11/28 Mimi AMPS 292 - Mimi PMPS 269 +2 289 +3 265 +4 295

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Mimis mom, Nov 28, 2019.

  1. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    http://www.felinediabetes.com/FDMB/threads/mimis-cruising-mellow-yellow.222212/#post-2484140


    wondering if she’s getting close for an increase or is she still clearing a bounce?
    Also starting to get paranoid that maybe her Lantus went bad or something (it’s nearing the end of the bottle and I’m trying to check off all possible reasons) and that could be a reason her BG is remaining high?
    No reason why it could be- it’s only 2 months old and it’s kept refrigerated, but then I wonder “maybe they’re right at the pharmacy when they told me the pen lasts only 28 days” even though I know that’s because it’s stable for that long at room temperature, my conscience starts to throw doubt into my mind..

    It looks like in the past she’s cleared bounces pretty quickly so I was wondering if this could mean she needs an increase?

    thanks everyone!

    @Sienne and Gabby (GA)

    @Gill & George

    @Marje and Gracie

    @Bron and Sheba (GA)
     
    Last edited: Nov 28, 2019
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  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    If you are following TR, you would have increased after 3 days/6 cycles. That may be one issue. It is also quite likely that the 0.75u dose is a failed reduction.

    Bounces are unrelated to dose increases. And as for the 28 day thing, I've used pens for almost 3 months without a problem. Most of us have used pens down to the last drop. I've also gotten a bad pen (like when a pharmacy tech bounced the box of pens on the counter) but it's not typical.
     
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  3. Charlotte’s mom

    Charlotte’s mom Member

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    Oct 2, 2019
    Hi! I’m not one the gurus here but I do know that the lantus pen has actually been verified to still be good 6 months from purchase if kept in the refrigerator. However, the veterinary profession advises to use it by 3 months. Are you slgs or tr? If the former you’re supposed to hold the dose for 7’days.
     
  4. Mimis mom

    Mimis mom Well-Known Member

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    Oct 12, 2019
    I was told it was too soon to increase- so I should by now? I’ve been posting about her numbers every day I haven’t heard anything about increasing yet and I was under the impression I shouldn’t do so until I’m instructed here.
     
  5. Mimis mom

    Mimis mom Well-Known Member

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    Oct 12, 2019
    No I’m TR, and ya I know it’s fine I’m just weighing out all the options :(
     
  6. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    I used a vial for almost a year - refrigerated the whole time. Also have used pens for varying amounts of time - until it's all gone. Usually from 3 months to just over that...I can't afford to toss it out with the cost and the tiny amount that Luci gets ...

    I think you could increase to 1.25 - and keep going up every 6 cycles until you start to see some nice green numbers like you had on 11/19. Just make sure she's eating and that you're available to test as often as you do - which is a good thing. It would be nice to get her out of those yellows.
     
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  7. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    So the green numbers I want to see- not just blue.
    I’m going to be working the next few days so there will be a good 8 hours I won’t test
     
  8. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Well yes, we all hope to see those greens. The healing numbers.

    Since Mimi has a little ketone thing going on and her numbers aren't ideal, if you can get as many tests as you can before work, after work and during the night time cycle (yes, I know, no one wants to get up to check BG's on the cat)...but it's the only time that you'll know if the dose is effective.

    Does she have access to food while you're away?
     
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  9. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    Yes she does have access to food while I am away. Her ketones are 0.5 - that’s in the negative range I thought?
    So should I increase then?
     
  10. Krystina & Nelli

    Krystina & Nelli Well-Known Member

    Joined:
    Jul 4, 2018
    Hi Rosa, I’d hold this dose for at least You really haven’t seen what it will do.. yet ;)
     
  11. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Jul 4, 2018
    Ketone at 0.5 is ok
     
  12. Sue and Luci

    Sue and Luci Well-Known Member

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    Nov 3, 2017
    If you're following TR and you're home to test, you can increase every 6 cycles. It's up to you, but if it were me, I'd give her an increase.
     
  13. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    Ahhh what to do?? What about her being at risk for glucose toxicity with it remaining high? Or keeping her at this dose is it increasing her risk for DKA again? @Sienne and Gabby (GA) you mentioned I should have increased it by now?
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Rosa --

    Either you're following TR or your following SLGS. You have to choose. It's not a hater of a bit of this and a dab of that. I gave you my thoughts earlier. Others have, as well. What you do is entirely up to you.
     
  15. Mimis mom

    Mimis mom Well-Known Member

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    Oct 12, 2019
    I’m following TR! So i increase? Tell me exactly what to do?
     
  16. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    I’m
    Weighing out all of the options as to why she hasn’t gone down yet - I’m sorry if that might have sounded like I wasn’t following TR or SLGS
     
  17. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
     
  18. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Since you are following TR, I would increase tonight if you didn't see any greens today. So new dose is 1.25u.

    I always re-read again and again the dosing methods sticky. Even after a year, I still re-read it. I recommend you continue to re-read it. It's great you're asking for advice too so I would take into consideration the advice you get, how Mimi's numbers are doing, how comfortable you are shooting a certain dose, and following the methods.
     
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  19. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    Thank you. I was starting to make my own decisions based on what the stickies say but someone with trusted advice told me a few threads back that I should wait until I’m instructed to increase until I get better at this..

