Bandit low numbers PS, no reason

Discussion in 'Lantus / Levemir / Biosimilars' started by AnneMuskoka, Jul 19, 2018.

Thread Status:
Not open for further replies.
  1. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    Hi team:
    Bandit (diagnosed 02/2018) has been on 5 units for 7 days. I went with the Go slow method, raising his insulin from 2 until 5.5, then reducing to 5 as he had some low numbers after starting off in the 22.5 range. I've been charting his numbers since he started and try to do a curve once a week.
    His last curve was last Friday, started at 18.8, +2 17.9, +4 14.8, +6 11.8, +8 13.3, +10 18.8, PMPS 20.2.
    Yesterday, he was AMPS 14.7 so I was confident to give him his usual dose of 5 units. After work PMPS was 3.6! No shot. +1 4.9, +2 6.7, +3 9.9. So rising, but didn't shoot.
    This morning, as expected, he was 25.3. Tonight +11 was 7.1, PMPS 7.8, +1 10.6. So rising again, again as expected. But the new question is I feel I need to head off another huge number but want to be cautious as I don't like the seesaw. Saying that, if I shoot at +2...what kind of unit number should I look at? I think lower than the 5, (this morning I gave 4.75)...but I want to stave off a huge bounce followed by a crash.
    Thanks for the input.
     
  2. JeanW

    JeanW Member

    Joined:
    Jul 24, 2017
    I'm sorry I don't know the answer your question but will reply here to bump the thread up.

    I am most definitely not an expert but 5 units seems like a lot to me. Are you doing 5 units AM and 5 units PM? I'm unable to comment on your numbers because I use an AlphaTrak pet monitor.

    Hopefully someone with more knowledge and experience will address these questions.
     
  3. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    Thanks so much!
     
  4. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    And yes, 5 units 2 times per day. Started at 2 and raised slowly. Haven't really seen these swings in his numbers.
     
  5. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I suspect you work full time since there are not many nadir values shown (AMPS+6). You are doing a good job on maintaining the spreadsheet. But the missing nadir values makes it real hard to adjust the dose. Is there any way you can start getting
    AMPS +6
    or PMPS +5 or +6?

    If there is no special reason for having "0:00:00" in the U.S.leftmost column, you may want to remove it.

    Many of the 12 hour curves in the last 6 weeks show the insulin is not effective at the current dose. Examples:
    June 10
    June 17
    June 24
    June 30

    But there are 12 hour curves showing good drops
    June 23
    July 8

    I do not dose past +1. But as an example, Leo is low tonight. So I fed him at PMPS, and will probably dose him if he comes up.

    For your kitteh, I see a 10.6 (191) at PMPS today. Since he is usually a lot higher, I would not dose him tonight. Bounces are better than hypos!
     
    AnneMuskoka likes this.
  6. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I would also ensure that meals are consistent in size and regularity. I have the luxury of feeding Leo all day. So he gets 8 small meals a day. And he doesn't overeat. If you are getting fluctuating glucose, it could be from eating too much or too little.
     
    AnneMuskoka likes this.
  7. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I think you need to try and find a dose that you can give consistently both night and morning and not have to skip because the preshot is too low.
    I'm not sure why you didn't shoot last night when you got PMPS of 7.8. You have shot numbers close to that before......8.2 on 7/11 and 10.7 on 7/8. It can be scary to shoot lower numbers at first but if you are going to be home and can test, you will start to get better numbers. If you are unsure, post and ask for help.
     
    JeffJ and AnneMuskoka like this.
  8. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Hi, and Welcome.
    From the remarks on your spreadsheet it looks like you shot his PM dose at +15 (15 hours after his AM dose). If that is so, his next shot should be 12 hours after that.
     
  9. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
     
  10. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    Sorry friends, to have newbie questions but I'm so new at this I'm thinking he went really low this afternoon after a dose reduction to 4 units. This morning he was 22.2. I haven't done anything but take his blood at 7:00 which was a wonderful 7.4 and not fed yet. He didn't finish his morning meal, and lately he doesn't. He's risen to 7.9 in half an hour without food. Is 2.5 units a better number than the others? I can do a curve tomorrow or Sunday but the new dose won't be in effect.

    I just re-tested and he's rising at 7.9 half hour after first test. I'm half hour past regular shot time, and I just don't know how bounces work. Two nights ago I didn't shoot and he rose to 25.3 AMPS. So in my ignorance I believe he still needs insulin. Should I wait through the next bounce and give him 24 hours to normalize?
     
