feed him.Usually it's a spoon of rabbit,maybe once every few hours.i remember reading once best to give small frequent feedings.
At night ( we live in Manhattan- can't leave food out or critters come),he wakes me up when he's already low(20's) starving....i give him karo, very scary.
not sure it makes sence to take blood before bed, since anything up to +4 is always higher than the pmps.
good to know ingrediants chnage-hadn't thought of thta one-thanks!

 

[pamela and tigger]

Buddy is the only cat-and i am home with him all day, so whenever he tells me he wants to eat, i feed him.Usually it's a spoon of rabbit,maybe once every few hours.i remember reading once best to give small frequent feedings.

Not always. Depends on the cat and their response to the insulin. If you want to try increasing the dose though you may have to be more diligent about testing earlier and feeding him a small snack to catch him before he goes too low to help even things out until he gets more used to the lower numbers (if that is going to happen).

At night ( we live in Manhattan- can't leave food out or critters come),he wakes me up when he's already low(20's) starving....i give him karo, very scary.

I imagine that is scary. So he goes outside at night? Not quite understanding here. And not trying to be judgmental either, just trying to understand the situation.

not sure it makes sence to take blood before bed, since anything up to +4 is always higher than the pmps.

Just to get a more complete picture. Like what happened on 11/11, 11/14 and 11/15 that he went so much lower by +5? That +2 check or +3 would have told a lot. Did he eat the same that night? Did he throw it up outside by any chance? Assuming he goes outside. When he has higher numbers can he be eating from a neighbors dish? Again, just wondering and trying to figure it out.

good to know ingrediants chnage-hadn't thought of thta one-thanks!

Yes, Melissa is pretty smart. That is why it is so nice when you feed just raw food. You know exactly what they are getting.

 

[Melissa&Paul-Kyle]

Hi Marci,

Yes, I've read about giving the more frequent small meals as well...I think many here do that as much as possible. It is someting to do with not overloading the pancreas, I think.

If that is what youhave always done, and intend to keep doing, If it were me, I'd probably stick with it.

I meal feed every 12 hours, and though I did try the portion feeding for PK for a short while, it did not improve his food spikiness, so I went back to meal feeding. Even though it was heavily suggested to me to do the portion feeding to "get him under control", I thought- "well, I am not going to be able to portion feed later, this is only a trial, so if I am going to maintain his numbers, I'll have to do it how we will ALWAYS be doing it, which is to meal feed".

That said, just know that with each bit of food, at least with my PK, there is a food spike- maybe your Buddy is different? If not, knowing when that spike happens and the duration of spike will be important in managing the BG's IMO.

As for the 20's and Karo- I have seen myself and with others that with Lev, being a "gentle" insulin, that many times you can actually feed the low instead of give Karo...

The benefit of feeding over karo is that you won't get that tremendous sky high BG after the karo, instead -preumably- with food you will get a gentle rise.

If it were me, I'd monitor the heck out of the drop to make sure you get a rise after the food....every 15 mins or so and if it does continue to drop- in my experience this is unlikely on Lev- then consider the karo.

Several of us have seen "symptomless hypos" on Lev...PK's only "symptom" being paranoia....he jets around as if being chased by spys with bath towels, threatening to soap him up and dip him in water or some such. Two times I have seen that on lev- both BG's were in the 20's and he raised gently with normal meal feeding right then when I found the low BG.

ECID- maybe Buddy does need the karo, and hypo is nothing to fool around with, but if you are home, awake and able, it might be worth a try to feed the next 20's rather than give the karo straightaway.

If you do this and need help, Health is a faster more visited forum and can offer you assistance right away where the Lev board might move slower.

I wonder why "everything up to +4 is always higher than PMPS"? Do you feed with the shot and get a food spike or would you classify it more as "insulin running out"?

Hope you don't mind the 20 questions! As Pamela said, just trying to get a better picture.

It's been a while since I tried to micro manage PK's BG as is common on this board...As I wrote before, he just does better in the regulated higher numbers than bottoming out and then skyrocketing ( 20 to 400 as you mentioned), so tightly regulated numbers elude us, but I understand your desire for the lower numbers and am just trying to offer what I can. ;-)

Just as a reminder, it IS a marathon, not a sprint, so patience is key.... ( don't you just HATE that reminder?! :lol: )

 

[Marci and Buddy]

Oh please continue with the 20 q's...it's great to have help trying to figure this thing out .
Buddy is strickly an indoor cat-he never ever goes out, we live in manhattan.
I have tried to feed the low, but i get scared and give karo sometimes,guess i will try not to next time.he actually saw some blue today, i am expecting it will be like this for a few days and then bg plummets to 20.
Could you explain what is meant by not micro managing the #'s? thank so much !

