Strange swing, shot time soon, do I change dose?

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my Casey bear

my Casey bear

Active Member
Hi everyone,

Just wondering if what you think of this swing.

PMPS ~ 199 ~ s1.0u Lantus
+2 ~ 172
+4 ~ 81
+5 ~ 112
+6 ~ 139
+11 ~ 252
AMPS ~228 ~ ??

What does it means? Was she getting too much insulin? Do I need to change her dose?

Roberta
 
I hope I did the right thing...

Because of the low # at +4 and high +11 companied with the dip less than an hour later, I decided to reduce her dose to 0.75u. (I was assuming it was rebound, but not sure what to do about it.)

Robrta
and Casey

(I usually like roller coaster rides, but I am not enjoying this one...)
 
What insulin are you using? The various insulins behave differently and that is the first thing we need to know.

Lana
 
Okay, I do see that you are using Lantus.

That curve is not a roller coaster ride. It looks excellent. Looks like you have found a good dose.

What is it about that curve that is making you nervous?

Lana
 
Roberta,

That was a beautiful curve, there was nothing scary about it as well, that looks just the way you want a lantus curve to look. One thing with Lantus is that unless Casey drops clear down into the basement 40s-50s early in the cycle you don't want to keep changing her doses around...Lantus like consistency, because it works off a shed that has to be built up before the insulin actually starts going to the cat, and not the shed. I can understand since you are new to this, that you got nervous and lowered her dose this morning. But unless she is really low tonight on her preshot number, if she was Musette I would go ahead and give her the full 1u tonight, hold that dose for about 5 days and then run a curve and base any dose changes off that week's worth of number plus that curve.

With the longer lasting insulins you need to hold a dose for 3 to 5 days before switching it up (6-10 cycles). Unless the kitty tells you otherwise, like being 36 at +2 fr example. You want to make your decisions on the patterns you see and try not to react to just one number. I know its hard in the beginning because we are worried about so much and all the thing that can go wrong. But with a little patience and consistant dosing, Casey will be just fine.

If you would like, let me know your time zone and when Casey's shot times are and I will make sure I'm around to help hold your hand if your nervous...cause that is what we are here for. :-D

Mel, Maxwell, Musette & The Fur Gang
 
Yes, that was a very nice curve! I just want to agree with the others, that you want to hold that 1u dose because it seems to be working working well. Unless you get a number that's less than 50 somewhere in the cycle, or a low preshot, then you don't need to worry.
 
Roberta, you're doing great!

Lan, Mel and Julia,
Not sure if you saw this
viewtopic.php?f=28&t=48984

I think the reason for the change was that Roberta saw the 81 at +4 after midnight and was still 2 hours from nadir, and was concerned about hypo. I think she fed a bit to bump up the sugar. She had probably also read the hypo-related threads from the previous 2 nights. There weren't too many veterans around last night to difuse any panic.

I wouldn't have thought it was a pretty curve at +4 if it were Bob, but yeah, it looks super 12 hours later.



Carl
 
In my experience Lantus has some pretty gentle drops once you get close to nadir time, so I would have kept testing through the cycle to see where it went to make sure there was no hypo, but no reason to panic because it probably wouldn't have dropped too much lower. But it's important to keep the dose consistent with Lantus, and stick with a dose until a reduction is earned.

Roberta, have you thought about posting for dose advice in the Lantus forum? There are people there who arevery experienced with Lantus that give wonderful advice. There's also alot more eyes over there than on the Health board, so in an emergency you'll get a faster response.
 
I'm a former super super tight regulator Lantus but would have to convert all the American numbers to International numbers first to see where it is at

US

PMPS ~ 199 ~ s1.0u Lantus
+2 ~ 172
+4 ~ 81
+5 ~ 112
+6 ~ 139
+11 ~ 252
AMPS ~228

Int

PMPS - 11.1
+2 - 9.6
+4 - 4.5
+5 - 6.2
+6- 7.7
+11 - 14
AMPS - 12.7


I think this looks very good.


In the days when I did super super tight regulation, I would shoot at pmps and amps numbers under 180 (10) - all hardcore calculated from the amount of food and calories he would come to eat during the day. And I liked to keep him at 90-180 (5-6). But the vets at our hospital are happy with a curve like Caseys and also if we can keep them in the 90-180, but they are not happy if shooting at numbers 180 and under.
 
