Should I decrease?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Marya, Mar 7, 2018.

  1. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    This is my first time posting and I could really use some help. Fern who is 12.5 years old was diagnosed in September, we tried just regulating her food for awhile but eventually had to put her on insulin in the beginning of February. I have just filled in a spreadsheet with as much information that I had so its not too complete. I was originally doing just weekly curves but her numbers have been going down so I have started checking before I shoot. She has been on Lantus twice a day, starting at 2 units which was slowly increased to 3 units. In this last week she has gone from needing 3 units to 2 units and I need help figuring out the dosing when it keeps changing so much. I'm not sure I even reduced it correctly.
    If you could tell me how to share her spreadsheet, I will do it that so you can see what I am dealing with and maybe give me some advice. After doing more reading today, I can see some of my mistakes already.
    Thanks so much.
     
  2. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    Hi there.

    Here is the instructions for linking it to your signature.

    Instructions for pasting the SS link in your FDMB Signature block:

    1. Login to FDMB and click on your user name in the upper right corner.

    2. Select "signature”. The signature block is limited to three lines. If you have a lot of other information in your signature block, please be sure you place the spreadsheet link so it is easily located by other members (i.e. please don’t stick it at the very end of a long, detailed description of medications).

    3. Put your cursor in the text box, type in your kitty’s name with the word “Spreadsheet” (e.g. Furbaby’s Spreadsheet), highlight those words, and then click on the “hyperlink" icon above the text box:

    [​IMG]

    4. A text box will open that states "link"; paste your link into the box next to “URL” and click on “insert”.

    [​IMG]

    5. This should result in the highlighted text turning light blue which means it is now a hyperlink to the spreadsheet and anyone clicking on it can see the spreadsheet.

    6. Click "save changes" and you're done!! Great job!!!! If you need any help at all, please send me a private message by clicking on “Marje and Gracie” (to the left under Gracie’s photo) and then “Start a Conversation”. I am more than happy to help you or do the Spreadsheet for you.
     
  3. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
  4. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    We usually adjust dosage by .5 increments or even .25 increments for low-does kitties. Once you get a spreadsheet up and running, the pros will chime in on dosage recommendations. 2u to 3u is a big increase, do you have syringes with .5u markings?
     
  5. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Okay, I think I've got I hopefully the link will work if anyone wants to give me some input that would be great! I have been using the Advocate Pet Test which I brought to the vets when she had her first curve so the vet could get an idea of how our numbers compared. I had to use a Human Meter last weekend because I made a rookie mistake and ran out of strips and had to wait until Monday. Of course, Sunday, 3/4, she decides to go low on me so I included those numbers and put (h) next to them because things have been all over the place since then. Long day but bottom line is she had Karo Syrup AND higher carb cat food at around +6, I just went into panic mode and forgot everything I had read. So her numbers zoomed up.
    I have been comparing the Pet Meter and the human meter in the last few days and the Pet meter is almost 100pts. higher when we get in the higher ranges. The gap closes as the numbers come down. For instance: 256/100, 312/391, 450/347 and 86/50.
    Some of her earlier numbers might have been higher before her shots because I didn't know about not feeding for two hours before. This may have accounted for Sunday's crashing numbers, she probably ate before hand and probably shot too low.

    I am not positive about the days we increased on in the beginnings but I think it was on every curve that I had done for the vet which was a approximately a week apart so they might be off a bit. She went up in .5U until 3 Units and then numbers started going down last week and we started decreasing her dose.
    This is all making me a little/lot crazy so I am looking forward to some help.
     
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello and welcome. I can see Fern's spreadsheet. Awesome! I see some number with an "h" after them. The colours are not coming through unless it's strictly a number. You can go in and manually colour the numbers with the paintbrush icon. We really are used to seeing the numbers patterns by the colours.

    Most of us here use human meters, the strips are so much cheaper. Plus our dosing methodologies were written using human meters, so it makes dosing decisions easier. You can use the pet meter if you want, but I suggest picking one and just sticking to it instead of doing comparisons. The main difference is that for a human meter, we don't want them going below 50, so it's our take action point where we start feeding higher carbs. With a pet meter, that number is 68.

