Curve Results - Time to Increase?

New spreadsheet setup with Bryce's Lantus history which include the results of the curve done over the weekend. Will be talking to the vet, but do appreciate the thoughts and feedback from those on this board. Time to increase or need more time? FYI - She was on Vetsulin for 10 months prior to the change to Lantus (late December).

 

A couple of things I noticed when looking at your ss:

1) under the section U - please put the amount of insulin you are shooting such as 1.0 or 2.0 or 0.5

This will help everyone understand exactly what you shot for each cycle. Why yes it is repetitive, it also helps to ensure that you did shoot the amount you write down.

Make sense?

2) I noticed that you don't have any data for PMPS. Why is that? Are you not home and able to get spot checks? Not even before shooting the evening shot? And before bedtime at a minimum?

With half your data missing, it is going to be very difficult to advise on dose changes. I will leave that advice to more experienced beans to help you with.

 

I agree with Hillary. Also, here we usually increse in .25 increments. I noted in your notes in the ss that you went from 1 to 2 to 2.5. Have you read all the stickies? I'm sure someone with more experience will be along to assist you as best they can. Have a good day.

 

I agree with Hillary and Barbara. It would be very hard to interpret what's going on without having pre-shot values and spot checks during the PM cycle. Without any checks in the evenings, you are missing half of your data. Another reason this is important is that many cats have lower numbers in the evening and that information is an important factor when it comes to dosing.

While Lantus dosing is based on nadir, having pre-shot tests is essential for Bryce's safety. Barbara is correct in that in most cases, dose increases according to the Tight Regulation Protocol, are in 0.25u increments but a 0.50 increase is used if numbers are consistently above 300.

I'd also point out that a curve goes from AMPS through PMPS.

 

I agree with Hiliary.
Also, you have jumped from 1u to 2.5u, in less than a month, on the vet's advice. Often when increases are done rapidly, the ideal dose is missed.
The good news is that you have not been using Lantus very long and would not lose much by starting over at 1u, allowing the dose to settle, and making increases in 0.25u increments based on the nadir. I would start over and I also would be checking for ketones.

 

Hi Debbie,

If you would like to take a look at Basil's spreadsheet, you can see how much we've learned by doing the preshot testing. He's gone from a rainbow of colors in his ss to blues and greens. I say this because it may sound as if you asked a question, and the answer came back that you aren't following "the rules." But the rules don't represent some kind of arbitrary fussiness. Following them as well as you can is the key for getting the information people need to be able to make a comment based on experience with many cats.

My advice would be to discuss this protocol with your vet and to kind of start fresh. Best of luck!

 

Thank you all for your feedback. Thought we were doing better with this process, but clearly have more work to do. I updated the ss yesterday and confirmed the updates, but didn't see them here today. Do I need to share the spreadsheet everytime I update it? I've updated it today with the Units so see if you can see the changes.

- Yes, have read and printed the protocol. The thought was that she was consistently above 300, so .5 increases made sense. Now understand that you believe the nadir may be in PM post-shot numbers. We will start collecting more of that information starting tonight.
- On the next curve, will check AM Pre-shot number.
- Yes, I check for Ketones often.
- What syringes measure in .25 increments? Using Reli On U100 3/10 - 29G - 1/2" from WalMart.

Thanks again!

 

I see the SS up until yesterday....but I notice there are no units for the PM shots...
You are giving two shots each day?

We enter AMPS and PMPS at the very least each day...AM morning Pre Shot=AMPS and the PM is PMPS...
Mid-cycle checks show us how the insulin is working as the hours go by...valuable information and important data.

Maybe you can say what food you are feeding and what times during the day...
Good job with attaching the SS...it is an important tool for communicating!

 

On the box of your syringes, does it say 1/2 unit markings on it?

Do your syringes look like this:

http://romlin.com/jock/SyringeFineGradations/

Here's a pic of what .25 looks like:
0.25 on 1/2 unit syringe/

If your box doesn't say 1/2 unit markings, then I suggest you get a box that does say that - you may need a script. But it will make micro dosing that much easier.

 

My syringes are Reli-On from Walamart...it says "doses up to 30 units 3/10 ml 31gauge 8mm short needle
The higher the number gauge, the smaller the needle....

I am wondering if you give insulin twice each day

Can you do the morning BG test before you administer the insulin when you feed? Put the number under the AMPS heading....likewise in the evening, when you feed, you can test first, feed then shoot and put that Bg number under PMPSalong with the amount of insulin you gave.It is most important that you do get those two readings at least before giving insulin. Other tests throughout the day really help gather the data on how the insulin is wworking.....

Each morning, we post our kitty's AMPS with the date and name of cat in heading. It is called our "Condo" for the day....all BG updates, comments, questions, etc are within that one condo for each day. Then, the following day, we link yesterday's condo to the morning post.

the Fancy Feast you are giving is low carb, correct? There are so many varieties so it's best to be sure....usually the ones that say "Feast" are the LC ones.... We do use the high Carb ones...usually just the gravy...for times when their BGs go lower than 50.

So there is a system to this whole thing...the pre shot Blood Glucose numbers are very very important....
Any questions so far? :smile: