what should the curve look like?

Discussion in 'Lantus / Levemir / Biosimilars' started by Pandasmom, Feb 22, 2010.

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  1. Pandasmom

    Pandasmom Member

    Joined:
    Feb 16, 2010
    Hi all,

    Odie and I have been learning how to deal with this whole diabetes thing for 5 days now. It's getting better (his poor ears from the first few days).

    Odie is also on Dexamethasone, Pepcid AC, and Chlorambucil to treat IBD (and pancreatitis initially). He was difficult to stabilize, and after many months, many medication and diet changes, we were stable. But now it's brought on diabetes. We are currently also trying to slowly get him off of the Dexamethasone and eventually switched to Budesonide.

    He eats Fromm's Salmon dry formula and Fromm's Salmon + Tuna can food (1/2 can pre-shot, twice a day)

    I've been testing pre-shot. It ranges from 253 to 340. He gets 2 units twice a day of Lantus.

    I did a curve the first day, mostly because I was so scared and not knowing how he'd react. We're doing a new one today, testing every 2 hours. I assume at this point, he should have stabilized on it a bit?

    I realize that every cat is different, but can someone tell me approximately what a curve should look like at this point?

    Thanks
    Odiesmom
     
  2. Nicole & Baby

    Nicole & Baby Well-Known Member

    Joined:
    Dec 28, 2009
    Good morning, Odie's mom!! My curve looks nothing like this - but here is an example in the stickies!! Good Luck!

    Example of a typical curve:
    +0 - PreShot number.
    +1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
    +2 - Often similar to the PreShot number.
    +3 - Lower than the PreShot number, onset has started.
    +4 - Lower.
    +5 - Lower.
    +6 - Nadir/Peak (the lowest number of cycle).
    +7 - Surf (hang around the nadir number).
    +8 - Slight rise.
    +9 - Slight rise.
    +10 - Rising.
    +11 - Rising (may dip around +10 or +11).
    +12 - PreShot number.
     
  3. Pandasmom

    Pandasmom Member

    Joined:
    Feb 16, 2010
    Thanks...

    How much variation should there be ideally between pre-shot and peak?

    Are we aiming to get him to eventually have him always within the "blue/green" range?
     
  4. Ronnie & Luna

    Ronnie & Luna Well-Known Member

    Joined:
    Dec 28, 2009
    Hi there,
    Odie's mom! Do you have a first name we can call you? It's ok, if you would rather be known as Odiesmom too.

    Welcome to the Lantus forum, known as Lantus Land (LL), I see you're in Ottawa! Hi neighbor!

    When you have a chance, you may want to read up on Lantus, up above in the "stickies" (anything with the "star" icon)....start with this one, that includes info on a typical curve with Lantus, as Nicole mentioned...

    New to The Group stickie:

    viewtopic.php?f=9&t=157

    Looks like you will be needing a spreadsheet, using google documents, you can creat both a U.S and World spreadsheet, since many members here are in the U.S, a U.S version is preferred, but you can also add a Canadian version for your vet...
    A spreadsheet will help for others to offer thoughts, input and suggestions.

    instructions can be found here: via the Tech forum:

    viewtopic.php?f=6&t=16

    We would like to learn more about Odie, what does he eat? Any health issues? How old is he? How much does he weigh?
    And so on.
    ... in this link, you can set up a profile for yourself and Odie, again through the Tech forum, if you need further techie help, there are quite a few tech pro's in that forum who can assist.

    How to Create a profile using google documents:

    viewtopic.php?f=6&t=531

    With all this, profile and spreadsheet, you can add the final product to your signature thru the "user control panel" for easy viewing.

    Hope to see you posting often, and please know, you can get lots of assistance using Lantus here.

    This group does follow one particular protocol, The Tilly Protocol, you can read about it here:

    viewtopic.php?f=9&t=1581

    If this is something you would like to follow, let us know. There are lots of experienced eyes here in this forum that can help you with dosing and following a protocol that has shown really good results.

    Do keep in mind, Lantus requires patience, and this forum encourages spotchecks so we can all see how Lantus is working on your kitty.
     
  5. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Odie's mom! Welcome!

    I have to say that you are not likely to find two cats the same: ECID. Every Cat Is Different.
    So, it's tough to tell you what you should be seeing.

    As Ronnie has given you the most important tools needed, I would suggest that you start up a spreadsheet right away and list all of the numbers from your curve. Normally, each person starts a separate condo, with their spreadsheet attached. When your spreadsheet is accessible, others more experienced can view your numbers and be better able to help you to regulate Odie.

