Too high a dose?

[nepenthe]

continued from here

I am really confused here about dosing. I recently switched from Lantus to Levemir to see if there would be more stability. I started on 1U Lev down from 1.75U Lantus and held that for approx 6 days before increasing .25 every 4 days or so. He is now at 1.5U and his numbers are getting worse.

When I look at his numbers now at the 1.5u Levemir he is getting, vs the 1U that he started on back on 7/11, it looks like he was getting better numbers back then.

Does this pattern over the past 4 days look like he is getting too much insulin? it seems whenever I raised his dose, he gets higher and flatter.

One thing is that he has had ongoing spells of pancreatitis for the past 2 yrs, so could it be that there is a low level residual inflammation in his pancreas that is keeping him from getting low numbers? Or, since he has been high for long time, maybe another factor keeping him from being low for long?

Could it be that following the protocol might not work if there is something else like p-titis keeping the #'s from getting low enough to benchmark? (Say there is a low-level inflammation somewhere, we might not see them getting into the greens/low blues and thus not be able to measure dosing and bounces).

Would I be better off dropping his dose tonight back to 1U Lev or even getting back on Lantus at 1.5U? (when I look back at his #'s over the past three months, seems he was doing the best at 1.5U Lantus.

 

[Sienne and Gabby (GA)]

I really hate saying this. Based on how you've been collecting test data, I don't know that I can answer your question. Both Lantus and Lev dosing is based on what numbers you're seeing at nadir. Dosing isn't based on your pre-shot numbers. Pretty much all of the data you've collected is pre-shot data. It's entirely possible that Chinga is getting too much insulin. It's also possible that he's not getting enough.

It would help enormously if you could get spot checks. At the minimum, if you're not able to get any tests during the AM cycle during the work week, then always get a before bed test. Try to get tests when you leave the house, when you get home, on weekends and holiday, etc.

If you look over the Tight Regulation Protocol, this approach was developed for both Lantus and Lev. As long as you're feeding low carb, canned food and can get additional tests, this protocol should help.

 

[Jill & Alex (GA)]

i really don't think the dose is too high given the limited data over the past four days.
however, if chingis were my kitty, i would continue collecting mid-cycle data before increasing the dose because i'd want to know exactly how low he's dropping on those days you're seeing blues.

when kitties have other health issues it's more important than ever not to become married to a dose. for instance, my cat has allergies, p-titis, liver disease, and kidney disease. she also stresses out easily when we have house guests. if you look at her spreadsheets over the last few years you can see how her dose goes up and down and up and down and up and down. i've learned to become very flexible when it comes to dosing. when she's having a problem... i take the dose up. as the problem clears... i take the dose down... sometimes rapidly, but this approach will require more testing than you've been doing. is it possible for you to get more md-cycle tests done?

What's happening is that the Levemir seems to kick in sometime (during the day) at +7 - +9, and then his pmPS is close to his amPS..

But then just three hours later, he seems to be climbing 100 or so in three hours right after his pm shot and staying high and flat all night.

what you're seeing is typical with levemir. *usually* levemir onsets at around +4. that means the numbers will often rise between shot time and +4 (unless you've built up a lot of overlap and carryover). then you'll see a gradual lowering until kitty nadirs later in the cycle. this action will often leave kitt'y's preshot numbers about the same.

 

[Chris & China (GA)]

I'm way too inexperienced to advise you, but I do have a couple of suggestions of things I noticed on your spreadsheet. On 7/17 you noted that you'd left dry food out all day since you were at work. What brand of dry food? Do you know it's carb content? Most dry foods are too high, and if he's getting dry on a regular basis (or sneaking it behind your back) that could be causing the problems with the readings.

The other thing I saw was you had said you were using the Alpha-Trak and back in February said you weren't testing to cut the cost of the strips. Is it possible you're not testing more due to costs? Is there any way you can get a meter with cheaper strips? I'm not at all familiar with what's available in Ontario, but in the US there are meters with strips that are only $9 for 50

Good luck to you both...I wish only the best for Chingis and you!

 

[Amy & Papaya (GA)]

I'm not at all familiar with what's available in Ontario, but in the US there are meters with strips that are only $9 for 50

Chris is talking about the Walmart Relion Prime meter. It's NOT available in Canada, sadly for us, but it's worth a border run (Buffalo?) if you can to get the meter and stock up on strips for the cost savings, if that makes it easier to do more testing. I'm in Winnipeg and buying the One Touch strips was killing me at around $75 for 100 strips, until I drove down to Grand Forks and then started training everybody I know to pop into Walmart in the US for me to pick up strips if they go down for a weekend!

I hope you can find a good dose for your kitty. Take care!

 

[nepenthe]

I'm way too inexperienced to advise you, but I do have a couple of suggestions of things I noticed on your spreadsheet. On 7/17 you noted that you'd left dry food out all day since you were at work. What brand of dry food? Do you know it's carb content? Most dry foods are too high, and if he's getting dry on a regular basis (or sneaking it behind your back) that could be causing the problems with the readings.

