? Marley Dosing - 02/16

MarleyMoo

MarleyMoo

Member Since 2020
I did a dose increase because Marley's number were kind of flatlined and not moving. I went from 2.75 to 3.25. After 3 days, there was a little change, but not much. Since nadir was still 200+, I bumped it up to 3.5. Well, this morning his number was so low that I wasn't comfortable giving a full dose and gave just 2.75. I don't want to do reduced doses and prefer to lower the dose if that happens, but I just increased from a dose that wasn't helping him. I also know that dose increases can be weird until the body "levels out." If a lower PMPS happens again, should I just do the full dose and closely monitor him rather than a reduced dose? It's just so strange how drastic his numbers get. It's like a pendulum that keeps swinging to extremes.

He was also obviously feeling incredible this morning based on his playing, running, jumping, and happiness. So I'm happy to see this with the lower numbers, but it's incredibly frustrating not being able to find a dose that works for him.
 
Also, looking at the "Why the +2 is important" document, I see that a higher +2 than AMPS can indicate a bounce, but I'm seeing that with lower and higher doses, so I don't know how to use this info to find a sweet spot. :( I'm losing hope that I'm the best person to get him regulated.
 
Thanks so much. I appreciate it. The pendulum is just so demotivating. I'm trying like hell to help him, but it feels like I'm just not doing anything right :(
 
MarleyMoo said:
Thanks so much. I appreciate it. The pendulum is just so demotivating. I'm trying like hell to help him, but it feels like I'm just not doing anything right :(
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I feel you ... I have a vet appt next week to see if maybe there is something else going on in my case but she was there not that long ago so vet thinks it’s unlikely. Have to try everything... thoughts are with you
 
Sorry I have to be brief - he was doing well on 3.25U and is coming down overall, so there is progress! These random lows do always throw a wrench in things.

I would hold the dose a few more cycles if above 200. Also try to get some +7/+8/+9 at night, as that seems to be when he's swinging low.

Excerpt from the MPM:
If the curve is showing a smile shape with a noticeable drop through the middle of the cycle (greater than or equal to 50%), you should wait a couple more days before changing the dose

In this case, this is what you're seeing every so often
 
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And keep in mind preshots are the last to come down, the fact that his nadirs are often blue or yellow is a good sign. Just have to keep going.
 
FrostD said:
Sorry I have to be brief - he was doing well on 3.25U and is coming down overall, so there is progress! These random lows do always throw a wrench in things.
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I'm confused. His numbers didn't come down with 3.25 and they stayed above 200, so I increased the dose which is what brought these lows. So do I hold the 3.5U that brought his numbers down or the 3.25U?
 
MarleyMoo said:
I'm confused. His numbers didn't come down with 3.25 and they stayed above 200, so I increased the dose which is what brought these lows. So do I hold the 3.5U that brought his numbers down or the 3.25U?
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Oh I'm sorry I missed the 3.5U last night.

Up to you. I doubt he went too low last night per MPM, so probably ok to hold the 3.5U if above 200
 
What do I do if he does another low PS tomorrow morning? Do another reduced dose or do the 3.5 again?
 
I would only give a full dose at 200 or higher...not enough data just yet for shooting these low preshots.

Between 150-200 I think reduced is best. All the reduced doses you've done seem to have worked pretty well, so go with your gut. Around 2.5U is probably good.

Below 150 I would do a token dose (0.25-0.5U) only if you can stick around to test. Otherwise, skip.

Caveat to all of the above: at some point, once you're comfortable and can stick around to test, you'll want to try shooting higher doses at some lower numbers. Won't know what happens until you try, it's how we get the extra data points.

But you need to be comfortable with doing that, stay around to test, and be comfortable with your ability to handle lower (sub-90) mid cycle numbers, slowing BG drops with food, and handling a hypo as a worst case scenario.
 
FrostD said:
I would only give a full dose at 200 or higher...not enough data just yet for shooting these low preshots.

Between 150-200 I think reduced is best. All the reduced doses you've done seem to have worked pretty well, so go with your gut. Around 2.5U is probably good.

Below 150 I would do a token dose (0.25-0.5U) only if you can stick around to test. Otherwise, skip.

Caveat to all of the above: at some point, once you're comfortable and can stick around to test, you'll want to try shooting higher doses at some lower numbers. Won't know what happens until you try, it's how we get the extra data points.

But you need to be comfortable with doing that, stay around to test, and be comfortable with your ability to handle lower (sub-90) mid cycle numbers, slowing BG drops with food, and handling a hypo as a worst case scenario.
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Luckily I'm currently WFH so able to test a lot, but come April I will be in the office and won't be around to test. As you can see I test all the time, so I would be most comfortable shooting now than if I were gone. He has food all day and all night.
 
Can you think of any trends on these days/nights he comes up lower? Perhaps not eating as much, any vomiting?

