Too low to shoot?

[Dale 'n' Chip]

Apparently not a problem I'll ever have with Chip (at the current rate) but is there a number with Levemir that would be too low to shoot?

It seems like the higher the dose, the later the nadir. But unlike with Lantus, the Levemir nadirs never seem to run together from opposing directions. So as long as shooting at the correct time, the PS reading seems somewhat irrelevant with Levemir? Unless it is the nadir?

 

[Sheila & Beau GA & Jeddie GA]

While it is true that you "shoot low to stay low" also with lev, you don't want to be doing that without data - meaning, the first time you get a much lower number either be home and test often or reduce a bit until you can catch the low PS when you are home.

There are do not shoot numbers with lev, but they will vary by cat. I have seen people shoot hull doses on PS's in the 80s and have the cat be fine with it, but I could not do that with Beau. Even when he was on .05u I had a do not shoot number of about 130. Again - finding those numbers is based on the data you are collecting.

You can set a do not shoot number based on your data and comfort level and slowly lower it as you test out how well your cat does - and/or reduce the dose and slowly bring it back up as data dictates. You don't want to be trying for a sliding scale-type thing. If you have PSs that swing from higher to lower, then a dose reduction is probably needed overall, not just on the low PS.

I have seen some shoot at numbers that I think are dangerous to give insulin on - like the 50s - and I feel that to shoot any insulin below 80 is risky, but if you had the data that says your cat will rise into the low 100s, surf there and then drop back to the 80s, then it would be ok, especially on lower doses.

But unlike with Lantus, the Levemir nadirs never seem to run together from opposing directions.

I don't know what that means.

I found that the higher the dose the earlier the nadir with lev, but lev seems to nadir later in a lot of cats - like +8 give or take.

 

[Dale 'n' Chip]

But unlike with Lantus, the Levemir nadirs never seem to run together from opposing directions.

I don't know what that means.

I found that the higher the dose the earlier the nadir with lev, but lev seems to nadir later in a lot of cats - like +8 give or take.

It's like having PM nadirs getting earlier and earlier in the cycle, with simultaneous AM nadirs getting later and later, until two appear to cross the PS and merge. Only seems to happen with Lantus.

Levemir seems to have more predictable nadirs in general.

What would cause Chip to appear to nadir at +12?

 

[Sheila & Beau GA & Jeddie GA]

What would cause Chip to appear to nadir at +12?

ECID, overlap....

I'll try to look at his SS later - about to run out the door right now.

 

[hmjohnston]

No idea, either.

Then again i'm dealing with an insidious little monster that is inhibiting my slowly growing fur ball of love :lol: .

Maybe you could ask Carl (and Bob). He has a really good grasp on the things that make my head hurt :roll: . On this forum there are really only less than 10 people who come here and some of those, like me, are completely out of their depth with giving advise.

 

[Dale 'n' Chip]

What would cause Chip to appear to nadir at +12?

ECID, overlap....

I'll try to look at his SS later - about to run out the door right now.

Maybe it's overlap? His actual nadir on that last transient green was 75 @ 11.5. Confirmed on two meters.

I wasn't comfortable shooting that without knowing he was (apparently) done dropping, so I tested a half dozen times that hour with both meters. If he's overlapping into +1 +2 +3, that might explain why his peak glucose level now seems to be around +6. And the the nadirs are at +11 +12. That makes for an ugly inverted curve (when he's not excruciatingly flat) but I don't see any evidence at all it's too much. Instead I think we aren't there yet. At this rate, it may still be a ways off unless there is some kind of abrupt breakthrough that will hold and settle.

 

[Sheila & Beau GA & Jeddie GA]

I'm not seeing that he has a +12 nadir. Looks to me like it is +7 to +10. That is normal for lev.

He had some great numbers for the better part of two days (3 out of 5 cycles), but he still bounced a bit after them. I'm not sure it was the right time for another dose increase this last time. He was starting to come back down to the number range he was at the day before the first cycle of blues and greens, but then you raised him and today's blues were not quite as low as Monday's blues.

I'd just slow things down now that he is hitting greens.

 

[max&emmasmommie]

You are getting Greens!!!!! All right!

dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat

 

[hmjohnston]

You are getting Greens!!!!! All right!

dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat

I will second that!- come-on Chip!