    I have no “ego” in this. Mimi’s little body is at the mercy of this page and it’s advice so I need to be doing this right and according to the stickies she’s been past 6 cycles correct?
     
  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    What do you think you need to do?

    Each of us has a different spin on dosing. I tend to like to see that people are learning the basics and interpreting the instructions in the stickies. If you are saying words to the effect that "This is what I think I should do -- is that what's indicated?" I think that's great. If everyone had to wait for someone with a lot of experience before making a decision, this place would grind to a halt.
     
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  21. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    I think I should increase? She’s been in too much yellow- I’ve seen her curve better on different doses and this time she’s been flat so my instinct is to go with an increase.
    I agree with you about waiting around but I’m also still a student and I’m extra nervous because of Mimi’s traumatizing hospitalization where I really thought she was going to die (and not just from typical paranoia - But because the vet was convinced). If she hadn’t been DKA I would have probably just followed SLGS because of my schedule and patience with her. She’s shown me she needs more aggressive action to be taken when she’s sick -
    with her bladder stone the vet told me to wait it out a little if I needed to- so I went to a holistic vet and they put her on herbs and homeopathic stuff, but not even a few days later she developed a very painful abscess on her anal glands that required immediate extraction of that (luckily for me a surgery without anesthesia- but not fun for her) and while I was worried about the large 1500$ cystotomy bill initially I ended up spending double taking it “slow”- 600$ from the holistic vet - cost of initial eval with the magic potions, and 600$ from the lancing and draining of the cyst with pain killers and antibiotics from the regular vet.

    Mimi is shown to be a little fighter but she’s also shown to be prone to illnesses and reactions to things.

    As far as I go? I have issues in general with trusting myself. I recall as early back to 3rd grade the teacher telling me to trust myself (when I kept asking her the same question in different ways about the same problems that came up in different questions on a test).
    She said “Rosa you know the answer to this, you need to trust yourself”
     
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  22. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    I was wondering if I needed to replace my Lantus too! lol The pharmacist told me that Lantus should be kept at room temperature, so that is what I did until I found this forum. The vet tech told me to roll the Lantus bottle not shake it - so that is what I did... until I found this forum. Thanks GOODNESS for the people and info on this forum!!

    My bottle is about 1/2 done and it was started at the end of September. The insulin is still clear, is now being refrigerated and not rolled or shaken but maybe the damage to the insulin has already been done? When Lantus is mishandled, does it lose it's potency on a gradual basis or is it an "all or nothing" kind of deal?
     
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  23. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    All of us at one point in time have thought, maybe it is the insulin...I know I have :). It rarely is...usually kitty needs an increase to kick things back into gear.
     
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  24. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Thanks Christie,

    In Freckles' case to GET IN A GEAR would be nice... I know, I know ... patient pants! :p
     
  25. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    the vet tech told me to roll it too!?? What is going on!!! Can every vet and vet tech be required to complete a felinediabetes.com test in order to even be qualified to give advice on treating your diabetic cat!? It seems like the info they give could kill them.

    Case in point- the vet tech- told me to roll it. The other one told me to decrease the dose one whole unit because they give out solo pens and they think a pen needle is the only thing you can use to draw the insulin out. I had two vets tell me I don’t need to test them pre shot- that to just look out for signs like not eating or acting drunk. Which by that time I’m imagining it’s already too late. And they also told me NOT to feed her more than twice a day..
    SMH
     
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  26. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    Increased dose to 1.25 tonight (forgot To mention)
     
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  27. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    @Marje and Gracie - why I’m confused because Sienne says right here about increasing after 6 cycles if I’m following TR. also stated the .75 could have been a failed reduction so I’ve been nervous because since that reduction she hasn’t seen any green. Did I misunderstand something?
     
  28. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    When a dose reduction is earned, like to 0.75u, there is no need to hold the dose six cycles. As soon as any bo7nce clears, if she doesn’t go back to green, you take the dose back up to the last good dose which was 1u.

    You reduced p.m. cycle 11/19. She bounced and cleared the bounce the night of 11/20. She didn’t get to green so the dose should have been taken back up to 1u the next day.

    You did increase to 1u on 11/25. I told you on 11/26 that she wasn’t ready yet for an increase b3cause she had only had three cycles at 1u. Six cycles ended by PMPS on 11/27 but she gave you a blue PMPS so I would have also held the dose. But...she didn’t do anything so I would have increased the next morning.

    Do I think she needs more insulin? Absolutely. If she doesn’t show you any blue by the morning, then go ahead and increase her dose by 0.25u if you can be there to test her and it’s very clear she isn’t clearing a bounce. She will have had seven cycles at this dose and the pink tells me she either needs more insulin or she’s going to clear the bounce in the next cycle.
     
  29. Mimis mom

    Mimis mom Well-Known Member

    Joined:
    Oct 12, 2019
    It’s such a complicated disease- her diet has remained the same yet her little body that was doing well on 1.25 units at one point - too well, because it earned her those reductions all of a sudden doesn’t want to accept those smaller doses. Are some things just unexplained?
     
  30. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    If doses are held too long, even after a reduction, the higher numbers can slow progress down. And, sometimes, insulin needs change for no reason.

    For example, my Gracie always did worse in the winter. The philosophy has to be “don’t get married to a dose”. When they need more insulin, they do. Things change.
     

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