I got a kitten!! (named Molly)

One of my civvies plays with those little furry rat toys that rattle (i have no idea what they put in them). He truly makes it an Olympic sport!! Yesterday i heard him playing and went to throw him a few and i could not believe my eyes!!! It was Molly!! Molly doesn't play - Molly is fat and sluggish!!

Then last night i was watching the Olympics and Will says "look behind you". Of course i expected to see Favorite on the large cat tree as that's where he usually hangs out. MOLLY! Molly got her fat a$$ up the tree climber and was playing!!

I just keep catching her playing and it's amazing!!

Her numbers could not be better (knocks wood, says 'antijinx', spits into the wind - wait is that really one?)! She's currently receiving 2.25 and i have all intentions of increasing her to 2.5 but her bx is just so good!! I will do a mini curve today -mostly just to shut Melissa up -HA!- but also to try to find nadir. At +3 she's 144 - WOO HOO!!

We don't find success often and frequently it doesn't last so i'm living this one up!!

p.s. the new feeding schedule (6/6 -which is actually the old feeding schedule) sucks for me but Molly seems to be loving it : ) Thanks again you guys - love ya Melissa.

 

well, good luck shutting me up with just one curve, but it IS a start!

Question: if she is acting so good and BG's are staying decent- why mess with success? Why "have every intention of raising her" if she is doing so well on the current dose/schedule?

Just a reminder that this is a marathon- a long distance, have patience marathon, not a see how quick we can squach the hell out of the BG's Race.

Why not let her rest and enjoy things for a while, let her ride the dose that is making her feel so balmed good and do a curve at least once a week BEFORE changing a dose and just see what you see....

ECID, of course, but you have been everywhere but still, so why not give it a try? ( yes, this suggestion based on current experience with PK doing SO well in a stagnent 200 curve!)

NOW- GO DO THAT CURVE!!!!!!!

 

That's great, Michele! Go Molly!

Agree with Melissa about staying with the 2.25u dose if she is getting great numbers and starting to play.

My two youngest are just about 2 ys old, then comes Jeddie at 11, Beau at 11.5 and Charlotte, whoe turned 17 yesterday. But, youwould think I have three 2 year olds the way Jeddie plays with the girls. I bet he didn't feel well for a long time and he didn't have any playmates to play with.

 

+7 52 - can i give a small snack to maintain

no idea what the star means but hopefully it will catch someones attention...

Molly is 52 @ + 7. To give a small snack or not to give a small snack is the question?

 

+7.5 ~70

Yay, she brought herself up all by herself. What a good kitty!! (i did not give food).

Will continue to monitor.

I would say this warrants a dose decrease -hmm, just when i was going to increase it. Should i go back to 2u? But her numbers have just been so good -sigh.

 

Yes- low carb, tbsp at a time, re-check every 15 to 30 mins, feed tbs again, repeat until 3 rising numbers in a row.

IMO, decrease is earned...down to 2u and HOLD for 5 to 7 days. CURVE and re-evaluate.

I know these are good levels and what we are looking for at this + hour for most cats, BUT, I also know you are not comfortable when she gets that low and I think she was getting decent numbers at 2u ( as I mentioned a few threads ago) and if given time at the decent numbers ( 200's) I think she will feel better and you will have peace of mind.

IMO, see what others say, of course.

I'll try to watch this thread through the day in case others are busy ( snowed in here again)

 

Good that she is holding her own- she may surf at that level from here or she may drop further...keep testing.

Just making the point here how important it is to do a full curve or two AFTER a dose settles and BEFORE a dose change- up or down- is considered.

I've vote for the 2u, but then I prefer shallow even curves- always have. see what others say.

 

You have snow?



that was a joke

 

I COULD KILL HIM!!!!!

It looks as though Molly will not be getting a dose decrease after all! Why you ask? I'll give you one guess (it's all you'll need),,,,

WILL!!!

He shot 2.5u this am. Now granted i was going to increase the dose myself but i was at least going to do a curve first (be proud Melissa!). So freakin' frustrating!!!! This was the first time i have slept-in in ages!! Ages, i tell you!!

