Frustrated with now LOW numbers

I started on 1 unit (and changed her diet) on friday, but as the numbers went down to 8 in a couple of days, I changed to .5 yesterday. Since then her numbers have been high again. They are filled in to the spreadsheet. This makes me sad

Stick to .5 or increase to a skinny 1? I KNOW it's early days, but the low numbers she had on 1 unit gave me hope. Now I feel sad about it again. I really like the idea of "starting low", but my patience just isn't made for the "going slow" part I cant be doing something wrong with the syringe I think, I have watched videos and studied the syringe.

Sorry for another thread

 

I never published a spreadsheet so I cannot read yours. Don't be sad, this is a medical procedure you're doing at home and you're going to have to adjust your patience level to deal with this. It can take time, sometimes a long time to find the right dose.
Noah was a high dose bouncer who never did get regulated. Those are terms we can deal with later, for now just keep doing what you're doing.

 

Carina this is where the patience part comes in as frustrating as it may seem. We all want to see immediate improvements but it takes time even when using the more aggressive Tight regulation protocol. It can take about 3 days for a specific dose to stabilize in the body. For a kitty just starting insulin this is the approach using TR which is the more aggressive protocol:

General Guidelines:

• Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
• Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
• Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/

Basing Kitty's progress on this principle you would want to hold the 0.5 dose for at least 3 days ( 6 cycles) Because you decreased the dose early in the treatment program you could make a decision to increase after this time IF the nadirs are still remaining high. Normally you would want to increase by 0.25 units each time. You can gauge the distance between the whole and half unit markings to get a 0.75 unit dose. Then again hold for 3 days and continue testing to see how low this dose will get Kitty. It is a process and cannot be speeded up if you want to keep Kitty safe.

Although you have not dealt with hypos it is a good thing to have a hypo kit and some knowledge about treating hypos. Some great information here:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/


Some kitties will 'bounce' even from safe numbers if they are lower than the kitty has become accustomed to. The body's natural defence system releases stored glucose to bring the numbers back to what it 'perceives' to be normal numbers. These bounces can take a day or several day to 'clear' the system. Glucose readings are constantly in flux and are not a linear process, so you will see ups and downs even on the same dose. Again..it takes time and patience to see how a dose works.

 

Oh, Carina, you have JUST started. Do not get frustrated yet... there will be plenty of time for that later . The 'sugar dance' can take a lot of patience.

 

Patience will save your sanity!

 

It probably shouldn't have, but oh, that actually made me laugh out loud, hahahaaa!
.

 

Because you know I'm right! haha

 

Thing is, I know I need more patience.

I am a behavior consultant, and my main work is with dogs that has become suddenly blind. I am often the first stop for these owners, after they come out of the vet's office with some devastating and confusing diagnosis. A lot of my work consists of telling people "It's early days, give it time". When it comes to mental health, I have my heart and head set on giving everything time. With this... not so much! I know, it's definitely a flaw of mine.

I will hold the .5 dosage for 6 cycles, even if today is the highest she has been since starting the shots. Then revisit a possible increase in 1,5 days! Thank you, again <3

 

I'l just stay in this thread, as I don't want to spam your forum here, and to be fair, I am still frustrated with numbers. Today they have been low!

Not dagerous I think, but enough for me to get scared and give her some Hills prescription diet after I tested her to 4.6. Yesterday she was high on the same 0.5 dosage, but dropped overnight. As I was thinking to stay on the .5 for three days, I gave her the dose, eventhough her preshot was at 6.3. That might have been a mistake?

Would somone look at her spreadsheet, and see if they get an idea on how to proceed?

I sms'd our vet, and she said to not give anything if she is under 12 preshot (but then again she wanted us to start on 3 units, so I don't completely trust her on this). Is it okay to do that? To skip doses now and then? This got me more lost that I was yesterday.

Edit: I can really tell when her test will be okay-ish (blue area) and when it is high. She was running around this morning, and I said before testing "I bet she is in the blue area" (refering to the sheet). Yesterday she slept all day (high numbers), while the days before they were in the blue area and she was active.

 

Kitty's numbers this last cycle were safe and very good, but I can understand why you are nervous about the lower numbers.

As I posted yesterday there are 2 different approaches to doing dosing. With the SLGS method ( which you may be more comfortable with at this point)


Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/

If you want to use this method you would decrease the dose to 0.25 units, which would be 1/2 way between the starting line and the 0.50 line, continue monitoring and hold this dose for a week...unless the numbers drop below 5 mmol again, in which case you can post and ask for advice.