    If you were to look at my spreadsheet, you can see how I am recording my Shadoe's numbers. She is pretty flat so it's tough to see her nadir, but others have kitties with much different curves. Just look at a few other ss and you will see that it's unique for each kitty.

    Yup, we are ultimately want to get down to those green and blue numbers and with no insulin. That's the goal.
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to LL Odie's mom!!

    Nicole and Ronnie have probably just swamped you with information!! (We tend to do that.) It's an overwhelming time and it really and truly does get easier. The front end of this learning curve is huge.

    Just a few words of caution regarding curves. Do not necessarily expect that Odie's curve is going to follow the rules at this point. At 5 days, he is just getting his depot (or "shed" in Lantus Land slang) fully built. A curve is what Lantus will look like at the ideal. In fact, for some cats the "curve" is flat -- it looks more like a surf. You might want to take a look at the spreadsheets (SS) of some of the kitties here who are on OTJ (off the juice) trials.

    Right now, you are in the process of taking the first steps toward regulation. A part of that process is what we call "liver training school" (LTS) and this is a time when Odie's numbers will bounce around until he gets used to lower numbers -- the blues and greens that you noted. Also, your curve is likely to be influenced by the dex. It is certainly possible to work your insulin dose around the steroid so if that is a concern, it's a workable option. There are several kitties here who have IBD and who can discuss their experience with you if you'd like.

    In addition to pre-shot tests, it's also important to be testing during the cycle. We encourage pre-shot tests for safety reasons. Mid-cycle tests are important for dose changes. With Lantus, dosing decisions are based on the low point (nadir) of the cycle. As a result, you will need to get tests during the AM and PM cycles. In some cases, a curve is great. On a more regular basis, spot checks are very helpful.

    When you have a chance, can you link Odie's spreadsheet to your signature?
     
  7. Pandasmom

    Pandasmom Member

    Joined:
    Feb 16, 2010
    Thanks everyone :)

    I've been keeping a spreadsheet (that includes a ton more info than your standard one, because I'm having to monitor stuff for his IBD too)... I have spreadsheets for over a year now :) Although it's now been rearranged to include something similar to yours.

    Currently it's in Excel, not Google Docs. I'm also in Canada and using mmol/L rather than the US units. I'm going to have to decide how to do this, whether to duplicate everything or what. I did create a profile this morning.

    As for spot-testing... yes, I will. I just messed up his poor ears so badly the first couple of days, that I wanted to keep pricking to a minimum for a few days to let them heal.

    I've read most of the info on this site over the last few days. It's a lot to take in at once. I'd become proficient with IBD/pancreatitis literature and lingo, now I'm having to learn all of the diabetes stuff too. I'm a researcher at heart (and by occupation), so it'll come.... but man there's a lot to learn very quickly!

    His internal medicine vet specialist who has been following him for over a year now has been great. She trusts me and knows that I monitor Odie very carefully and do whatever is needed to make him feel better. She said I'd be home testing and doing curves, and that she would work with me to get this figured out. We're having to be very slow/cautious with switching his Dexamethasone because it takes so little to upset the balance.

    Has anyone around experienced the switch from Dexamethasone to Budesonide?
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I'd suggest posting on the Health Board about the switch. They have a few vet techs as well as a ton of people who read that Board and can offer their thoughts. Several of the people here use prednisolone vs. dex.

    Several of the people here who have to administer other meds use 2 lines on a SS per day -- one for the BG tests and one to reflect when the other meds are administered. Take a look at Latte (Carolyn)'s SS.

    FWIW, most of us are metrically impaired. Ronnie can help you negotiate the US vs. Canadian perspective on the SS. Someone did have a SS that had a conversion between systems was done automatically by clicking on a button. I'm not that clever!
     
  9. Pandasmom

    Pandasmom Member

    Joined:
    Feb 16, 2010
    thanks, I've posted a message there too and try to find Carolyn's spreadsheet.

    Odie did not do well on prednisone, which is why we had to eventually go to dexamethasone.
     
  10. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
  11. Pandasmom

    Pandasmom Member

    Joined:
    Feb 16, 2010
    Thanks. I'll see what I can do with getting Odie's spreadsheet up on Google docs too. I just feel like I'm juggling so many things right now, it might be a few days.

    His BG today was:

    AMPS 17.7 (318), got breakfast and 2 units Lantus
    +2 --> 14.3 (257)
    +4 --> 11.2 (202)
    +6 --> 12.4 (223)
    +8 --> 12.8 (230)
    +9 --> 15.0 (270)
    PMPS 14.9 (268), got dinner and 2 units Lantus

    So he seems fairly flat, really. The lowest I've seen him so far with spot checking was 9.7 (175).

    Does this tell you anything?
     
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