Very decent #'s ,just sometimes

rebound still a problem,hoping it gets easier. finding the trick to keeping him low is to shoot low,
but not under 190. Can only do this if I am home.

 

Wish I could offer some wisdom - instead, just an observation. I wonder what causes a kitty that's been in the blues/greens to suddenly change to the yellows/pinks and then reds. Wish we knew the answer. I'm sure it's frustrating. Too bad there's not a cookie cutter, one size fits all solution for them.

On another subject, have you seen the post on health (I think) about tuxedo cats? If not, you may want to look there.

Hope things get back on track & stay there. Good luck.

Lu-Ann

 

i did see the post just now-but only the posts, no article about tuxedos..was there one ?I'm very interested-thanks.

 

Just popping in and saw your post and wanted to say "hi!" It's nice to see a post from you. I hope Buddy stops bouncing soon! Klinger continues to bounce as well, so I know your frustration.
Marcy

 

Hi, Marci,

I think I would post this question: "After taking the reduction on 8/26, I didn't take another on 8/28. Should I have? Could this be part of the reason that I'm getting numbers all over the place?"

Also, I notice that on 9/1 you had an 88, and I wonder if there was an even lower number earlier in the cycle. If you think so, I would put that into your post, too. That was a huge bounce Buddy got from that 88, which is certainly low enough to bounce him hard, but he seems to have bounced harder and faster than usual. Mind you, I have no idea if that is a clue or not. I don't use Levemir, and I'm pretty new at this, but I'm hoping I can help you ask the right questions, by accident or not. My philosophy is, "There are no dumb questions, and I would rather someone think I asked one than miss asking a pertinent question because I was worried about asking a "dumb" one!

Hope you get Buddy under control soon. I know how hard it is to see those numbers, get my hopes up, and then see another Red. Ugh, it's such an emotional rollercoaster. Hugs!

Yours,

 

I really appreciate your thoughts--on my way out to work now and will
respond more fully later-thanks!

 

I am really at a loss as to how to explain rebound and using lev to you so that you understand. Obviously, I have failed at it so far.

You can not shoot lev 2 hours early, or 6 hours early, or tid, and expect numbers to NOT "be all over the place". That is problem #1. To best use long acting insulins they need to be shot consistently on a 12/12 schedule and the same dose. It will not work to use a sliding scale or as needed (not at this point at least - going OTJ is another story all together).

Problem #2 is that he is clearly rebounding to me. When you have numbers in the 40s and 50s followed by numbers in the 300s and 400s, that is rebound.

This is what I recommend:

1) Drop the dose to .5u bid
2) shoot on a 12/12 schedule
3) if you are not home on a 12/12 schedule, let us know so we can figure out a changing shot schedule.
----It is very important that you understand that shooting early, even with the same done = a dose increase. I see you reduced the dose a bit on some of those early shots, but then shot more total insulin in a 36 hr period because you shot at +0, +6, +12, +10 for a total of 3.5u when his normal amount would have been 3u (for 3 shots). I am unclear what you shot on the last shot or when the next (4th) shot was (+12? +14?) since you didn't put that in the SS.
4) Hold that dose and schedule for a minimum of 5 days. DO NOT "panic" and shoot early or raise the dose. All that will do is reenforce the rebound response.

He will probably see a few higher numbers in the first few days and you MUST hold the dose and let him settle out. His body is used to pumping out cortisol and glucagon to prevent very low BGs. It will continue to do that, overriding the insulin dose until it figures out that there is less insulin to counteract. This can take 3-5 days. It may take longer with him.
5) if, after that settle period, his numbers spike higher, than I would actually reduce the dose again, but I would want to see his numbers to know that for sure.
6) test for ketones while you are doing this to be on the safe side.

I don't think I can help beyond this because it is, basically, what I have been suggesting for something like a year or more and I don't know how else to explain it to you.

 

Oh, my, well, that's what I expected -- someone who really knows her stuff sees things I wouldn't even know to look for. What do you have to lose, I say? At this point you have been struggling for over a year.

 

Sheila - I know that you are one of the most knowledgable people on this board and i do highly respect that.
I have done exactly what you suggested to me on several occasion in the past few years. , starting from .5u.
But because ecid,I know Buddy well enough now to know that he cannot maintain #'s under 300-400 if dose is under 1u.
i have a feeling that he probably needs a fluctuating dose , not a consistant one , like what Dale has done with Max,
which may be between 1u and 1.5 u. When he is on f1u for several days he gets good #'s but the rebounds ,
which is when i may need to give 1.25u. Dr.Lisa said because he is older (16) it may be more differicult to regulate.
I know you are right about the 12/12 dose schedule. I am unable to wait several hours if he is over 300, knowing the damage that is taking place as i wait. in those cases where i have shot early, I am always home, and his bg does come down to a decent # early rather than later, which is my goal. . i try to do everthing possible to keep his #'s under 200 to prevent damage .
i am lucky because i work at home and am rarely away from him very long.i hear you that because
i shoot early he rebounds, and i am not able to find his ideal dose. I am not convinced he would not rebound regardless. I just try to keep his bg low, and will work on keeping to a 12/12 schedule,but i do know he cannot make it under 1 u. Thank you for all for help.

