9/24 Kitty Boo AMPS 371 ???

Discussion in 'Lantus / Levemir / Biosimilars' started by emmabirch, Sep 19, 2014.

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  1. emmabirch

    emmabirch Member

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    So I am posting.....tired of the bouncing...switched to Levemir still bouncing.

    Emma
     
  2. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    OK, I've looked at the spreadsheet.

    An important note about Levemir - the nadir may be later than +5 to +7. It can even happen at pre-shot. You might want to check a +9.

    With the tiny dose you are giving, I'm wondering if a day or two off of the Levemir might let us see just how much he needs insulin. he may be bouncing because he doesn't need it. Its an idea; it could be wrong.

    Have you been testing the urine for ketones and/or glucose?

    And the 49 yesterday morning provoked the high numbers today; there's your bounce.
     
  3. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    It may be helpful to learn drop dosing.

    Drop method of dosing:
    Practice by filling the syringe to the first non-zero mark using an easily visible liquid, such as coffee. Carefully squeeze out equal sized drops - you may find twisting the plunger helps - and repeat until you can get the same number of equal sized drops each time. Now, when you dose the insulin, you can discharge drops (into the sink) from the dose, based on your cat's response.
     
  4. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    No, have never checked the urine. No one has advised that. Even when he was extremely high the Vet checked him for ketones and he didn't have any. I have the ketone strips, but never tested him.

    Emma
     
  5. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    It doesn't look likely for ketones, however it is good to check when you see high numbers. Ketones form as a by-product of fat breakdown for calories. Too ,maney ketones may indicate diabetic ketoacidosis, a potentially fatal, expensive to treat, complication of diabetes.

    See my signature link Secondary monitoring Tools for some tips on testing urine, as well as some other assessments you may wish to make to evaluate your cat.
     
  6. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Don't shoot unless he goes above 300 and then just a drop. Just what the plunger will draw in when it flexes back into place. But you might be looking at an OTJ trial really soon. Lev can be shot on an as need basis.

    Mel and The Fur Gang
     
  7. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    BJM you came to my house and met Kitty Boo. He is active and doing OK..it is just I get him down and don't know what to do..if I don't shoot him he continues to rise (Blood sugars) and if I shoot he bounces...and sometimes I don't shoot and he bounces..I am down to do on a smidgen....I call it .15 as it is only a small amount..but now he is staying up.

    Emma

    Just don't know of a schedule for him...if I feed him every 6 hours, he BS goes up..if I feed him every 12 it goes down but bounces..

    Emma
     
  8. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    I think part of the erratic numbers is because he may not need insulin, or not need much. You've made the changes to his diet and he has had insulin long enough that he's getting ready to go off the juice.

    Mel just suggested above giving only a drop when he is over 300. You just "chase the numbers". That means that you wait until he's over 300, then give a drop.

    Will he graze or does he eat it all at once? If he eats all at once, a timed feeder may work, like the Pet Safe 5 (its on Amazon - then price match at PetSmart).
     
  9. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Emma

    Look at Autumn's spreadsheet I'm going through the same thing with her. You've gotta stop the swing to see where the dose truly is better. Its much easier to raise a dose if not enough than chase a bouncing ball down the scale. You need flat right now even if that's higher and flat.

    Mel and The Fur Gang
     
  10. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    So what do I do? I can't get flat..I have reduced and reduced and reduced...from 1.5 units to 1 unit to .75, to .5 then .25 and now just a smidgen.
     
  11. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    I think Mel is saying:

    If Kitty B00 is 300 or higher, shoot 1 drop.
    If not, wait.
    Test again 12 hours later


    Nope. She's saying to give it a break for a couple of days.
     
  12. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    You hide your syringes and STOP shooting for a few days. Give the Lev a chance to clear his system he could be bouncing off the insulin itself. If he flat lines even in the reds just let him go flat. As long as he's testing negative for ketones just test him but withhold insulin.

    In fact now that Autumn is back to blues that's exactly what I'm doing with her. Tapping her down if she goes above 250 but otherwise leave her alone and give her pancreas a chance to show me what it can do on its own.

    Mel and The Fur Gang
     
  13. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Ok..stop shooting but still test...watch for ketones if he goes high...but how long do I wait?

    3 days, 4 days?? how long?
     
  14. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Give him a good 3 days off let him clear the insulin out of his system. Shoot only if he goes over 300 to start until we know how low a drop takes him and to help clear the bounce

    Mel and The Fur Gang
     
  15. KPassa

    KPassa Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Glad you found your way back here and into excellent hands. :thumbup

    If you want to keep this same post tomorrow, you can change the subject to the current date and maybe something like "Dosing Questions" and keep posting on this same thread if that makes things easier for you. Then, if you have a change in topics or questions or if this thread gets overly long, you can just start a new one.
     