 

[Melissa&Paul-Kyle]

I have tried to feed the low, but i get scared and give karo sometimes,guess i will try not to next time.

I think you should feed the low ONLY if you are comfortable with it. As I wrote before, hypo is nothing to be taken lightly.

The benfit of feeding over Karo is to avoid that super high rush of sugar and skyrocketed BG's, keeping BG's more level and predicatable with the slower food rise. Lev is a good insulin for this- others like Vetsulin are NOT.

The benefit of Karo is to raise the sugars drastically away from any potential hypo situation. Hypos can be a serious and life threatening issue- not child's play or time for experimenting.

I understand you have been around for awhile, though and it seems as if you have a fairly decent grasp on how Buddy usually reacts to certain BG levels.

IF you feel confident and if you can be awake and available to test consistently thorugh it, feeding the next hypo level *might* give you better results than the Karo.

Hoping there is not another hypo level of course, but if there is, maybe note the dose that brought him there and see if you might back it off a titch...like .1u ish.

I would also note the eating for that day and any odd or interesting behavior differences that might indicate and outside source (not the insulin) contributing the the fluctuations.

Also realize that if you do choose to feed hypo numbers instead of the karo, you can always get the Karo involved if the feeding doesn't seem to be working.

As you know, remember, too, that Lev being a long duration insulin also results in long duration hypo numbers sometimes. My rule of thumb is 3 rising numbers in a row at 1/2 hour intervals before I relax. Even then, I am known to set an alarm to test again in an hour. ;-)

he actually saw some blue today, i am expecting it will be like this for a few days and then bg plummets to 20.

Now, Now! Let's think positive! This may be the time when things actually level off for you and Buddy....I mean, keep your guard up- you know your cat and if plummets are typical, you don't want to ignore the potential. But maybe interjecting some positive vibes into the situation can help turn things around?

Could you explain what is meant by not micro managing the #'s? thank so much !

NOT micromanaging, by my definition, is what I have been doing with PK for a few months now.

Please realize we have been at this nearly 3 years now, and thousands of tests and trials and 6 month hiatus of OTJ and working things everywhichway later, it finally dawned on me that PK is a much happier kitty riding a little higher in the BG's.

His BG results are extemely predictable and boring ( knockwood, antijinx) at the higher levels (100 ish- 300ish) so I don't feel the need for constant curves and multiple spot checks through EVERY day.

His behavior is as good of an indicator as testing BG's and managing his FD by the numbers...I know when he is chasing the old lady kitty's and making them screach that he is around 100's or lower....if he is slinking around like an outlaw with a bag full of "goods", I know he is closer to 40's....if he is sluggish, sleepy-looking and unreactive w/ third eyelids up, I know he is riding a food spike of 300's or so. I think that food spikes make him feel kind of crappy.

With his behavior ( 5 P's) indicating a happier kitty "regulated" between 100-300, I don't feel the need to reach for "the greens" as many others do.

I don't advocate letting your cat stay in the higher numbers...if your cat can achieve the greens and blues and be a happy kitty, PLEASE by all means, go for it!

For PK, it just isn't in the stars for him to do well that way.

So, that is what I mean by NOT micromanaging BG's...we are just more relaxed at our house, our goals are blues + ( 100's +) , not greens - ( under 100 ) and b/c of that, I don't test like I used to, I don't worry about getting under renal and other things that come with micromanaging PK's FD.

I used to, and it worked for us then, and works for many others now, but for us now, NOT micromananging works well.

Keep us posted!

(((hugs)))

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Marci and welcome back.

Taking in to account the entire chart, it seems very possible that Buddy is a diabetic cat who is flirting or has flirted with remission. The indicators to me are those 30s. A cat who is eating well on their dose rarely gets in to the 30s. 60s even 50s yes, 30s are a red flag for dose decrease as long as the cat's appetite is strong.

So now you must wonder what decrease you should make. I suggest going back to his last best dose - which was .5U. That may seem like a big drop, but if it doesn't pan out, you have room to work back up.