 

Ok, Marci, I have been there, too. It is very scary, and upsetting to see those high numbers.

Again, I know nothing about Levemir and very little about all of this compared to Shelia, but it seems that giving the same dose everytime 12 hours apart is absolutely crucial to getting either Levemir or Lantus to work properly. I know how worried you are about the damage, but the damage from the numbers jumping around may be just as bad? I don't know, but it's certainly possible. I'm not sure you are gaining anything in that department by what you are trying to do. It's worth a closer look, I think. I do believe that you want to change the dose based on a spreadsheet that is useful, and you can't get a useful spreadsheet with the way you are using the insulin. Therefore, I don't think you will have any progress, and might be doing the same or more damage?

Dale

 

Cats will not sustain immediate damage from higher BGs. Only sustained BGs will cause damage. I am talking about months, not hours.

And if the higher numbers are caused by rebound, caused by too much insulin and/or shooting too early, then the way to stop them is to use the insulin the way it works best: on a consistent dose, on a 12/12 schedule.

Also, an inverted curve is not unusual on these insulins where the nadir is at +12 and the highest BG is at +6. The ct will be bringing himself down on his own without additional insulin. But an inverted curve can also be, yep you guessed it, another sign of too much insulin.

Please show me on your SS where you have stuck with .5u on a 12/12 schedule for a minimum of 5 days. I'm not seeing it.

 

Thanks Dale-I will do my best to shoot 12/12 , but here's an example of my conflict:
Today at +8 he was 305...I know for sure at +9 he wiil be red ..that means, if i wait, at least 6-9 hours of glucose toxicity,
till the +12 shot takes effect.
I gave him a shot (reduced) at +8.5 (tried to wait), and now 3.5 hours later he is blue(166). I saved his liver 8 hours of poisen.
that's how i see it.
how many of us can really wait around till +12 in this situation? would you? I don't mean to be unagreeable, I know all of you have the utmost compassion.Just trying to figure out how to best deal with the damaging effects of the wait till 12/12.
i find it hard to beieve i am alone in this struggle,but i guess I am.

 

Shelia wrote:

That's a relief. I read somewhere that spikes are bad, too, but I can't remember where.

I may not have been as clear as I would have liked -- hours or days at a high BG are not my concern. My concern is that if you have spiking numbers over and over again, for months, because you can't use the Levemir the way it was intended (either because it doesn't work for you cat or because you can't, emotionally, make it through the highs without taking action that is not prescribed by the protocol) you are, in effect, going to eventually have seen high numbers in the form of spikes off and on for months. I think my main point, that it is important to get a dose that can be used every 12 hours consistently is more important. The only way to do this is to ignore the high numbers, stick with the protocol, and give it a chance. Perhaps you have done this and it did not work. In that case, I would have the cat tested for pancreatitis if not several other issues with which I have no experience.

 

What I'm saying is that, from my understanding of the way long-acting insulin is designed, I don't think the blue number you saw tells you that you saved his organs from damage for eight hours by giving the reduced dose 3.5 hours early. I think the shed did that based on shots you gave him several cycles ago -- unless Levemir's shed action is totally different from Lantus' shed action. Nonetheless, they both have sheds, and they are supposed to use those sheds to regulate the BG, NOT regulate the BG through the shot that you gave immediately before you see a Blue (or Red, or Yellow, you name it) number.

I think the only way you could know that you cat's body is sooo different, and is using Levemir in a unique way that makes your actions make sense is if your cat had a continuous glucose monitoring device that graphed a curve for you in real time. I also think that if your cat had such a monitor, you would see what the Levemir really does, and you would see that you are actually bouncing your cat's BG around in a way it would it not be bounced if you were using a 12/12 schedule.

The concept of the shed was very, very hard for me to grasp because I was resistant to it as you are. You are definitely not alone. I think that if my cat had not been a bouncer, I would have understood it sooooo much earlier, and that my anxiety and fear of his high numbers was getting the way of my brain working properly to understand. I gave him one, only one dose, at 1 unit, saw a high number, and couldn't stand to take the risk that going up in dose was the appropriate thing to do instead of holding the course at 1u for a while.