Thank you everyone fo the info. And thank you Mel and Carl for being understanding. Have to get back to work...

Roberta
 
Ok....back home from work...

Mel and Carl were both right..., being new at this I did get nervous and afraid that Casey was heading toward HYPO.

It has only been about a week since I started giving Casey insulin and was basing things on what her limited track record had been. Other than right after the increase in dose, her curves had been relatively gentle.
my Casey bear wrote:
Tested her at +2 ~ 172, and now +4 ~81
Click to expand...
When I saw the rapid decline, compared to the previous 2 cycles, I was not sure if that was normal or not and if she was just on a curving or heading into a nose dive. I was happy to see her at 81, but the big drop in getting there and not being sure how much lower she would be going scared me. Then her +11 being at 252 made me wonder if I did something that caused her to do a rebound... Her curves have not been that extreme before, so even though I had prepared her AM shot to be the full 1u, I last minute, still not sure if it was a rebound or not, decided to decrease just incase it was. And yes, I know realize, thanks to everyone, that it was a bump...not a rebound.

I plan to resume her full 1u tonight.

Mel, I am in central time zone and I give Casey her shots at 7am/pm.

And Lana, I guess I should have made myself more clear...
by Lana & Yoyo » Tue Aug 02, 2011 7:39 am

Okay, I do see that you are using Lantus.

That curve is not a roller coaster ride. It looks excellent. Looks like you have found a good dose.

What is it about that curve that is making you nervous?
Click to expand...
The "roller coaster" I was referring to was the emotional one I have been on since I found out Casey was a DC....sorry

Well, I need to go eat and get Casey ready for her PM shot....

Thanks again,

Roberta
and Casey
 
roberta, you probably want to stick to getting advice just from the lantus forum. you don't want conflicting advice from different places when people can't see what others are saying. it's not a problem, but open discussions when we give each other advice, especially on dosing, is part of what makes this site work.
 
Julie,
The past several days, whenever I have seen a post where Lantus is mentioned, and it's sounds like an emergency, I've been cross posting the thread into the Lantus forum for them. What's sometimes frustrating for them (and for me a couple times) is that they may not get a response for 10 minutes and that seems like an eternity when you're freaked out and needing somebody to tell you what to do. It's good that you are telling her that posting first for dosing advice in Lantus rather than in Health, where Lantus users are more likely to see it and reply quickly. But most newbies aren't even aware that there are different forums for each insulin type. The see "Feline Health" and "ALL cat health posts, even if they aren't about diabetes, belong here." , whereas they might also see : "INSULIN SUPPORT GROUPS (ISG)
IF YOU ARE NEWLY REGISTERED, PLEASE DO NOT USE THESE GROUPS for your first post. Please post in the FELINE HEALTH forum. " So they post here and hope somebody will help them.
Seems to me, the more people that see these discussions, the more they'll learn about every type of insulin. I'm a PZI'er, don't know squat about lantus, levimir, humulin etc. But I'm learning something new every day. I wouldn't be if I had to go visit each support group's page in order to learn. I don't have that much time in a day. The more people there are that can respond to "newbies" with some sort of degree of competence, and at least be able to answer basic questions or be able to figure out who to direct the questions to, the better (IMHO) the board on the whole will be.
Hope I'm just having a bad day or taking what you said the wrong way, but " you probably want to stick to getting advice just from the lantus forum." ?

Carl
 
carlinsc said:
Julie,
The past several days, whenever I have seen a post where Lantus is mentioned, and it's sounds like an emergency, I've been cross posting the thread into the Lantus forum for them.

Carl
Click to expand...

Carl,

How do you cross post the threads?? I have been trying to figure that out.

Roberta
 
Roberta,
Go up to the address bar on your browser. Right click on the url address and pick "copy". Then go to the forum you want to post the link to. Open a "New Topic", then go to the message part, right click, and pick "paste". That'll put the thread url address in your message.
I usually add a line of my own like "can someone please take a look at this?"
If it's an emergency or something that needs immediate attention, indicate that in your post's "Subject" line above the message window.