Also, .25U increases when dose is 1U or less are too large. Think in percentages - .1U is 10% of 1U, while .25U is 25% of 1U, so an increase of .25U from 1U to 1.25U is a 25% increase. Ideally Lev regulates best when increases are no more than 12-15% of present dose. A bit contrary to Tilly protocol recommendation, but I see better regulation when I increase by .1U or even .05U than by .25U at one time. I also feel it is why so many cats experience what Buddy is - constant fluctuations of BGs within 1 cycle, especially at the lower doses.

Another key with Lev is give it time - you will see responses to dose changes that will make you think rebound, that will make you think it's not enough insulin, that will make you crazy!! So that's why it's best to decide on a change, give the dose 5 days. As long as the cat is otherwise healthy - good eating habits, no infections, the 5 Ps - you should not run the risk of ketones or other problems. Curve after 5 days and see what the +7 to +10 BGs are. A good dose should produce steady numbers, not necessarily low/double digit numbers either. BGs steady in the 100s are better than BGs ranging from 30 to 300/400.

Hope that helps. I've been offline for a week now and just now back on the boards, but will try to keep in touch here.

 

[Vicky & Gandalf (GA) & Murrlin]

Oh please continue with the 20 q's...it's great to have help trying to figure this thing out .
Buddy is strickly an indoor cat-he never ever goes out, we live in manhattan.
I have tried to feed the low, but i get scared and give karo sometimes,guess i will try not to next time.he actually saw some blue today, i am expecting it will be like this for a few days and then bg plummets to 20.
Could you explain what is meant by not micro managing the #'s? thank so much !

Not micro-managing numbers means looking at the whole cat, as you have done by noting that he's great on the 5 P's. It also means not adjusting dose based on individual numbers. You cannot get a BG of 400 on Levemir and automatically think that means the cat needs more insulin - it can mean the cat needs less insulin.

One of our members, Illka, likens managing Levemir to steering an ocean liner - it takes a long span to react to course corrections. That's why 3 to 5 days on a dose is needed before deciding what the numbers mean.

 

[Marci and Buddy]

Wow Vicki-what great information-thank you! makes alot of sence that an increase should be less than .25 if 1u or less....but 12-15% is so hard to measure,guess its just a question of a drop or 2,right?
so yuo suggest going to last best dose of .5-are you thinking I should go from 1.20u to .50 directly or gradually ?
very good news to me that he still has at chance at remission...i was beginning to give up hope.thanks for the help, everyone. ;-)

 

[Vicky & Gandalf (GA) & Murrlin]

There is no reason you can't drop right to .5U as long as he's eating well and has no infections. Changing the dose gradually only makes sense when increasing, not decreasing. But a large dose change in either direction may cause fluctuations in BG levels, mostly higher. The thing to look for is steady numbers, even if they are in the 300s. Hopefully they'll settle in to the 200s soon after, but it's hard to say. He's had quite a bit of swinging going on, so this may take a while.

As for measuring small doses - If you want me to go on about my micrometer device, I will. In short, I use an external measuring device called a micrometer. It works well for me, because my dad was a mill worker and I know how to use one. It can be helpful down to about .2U, beyond that, I think Sheila's droplet method is better. The most important thing is consistency. If you have a technique that produces a consistent result, keep doing that.

May I ask what brand syringes you use? Some are better than others at having less bubbles.

 

[Sheila & Beau GA & Jeddie GA]

Marci, I have been thinking he was rebounding as well, but I tend to look at things in "rebound-colored" glasses and I always see it, so...

I think the suggestion to go to .5u is good - allowing for him being in good health otherwise and eating well. If he has been rebounding the numbers should improve fairly quickly.

His numbers have looked a lot like Beau's did at the start of Lev. Particularly toward the middle/end of July (if you are interested in looking at his SS - that would be summer of 2009). I saw a huge improvement as I decreased his dose.

A couple of comments on food: do you know how much you are feeding overall for the day? Is it enough/too much calorie-wise? How much does he weigh? I am assuming that the "critters" coming out you refer to are the nasty crawling kind? I don't blame you for not wanting to leave out food. Can you feed a snack right before bed?

Finally, you might try a few drops of karo in a tablespoon of food when he drops low next time. The karo will help get his BG up and the food will help keep it up. That's what I did with Beau when he dropped into the low 30s once. It was his third shot of lev and I panicked a bit, but I think the technique is sound. "Gravy" food is often recommended, but you'd have to stock a few cans of Fancy Feast gravy flavors or something and I'm not sure you want to since his regular diet is so much better for him.