  16. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Ok let me get this straight...I shot a smidgen tonight..he was 382. As long as he is up there do I keep the smidgen? I am confused.
     
  17. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    For 3 full days, give no insulin.
    Test at AM and PM (AMBG and PMBG) and when possible, about 2 hours after fresh food is put down. (likely food spike)
    Test for urine ketones (KetoStix, KetoDiaStix, or generic); if ketones, give 1 drop of Levemir
    - Just what the plunger will draw in when it flexes back into place.
    Feed mini-meals or allow Kitty Boo to graze.

    Evaluate how the glucose is after 3 days.
     
  18. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Ditto what BJM said. Tonight was fine because he's high enough but tomorrow especially if he's low stop shooting for 3 days. Don't worry if he goes even really high as long as he stays ketone free.

    If you're unsure post here first we'll walk you through.

    Mel and The Fur Gang
     
  19. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Kitty Boo won't graze..he grubs. He will eat what I give him and even eat what Pumpkin will leave or he roots Pumpkin out and finished his if I don't watch him while he eats. Are you saying keep wet food down for him all day? Let him eat as much or as often as he wants and just monitor his blood sugar? With given nothing for 3 days and watch for ketones? Do I have that right?
     
  20. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    You can feed him in mini-meals - half at test time, half about 4 hours later.
    No insulin; check for ketones.
    For 3 days.
     
  21. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...3/20 continue dosing problems

    Ok so this morning he was 331 and +6 1/2 he was 370. This is with no insulin. I am still using the same schedule for testing and eating. Since he likes that schedule and he comes to me and tells me it is time for testing and eating..LOL. But he is in the 300's.

    Emma
     
  22. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Give it time to settle down and clear out the Lev.
    He may be bouncing because he didn't need the insulin you gave last.
     
  23. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    I am doing as you say, but I know he isn't bouncing. This is his regular highs...in the 300's. I was stuck in the 300's for a long time when we were doing Lantus in small doses.
     
  24. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

     
  25. emmabirch

    emmabirch Member

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    9/21 Kitty Boo test 374 please review..he is drinking water

    Kitty Boo is now drinking water and peeing excessively. His pee is strong, but no ketones yet. But, he is sleeping and lethargic.

    His morning blood sugar was 374.

    Emma
     
  26. KPassa

    KPassa Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    I know how tough this is for you, Emma! Especially since I know how bad you want to bring those numbers down. Just a little longer. :YMHUG:
     
  27. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Yes, it is difficult. I love my Kitty Boo very much and it pains me to see him not feeling well...But I have my patient pants on...being patient.
     
  28. tibbs5

    tibbs5 Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Hi Emma
    hope your baby comes down soon and feels better. I know how hard it is when they are sick . It breaks your heart.
    hang in there. Sending healing your way.
    :YMHUG: :YMHUG:
     
  29. emmabirch

    emmabirch Member

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    9/22/ Kitty Boo down to 294

    This morning he is finally below 300! Only 294 but better than the high 300's...so continue no insulin?

    Emma
     
  30. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    OK, great. Based on your previous tiny doses, plus what Mel suggested, I think that doing drops, plus chasing numbers is where you might go.

    You might try Mel's trick - press the plunger down firmly, insert in insulin container, and release the plunger. This will draw up a tiny bit of insulin. If it is as low as you 0.15 doses, or lower, we'll see how that works.

    Or, you might dry drop dosing as I explained previously.

    Then, test around nadir to see how low he goes on just a tiny bit of Lev.

    We'll plan more after that.
     
  31. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    So when do you want me to start this...tomorrow morning? If I do it at the feeding tonight, then I won't be testing until feeding time in the morning, as if I get up early to test him..he is wanting his food right then...LOL
     
  32. KPassa

    KPassa Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Since you won't be able to monitor tonight, I think tomorrow morning would be the best option. :D
     
  33. BJM

    BJM Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Starting in the am should be OK.

    I've sent you a pm.
     
  34. KPassa

    KPassa Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    How are things going this morning?
     
  35. emmabirch

    emmabirch Member

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    Re: 9/19 Kitty Boo PMPS 382...

    He was 301 did a drop and this afternoon he was 273...Which means he ate and also saw a drop of 28 points.

    Good drop for just a drop of insulin..

    Emma
     
  36. KPassa

    KPassa Well-Known Member

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    Re: 9/19 Kitty Boo PMPS 382...