Okay, find the good here,,trying, trying, 1. At least i figured out why she went low - thank goodness i call him just now 2. I learned that 2.5u is too much and 2.25u is great for now.

I apologize to all of you for taking the time to help and give advice. I’m sorry if i wasted your time. Humbly yours, Michele

 

Agree - but as long as she doesn't drop lower, she is safe. Most cats can go as low as 35 with no symptoms, issues. (left that in so others ready know not to panic).

She may bounce a bit from this because she isn't used to the lower number. I wonder how long she has been dropping this low? So NO dose increase at all right now - and possible a dose decrease depending on if she goes lower or not. If you do decrease, you want to go no more than .25u lower to 2u.

OK - see she came up to 70 - so decrease is your call. I would not be comfy with a 52 for a cat that is not being monitored during the day and doesn't have food available. I would be uncormfortable with Jeddie at that number - as I am a bit uncomfortable with him at 60 for the same reasons.

And I agree, again, with Melissa on letting doses settle and doing curves before changes - even though I don't always follow that advice myself. I do get a spot check or two before dose changes if I am increasing.

OK - so Will shot 2.5u. So you know that is not a good dose. Looks like 2.25u might be right, but can you get him to shoot that? Does he understand that he needs to be, um, more vigilant about doses? Maybe get a small white board, or chalk board to put up over her testing stop with the day's dose written on it?

 

+8 ~49 She's getting a small LC snack.

A wipe-off board is a great idea Shelia, ty.

 

I had a feeling the punch may be coming still...feeding is a good idea. If you can feed and test every 20 to 30 mins until you get 3 rising numbers in a row, that would be good.

Keep it LC unless you can't get her to rise, then whip out that gravy laden sugar fest HC stuff, IMO.

Once this is over, please go back and re-read this thread when it makes sense to you.

After whatever dose you decide on today settles- do another curve BEFORE you make any dose adjustments.

Every time one of these dose mess ups happens, it's like starting over again and you have to start the settle time countdown at the first correct dose you mean to be giving IMO and experience with the L's.

As for DH...(tapping foot)...you guys HAVE to get this worked out. This has been going on too long, now.

Try Pre-loading syringes, threaten to stop feeding him ( Will, not Molly) whatever it takes...

FWIW, I still like the 2u.

 

update -

amps 213 given 2.5u (this is an accidental increase from 2.25u)
+3 144
+6 80
+7 52
+7.5 70
+8 49 fed LC FF
+9 80
+10 82

I know i'm supposed to shoot through this with the 2.25u but i will need to see the pmps first. Whatta day!

I am also anticipating a HI amps tomorrow.

 

Boy, I might be cautious about 2.25u if she isn't above her amps of 213. She may soar after the 49, but she is not right now.

So 2.25 if she is, mmm, above 250, 2u if 150-250, if below 150, wow, not sure what I'd advise you to do. Reduce, but not sure how much.

 

Can you be up to test tonight?

Here is what I am thinking:

You are going to feed with shot, so (hopefully) she will spike form that, in addition I anticipate rebound numbers to be kinda high for tonight's cycle and probably through tomorrow, so I am thinking the 2u ought to do it fo anything over 150.

If she is under 150, I might be tempted to skip shot or give 1u...she is going to likely be high anyway and with the next dose you are "starting over" anyway, so loosing any momentum isn't really an issue to consider.

I would go 2u over 150 or 1u under 150...back on track tomorrow AM with 2u. That my 3 cents.

Thanks for the update- will try not to worry now.

 

Thank you Sheila and Melissa (Sheila, sorry about the name mispell above, it's actually how i spell your name before i go back and fix it everytime. If it makes you feel any better i always type Vivky before correcting )

I appreciate you guys giving parameters. Definitely helpful to get advice from more experienced users of Lev and i thank you.

A bit gun shy about giving 2.25. Will most likely shoot 2u depending where she is at at preshot (30 minutes from now). At +11 she was 113. If she is under 150 i will shoot 1.5u.