With Kitty dropping into lower numbers today it is possible the numbers my 'bounce' up higher for a day or so, but still keep the new 0.25 unit dose. As I said before glucose numbers will fluctuate and you do not need to react to them immediately...unless they go lower.

You can post a new thread each day with a link to your earlier post and a "?" in the title to get more attention and get more people giving feedback. The SLGS approach is a guideline that you can follow and is not a hard and fast rule. Overall Kitty is responding very nicely to the treatment program.


ETA Also posting on the Lantus/Levemir forum will get more attention on your questions from members who use those types of insulin.

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

 

Thank you. I originally thought the cycle had been pretty good, and Kitty has been very social and cuddly, so I thought maybe .5 would be a good dose (apart from ME freaking out at +5). However, looking at the protocols (either of them) continuing to give .5 is not safe. As soon as her nadir is below 5, it is instant reduce, regardless of protocol. Did I read that right? Or is it the preshot number that should not be under 5?

I was thinking that maybe the Tight Regulation would suit me better, as I am home with her almost all the time, and I am not the patient type. But I do get scared for her as well. I just notice such a difference in her the days numbers are good, and I want to give her more of those days
9.9 now

 

The TR protocol calls for a lower number for reduction. You use the nadir (lowest reading) as your reduction or increase number. For TR a reduction is not given until the nadir reaches 2.8 mmol ( 50 mg/l) when using a human meter. The TR is a more aggressive approach so regular monitoring is necessary. Regardless of which approach you decide on patience is still necessary. If a kitty drops too fast, too low or lower than usual, a bounce into higher numbers can occur which would give higher preshot readings at the next cycle. However this can take a day or so to settle and increasing a dose based on one or two high numbers is not safe.

In conclusion...if you are going to follow the TR approach then you would continue with the 0.50 unit dose...if you choose SLGS then you would drop to 0.25 unit dosing. Since you are currently home and able to monitor either approach would work depending on your comfort levels. But both approaches require patience.

Did you do any food changes after Kitty was diagnosed such as removing dry food or going to a lower carb wet food. Food changes to a low carb wet food can cause glucose levels to drop just with the food change.,

 

@Tuxedo Mom
Hi Mary Ann, I think you have a typo with the 2.6 (50). Think you meant to type 2.8 (50)
Bron

 

Thanks for catching this Bron. I have corrected my post.

 

Hello and welcome. You might want to pop on over to the Lantus and Levemir forum and read the Sticky Notes at the top of the forum. Since Levemir is a depot insulin, you really will have to learn to take it slow. I have seen people refer to it as turning a huge tanker, instead of a speedboat. Changes take a while, and can keep on moving after you have stopped pushing. But that depot also is how you can get nice flat cycles.

Since you are seeing green on this dose, I would hold it at least 10 cycles, not six, unless she goes low and earns a reduction. We determine how to change dose primarily on how low that dose takes the cat, or the nadirs. Since Levemir has later nadirs than most insulins, you might end up with lower preshot numbers than most people see in the beginning. The upside is the onset is later, meaning you have hours after the shot before it starts lowering the blood sugar again.

 

Yes, I did change her diet last friday! Wet food only from now on

I had read all those files several times. Maybe I am just stupid or a slow learner, but I am still unsure of how things should go. It frustrates me, as I do feel like I should understand after reading them over and over.

When you say "Since you are seeing green on this dose, I would hold it at least 10 cycles, not six, unless she goes low and earns a reduction", what do you mean by "low"? Did Today's 4,6 not earn a reduction?

 

Good Stuff!!! Some kitties can have great results with their glucose readings largely based on switching to an appropriate diet. This may be part of the reason Kitty is responding well at this time and another reason not to be too impatient with bringing the numbers down quickly. The combination of a change in foods and starting a low dose of insulin may show good results. There have been some kitties on this forum that have been able to go into remission with a food change and some insulin initially. Hopefully Kitty will fall into this category!

 

If you are following Tight Regulation protocol for dosing, a reduction is earned either when they go below 50 (for a newly diagnosed cat, which yours is), or by spending a week in normal numbers or under 100.

Feel free to pop in and ask questions about the Levemir. There is a LOT to learn at first and a we all remember that steep learning curve.