Too much insulin? amps 246 +4 332 (Atrak)

[sofietca]

Hi,
I wonder if anyone could look at my spreadsheet and tell me what they think for the past couple days' numbers. I increased Trouble's dose on the morning of the 21st to 1.25 units and since then things have seemed weird. I wonder if it's too much insulin maybe?

The morning of the 22nd she was 219, which I retested 10 minutes later and got 258 and confirmed it was somewhere between the two by also testing with one of my Relion meters. I was about to leave for the day and was nervous giving a normal dose since I didn't know how low she'd gone overnight with it, so I gave only .5 unit just to be safe. At +7 she was 375 and at pmps she was back down to 288. I went back to the normal 1.25 units Friday night. She had her highest value that I've ever seen with her 455 (on Alphatrak and 516 on Relion Confirm) on Saturday night. Unfortunately I haven't been able to do tests throughout the day lately so I don't know how low she might have gone to help in understanding what's happening. She was at 246 this morning (alphatrak; 226 Relion) and I gave 1 unit, and at +4 she is up 332 and it seems odd. Maybe I'm still used to ProZinc and expecting her lows to come in the 4-7 hour range, and maybe they're happening later? That's possible right? I'm going to test throughout the rest of the day and night and hopefully it will make a bit more sense to me. I just wondered if anyone can spot any problems right now from my spreadsheet - other than I need more data throughout the cycle.

Thank you!

 

[Ronnie & Luna]

hi there

looking at ss, the thing that pops out to me, is the inconsistent dosing, Lantus does do better on consistent dosing, takes a bit of time and patience, but can give you a better idea of how each cycle is going.


I'm linking your previous thread, viewtopic.php?f=9&t=47752&p=513931#p513931
as there are plenty of links that were posted for you - print them out if you can ok?
and do read up on the protocol --> viewtopic.php?f=9&t=1581
Let's see what others can add thru the day.

 

[sofietca]

Hi, thanks for the response and a reminder of the links. I did read through all of that when I first came on board, but maybe I missed something. I was following the protocol (Rand?) - waiting at least 3 days before raising a dose. I only was inconsistent with the .5 on Friday morning, and like I said that was because I was worried 1.25 units would have been too much and since I was going to be gone about 8 hours I didn't want to take a chance. I just didn't have a way of knowing at that point why she was so low in the morning since I hadn't tested overnight while I slept, and since I had about 10 minutes to make a decision on what to do, I opted for a dose I felt comfortable wouldn't being her into hypo. The same thing happened this morning too where it was hovering in the low 200s (226 on the relion meter) and I was worried about it going too low, so I backed off the 1.25 and went with 1 unit, which I think I'm going to stay with. I like the low ps numbers, I'm just not sure if I should go ahead and continue with the higher dose (1.25 unit) when she's there.

She also has a history with ProZinc of bouncing up high once she would go anywhere near <180, and I wonder if that is still happening when 1.25 might be taking her into the 100s. I think I'm going to stick with 1 unit for the next 3 days or more, and see if things even out.

Thank you again.

 

[Sienne and Gabby (GA)]

It's hard to know what to do sometimes when you need to shoot and you don't have much data. To back track a little... I suspect that one of the reasons that your numbers aren't stabilizing yet is that you increased Trouble's dose after 3 days. The initial dose of Lantus is typically held for 5 - 7 days in order for the shed to fill. More insulin may have been needed but the first week it's generally expected that you're not necessarily going to see the numbers stabilize until the shed is in place. On top of that, shooting a reduced dose may have also contributed to numbers being wonky. When you temporarily reduce a dose, the effects may even be seen a cycle after the reduction. It may have also been that dropping the dose to 0.5u had a bigger than expected impact.

The other important factor to keep in mind is that Lantus dosing is based on the nadir. We get pre-shot tests to make sure it's safe to shoot.

As far as nadir, it can be anywhere. Gabby's typical nadir is at +3 or +4 but it's also been at +9. Some cats do have a late nadir. In addition, the nadir can change from cycle to cycle or day to day.