Means the world to me knowing all of you are here for support - thank you.

Will keep updating, thanks again. -M

 

update -

amps 213 given breakfast and 2.5u (this is an accidental increase from 2.25u)
+3 144
+6 80
+7 52
+7.5 70
+8 49 fed LC FF
+9 80
+10 82
+11 113
pmps 130. Gave dinner and shot 1.5u.

 

Looks like an exciting day in Molly's house! Nice advice from Sheila and Melissa. You did good Michele!

I am glad you are home this week so you can do some more testing.

So it has been almost a week since you started feeding her with her shots? She gets fed and shot at 6AM/6PM and you normally give her a snack before bed at 9PM? Did you give her a snack today when you tested at +3 and got that 144? Not really relevant but I am just curious if she went ahead and dropped that low even with feeding at +3.

It will be interesting to see how she does from here. Nice that she is feeling so good.

 

I a little surprised that she isn't higher, but the second low came late in the cycle, so be prepared for her to climb and keep climbing this evening. She may not, but just don't over-react to whatever you get in the next few cycles.

Good job - glad you were home to "see" this happening.

 

I think that 1.5u was a good compromise, Michele.

If it were me and my Paul, I would test until I went to bed and then set my cell to test around +6 OR +7 to catch any potential lows that are too low. ( ask Sheila, I DO set my cell alarm for times like this!)

Chances are you'll catch a high 200 or even 300 around that time, but better safe than sorry. ( you can sleep in class!...call it "stillness therapy"...tell 'em you learned it at the last seminar!)

What are you thinking to setle on for a regular dose for now?

( I am jealous that you don't misspell MY name!)

 

Hate to be the party pooper here, but i can't believe you reduced the dose to 1.5 tonight. She did great on the 2.5--tell Will he's my kind of guy. I would have shot a skinny 2.5 myself.

Glad you got to sleep in though. Apologies for not joining the bandwagon!

 

Agree with Terri - the numbers you got today are WHY she's playing. The 2.25U was probably working well for her, as evidence by the nadir on the 2.5U.

She's really going to go up now and not from rebound.

Sorry I was at work today.

You need to do 2 things - 1. figure out a regular shot and feeding schedule, which I think you've done, also indicative of why she's playing.
2. Pick a weekend day to test her every 2 or 3 hours. What do you do on Sundays? You need more data on a steady, regular schedule and regular dose before doing increases. At this point and at 2.25U you need that data more importantly to determine DECREASES. She may just earn them if all the other factors line up right.

Yes, I have my stern face on.

 

Well, I can totally see Michele's concerns and support her on this. When you work all day and have to leave your kitty unmonitored it is too uncomfortable to shoot the same dose on the low PS's that caused very low numbers on a higher PS. Especially without data to show it will be ok. She was nearly 100 points lower tonight than this morning - after dropping to a low she wasn't used to.

Since I am one of those people that will not shoot a full dose on a low PS, and cringe every time I see someone else do it, I think Michele made a reasonable choice here. I remember when "do what is in your comfort level" was a mantra on the Health forum all the time.

And I have to respectfully disagree that she "did great" on 2.5u. Dropping to 49 is not great. It is too low for a "goal" BG level. For instance, Michele works and is gone during the day and I understand that Will is often not home - so no one would have been there to feed that 49. Then what?

I still think that 2.25u *might* be her best dose - that or 2u, but I also think that shooting 2.25 tonight would have only been safe if she was above her amPS number. I know some folks think that is "short duration insulin thinking", but I have seen Beau drop low too many times on lev when I was "told" to "shoot low to stay low".

 

I also understand the not wanting to go too low while you are at work thing- makes sense and its safer. ( FWIW, I ditto the respectfully disagree with "did great on 2.5u"...it was scary and if -M had not been home to catch it and feed it, it could have gone very badly)

I also have always been a fan of the shallow curve...I'd rather have higher numbers that are more even than a curve that plummets to the 80's and skyrockets to the 300's and back in 12 hrs time.