    Last edited: Jul 20, 2018
    Reason for edit: Re-tested 1/2 hour after regular feeding time, fed and still over-thinking
  11. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    The standard protocol here is to only dose one hour after standard dose-time if that is needed. When you dosed 3 hours after PMPS last night, that messes up the cycle.

    On your spreadsheet, it now shows you have dosed 2.5 on 7/20 at PMPS.

    I agree with others that it is best to find a dose value that you can provide at AMPS and PMPS. Example 4.0 in A.M. and 4.0 in P.M. If you could do a consistent dose and do more testing, it will help us - so dosing advice can be provided based on the extra data.
     
    AnneMuskoka likes this.
  12. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    We can't use Leo's spreadsheet as a guide. In the AM he gets prednisolone. That drives up his AM 12 hour values, and insulin demand. And in the PM he eats a lot less food. As a result, I cannot dose him with the same units in AM and PM, or else he ends up really low / hypo in the PM.
     
  13. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    I agree with everyone that it is best to find the dose that works for him. Finding that dose is the hard part. I have been stepping it up slowly (as I understand) by .25 units per step. I need to test for IAA, etc. with my vet to see if he is insulin resistant. With the spreadsheet, I kept the doses very consistent and predictable for the most part, it's just recently that I've had to reduce doses as it seems to cause a drastic drop. It seems like the last few days have been off the wall and I am kind of starting fresh.
    Just now I took his BG and it's rising slowly, 6.9. Which is awesome! Vet said never shoot under 9, but others give regular insulin even at that number. I'm hoping to get a nice gentle curve to stay, then I can more or less predict the shot.
    Morning will tell as well as continued testing tonight to catch a drop if it happens.
     
    JeffJ likes this.
  14. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    Oh, I never heard of that before! I actually hadn't looked at other spreadsheets yet. I'm going by the information I glean from reading Roomp&Rand and trying to follow discussions. I hadn't really even heard of FDMB as a source for info until recently (I looked at the forums in February, but for some reason I kept getting blocked by my antivirus.). I free feed Bandit, never actually let his plate get empty. If he doesn't finish it, I simply dump it and give fresh at shot time. I feel a little OCD sometimes, and it's like if I back off too much he won't get to blue numbers. It's my fervent hope that he can achieve remission, for him as much as us.
     
    JeffJ likes this.
  15. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I agree with you Anne. He looked pretty good at that dose up until the last few days. As you say, he could be insulin resistant.

    Many people on this subforum are following the TR (Tight Regulation) protocol. They dose even at the low numbers. As I said, it doesn't work with all kittehs, including Leo. You may want to look at some other threads and their spreadsheets.

    For Bandit's AMPS and PMPS tests, he should not have food for 2 hours prior to those tests. Otherwise, free feeding is good.

    You're not OCD. There are many on the forum dedicated to our kittehs. For Bandit, remission probably will not occur for awhile at the high insulin levels.
     
    AnneMuskoka likes this.
  16. AnneMuskoka

    AnneMuskoka New Member

    Joined:
    Jun 23, 2018
    Thanks that makes me feel better (and understand I'm not trying to disparage or make light of OCD....I get truly anxious and over-think, which is why I'm super tired tonight and a little inconherent.) You were correct yesterday with the assumption that I'm full time working mom, 3 kids at home, 1 adult daughter with severe autism. I'll get there with support from everyone, I know.
     
    JeffJ likes this.
  17. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Welcome Anne, from a fellow Canadian. (west coast). You mentioned getting Bandit tested for IAA - I would also add a test for acromegaly (the IGF-1 test). My Neko had both conditions.

    If yesterday you shot at +3, could you change the shot time column, so it's easy to see at a glance. As others have said, you should be shooting as close to 12 hours apart as possible. After a delayed shot, you can move shot times up by 15 minutes a shot, or 1/2 hour once a day. Every time you skip, reduce a dose, or delay, you interupt the depot, which makes it difficult to decide what to do next with dosing. I know sometimes it's hard not to skip or delay, just letting you know the impact.

    As for shooting below 9 (162), that's something many of us do. We gradually lower our (no shoot) or shoot BCS numbers, as we gather data. If you read the SLGS method document, the section on shooting low has two parts. One for in the beginning, and the second as you gather more experience. Any time you are home and can monitor, you can shoot lower and lower, though not below 90. When you shoot lower numbers, the cycles tend to be a lot flatter. Lantus is great a keeping low numbers flat. You tend to only see the big drops if you shoot higher numbers.
     
    AnneMuskoka likes this.
Thread Status:
Not open for further replies.

Share This Page