There may not be any explanation, but it's worth thinking about. I was thinking you might be seeing overlap between cycles, but the numbers don't quite support that

Example: for us, I know I can expect higher BGs any time I do laundry, it stresses him out. Conversely, when he's less ravenous/not eating quite as much, I know BGs are about to come down. It's just anecdotal stuff I've learned over time, and document in the Remarks column.
 
MarleyMoo said:
Luckily I'm currently WFH so able to test a lot, but come April I will be in the office and won't be around to test. As you can see I test all the time, so I would be most comfortable shooting now than if I were gone. He has food all day and all night.
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Yep, I get it. Totally up to you, I wouldn't push anyone to something they weren't comfortable with. But the only way to see what happens is to experiment. So far he hasn't dropped too low on reduced doses with the 160-ish preshots, so in my opinion you definitely have wiggle room to shoot higher doses when that happens. But again, comfort level!
 
FrostD said:
Can you think of any trends on these days/nights he comes up lower? Perhaps not eating as much, any vomiting?

There may not be any explanation, but it's worth thinking about. I was thinking you might be seeing overlap between cycles, but the numbers don't quite support that

Example: for us, I know I can expect higher BGs any time I do laundry, it stresses him out. Conversely, when he's less ravenous/not eating quite as much, I know BGs are about to come down. It's just anecdotal stuff I've learned over time, and document in the Remarks column.
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None at all. He's a chunk and always willing to eat. No vomiting whatsoever. The only worry I have with shooting today is even at the reduced 2.75, it seems he "bounced." He went from 180 and the next hour he was 360 and it climbed to 411. Should I attribute that to odd bouncing because of the dose change rather than a legitimate bounce?
 
MarleyMoo said:
the dose change rather than a legitimate bounce?
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I've been staring at the spreadsheet for an hour on and off trying to make sense of it lol

It doesn't seem like he's bouncing in the typical sense, those usually take longer to clear (so you wouldn't be seeing as big drops to nadir in subsequent cycles...but you are).

Even on days this doesn't happen, he often has a very steep ascent (practically vertical) after nadir. It still could be overlap but I don't have much experience with that. Or, there is no explanation...and boy do I hate when that happens!

Also tagging @Deb & Wink

@Critter Mom - Mogs, I know you're not a PZ user, but for the life of me I can't find the post where you explained the Vetsulin curve shapes a few days/weeks ago. I'm wondering if similar concept may apply here. Thoughts? Or a link :oops: I'll save it this time, I promise!
 
FrostD said:
I've been staring at the spreadsheet for an hour on and off trying to make sense of it lol

It doesn't seem like he's bouncing in the typical sense, those usually take longer to clear (so you wouldn't be seeing as big drops to nadir in subsequent cycles...but you are).

Even on days this doesn't happen, he often has a very steep ascent (practically vertical) after nadir. It still could be overlap but I don't have much experience with that. Or, there is no explanation...and boy do I hate when that happens!
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Believe me. I stare at it all the freaking time trying to make sense of it. I test as much as possible, I follow the "rules," I try to never dose change based on the PS except when obviously low, but nothing seems to help. Even doing just a half dose reduction (like 2.75 to 2.6) causes such an enormous change from extreme highs to extreme lows. I just don't even know what to do to help him at this point :/

It's shot time. He just tested as "HI" as his PMPS. He hasn't had this happen in over a month. I'm hoping it's just him adjusting to the dose, but I'm worried.
 
I thought that might happen. Just continue to test like you have been...if you can sneak some +7 to +10 tests that may give us more visibility into what's happening and when in that later part of the cycle.

He may benefit from a more gentle insulin like Lantus, but let's see what Deb and Mogs have to say.
 
FrostD said:
I thought that might happen. Just continue to test like you have been...if you can sneak some +7 to +10 tests that may give us more visibility into what's happening and when in that later part of the cycle.

He may benefit from a more gentle insulin like Lantus, but let's see what Deb and Mogs have to say.
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His vial is almost out within the next 2 weeks. I may switch if it's a good idea. Or should I wait until after 1 more Prozinc vial?
 
Deb & Wink said:
I think you have given Prozinc a fair chance to see what it will do to control Marley's diabetes. Next choice would be either lantus or levemir, one of the depot type insulins.
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I'll call my vet about a prescription tomorrow. Do you have a link on how to order from Mark's Marine or another decent place to order?
 
Hi Melissa,

FrostD said:
@Critter Mom - Mogs, I know you're not a PZ user, but for the life of me I can't find the post where you explained the Vetsulin curve shapes a few days/weeks ago. I'm wondering if similar concept may apply here. Thoughts? Or a link :oops: I'll save it this time, I promise!
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Not sure whether this is what you're after:

https://felinediabetes.com/FDMB/threads/new-member-advice-needed.242265/#post-2729577

I'm sorry that I can't help in this situation. I just don't have experience of the nuances of Prozinc.


Mogs
.
 