As for the mico dose changes using percentages, just round up/down to the nearest .1u or whatever you can draw comfortably. The drop method I use is to practice with a used syringe and water or expired insulin and draw up 1u, then twist the barrel (clockwise if the needle is pointed away from you) slightly until a drop forms on then end of the needle. It will be about the size of the end of a straight pin. Flick it off and twist to form another one. Practice until you get 10 drops that size from one unit and 5 drops that size from a half unit. Those would be .1u drops, so you can dose fairly easily in any increment of .1u. If you want to perfect that, try for a drops HALF that size. Those would be .05u drops. Loads of fun to draw! I have to take off my glasses to see to do that. Beau was on .05u for several weeks before he went into remission. He would even, occasionally, drop to the 30s on that dose.

 

[Marci and Buddy]

Ok so drop to .50 u it is, or will be ...when i get his newly ordered insulin next week.i think this batch may have froze for few hours, not sure, so i will wait and start new-only concern is, when Buddy was on .50u he didn't well for very long on that amt, which is why i increased....wondering about your thoughts on that? Meantime i now uped him to 1.25u from 1.20 b/c his #'s so high.
Sheila, i noticed you didnt keep Beau on the same dose very long- at times only 1 or 2 cycles and seems to have worked for you..how did you decide that? i want o change his dose more often but read its best not toso i dont.
BTW-Buddy eats 4 nuggets of rabbit per day-he weighs 12.5 lbs, (he has a lovely figure).
we use the monoject needle 3/10cc, w/ 1/2 markings. what do you use?
thanks sooo much for helping...can't wait till these crazy fluctuations pass-i feel so bad for him. :YMSIGH:

 

[Sheila & Beau GA & Jeddie GA]

Beau is his own cat - he does NOT follow the rules very well!

I wasn't changing the dose that much, but it is important to note that I was going from 2 years of vetsulin (very fast acting) to lev and started at the "conservative" dose of a half unit where he proceeded to drop to the 30s on the third shot. Whoa! That called for an immediate dose decrease, of course. And then I tried to hold the dose and increase slowly, but I would get a sudden low number at PS (lower than he was trending) and since I was going to be gone at work and feared that drop to the 30s, I decreased a little for that cycle.

That thinking is "fast-acting insulin" thinking, and, yes, you are supposed to hold the dose with the idea that lev (and lantus) gets kitty's number to the normal range and keeps them there. But you do have to do what you are comfortable with. I was not comfortable shooting a full dose at that stage on a low PS number.

Pretty much most of July (2009) to the first week of August I was struggling with rebound but didn't know it. I was so frustrated I was about to go back to vetsulin! Then I read the petdiabeteswiki page on somogyi rebound and it "clicked" for me. After the 1st week of Aug I was slowly, but steadily, reducing his dose each time I saw a low number (below 40-50). Since he was going into remission he was sort of in an "as needed" stage where I had to respond to his decreasing numbers with decreasing doses. I did a lot of spot checks to catch any real lows and would then decrease.

I think if you have the data and your cat responds well to dose changes done to accommodate a lower PSs - meaning you know he will drop low if you shoot the full dose then it is OK. But you have to have the data otherwise you are guessing and can end up chasing numbers up and down. It took me a long time to treat Jeddie as if he wasn't Beau and I have been holding him at the same dose even with occasional high or low PS numbers. Plus I am home during the day now (thanks to unemployment) and can watch him.

So, I would recommend holding steady and making changes based on data, especially nadir numbers - unless you get a sudden PS of 80 and have an all day meeting outside your home. Then I would be inclined to cut the dose some.

 

[Sheila & Beau GA & Jeddie GA]

Oh, I use the same size syringe by GNP (sold by Hocks).

I'm not sure on the food. Are those 1oz medallions? That sounds about right for a normal healthy cat, but don't forget that diabetics can eat a lot more when they are not well regulated (not saying he is not well regulated). Both of mine ate like small horses for quite a while in the beginning. Beau was eating up to 10-11 ozs. He now eats about 6 ozs. This is canned food, where 6 ozs is about 200 calories. He only weighs about 10.5 lbs. Jeddie weigh 12.5 or so and eats about 8 ozs these days, but he ate more for the first 6-8 months that I had him - which was right after he was diagnosed and had lost 5 lbs (he was 8.5 lbs when I got him).