I couldn't stand to wait for 3 or 6 cycles to find out. By complete accident, I may have done the right thing, but it could have gone the other way. I say "may" because I found out later that glucose toxicity had set in (most likely) and going up was the only way to go. However, if GT had not yet set in, and it actually happened a few cycles later while I was going up by .25u until I got all the way to 2.75, it is possible that that 1u dose may have worked. I will never know for sure. This is why it is recommended that you drop to 0.5 or 1u and start going up slowly based on data that you get from shooting every 12 hours no matter what numbers you see until you have held the dose long enough for it to settle. In the end it takes less time to get to the right dose! (You just have to test for ketones religiously, and you are home. So, you can do that.

In any event, I think that if you cannot believe or feel comfortable using Levemir the way it was designed to be used, you should talk to someone who has used a different insulin and see about switching to one that lets you determine the dose based on the Amps and Pmps BG reading. I am not saying give up on Levemir, but you need to explore the idea of using a different insulin at least. It may, at the very least, help you understand the shed concept better, and if necessary you could use the other insulin for a while until your cat stops bouncing. You could possibly come back to Levemir later? I hope that it helps you to understand the shed and trust that the protocol is the right way to use Levemir whether you stick with Levemir or not.

I also hope others who know about Levemir and the other insulins besides Lantus will chime in here with thoughts about my suggestions.

 

Dale, I think that what you said and suggested is good. I agree that Buddy's bounces are most likely from erratic dosing and overdosing. It is something I have been saying all along.

I also agree that Marci should consider switching to Pro Zinc based on how she wants to use insulin.

Marci, I am bowing out - for good this time. I posted that before to you, I believe, and you talked me out of it. I can not, in good conscience, enable you to use levemir the way you are using it. I feel it is at best, ineffective and at worst, dangerous to Buddy. Plus, you simply discount everything I suggest or ignore it so it is a waste of my time.

He is your cat. You hold the syringe and the insulin and I can't for the life of me convince you to use levemir the way it has been proven to work on cats. I can't even make you understand that YOU are causing the 300s and higher be doing what you are doing with early shots and too much insulin.

If you really want to learn about using levemir or about feline diabetes then I suggest reading, studying actually, both the Lev 101 sticky and petdiabeteswiki.

And I will try to not worry about Buddy, but of course that will be very difficult.

 

Just a quick thought......if you cannot take those high numbers (I hate them too) have you ever considered using R insulin? I have not yet tried it, so nothing real to offer in advice, but I have seen many people use it to help their cat's out of high numbers until the lev kicks in. But, from what I understand it requires close monitoring, if you do use it, until you learn how your cat reacts to it.something to think about.

 

I do trust the advice here- I am on a 12/12 schedule past 2 shots.he is now 345 and it's only +9 but I will wait .
I just have to be able to see the longer view and not act in the moment. Thank you, everyone.
will update post later.

 

Using R is for experienced care givers. It is not something that anyone should go out and get and just start using.

 

I, personally, would try switching to ProZinc before I tried to use R with a long-acting insulin. I understand it is very, very tricky to do that, but can be successful. I do not think that most people can do it safely especially now that I have first hand knowledge with how difficult it is to give a dose less than 0.5 with these syringes we are using. I'm trying to get a better syringe, but it is really hard to do, and I understand that they may be very difficult to use in and of themselves.

I really hope you can make Levemir work for you. That would be much safer and more likely to get the result you want to see, IMO. If I were you I would keep trying unless I just couldn't resist shooting early or changing the dose without good cause. Just say no! If you look at my spreadsheet you will see how I suffered, but it did work out eventually, and how!

I am very glad that I was able to control my emotions enough to get through to having Max regulated. He is holding his weight steady, he has no dandruff, he eats A LOT less -- just about in line with what a healthy cat would -- and he is going to live a lot longer and be happier while he's still around.

 

Dale- thanks for reposting Sheila's words about sustained Bg doing damage, not for hours.
I'm sure she has said that to me before, but it just hit me-and was exactly what I needed to readin order to wait 12/12.
i will give Lev a one last try over the next month, doing 12/12 before switching ., it would be good for both of us , actually. it 's been hell
having to be home all the time to test and shoot. and have not been able to make any plans to go out , except for
and hour or 2.Knowing his shot is not due for 12 more hours is real freedom . I hope it will be for him too.
i really appreciate the help.

 

Do you test regularly for ketones? Could an infection be setting in which is causing the bounci-ness?

I've already posted on your other thread for food and other stuff.

I hope Buddy will settle down and not be miserable with lev. Give it a chance to work how it is supposed to and maybe it will be great.

 

yes do test for ketones---thanks.