Critter Mom said:
Hi Melissa,


Not sure whether this is what you're after:

https://felinediabetes.com/FDMB/threads/new-member-advice-needed.242265/#post-2729577

I'm sorry that I can't help in this situation. I just don't have experience of the nuances of Prozinc.


Mogs
.
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Not quite. There was one post I mentioned that my vet said dose could be too high because we had an early nadir, and you had listed several different types of curve shapes (tick mark, reverse, etc). But no matter what search terms I try I cannot find it again. Ah well.

Just strange to me that poor Marley here is having practically a straight vertical jump in BGs after nadir. For me at least, first time I've seen this.
 
FrostD said:
Not quite. There was one post I mentioned that my vet said dose could be too high because we had an early nadir, and you had listed several different types of curve shapes (tick mark, reverse, etc). But no matter what search terms I try I cannot find it again. Ah well.

Just strange to me that poor Marley here is having practically a straight vertical jump in BGs after nadir. For me at least, first time I've seen this.
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He's definitely not feeling great. Tested at +2 and still "HI"
 
MarleyMoo said:
Thank you, guys. Which would I order? I don't know the difference between a cartridge or a Solastar pen?
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The cartridge is for use with reusable pens. I suppose if you already have a pen laying around it's compatible with it might make sense?

The SolaSTARs are disposable pens. They're what most people on the Lantus forum use - you can use U100 syringes to draw the insulin straight from the pen. Most people don't use the actual pen to shoot because that requires priming it and wasting something like 3U every shot.

Then there's the vials like you're used to.

Benefit to the pens is they will last longer in terms of expiration/waste - they're 3mL each vs 10mL vial. So you're much more likely to use up a whole pen before it expires vs a vial.

Just make sure you get U100 syringes! You'll definitely want the ones with 1/2 unit markings
 
You'll want to start reading all the stickies over in the Lantus forum, namely understanding what the depot is and how it works, as well as the two dosing methods they use. They'll be able to guide you as to starting dose once you have it.

I find it to be a slightly more complex insulin to understand/navigate (coming from Vetsulin and ProZinc)...so I just read a lot over there, various posts, look at various spreadsheets to see how people handle things.
 
Checked SS when I saw your post over on Lantus board - since you're following MPM, still hold the 3.5U unless he throws you a low PMPS. Great catch on the 77. Don't be surprised if you start to see some weird numbers tonight and tomorrow, just hold the dose as long as safe to give and not dropping below 50.
 
FrostD said:
Checked SS when I saw your post over on Lantus board - since you're following MPM, still hold the 3.5U unless he throws you a low PMPS. Great catch on the 77. Don't be surprised if you start to see some weird numbers tonight and tomorrow, just hold the dose as long as safe to give and not dropping below 50.
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Thank you so much for the response and looking out for us. I took a nap so didn't see this until now.
You think to hold it? Once I got the 77, I was pretty much shoving all the food at him like "EAT PLEASE" including some Dr. Elsey salmon which I know is slightly higher than the chicken. Should I still stick with 3.5 tonight? I know he won't have a low PMPS. He's already at 450 right now and he doesn't shoot for another 2 hours.
 
Sorry I am running all sorts of behind tonight! Yes I would hold.

Remember as long as you're above 50, it's not necessarily the number itself - it's the direction it's heading. I'm not too concerned about a 77 at Marley's typical nadir time...I'd be concerned about a 77 before nadir because I know it'll still drop.

This post, although specific to Lantus, does a good job explaining the concept of using food to manipulate the curve. So today instead of waiting til you got the 77 - when you saw the big drop to 166, you could have fed a little bit of LC food (1-2 tsp) to slow the drop a bit. Then again a little more at +4 if still dropping quickly. There's no harm in how you did it today, it just helps the BG drops be more gradual and less harsh for the cat.

It's also something you'll have to get used to on Lantus, you should peek at some of their spreadsheets when you get a chance. A main goal with Lantus is keeping them in almost all greens... which can get stressful, but you'll see it's nothing to be afraid of!
 
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I gave a skinny 3.5. He always has access to food through the day until 2 hours prior because I free feed. So he had plenty to eat, but I made sure to give him the salmon which is slightly higher and some extra of his favorite pate to make sure he ate right when I started to panic.

I leave a bowl of pate out through the day. Then give him dr elsey chicken clean protein as poking treats. And have the salmon for when I really want him to eat.
 
Well Mr. Marley didn't go to an extreme low last night as far as I can tell. I feel good he didn't go hypo or anything, but also a little sad his numbers were so high. Hopefully today is a bit better as he adjusts to 3.5
 
Probably just a slight bounce/overreaction from yesterday! Could be worse. He seems to recover quickly, so he may surprise you.
 
The poor boy has gone through so much in 8 months with this, pancreatitis, dka, uti, etc lol. I hope he balances out soon so he can be happy again.
 
Well so far his numbers aren't dipping much. Hopeful that tomorrow will balance out and I"ll start to see a couple lower numbers.
 
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