    To make things easier, I suggest sticking with the 2.0 unit dose for now, and getting enough tests so we can figure out how low this dose is taking Fern. We make dosing decision based on the nadirs or how low the insulin is taking the cat. That includes the night cycles, since many cats go lower at night. Try to get a test just before you go to bed every night, and that will be very helpful. Currently the right hand side of the spreadsheet is blank.

    Those numbers on March 4th could have been as a result of the depot from the larger dose you were shooting before that. The larger depot can take 4-6 cycles to deplete after a reduction. When you see low numbers (below 68 on that pet meter), start with a couple tsp of higher carb food and see if that's enough to bring up her numbers. Cats differ in how carb sensitive they are, so take good notes on how much of what you fed and when if you are trying to steer or raise the numbers.
     
  7. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Thank you so much for your help! I can breath easier knowing I won't be making these decisions myself. It was starting to get scary with the lower numbers and not knowing where to go with it. My plan was to switch over to the Human meter (I have learned my lesson about with not having strips) but I already started the spread sheet with the Pet Meter numbers, so how do I make that transition. I can use the Pet Meter for the curves for my vet so we are still on the same page and keep her happy. I have the Relion Confirm, is that pretty accurate? I ask because even when her number said it was 34 on the meter she was perfectly fine which is a little unnerving, I won't know she is getting low if she doesn't have symptoms only with testing.

    Any thoughts on why it jumped to over 500 yesterday morning when the day before it was perfect? I thought it was leveling out and then boom.
    I will definitely start with a higher carb food next time first and I will calm down next time so I can think clearer.
    I added the color. I had left the spreadsheet open on my computer but in the future, where do I find on my computer?
    Thank you so much for all your help!
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I used the Confirm too. My Neko sometimes didn't show anything but hunger in lower numbers, which is why it's good to home test. Better to overcarb than not at all. I won't tell y how overboard I went the first time. :p:oops:

    Yesterday's high number was the result of what we call a bounce. It's the cat's body's reacton to lower numbers than they are used to. They dump sugars and counter regulatory hormones int the blood stream. It can take up to six cycles for the n bees t come back down.

    If you log into Google Docs, you should be able to see the spreadsheet.
     
  9. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Thank you, I feel more confident you use the Confirm too and knowing how you overcarbed too. SAd thing was I printed out what to do if they go hypo and never even looked at it.

    I just officially switched over tonight at dinner to the Confirm and its nice now because it makes her numbers look so much better:) I will start getting one test more before bed. I admit one lame reason that I didn't was I kind of didn't want to know if it was bad right before bed, I've lost enough sleep checking how she looks and if the automatic feeder was actually going to work. I can she now just checking how she looks isn't going to cut it.

    Thank you again. Neko is adorable. I will have to get Fern's picture up, one thing at a time. She's a plain Jane tabby.
     
  10. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Fern's bounce seems to have ended and now here numbers are back down and I'm not sure what to do now. Long story and not planned but I wasn't here and she ended up not getting her insulin when it was due but about 45 minutes after her regular time and after eating and it was 267. I gave her only 1.5 units. She's not that hungry today and her numbers have been in the 200's all day except at the AMPS.
    I know 200 is one of the thresholds for shooting so I wasn't sure what to do. I'd appreciate any direction you can give me.
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Sorry no one responded to you yesterday. We tell new people it's OK to shoot the full dose if over 200. You would have been OK sticking with 2.0 units. Any reductions are done by 0.25 units at a time, not the 0.5 units you did do. She was only getting to blues on the 2.0 units dose.

    I recommend you take a look at the Sticky Notes on our two dosing methods, Tight Regulation Protocol and the Start Low Go Slow method and chose one that works for you. Following one of those will make dosing decisions easier.
     
  12. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    I gave Fern 1.75Units this morning and her BG is now 64 and one more hour to go before it peaks. I gave her some higher carb food but don't know where to go with this. I feel like every amount is too high lately. She keeps going to low and then bouncing. I will recheck in 15 minutes.
     