The other thing I saw was you had said you were using the Alpha-Trak and back in February said you weren't testing to cut the cost of the strips. Is it possible you're not testing more due to costs? Is there any way you can get a meter with cheaper strips? I'm not at all familiar with what's available in Ontario, but in the US there are meters with strips that are only $9 for 50

Good luck to you both...I wish only the best for Chingis and you!

thank you. It is all to do with the cost of these strips. Background: I tested him lots throughout the day before from when he was hospitalized with p-titis back in Jan 2011 until last fall, using the FS Lite.. Then at the vets' I tested against her AT and found it was 90 variance. So, I read up on here and found that most ppl agreed that the human meters read higher. I really blamed (and still blame) myself for exposing him to numbers for almost 2 yrs which were higher then reality. I had a false sense of security, thinking he was between 140-180 when he may have really been between 200-250.

People will say that the numbers don't matter as much as using the same meter, and I agree when it comes to understanding trends, etc, but the one thing that scares me is that you may think your cat's #'s are below the renal threshold, when they could be higher etc.. And then I've heard the vet say the human meters vary with higher doses.

The dry food was a brand like Evo called "Go!", which is one of the lower carb ones out there. But with this cat, even some of the low carb canned foods, like Wellness Chicken which is apparently 4% will cause spikes/rises as he seems sensitive to vegetables like sweet potato/carrot etc..

 

[nepenthe]

I'm not at all familiar with what's available in Ontario, but in the US there are meters with strips that are only $9 for 50

Chris is talking about the Walmart Relion Prime meter. It's NOT available in Canada, sadly for us, but it's worth a border run (Buffalo?) if you can to get the meter and stock up on strips for the cost savings, if that makes it easier to do more testing. I'm in Winnipeg and buying the One Touch strips was killing me at around $75 for 100 strips, until I drove down to Grand Forks and then started training everybody I know to pop into Walmart in the US for me to pick up strips if they go down for a weekend!

I hope you can find a good dose for your kitty. Take care!

Thank you. I wish I lived on or close to the border. It is beyond BS that we cannot get the Relion meter here in Canada. If I were to get a human meter, this would be the one, as I think it has the best reviews overall and the cost is unbeatable. We can't even get PZI here either, due to the paternalistic government here

 

[nepenthe]

i really don't think the dose is too high given the limited data over the past four days.
however, if chingis were my kitty, i would continue collecting mid-cycle data before increasing the dose because i'd want to know exactly how low he's dropping on those days you're seeing blues.

when kitties have other health issues it's more important than ever not to become married to a dose. for instance, my cat has allergies, p-titis, liver disease, and kidney disease. she also stresses out easily when we have house guests. if you look at her spreadsheets over the last few years you can see how her dose goes up and down and up and down and up and down. i've learned to become very flexible when it comes to dosing. when she's having a problem... i take the dose up. as the problem clears... i take the dose down... sometimes rapidly, but this approach will require more testing than you've been doing. is it possible for you to get more md-cycle tests done?

What's happening is that the Levemir seems to kick in sometime (during the day) at +7 - +9, and then his pmPS is close to his amPS..

But then just three hours later, he seems to be climbing 100 or so in three hours right after his pm shot and staying high and flat all night.

what you're seeing is typical with levemir. *usually* levemir onsets at around +4. that means the numbers will often rise between shot time and +4 (unless you've built up a lot of overlap and carryover). then you'll see a gradual lowering until kitty nadirs later in the cycle. this action will often leave kitt'y's preshot numbers about the same.

Thank you. I am going to definitely keep up with the testing schedule that I have going now, as its maintainable with work etc: amPS, +3 or +4, +6 or 7 or 9, pmPS, +3. So, 5 tests a day - if I move some of the daytime test numbers around, over the course of the week, it should present a pretty good picture, no?

So, with your last few sentences - do you think that it might take some time longer at this dose for him to settle as the overlap builds?

 

[Chris & China (GA)]

I wish I lived on or close to the border. It is beyond BS that we cannot get the Relion meter here in Canada. If I were to get a human meter, this would be the one, as I think it has the best reviews overall and the cost is unbeatable. We can't even get PZI here either, due to the paternalistic government here

Any chance someone could ship one to you? I'm not sure how customs is regarding medical supplies, but since they're not drugs, it seems to me that it wouldn't be a problem....but then again, governments seem to have their own ideas as to how much BS they can get their people to put up with :evil:

 

[nepenthe]

After having raised his dose for at least 5 days, I have decided to reduce his dose and switch it back to Lantus.

On 7/11 I switched from Lantus to Lev, starting on 1U and held that for 6 days, then increased by .25 to 1.25 for another 6 or so days, and then when I wasn't seeing any significant blues, I raised him again to 1.5U Lev. When I seen the numbers trending towards higher and flatter, contrary to what the protocol (and others) told me, I got too scared to either hold or increase this dose, as the last dose that he was doing passably ok on was around 1.5U Lantus. He was high and flat for days.

On thing with following one of these protocols - they all use the low numbers as a benchmark of dosing. What if one follows then and increases every 3-5 days and never sees greens/blues and just sees high flat numbers - what could that indictate?

Another question: when you reduce a dose after your cat has been high and flat for days, could it be that you might see even higher numbers for a few days? (am thinking this because could it be possible that after the cat has gotten too high a dose, the shed will start to dump stored buildup as it anticipates not needing at as the dose is lowered. So, the shot has more strength because the shed is dumping stored insulin, increasing the strength of the initial new lowered dose)