I believe the shallow curve- even at higher numbers ( 200-300) is easier on the body, more predictable and promotes healing. A body not having to defend itself from ultra lows or superior highs can relax and heal, IMO, observation of others and experience with PK.


A while back I asked Michele how low could Molly go before Michele was uncomfortable with the level...never got an answer, but I think it is something Michele needs to consider.

Do you want Molly in the tens ( 40-60), the 100's or the 200's at the lowest point when you are not home?

I think once that question has found an answer that is satisfactory to Michele, there will be a clearer picture of what dose this cat needs. Until then we all continue to give advice based on OUR comfort levels and it can get confusing.

So, IMO, Michele needs to decide where she wants Molly to be on the BG scale. Answer it out loud on the board so we can be more helpful.

 

How low is too low?

Given Molly's dose history, I highly doubt 2.5U would have put her in crisis had Michele not been home. It's not helping Michele by implying she would have.

Proper Levemir action maintains blood glucose within normal ranges over hours during a cycle. If you're uncomfortable with 50s during an otherwise promising cycle then Molly is going to continue bouncing around (and I don't mean playfully) from skiddish dosing.

1.5U was a 40% reduction in dose from the 2.5U, far larger of a decrease than needed. 2.25U looks like a good dose, but all the factors which lead to those smooth cycles (feeding & dose schedules and the dose itself) needs to be maintained. Michele is doing much better at keeping those factors aligned, hence the playful activity and IMO marvelous cycle she just had. For those cycles to continue, the factors much remain in place. Dropping the dose impairs the whole process, even if the other factors of scheduling remain the same.

This isn't exactly what I wrote previously before the board hiccup, but I hope I'm getting the point across. I am gone from home for 10 to 11 hours a day. I shoot on low numbers because I have witnessed Gandalf's bx at hypo numbers - he goes to his food and parks, eating steadily. I've tested him in the 30s and even 20s then and he's been fine, although of course I supplemented with HC, but he has no doubt gone low when he's been alone and he's been fine. But he must have food available. So should Molly.

Michele, it really helps your peace of mind if you see what they do on low numbers. While I'm not saying you should purposefully give her more insulin, being too conservative on dose (such as 1.5U when 2.25U was working well by all indicators, not just actual numbers) will never keep her in normal range, as Lev is meant to do.

 

Re: How low is too low?

While I agree with most of Vicky's post- helpful and factual as they always are- I do disagree about the 2.5u putting her in crises mode or not. Well- I guess I don't disagree, but rather think it isn't necessary to push it and find out.

Some folks can handle the pushing, other's can't, and I think it is important to support in both circumstances. ( as we all have so far)

As for leaving food out, it may be a situation as in my house, where it doesn't matter if the food is out- it likely won't be available when PK needs it b/c it has already been eaten or, again in PK's case and Molly's too, our sugarbabies eat everything that is in their site right away and leave nothing for later, therefore have to be controlled/supervised at eating time.

Timed feeders are not a solution here b/c 1. PK is too slow to get there before the food is gone and 2. the cats beat the timer all to hell until the food falls out before the slots open!

A solution for Molly, if Michele wants to have food available when she isn't there, is maybe to close Molly in a room without the other cats and WITH a timed feeder to open. I would make sure the sceanrio works on my day off where I can observe before I count on it while I am at work.

Of course the other option is not to give Molly so much insulin that she needs these things to bring her numbers up in Michele's absence.

The fact still remains that Michele needs to find HER comfort zone before any dose is decided on, or as Vicky mentioned, things will contine to bounce around from undecided/skiddish dosing.

So- Michele, what is your comfort zone? How low can Molly be in your absence before it is too low in your opinion?

 

Molly went from 213 to 49. That isn't a big drop. It's a pretty normal curve, in fact. There's no way to know whether the food kept her from dropping further or whether the 49 was as low as she was going to go.

Michele chose to switch from PZI to Levemir for a reason--she wanted to give Molly the best chance for remission. But if we treat the Lev like PZI or Vetsulin, there was no reason to have made the switch. That's why it's so important to test and know how YOUR cat responds to the Lev.

