Sue and Ruben --higher numbers question

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Sue and Ruben

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I have not updated my spreadsheet in some time..so I know I need to do that.
I am hoping that someone can provide some advice regarding a shift in Ruben's numbers.
He was getting 2.5 units of Lantus for a very long time (over a year). I had a honeymoon period of about 2 weeks (about 3 months or so ago) when he was getting great numbers (low 100's and below 100)

However, in the past 2 months, his numbers started to climb a bit and my vet advised an increase to 3.5, after running some test. I upped the dose but despite the increased dose, his numbers are still in the 300 range for both the AMPS and PMPS and around 200's at nadir. He has even hit 400 a few times, which he really has never done in the last 1 1/2 years that he has been on the medication.

My question is whether to up the dose again and more importantly, what issues could arise with the numbers remaining high. I am going on vacation for 2 weeks and my pet sitter will not be able to do the daily testing. Can high numbers be a serious concern if they stay that way for the next 2 weeks?
 
also...i should add that he is on wellness and one of the low card FF (beef and chicken and also tender beef) and is acting perfectly fine.
 
Sue and Ruben said:
I have not updated my spreadsheet in some time..so I know I need to do that.
I am hoping that someone can provide some advice regarding a shift in Ruben's numbers.
He was getting 2.5 units of Lantus for a very long time (over a year). I had a honeymoon period of about 2 weeks (about 3 months or so ago) when he was getting great numbers (low 100's and below 100)

However, in the past 2 months, his numbers started to climb a bit and my vet advised an increase to 3.5, after running some test. I upped the dose but despite the increased dose, his numbers are still in the 300 range for both the AMPS and PMPS and around 200's at nadir. He has even hit 400 a few times, which he really has never done in the last 1 1/2 years that he has been on the medication.
Click to expand...

hi sue. how low is the current dose taking ruben?
dose adjustments when using lantus/levemir are based on nadirs, not preshot numbers.

EDITED TO ADD: i missed the mention of nadirs in the 200s. did you catch these nadirs on more than one day? the reason i'm asking is a drop to a number lower than kitty's body is used to can cause a bounce lasting for as long as 72 hours.

are you familiar with the Tight Regulation Protocol most of us use: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581?

a general guideline:

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

you'll notice we generally increase in increments of 0.25u or 0.5 unit. by increasing the dose in increments of 1 unit, you could be giving ruben more insulin than he needs... which could cause the numbers to remain high. another possibility is the higher numbers you're catching what *could be* a bounce from ruben dropping lower than you think.

My question is whether to up the dose again and more importantly, what issues could arise with the numbers remaining high. I am going on vacation for 2 weeks and my pet sitter will not be able to do the daily testing. Can high numbers be a serious concern if they stay that way for the next 2 weeks?
Click to expand...

some kitties are prone to developing ketones when they're hanging out in higher numbers (although a cat can develop ketones while in lower numbers also). insufficient insulin + infection + inappetance is a recipe for diabetic ketoacidosis. oftentimes kitties do not eat as much as they normally do when their caregiver is gone.

i'd want to know exactly how low the dose is taking ruben before i left... especially if the petsitter will not be testing. hypo, hyperglycemia, kitty eating, and ketones are my concerns when a caregiver is gone for more than a day or two.
 
Hi Jill
thanks for the thorough reply. nadir's ranging from 175 to a high of 356. i have to admit i have not tested enough during the day and will do more. today at +6, he was 350. overall range (amps and pmps) in the last two weeks has been from 118 to 413
 
cool. you have a week to collect as much data as possible.

if i were in your shoes i would get as many nadir checks as possible in both AM and PM cycles. i know PM nadir checks are tough to do, but at least get a before bed spot check every night.

update the last couple of weeks on your ss and record collected data over the next week. the data will give you/us a better idea of what's going on. this in turn will give us an idea of a "safe dose" for your petsitter to shoot while you're gone.

sound good?
 
yes. sounds very good. i so appreciate your help here. i am a nervous wreck leaving for 2 week vacation with his numbers higher than i would like. i do test every morning and every evening before bedtime...and usually 1x during the day.
will get more spot checks over the next few days and update the spreadsheet at least from the last 2 weeks.
thanks jill.
sue
 
i just updated his #'s for the past month. any insight would be greatly appreciated. will continue to check multiple times a day and update. thanks!
 
hmmm, it's hard to draw any conclusions without sufficient data.
you'll have to step the testing, especially those before bed spot checks every single night in order to put the pieces of the puzzle together. once we have the pieces, the picture will become clear.
 
hi
i do test every morning and every night and have posted the last month or so. i could go back further, as i have results for every day but thought the past month is most helpful. will fill in with mid-day testing as well.
sue
 
Sue and Ruben said:
hi
i do test every morning and every night and have posted the last month or so. i could go back further, as i have results for every day but thought the past month is most helpful. will fill in with mid-day testing as well.
sue
Click to expand...
just took a peek at ruben's ss to see how things are going, but i see you haven't had a chance to update it last night and today. i'll check again tomorrow.

about those night time checks...
i was referring to before bed spot checks. the right side of ruben's ss is sorely missing data. i know it's tough to get nadir checks at night, but before bed spot checks would help fill in the picture. a before bed spot check every single night and occasional nadir checks at night will often give you clues as to whether further testing is necessary. if you shoot and then head right to bed, you may have to get some sleep tests done mid-cycle. we'd really like to help, but all we can do is make suggestions based on hard data. without sufficient data our hands will be tied. kwim?
 
03/03 Sue and Ruben --vacation/shot question

hi,
i have updated the spreadsheet and was wondering given the fluctuation in numbers and that i am going on vacation for 2 weeks (where the sitter will not be doing BG checks) what the ideal amount should be? he had been on 4 units and as you can see from the spreadsheet only recently have the numbers fallen a bit. I am considering dosing at 3 units in the morning and 3.5 at night...down from 4 units. i don't want him to go too low and be given a shot on the other hand i don't want the #'s to be very high. what do folks think? Jill and Alex? Seems to me that if he is too low ..that creates more problems than if his numbers are too high. thanks
 
Re: 03/03 Sue and Ruben --vacation/shot question

Sue,

I am absolutely no expert on this, but personally I'd be much more concerned with a hypo while you're gone than anything else. Especially since you've seen the numbers drop quite a bit in just the last few days on 3u. I don't know anything about ketones, but I do know my Gracie has had a lot of red and black with no ketones yet, and when I had a family emergency and was gone for a week without testing, I got home(see spreadsheet 2/19) and her numbers were way lower than they had ever been. I had to go away for two days again right away and decreased the dose my neighbor gave. Two weeks is a lot longer than 2 days, but I'd still rather have slightly higher numbers than have the numbers drop out from under him with nobody around to watch him.

Good luck, and I hope you can relax and enjoy your vacation.

Jason

Sue and Ruben said:
hi,
i have updated the spreadsheet and was wondering given the fluctuation in numbers and that i am going on vacation for 2 weeks (where the sitter will not be doing BG checks) what the ideal amount should be? he had been on 4 units and as you can see from the spreadsheet only recently have the numbers fallen a bit. I am considering dosing at 3 units in the morning and 3.5 at night...down from 4 units. i don't want him to go too low and be given a shot on the other hand i don't want the #'s to be very high. what do folks think? Jill and Alex? Seems to me that if he is too low ..that creates more problems than if his numbers are too high. thanks
Click to expand...
 
thanks for your reply. i just tested now at +6 and he is at 55.
i will decrease to 3 units evening and morning. i think that makes the most sense.
any others?
 
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