11/18 Mačka AMPS 390, +4 378

http://www.felinediabetes.com/FDMB/threads/11-17-macka-pmps-264-2-306-flat-yellows-all-day.221818/

Little Mačka surfs differently these days. His health is slightly improving, I think. He can jump again from the counter stools to the table, and from the table to the stools (but can't jump up lol - and down, it hurts his joints, so just straight, you know). He feels like a younger cat he said.

I have to work all day for the next three days, so I was thinking of starting Levemir on Thursday, if it's a day off (I never know in advance). I don't like these work days, and try to go home for lunch and get a test, as much as I can. Today I can't do that, so I'll get a +4 before I leave.

Have a great week everyone!

 

Here's hoping Macka makes it back to the beach in the very near future! Have a great day at work!

 

It's good to hear Macka is showing improvement and jumping from place to place. I hope he slides down today.

 

Do you have plans to increase soon? If you switch to Levemir are you familiar with the protocols for doing so? There are threads here that discuss that process.

 

I think the 70% rule on switching to Levemir was discussed. It would be nice to sneak an increase in on that 70%!
We are so happy to see some blue on that little boy's SS, now we want more!! And GREEN too!!
Penelope - I hope your work day is flying by! I'm feeling dumb, my Macccccka tic mark works like that I am going to get it down for the future though! Hug him for me!

 

What are your reasons for switching to Levemir? While I personally preferred it to Lantus, it isn’t going to help if you keep Mačka’s dose too low and hold the doses too long, as you have been.

 

I am switching to Levemir with the hopes of flattening the curve. I think that Macka metabolizes Lantus too quickly.
Since I am following SLGS right now, and his nadirs are under 150, when he actually does nadir, I did not want to increase the dose right away. I also had to leave the country for a while and was not comfortable leaving Macka with better numbers but not monitored. Now that I am back, I will do my best to bring him to good, safe numbers soon.

 

70% would be 2.8. So what about a 2.5 dose as a start?

 

I would agree that's a conservative amount to start with. You'll want to be sure to increase as often as necessary to push Macka into lower blues and hopefully some greens - under 100. I used TR during that time to make sure that I was increasing often in order to get Luci into better numbers as soon as possible. If you look at her SS around mid-July you'll see my process as I went from Lantus to Levemir.

 

It’s really hard to say his duration is short when he is in high numbers. As you get closer to a better dose, with both Lantus and Levemir, they flatten out and you see better duration. I really hope Lev helps, but don’t count on it being the only solution for flatter cycles.

It is good to wait for the switch for a time when you can closely monitor the first couple cycles. Some cats, but not all, respond strongly to the change. If we find he goes really high with the lower dose after the switch, and with the amount you can monitor, I think you’ll be able to increase faster than 1 week. Especially with DKA in his history, you might need to be a bit more aggressive. And do check daily for ketones.

 

Thank you! I'll take a look right now.

 

Yes, I don't want to wait 1 week to increase while looking for a better dose, that would be crazy. Of course, I'm very nervous of the switch. I also have a new Lantus pen, should I continue with Lantus? I was really hoping that Levemir would be more predictable for him, flatten the curve, and spare me the anxiety.
The emotional rollercoasters of curves have been really tough on my health (and marriage), and he's not even in the greens!

 

I kinda think I'd leave well enough alone - the first thing you need to do is increase as often as needed to get Macka into better numbers. Rather than switching insulins which may or may not bring him down lower - you really are going to have to get comfortable with shooting lower numbers than you're used to and to getting him much lower.

Right now Macka needs MORE insulin, not a different kind of insulin. Even on SLGS which is a slow protocol you need to increase after being on the same dose for as long as you have been and not seeing any better numbers than you have seen.

May I ask, please, why the hesitation to increase and get Macka into healthier numbers? You are aware that anytime you're uncomfortable with a low blue or even low greens, you can feed him high carb foods to bring the numbers up, right?

 

Yes I am aware, but that's if I am awake and at home :/ However, I haven't practiced cycle abortion, and so I don't even know how sensitive this little guy is to carbs.

In the SLGS method, it says that if nadirs are between 90-150, we should keep the dose. When Macka was not bouncing this month (I agree he bounces a lot), he was in these numbers at nadir. I was always expecting numbers would go lower at some point. + I'm terrified of leaving him at home while I go to work, with no control on his numbers. I usually leave him plenty of LC food, but what if he went ultra low one day, and died? Same when I sleep. This is what I have in mind all the time, it's exhausting. Thus my hesitation (plus the fact that I had to travel). I agree that his numbers are too high anyway, yes!

 

So, there is little harm if you overdo the carbs to start. If you have to go to work or to sleep, and you think he might go low (and I don’t mean mid blues which are perfectly safe), you leave out high carb food. It could shorten duration, but that’s fine if you have kept him safe. I am pretty sure we all gave higher carbs than needed to start. Over time you will refine how many carbs he needs, based on his numbers, how fast he is dropping, and what point in the cycle he is in. For example, earlier in the cycle the insulin is stronger, so you need higher carbs than later.

Food is how we control the numbers and keep them safe. Learning his onset and nadir helps you determine when that food should be available. If you worry that he’ll eat his food early, you used an autofeeder to have the food available when he needs it. I also spent a lot of time early on looking at the spreadsheet, trying to figure out patterns in the numbers. Look at patterns over several cycles. For example, how many cycles does he bounce these days. Bounce cycles will be quiet ones where you can leave just regular low carb food out.

 

Then it would be an excellent opportunity for you to find out. How about starting with an increase when you're going to be home and IF he starts to go into lower blues or high greens, you could test by feeding him some higher carb foods. He's not close to a hypo - and then you'd know what carb food will cause him to rise.

It's been 10 cycles since Macka has seen anything near the numbers described in SLGS as below 200. He really needs an increase.