In my mind, one of the worse disservices we do on this board is perpetuate fear of scary hypos while we are away. Lucy has been diabetic for 6 years. She's thrown me some pretty surprising lows during that time. But all that happens from those lows is rebound. Look at the Lantus board and you'll see the same thing happening over and over again. Lucy is a healthy girl, as I'm sure Molly is, so the chances of having a scary hypo reaction are incredibly slim. And yet, fear of that one in a million chance prevents so many people from being proactive and giving their cats the best possible chance of remission, or at least protection against kidney disease.

The real protection against fear of scary hypos while away is to know how your individual cat responds. And you get that security from your test data.

Yesterday is done, there's no point in rehashing all the 'what ifs'. Hopefully, the dose was raised back to a skinny 2.5 this morning and Molly is causing lots of confusion in the family once again with her playing.

Sorry if Vicky and I sound like we're lecturing Michele. I hope you understand we are taking this stand out of friendship and our own years of experience. Neither of us would ever recommend anything that would cause danger to you or Molly.

 

Ditto.

 

Ditto to this too.

 

I have said this many times before and i will say it again now,,,,

This is a remarkable group! The way everyone can state their opinions and even disagree without feather's being ruffled is characteristic of mature, knowledgeable people with one common goal - the health of a cat. It's easy to disagree with someone you're not fond of, it's 10 times harder to share a differing opinion when you respect the person you're disagreeing with. I know i'm not here to accept an academy award but boy, am i thankful to be amongst all of you and have your support. I would also like to thank my,,,oh wait.

That said, i have read everyone's responses several times and i think you all make valid points even if you're not all in agreement.

Truth be told, i wish i didn't drop the dose quite so much last night. I probably should have went with 2u but like Terri said, what's done is done and i can only move forward.

I was happily surprised by today’s amps: 291. A bit high sure but i clearly expected to see something in the higher 300 range. I think the recent dose of 2.25u has been great for her (again, numbers aren't everything; it's her behavior -bx- that has me convinced - playful, lovey, etc.). Given that, i shot 2.25u this morning (Will did actually).

As for my comfort zone - a bg of 49 is not okay with me. Do i think Molly would have brought herself up without my aid (food), i do, but it's not somewhere i’m comfortable with. (side note here: i can' see the box i’m typing in - when my text gets too long, the cursor goes out of my field of vision. So i'm typing blindly here). What is my comfort zone? Having Molly not be diabetic!! Okay, just kidding. I would love to see 200's at preshot and 100's at nadir. I am perfectly okay with low 200's across the board.

Do i think Molly is going to go into remission, i don't. She already did that for a year and that was many many years ago. What i want for her is one thing: quality of life.

She's here begging for a test. Let me go do that and then i will post today’s numbers on the 2.25u. brb...

 

ahh it's so nice to be able to see the box i'm typing in again! Does that happen to anyone else?

After yesterday (the low compounded by shooting only 1.5u in the pm), i think today's numbers are actually pretty good;

amps 291 fed and given 2.25u
+3 270
+6 248
+9 230

I hope i answered all the questions asked above. Please let me know if i forgot something.

Again, thank you my friends.

 

Ah, I was wondering where she was this am....

Hmmm, I hope she shakes off the highs in the next cycle or two.

 

You may have the open window too close to the bottom of your screen. That's the only time it happens to me.

This is an excellent cycle after the mess ups. Going down but remaining flattish. Very good indicator of a good dose. It's able to bring things in line fairly quickly.

 

So, your goal is to get Molly in lows no less than 100's and high's no more than 200's, right?

Of the recent doses you have tried, what dose do you think is best to get Molly to meet your goal BG's?

Of the recent feeding plans, which feeding plan do you think will best help the dose you choose?

Also, what plan do you have in place now to keep you and DH on the same shooting dose? How will you prevent confusion and incorrect dosing from here out? ( some mentioned a wipe board, pre-load syringe, slap W upside head- oh, wait, no that one was just imagined not written!)

Lastly, can you choose a day of the week to conduct a mini curve on a regular basis to check what doses are doing throughout entire cycle?