    Not bad at all. It's going to take about 5-7 days before we really see how this drop is working since we emptied the depot, but I'm liking the numbers so far. :thumbup
     
  37. emmabirch

    emmabirch Member

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    This morning...371 again.

    Emma
     
  38. BJM

    BJM Well-Known Member

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    Stick with it. Remember, depot insulins build up in the body over 5 to 7 days when you're starting over.
     
  39. emmabirch

    emmabirch Member

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    277 at +5

    Emma
     
  40. BJM

    BJM Well-Known Member

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    About 100 mg/dl drop, so the insulin is working.
     
  41. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Nice drop for just starting back on insulin and its an easy drop so shouldn't <anti-jinx> start him swinging again. That is exactly what we want to see a nice easy slide down and hopefully a nice easy slide back up at preshot.

    Mel, and The Fur Gang
     
  42. emmabirch

    emmabirch Member

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    346 morning AMPS today.

    Emma
     
  43. KPassa

    KPassa Well-Known Member

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    This is Day 3 since restarting insulin, right?
     
  44. emmabirch

    emmabirch Member

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    Right...this evening he was 113...??? didn't shoot.
     
  45. emmabirch

    emmabirch Member

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    This morning he is 378.. :( :YMSIGH: :sad: :!:
     
  46. MommaOfMuse

    MommaOfMuse Well-Known Member

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    To be expected with the skip last night. He'll come back down again.

    Mel and The Fur Gang
     
  47. emmabirch

    emmabirch Member

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    I was afraid to shoot with him being at the low hundreds and it was at night and I knew I could not stay awake all night to watch him..is that bad of me?
     
  48. BJM

    BJM Well-Known Member

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    Not bad of you at all; completely reasonable, since you're restarting him.

    Are you interested in learning to shoot at lower numbers? It is possible to give insulin when the pre-shot is below 150 mg/dL if there is mid-cycle test data to show it is safe.

    The trade off is being quite vigilent in checking for low numbers and being ready to intervene with higher carb foods to steer the numbers and keep them safely above 50 mg/dL.

    You would do this by slowly lowering your no shoot number a little at a time. Doing this gradually might reduce the wide swinging and get him down to more sustained lower glucose levels.
     
  49. MommaOfMuse

    MommaOfMuse Well-Known Member

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    No its not bad, always better to err on the side of caution. It just explains the high morning preshot number is all.

    Mel and The Fur Gang
     
  50. emmabirch

    emmabirch Member

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    Tonight his PMPS is 131..tonight I did do a drop...I will be able to watch him tonight.

    What hours are the most dangerous? He is eating now.
     
  51. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Usually they drop the lowest between +6 to next preshot on Lev. But I've found with my kids I need to stay with them and watch them close if they are already dropping at +3, since they normally should be rising until +5 ish

    Mel and The Fur Gang
     
  52. MommaOfMuse

    MommaOfMuse Well-Known Member

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    Funny you should ask, because I'm actually still awake to answer because I'm in that situation with Autumn right now. Usually with my cats on Lev if they are starting to drop already when I do my normal +3 lights out test, I'm in for a long night of testing and steering. However especially Autumn nadirs very late so she is her lowest at about her next preshot or on her preshot. And right now because he's just starting back on we aren't sure where his nadir is but I suspect looking at his spreadsheet he's much like Autumn with a nadir almost on top of his preshot. So you're basically shooting his preshot number and he should be rising until right around +6 ish. I didn't take a real good look as I'm about to need to go poke a kitty here shortly. But wanted to get you a fairly quick answer.

    Mel and The Fur Gang
     
  53. emmabirch

    emmabirch Member

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    This morning he was 45 pre shot. Didn't drop lower, but he ate well and shot only a drop...because I don't want him in the 300's...gave him a little more food...so I will see where he levels today.

    Emma
     
  54. BJM

    BJM Well-Known Member

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    Have you checked him again since then?
     
  55. aochoa

    aochoa Member

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    just read all your posts, I see you have great coaches already!! Just wanted to see how your kittyboo is doing this morning (night for me in Ukraine, already).

    I think I read all the posts, but wanted to mentioned that as you can see from your ss, on Sept. 16, you made a curve with Lev for the first time. Lev is more like flat numbers instead of a proper curve. And nadir can vary a lot from cat to cat, but more important is to have couple more tests between +6 and pspm. It sounds super scary, it certainly was for me, but since Lev is more flat, I learned to shot on a low ps number, since I knew my cat will not get much lower than that, and I was ready to fed him in case I saw a big drop at +2.

