Shaak's first shot given.

Actually, I’d like to see Cathie test when she gets back at +7. Then she can test at PMPS.

One thing I wanted to mention from our discussion earlier on bouncing vs duration (sorry...I had to run out so just left a quick comment) is that the reason I was asking Sue was because with a depot insulin, the caregiver (CG) is generally holding the dose. We are shooting, primarily, for the number we expect to see at the peak action of the insulin (i.e. nadir). So if we see the kind of cycle Shaak had last night and then get a pink AMPS, we aren’t changing the dose based on the preshot so we can wait and see how the next cycle or two play out.

However, with a short acting insulin like N, and even with a longer acting insulin like ProZinc or PZI, the CG can change the dose at PS to shoot a higher number down because they are usually looking more at dosing on the PS rather than the nadir. In that case, if the CG didn’t know if it was duration or bouncing causing numbers to go right back up, he/she would need to hold the dose longer to run a curve and see if it’s repetitive or not. Does that make sense? It goes back to the difference in how the insulins work.

Not exactly. When a cat has been undiagnosed and in higher numbers for a while, their body becomes used to those higher numbers as “normal”. Shaak probably feels pretty good at these higher numbers now although she is definitely consuming a lot of water. When you start insulin and the numbers come down to lower numbers....not even that low (e.g. yellow numbers are lower if the cat has been sitting in black and red numbers), then the liver pumps counterregulatory hormones and glucagon into the system to bring the blood glucose back up to what has become the new “normal”. That’s a bounce. Bounces can take up to six cycles to clear but if a dose is working well for a cat, they could potentially clear much faster.

Lack of duration is something you would expect to see in a short acting insulin more so than a long acting insulin because those insulins, like N, have no depot and are designed to be “in and out”. With lantus and levemir, hopefully, the CG gets the dose just right so it takes maximum advantage of carryover (duration lasting from one cycle into the next) and overlap (one shot is diminishing as the next one onsets). There is no carryover and overlap in the short acting insulins. This isn’t to say that lack of duration does not occur in the long acting insulins; it can and does especially if there are a lot of carbs involved in the cycle or a lot of feeding after nadir which puts the brakes on the insulin action/duration. But it’s definitely a factor in the short acting insulins.

Never worry about telling a vet you are home testing. Shaak is your cat, not hers. I think it’s too soon to decide if N is working for Shaak or not and we need to see what she does over a few cycles to even decide if she needs more insulin. One always has to be careful with increasing doses on the short acting insulins because if it causes the drop to be faster, it can trigger additional bouncing. The question more is whether you prefer to have her on a short acting insulin or a long acting insulin. The long acting insulins require more monitoring sometimes (if duration is good or the cat has a really late nadir), they are definitely more costly, they are less harsh, and they do have a better record for cats going into remission. But you have to consider the whole picture on what also works best for your specific situation. It’s hard to know how an insulin will work for Shaak without trying it. We used lantus for a year before we made the switch to levemir and Lev just was so much better for Gracie that I wish I had switched her much sooner. Some people find ProZinc or compounded PZI works better for their cat and their personal situation than lantus or levemir.

Because members usually indicate the insulin they are using in their signature line, you can always peek at different SSs and see how the insulin is working for that specific cat.

 

Won't hear me complaining Is that just for a general data point, or are we looking for something in particular?

Can we actually say that "1 unit of N drops Shaak's BG by 150-200"? Is it that simple to develop the sliding scale?
That's the counter-intuitive part of the L's that was so hard to grasp.

So basically, if a bounce is suspected, drop the sliding scale and hold the dose?

 

yes but also to see how high she might bounce and if she comes back down by PMPS. If she’s bouncing, and her PMPS is way down, then we would know exactly how high she went before she headed down. And those of you who know me know I am data driven.

This is a question for someone experienced with the non-depot insulins. I just don’t know the answer to that question. I will say that when I was using R, which is a very short acting insulin, 0.1u did not always give me the same drop from time to time but that could be because there was also a long acting insulin in play. If you just consider the action of one, short acting insulin, I have no clue.

I would think, yes this is true but would also prefer someone experienced with a non-depot insulin respond

 

We generally try to get a week or more of data before we try to put together a sliding scale

I would hold the dose and get some data. My thinking is that her numbers are safe. Yes, she seems to be bouncing
But as long as they are in safe ranges, I would consider these next cycles as data collection.

As I said earlier, an increase is most likely to make the drop lower, not extend the cycle. Her mid cycle numbers are in safe ranges so a decrease doesn't seem warranted to me

Just my opinion

 

I have not read any of the last few posts but has been crazy driving back and forth for last 4 hours.

+7 330
+8 344

so really level high numbers. she barely changed at all between +3 and +5

I am going to read all the above posts I have missed till now.

 

driving my kids back and forth from classes I mean.

what exactly is a non depot or depot insulin? I tried to find it in the FAQ but couldn't find it.