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am glad Fern came up easily for you. I think she's told you to go back to 1.5 units again. Although stressful, it's a good thing that her insulin needs are reducing.

    It's good you gave high carb food at that 64 on an AT. Our "take action" number where we give higher carbs is 68. When she dipped down to the 80's later on, you probably would have been fine just giving her a little of her regular low carb food. You might want to take notes about how much food, what carbs, and when you fed it, to help you next time you see low numbers. I kept those notes in the Remarks section of the spreadsheet. Looks like she didn't need as much high carb food as you gave. The idea is to bump them up around 30 points or so. The time she spends in those upper greens are healing numbers for her pancreas.
     
  14. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    I agree, I think 1.5 units is where she wants to be for the moment. The 64 was the Relion Confirm but it hadn't peaked yet so I was a little concerned. I don 't trust my Advocate Pet meter because it read 130 at the same time, that's a big spread. If I waited for it go sink to 68, I think she might have been in trouble. I think on that meter 86 would be a 50 on the Relion Confirm. Since I didn't do any mid cycle readings this weekend, who knows if it didn't happen then too. I guess I'm having a hard time because I was comfortable with the Pet Meter numbers because I started with them and kind of knew what was safe for her. I hope today didn't cause another bump, she seems to like to do that.

    I spoke to my vet today and told her I was using a human meter too but she didn't understand how it could work the same if we have to calibrate the pet meters for dog or cat. I didn't have an answer. She's very willing to work with me on home testing but we need to get our meters to match some how. When she had her initial curve done, it was about 30 or 40 points off from hers but it was inconsistent. She gave me a free IPet pro Meter but I haven't been able to test it because I am waiting for a replacement chip since I kind of bent it, they are supposed to be accurate within 15%, 98% of the time. Have you heard anything about them?

    Thank you for your help! Its so comforting...
     
  15. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I have heard of one or two people use the iPet. Most people using pet meters use the AlphaTrak. I never used a pet meter. Our dosing methods we use here are written for the human meter, so we use those numbers to figure out how/when to change the dose.
     
  16. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Well, we went down to 1.5 units last night and this morning her reading is 194. I'm not sure how much I should give her since its under 200. She ate good this morning so she should probably get something but not sure how much?
     
  17. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am glad you gave 1.5 units today. Our "no shoot' number for newbies is 200, she was barely under that. Over time and as you gather data, you will be able to shoot lower numbers. Looks like she's bouncing from those greens she had yesterday, so it's really good you got some insulin into he today.

    Sorry no one got to you when you needed to. On this forum, we start a new post every day. That way people people know there might be a new issue. The other thing you can do is to change your subject line and add a "?" icon to the title. That usually grabs some eyes. To change the title you go to the first post, and on the right hand side there is a drop down menu with something like Edit Title on it. You can change the prefix to the ? there.
     
  18. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Okay good. I used to shoot lower numbers in the beginning before I knew what I was doing, probably too low and she was okay, ignorance can be bliss. But things have changed so much, in a good way because she is not needing as much insulin but the insulin seems to bring her much lower. And also having her go low a couple times kind of unnerved me but what you said about her healing when its low put a whole new light on it.

    I'm glad its a bounce, I thought I messed up by waiting for the numbers to go up. I wasn't sure how the posting went but now I now, that makes a lot more sense. New day, new post and question mark? Got it. Thanks so much!!
     
  19. Marya

    Marya New Member

    Joined:
    Feb 9, 2018
    Fern's bounce has ended again, I tested her at an hour past her usually peak and her reading was 90, I went out and I left out food so I know she ate something before I tested her so I'm quite sure it was lower at some point. Her AMPS was 378. I figured at 378 this morning there would be no rush to be home for the nadir, I can't believe she keeps dropping like this. I would like to avoid another bounce so we don't keep going in circles.
    Does she earn another reduction?
    I can't be here the next two days in the middle of the day so I'm worried about it dropping too low when I'm not around. I'm glad her insulin needs are going down BUT some stabilization would be nice before I have to go for the day. I can't believe I am even contemplating missing a funeral to get a reading.

    Thanks for you help!
     

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