    When I switched to Lev, somebody also explain me that Lantus (our previous insulin) depot was emptying and Lev depot needed to be filled. I hope those 3 days with no insulin helped to clear the leftovers and you can start from 0.

    Bruno was also on 1 drop and tiny more (shooting on the 0 line of the syringe) it seems like nothing but sometimes they do need it, you see what happens when you skip. I know it sounds mission impossible, but maybe instead of skip you can shot half a drop somehow? Not even sure if that's possible.

    Good luck for kitty boo and you Emma, be patience. I hope Lev will do its magic for you two. ;-)
     
  56. emmabirch

    emmabirch Member

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    thank you Ann, yes I shot at the 45 this morning and fed him...I then also feed him again at+3 and I will test him again at +6 to see how he is doing.
     
  57. emmabirch

    emmabirch Member

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    Ok...Could someone review today's numbers? He is at 74 right now and it is 2 hours till food/shot...I moved him back to the original 10 & 10 because of football...instead of the 8 and 8. So here at 8:00 which is +10 he is 74. He was 45 this morning and this time I gave him a shot..and food, and then at +6 1/2 he was 108 at +3 I fed him more...because of the low number of 45 and giving him a shot.

    Please review.

    Emma
     
  58. BJM

    BJM Well-Known Member

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    Generally, getting anything below 50 mg/dL earns a reduction, but you're already down to 1 drop.
    You've seen that no insulin results in higher numbers. You might try shooting once a day.

    You'll recall I mentioned chasing the numbers. This means waiting until the glucose has gotten high enough to shoot. That is one option.

    Another option is to very, very slightly increase the carb content so you can get shootable numbers. You might do this by mixing 1-2 teaspoons of medium carb food with the low carb food, then portioning out the amount you feed.

    A third option is to switch to a non-depot, U-40 insulin such as ProZinc or BCP PZI. With a U-40 concentration, it becomes easier to give very tiny doses.
     
  59. emmabirch

    emmabirch Member

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    thank you BJ, but I think feeding him more has helped. It is only at night that he may drop because I am not awake to feed him during the night. But if I feed more during the day to see if his numbers are higher at night like last night..he was 45 this morning. I will see here in half an hour what his numbers are..

    Emma
     
  60. emmabirch

    emmabirch Member

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    His PMPS was 258 and it was because I fed him at +10 so it hadn't been 2 hours since he had eaten..but he ate more and I gave him his drop...will see what the AMPS are.

    Thanks.
     
  61. aochoa

    aochoa Member

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    108 after feeding is a very good number!!! feeding small amounts is a good call to make the curve more flat.

    BJM mentioned the SID, shooting once a day. I did that for around 10 days because my working schedule was crazy. Bruno was also on 0.1u. This helped him to start working more on his own and now we are on OTJ trial (only for 2 days).

    I think that with so little insulin, it might be worth it to try SID. I did it every morning at the same shot time than before, it was hard to resist and not shot, the days I was home at pm shot time, because his numbers could go a little bit higher, but within normal range, even 150. But you should hold your shot and let him try to work on his own.
     
  62. emmabirch

    emmabirch Member

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    This morning he had another below 50 reading, fed then shot...later it was 74 and then +9 was a little above 150...

    Will post at his 12

    Emma
     
  63. BJM

    BJM Well-Known Member

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    I am really nervous about giving him insulin when he is so low.
     
  64. emmabirch

    emmabirch Member

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    I was nervous too, but he would go up really high if I didn't..and the two times I have done it he has been ok as I feed him right then. I wish he would stay more on an even keel, but at least he isn't bouncing. when he is lower I feed him like 1/2 can and also give him some more at +6 and he seems to be doing ok. It is just the long night that he goes lower in the morning because of not having food during the night. I think tonight I will skip the dose and see what his mornings are without the shot? Then maybe he will just get shots in the AM for his eating during the day???

    Emma
     
  65. BJM

    BJM Well-Known Member

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    Can you feed him more at night? Or maybe feed him something just a bit higher in carb level? Maybe the Friskies Mixed Grill @ 11% calories from carbohydrate?
     
  66. emmabirch

    emmabirch Member

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    He wasn't still down..he went up to 302 again not as high as the other bounce...guess I should have fed him about an hour earlier instead of trying to wait for the +12 to do the pre shot. So I went ahead and gave him the regular dose, as he wont be low in the morning...but he will be back down by tomorrow night...his recovery is faster too...he gets back into the green..so tomorrow when he is down in the 113 to 130 range I will do shot and feed him mixed grill and see how his AM is...???
     
  67. BJM

    BJM Well-Known Member

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    That sounds like a plan.
     
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