? 12/28 Zeke crazy numbers needing advice.

Discussion in 'Lantus / Levemir / Biosimilars' started by Meridith and Zeke, Dec 28, 2017.

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  1. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Prior Thread

    We haven't posted in awhile but figured it was some time for some advice. Zeke's numbers are really doing crazy right now. We are on day 4 of this dose and he should have leveled out, but he went so high at +2 that it took him until +6 to get back to his amps and he is already raising back up. Is it getting time to start thinking about changing insulins? We have been on this dance since April, end of May if you don't count the time we were following the Vet's advice.
     
  2. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Nov 30, 2016
    Maybe time for another .25 increase?
     
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  3. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    He will be getting an increase the day after tomorrow. My question is on the crazy numbers. He should be settling in to this dose and flattening out since he has been on this dose for 4 days now but he is still getting crazy numbers.
     
  4. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Nov 30, 2016
    The numbers don't seem so out of whack, new pen was shipped/stored as normal?
     
  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Numbers bobble around a bit during a bounce. Could be today's he's going to go a little higher before breaking the bounce and going lower tonight.

    Good thing the increase is on the way. I think he hasn't hit his breakthrough dose yet. I'm not sure what ECID reasons are for holding the dose longer, but it looks like glucose toxicity is developing due to holding the doses too long but even more importantly, from going back in dose to 1 unit. It's been almost a month since he last saw green. What was the reason for going back to 1 unit? With Neko, I had to keep chasing greens and be a bit aggressive about it cause she would easily develop glucose toxicity.
     
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  6. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    This pen is #4 out of a 5 pack and has been stored as all the others.

    Thought new dose wonkiness only lasted 3 days at the most? Was expecting a little bit more "normal" starting today.

    Because of his bouncing, he needs a little longer to settle into a dose. Can't know if he has hit his dosing or not if he is still bouncing all over the place at the end of the 3 days. Just wasn't expecting numbers to still be this crazy at the end of his am cycle.

    Was a safety call because he had some dental done at the first of the month. He broke a tooth and then had to have the root dug out surgically. Since the tooth was bad and there was a good chance he had elevated numbers due to pain etc, I lowered him so there was no chance in him taking a dive.

    I have talked with Robyn (Penny's mom) some over this on the phone and she did help me make some sense of all this.
     
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    New dose wonkiness lasts less than 2 days. I was talking bounce - he's bouncing off the blues.
    TR timing takes into account bouncing. If he's bouncing from blues, it's not enough insulin and he needs an increase. He now seems to be taking 5 cycles to clear a bounce. This post by Libby is a good explanation of the timing and why it's OK to increase during a bounce.
    But having elevated levels due to pain and inflammation is why you should increase (to lower the BG), not decrease the dose. Neko had a growth on her jaw that was removed (dental vet thought it was cancerous, thankfully not), but that work meant quite a bit of inflammation during the healing process and earned an increase, until she told me she was healing by going lower. And she got buprenorphone to help with the pain.
    One of the beauties of FDMB is that it's an open forum, where all can read and comment on dosing suggestions if we don't agree with what is said. Dosing discussions via PM or phone/email go around that. Of course it's your job to sort through all that you hear and decide what's best for your cat.
     
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  8. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    I did the decrease after his surgical procedure, the small dose the night before was because most were saying no insulin before the procedure though for that night do a small amount so he wasn't too long without any. Afterwards, since the tooth was gone, was figuring his pain would be less so therefore his numbers would be naturally lowering so needing less insulin.

    As for for the phone call, she was explaining to me insulin resistance and how that could be what it is with Zeke right now since it seems that he is getting higher numbers even though his dose is increasing. And I started talking to her on FB, not here.
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Glucose toxicity is a type of insulin resistance.

    I wasn't talking about the descrease around the day of the procedure, but rather going back down to 1 unit from 2.25, starting December 11th. It's too hard for us to guess what less pain means in terms of lowering the dose, best to just let the cat tell you by earning a reduction. As an example of glucose toxicity, take a look at Boomer's SS, starting July 7th he had a dental. Judy lowered his dose from 1.25 to 0.25 for the same reason, thought he'd need less insulin. It took almost three months and up to 3.0 units before he turned around.
     
  10. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    I didn't know that they were considered the same like that.

    What numbers are considered under "renal threshold"?
     
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    ECID of course, but generally in the upper blue to lower yellow range. Neko's was around 220. You can test with ketodiastix, but I would do a BG test before taking her in for a urinalysis, so I could see at what BG she was spilling sugar into her urine, or not.
     
  12. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    The same as you would test for ketones?

    We already do that when he starts getting more pinks to make sure no ketones are showing up. So as long as the ketones aren't there that means he is below the threshold?
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    No, it's ketodiastix vs. ketostix. They test for a few more things besides ketones in urine.
     
  14. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    I will look into buying some of those since it looks like they can be bought at walmart too.

    So if the test shows glucose, that means they aren't below the renal threshold?
     
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