Carl
 
carlinsc said:
Roberta,
Go up to the address bar on your browser. Right click on the url address and pick "copy". Then go to the forum you want to post the link to. Open a "New Topic", then go to the message part, right click, and pick "paste". That'll put the thread url address in your message.
I usually add a line of my own like "can someone please take a look at this?"
If it's an emergency or something that needs immediate attention, indicate that in your post's "Subject" line above the message window.

Carl
Click to expand...

Ahh, ok...thank you

Roberta
 
how bizarre. carl, i thought i answered you but i'm distracted by sushi's situation, so maybe i switched screens without posting.

i was just gonna say that i've noticed that you've been cross-posting when there's a need and that's super!! i'm responding to those and so are others - it's helpful for us to come help when it's a lantus user - so i think we all appreciate the flags.

at the point where someone is transitioning to one of the insulin support groups, i think they're going to get the 'cleanest' help and advice if they stay in just one forum rather than asking the same question in multiple places. if people have several different comments in one thread, the person getting the advice can see it all and the advisers can see what others have said, but especially with dosing, if it's in multiple places i think the potential for mistakes increases significantly. that's my only point. if it's general health or diabetes advice, that's different, but i'm just encouraging roberta to ask questions about lantus specifically and dosing on the lantus forum.
 
julie1220 said:
how bizarre. carl, i thought i answered you but i'm distracted by sushi's situation, so maybe i switched screens without posting.

i was just gonna say that i've noticed that you've been cross-posting when there's a need and that's super!! i'm responding to those and so are others - it's helpful for us to come help when it's a lantus user - so i think we all appreciate the flags.

at the point where someone is transitioning to one of the insulin support groups, i think they're going to get the 'cleanest' help and advice if they stay in just one forum rather than asking the same question in multiple places. if people have several different comments in one thread, the person getting the advice can see it all and the advisers can see what others have said, but especially with dosing, if it's in multiple places i think the potential for mistakes increases significantly. that's my only point. if it's general health or diabetes advice, that's different, but i'm just encouraging roberta to ask questions about lantus specifically and dosing on the lantus forum.
Click to expand...
Julie,

The only reason I posted the question in multiple locations yesterday was because I could not figure out how to cross link the original post. I new that the Health SG had the most traffic, but wanted the Lantus SG to see it too.

I did not main to complicate things.

Roberta
 
julie
thank you very much for the response. I understand better now what you meant. and I agree, when someone gets to a point where they are settled in with the "introduction to fd-101", and they have insulin specific issues, then it makes perfect sense to go to where the expert knowledge is. And I know my current limitations, so if I don't know the answer, I'll direct the question to someone who most likely does. Or PM them in a crisis for help.

I did notice one thing during the "Hypo signs" thread a little bit ago. Half a dozen people joined in within minutes, then several more within minutes later. Everyone was posting simultaneously. No answers were being posted for a while.
Side bar - IRL, on any given day, I am likely to be put in an emergency type situation (injury/accident/first response/crisis) where there are at least a dozen people with radios trying to manage that crisis. At some point, people will start talking over each other, and that can become dangerous. So at some point, the person in charge of the situation (which could be any of those dozen people) will get on the radio, and in nice clean radio language, tell everyone to shut up and clear the radio channel. Then he or she manages the crisis.
OK, in a thread like that, I looked over to the right side of the screen at everyone's info, and saw that there were 3 people in the thread with thousands of posts to their credit. Obviously, they are the best suited to manage the "crisis" due to their extensive experience and knowledge and the many years they've dealt with these sort of issues. I instantly quit posting and just observed. My question is :Is there a tactful way to ask everyone to please stop posting and let person X talk to the person with the crisis without all the other "chatter"? How do you tell everyone who only wants to help "It's okay, I've got this"?

I didn't mean to hijack this thread, but I think it might be good for me and some other newer members to understand how and when we need to just sit back and watch and learn in case it's 2 in the morning some day and we're the only ones around and somebody has a hypo or someting equally scary, so that we can manage to help them effectively.

Thanks again,
Carl
 
roberta, it wasn't a problem - i'm just trying to help you get settled so you get the best possible advice.

carl, you're absolutely right - today that there were behind the scenes pm's going - i think you started one, perhaps, to get help. i think usually people will simply watch if someone else is leading. i'm not an expert and today's was a little unusual, partly because there was more than 1 thread going on.
 
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