 

A depot insulin is like Lantus and Levemir. It builds up a "depot" in the body that allows for some carryover of insulin from one cycle to another. A non depot insulin like ProZinc or N is considered an "in and out" insulin. In general, it is not any carryover; after 12 hours, there is unlikely to be any influence from the insulin. That is a very basic explanation. Hope it makes sense.

The reason we have been talking about depot vs non depot is that the insulins are dosed differently; they react differently; the patterns you see tend to be different.

 

okay, I see.

That was easier to understand than bouncing.

 

Good explanation, Sue. Cathie, as you read through, you will also see me talk about carryover and overlap which occurs in the long acting insulins due to the depot.

Everyone has a hard time getting their heads around the concepts of bouncing and depot so don't get frustrated. We will go over it as much as you need.

She's pretty flat and I know she's higher than you want her but not as bad as when she was diagnosed. Progress.

See you in a bit.

 

sounds good.

okay, dilemma. I have had to restructure Shaak's feeding and shot schedule. She has been eating at 9:15 AM and 9:30 PM for a long time. It was never an issue because we have a room mate that has been feeding Shaak her 9:30 PM meal when I am in the process of picking my son up from school. I started Shaak's schedule using the same schedule she has always had, problem is, our room mate is not capable of doing a PMPS so I will have to be home to do this. Since I can't be here at that time due to having to pick my son up at that time (I could make him wait but it is a very dark campus and it takes me 40 minutes to get to him I don't want him waiting that long that late at night).
So what I am going to do is change Shaak's feeding time to 7 AM and 7 PM (she will have to get used to it for a few days) Question is do I not give the shot tonight since I will have to give a shot at 8 AM in the morning. If I give her a shot tonight it will only be 8 1/2 hours before I have to give her another shot. what do I do about the shot tonight?


I edited this post because I originally said 10 1/2 hours when I meant 8 1/2 hours

 

Shaak's PMPS is 365

 

Give her the shot as long as she has eaten. When you test in the morning, if she's 200 or below, don't shoot but post for help.

Thanks for letting us know. With an in and out insulin, it's not as crucial to worry about shooting a little early especially if numbers are up like this.

 

okay, sounds like a plan

 

You might want to grab a +1 and +2 test if you can so we can see where she onsets.

With the data gathering Sue was talking about, the goal is to identify her
Onset...when does the current shot kick in
Nadir...when is the peak action or lowest number of the cycle
Duration...how long does the insulin last.

These are important things for every CG to learn about their cat. It helps so much with dosing, feeding, and even planning your day if you know these three things. It will take some time to figure them out but just watch her SS and see if you can start to pick them out each cycle.

 

shot given, still a drop left over again. wonder if that is where the problem is coming from, looks like such a tiny drop but when such a small amount to begin with it could make a difference. I am going to go slower in the morning and concentrate more. Shaak is getting more and more comfortable with the situation.

I am now going to take a two hour nap. morning comes soon when you will be up for several hours.

 

oops just read your post, okay a one hour nap

 

If you just want to do the +1 I'd assume that would be fine...we already know Shaak onsets before +2 from last night and today. Gotta remember we can't take care of the sugarkids if we don't take care of ourselves

 

I agree with Andy. If you are tired and need to grab some sleep, you can get the +1 and then a +3.

I'm so glad she's relaxing with the routine. BTW, we changed Gracie's feeding schedule twice...once after she was diagnosed and once when we switched to levemir and she did just fine with it. I'm sure Shaak will too.

I'm headed to bed soon but others will be around. See how much difference even a day makes?

 

+1 210

my sugarcat is so sweet. she snuggled even after I took her blood.

 

The bond you will form with her over all of this is indescribable

So she does start to onset before +1, great data to have. Get some sleep tonight, you deserve it!

 

+3 260

gonna get another nap, last night is catching up with me. I did not ever want to sleep for it being first shot ever. Third shot tonight not quite so rough.

 

oh gosh... okay

+4 335

AMPS 349

last night I fell asleep sitting up practically right after +4 and did not even have the wherewithall to get online and post BG, so here it is along with AMPS.

got some sleep. Up to see to another day with my Shaak!

 

what does OTJ mean? I can't find it in the glossary of terms.

 

'morning Cathie

OTJ=Off The Juice=off insulin

http://www.felinediabetes.com/FDMB/threads/lantus-land-slang-dictionary.1903/

 

Shot given 1U best she has done yet, I was able to get it all in this time. she is having some water.

I will do a 1+ in an hour.

thank you for the definition Andy.

 

Cathie,

Could you start a new thread with the amps number this morning? This thread is getting long; we get lost easily.

Good job on the shot this morning. Like everything with this sugar dance, practice makes it easier.

 

Cathie

Glad you got some rest! I'm also glad everything there is going so well.

I think it's a good idea to start a new thread today. This one is getting too long.

here are the instructions to do that:
--copy the browser address from this thread
--go back to health forum (this one you are in) and start a new thread
--put the cursor in the text box and type Shaak's First Shot and click on the hyperlink tab above the text box (looks like a paper clip)
--paste the link in the box and select "insert"
--voila!! Then you can hit the return and start today's thread

Thank you,