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? 1 hr pre-shot - Acro kitty Rocket at 67 & dropping. Don’t know what dose to shoot.

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Keskat&Rocket, Aug 21, 2019.

  1. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Hi all - Rocket has been dropping for at least last three hours or so. I fed him some regular (not low carb) food about half an hour ago. He had SRT treatment for his Acromegaly last week, and this is the lowest he’s ever been, so I’m concerned. He’s due for his shot in about 45 minutes, and I’m really unsure as to how much to shoot now. This is all new territory for us, since we switched to Levemir last month and have been increasing his dose steadily due to the acro. He’s currently at 9 units. Any advice?
     
  2. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    Hi Karen and Rocket!

    I'm saying hi and bumping this up, because my advice would be intuition only! Great to see you back.
    I would decrease, yes, but by how much I don't know.
     
    Keskat&Rocket likes this.
  3. Chubba (GA)

    Chubba (GA) Well-Known Member

    Joined:
    Apr 30, 2017
    Bumping you up.

    Is he still dropping even after you fed him? Are those numbers with human meter or alphatrack? I’m assuming human but saw you test with AT2 sometimes also.
     
    Keskat&Rocket likes this.
  4. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you both. Yes, still dropping - he was at 62 a few minutes ago. I have higher carb food etc. ready to go. The numbers I'm posting today and now on are human meter only (he had a vet appt yesterday, and she wanted to see some AT numbers).

    edit: he's super alert and talkative right now. seems happy.
     
  5. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    I say the SRT is working very well. Maybe skip shot but @Wendy&Neko is the person to ask.

    The SRT is after all altering the tumor and their need for insulin., If still dropping I say skip.
     
    Chubba (GA) and Keskat&Rocket like this.
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    WOW! I am not sure what to tell you. He is still dropping and with Lev a nadir at shot time is not unheard of but with his recent SRT....well. While I've dealt with a high doser, she wasn't acro. Can you check him with the AT2 to see where he's at on that meter? Just wondering if he is as low as he looks in comparison. My human meter read quite a bit lower at low range.
     
    Keskat&Rocket likes this.
  7. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you. I tagged Wendy in my SRT thread (on the acro boards). At this point I'm thinking of skipping too. :bighug:
     
    Olive & Paula likes this.
  8. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks Linda. :bighug: The last AT # I got was 104 (67 on human meter). Probably under 100 now? I'll test him again in a little bit (with both). I'm not worried about hypo just yet, but I just don't want to shoot this low.

    Is there any info about how the insulin depot works with decreases? If I skip (or decrease) a shot, what should I expect to happen? Still unclear about that part of Levemir.
     
  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    When you skip a dose, you deplete the depot so it would take a few cycles to get the depot built up again. Basically you start the count for holding doses over again. I don't think you need to skip totally but you probably should reduce and the question is by how much. Lev won't onset for a few hours. I'm kind of leaning toward suggesting maybe 20 to 25% reduction. Will you be around to monitor him today?

    ETA there is also that inevitable bounce to think about.
     
    Sharon14 and Tina Marie and Jan like this.
  10. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ok, so does the depot take time to deplete, or basically depletes within one shot cycle? And does any of that get into kitty's system? I'm probably overthinking it.

    Yeah, I'll be around today to keep an eye on him. I'm going to delay just a little more to see what happens - maybe half an hour.

    I'm thinking of the bounce too. Rocket does love to bounce. =/

    Thank you Linda.
     
    Sharon14 likes this.
  11. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    When I have skipped, I have been pleasantly surprised at the depot working, and kitty didn't go that high. It varies, I believe, on length of time it lasts though.
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Every time you shoot a certain amount of the insulin goes into the depot. When you change doses, the depot has to build up to that dose level which is why you don't see the results of a new dose right away or get new dose wonkiness. After a few days at a dose, the depot is stabilized at the new dose level and you start to see just how effective that dose is. Any time you reduce or skip, the depot is still available so there is still some insulin action going on but as the depot gets used, the effect on BG diminishes. If you skip, you're depleting the depot more than if you give a reduced dose so it will take longer to regain full effect of the dose.
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Sorry you fed him. When stalling, do not feed so you know what his numbers are doing without carbs.