 

[max&emmasmommie]

Pumbaa and Chip,

Wow! Look at the three of us go!

Max

Max can have his phone (and his iPod, and his laptop) back now that Pumbaa and Chip have decided to be good little boys and won't be a bad influence on Max, and neither will he be on them! Both are below renal threshold even if they are having Blue pre-shots!

:RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT

 

[Grayson & Lu]

Looking good kitties - LOOKING GOOD!!!

 

[hmjohnston]

OUCH! What happened? Did Chip find some contraband? Or was it storm stress?

 

[Dale 'n' Chip]

Nope, no contraband, stress or furshot I'm aware of.

Hopefully it will just take more juice to tamp this down.

But he was nominally regulated for about 3 days which is a minor miracle for Chip these days. :smile:



Perhaps this is *extreme* "New Dose Wonkiness"?

hold the dose and ignore the fluctuations.

 

[max&emmasmommie]

Let's hope it's just a big, ugly bounce from those Greens.

 

[Sheila & Beau GA & Jeddie GA]

Or maybe those 400s are from the 3u dose.

I'm really not sure why you have increased above 2.5u. He had an 88 PS on that dose, on day 5 at that dose. If it were me, i would have held that dose a lot longer and "ignored the fluctuations" at that point when he threw a few 300s.

 

[Dale 'n' Chip]

Or maybe those 400s are from the 3u dose.

Whatever it was it was entirely gone in 24 hours.

I'm really not sure why you have increased above 2.5u. He had an 88 PS on that dose, on day 5 at that dose. If it were me, i would have held that dose a lot longer and "ignored the fluctuations" at that point when he threw a few 300s.

You'll be happy to know I reduced because he actually was too low to shoot. :smile:

The reason for the increases is because I'm doing Tilly, you never sit still more than 7 days as long as they are seeing yellow or above. For flat yellow, pink or above the maximum is 3 days. I held each dose the absolute maximum possible. Looks like (maybe) it's actually working for Chip.

I can always lower the dose it when he's too low to shoot, the protocol does have provisions for that.

Do any seasoned Levemir users (here) have experience with Tilly/Roomp Rand TR?

 

[Sheila & Beau GA & Jeddie GA]

Do any seasoned Levemir users (here) have experience with Tilly/Roomp Rand TR?

This is my opinion only, but I think that we are posting here because Tilly/Rand didn't work for our cats and/or our situation (work schedules, etc.). Although Pamela has experience with Rand using PZI, I believe.

For me, I just could not be here to do all the testing for TR (although they weren't really calling it TR using the Tilly protocol yet) and Tilly did not work for Beau. If I had followed Tilly I would have kept raising the dose at the point where .4u seemed like not enough and .5u seemed (was) too much (and there were people to told me to raise the dose to "break through"). Instead, I lowered the dose even more and that worked and he was off insulin in a few more weeks.

What is "Roomp"?

 

[Dale 'n' Chip]

Oh, I thought we were all here for Levemir. ;-)

And for the crowd and the prompt personal attention. I just assumed the Levemir dosing protocol (whatever it is?) was adapted from Tilly since Vicky has a link to it in that sticky.

As for who is K Roomp? Maybe actually Kirsten from Tilly?

The Roomp/Rand TR protocol is specifically only for glargine or detemir. There is another (apparently) entirely different Tight Regulation protocol from Dr. Hodgkins for PZI which seems to promise faster regulation than Roomp/Rand TR. Perhaps that one is a sprint instead of a marathon?

 

[Sheila & Beau GA & Jeddie GA]

This isn't an official levemir ISG dosing protocol. We general direct new users to the Tilly protocol as it is a good place to start, but it isn't usable for everyone and doesn't work for all cats.

The Lev ISG seems to have become a place for those who's cats didn't read the Tilly memo, have odd schedules, just don't want to follow the whole Lantus Condo thing, etc., etc. Some of us tried to make the point that the lev ISG was already the place for non-TR management, but for some reason it was decided that yet another ISG, relaxed lantus, was needed. Whatever.

Yes, you are right about the old TR for PZI being the Hodgkins one. My mistake. But the principals are very similar.