    Can you monitor today? Do you have plenty of test strips?

    Can you test again? Post SRT, I moved my reduction point to 70 on the human meter, so I would decrease to 8.5 units as his new dose.
     
    Tina Marie and Jan likes this.
  14. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Neko used to nadir at preshot time a lot on Levemir, which is why you have to eventually get used to shooting low. If onset is 4-5 hours later, you have plenty of time to get him up.

    The larger depot can influence up to six cycles after a reduction. Typically, with a larger dose and post SRT (or other acro treatment), it’s a good idea to start with a depot draining one time reduced dose first after earning a reduction, before resuming the new dose. We call it BCS, or big chicken shot. Something like a half dose is a good place to start, over time I moved it to 2/3. But Neko was bouncy so I was pretty sure she would bounce after going low.
     
  15. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thanks! So are you saying we should go 8.5, or half? I’m leaning toward going more conservative until we’re comfortable with what’s going on.
     
  16. Tina Marie and Jan

    Tina Marie and Jan Well-Known Member

    Joined:
    Jul 24, 2019
    I'm thinking 1/2 dose, 4.5 units, is what Wendy is saying?
    You have to be comfortable with your choice.
     
    Keskat&Rocket likes this.
  17. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'd go with the 50% reduction.
     
    Keskat&Rocket likes this.
  18. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Do we have a recent test?
     
  19. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    87 just now. But unfortunately probably food influenced. I think since we're new to this dance I'm thinking of doing a 1/2 dose this morning. But (depending on what happens today) do we increase gradually again if needed, or go directly back up to his dose of 8 or 9 units? Sorry for all the questions. :blackeye:
     
  20. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    What carbs did you feed and where in relation to the 67 and 66? It takes carbs 20-30 minutes to show in the blood. Whether you do a half dose or skip is up to you and your comfort level. If you shoot, test again in an hour. Tonight’s dose would be 8.5 units, post SRT reduction earned. Hold that new dose until any bounce is over, before deciding what next to do, unless he earns another reduction first. Bounces can take six cycles to resolve.
     
    Tina Marie and Jan likes this.
  21. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Ahh ok got it. It wouldn't be a shock to his system to go from a skip, or half, back up to 8.5.

    I fed him 1/2 can of FF (chicken classic pate, not carby) at 8:45. BG 87 an hour later.
     
  22. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    No, it won’t shock his system. It’ll be like a fur shot or partial fur shot, only deliberate. :p

    In the Sticky Note on becoming data ready, one of the suggestions is to get some +1 data. That way you have an idea how much food will impact their numbers. I knew Neko got about a 30 point bump from her raw PS meal, so if I had to feed (never did actually), then I knew what she would be without the carb influence.
     
  23. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Y’know I've read that, about the +1, but I guess it didn’t stick. I’ve read all the stickies (believe it or not), but we’ve had so much going on that it would be good to go over them again. Thanks for your help. I feel like I’m still stalling, but we may just call it a fur shot today and see what happens.
     
    LizzieInTexas likes this.
  24. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    All data is good data. No matter what you do, test in an hour after the last test to make sure he is still coming up.

    I still read the stickies every once in a while. There is lots in there.

    I have got to hit the pillow, was up at 4:30 this morning. I will check in later.
     
    Keskat&Rocket likes this.
  25. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I forgot to say, congrats on those greens. First greens are to be celebrated. He stayed there a good long time. :D And no, you didn’t screw up, you learned something. :bighug: Every cycle, every day, is a do-over.
     
  26. Keskat&Rocket

    Keskat&Rocket Member

    Joined:
    Feb 4, 2019
    Thank you. :) I'm going to do his PM shot at 8:00 (a little early). That's in about an hour and a half. Going to take him out on his harness now to enjoy a little evening breeze. :bighug:
     

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