starting over at 1U BID! help!

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alexia&wednesday

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Hi,

I have posted on here quite a bit. I don't know how to make a condo...

Basically, I have decided to restart my cat's dose from 2.5 BID (which was doing nothing, increasing slowly didn't help at all....was she rebounding all this time?)
I started her on 1U tonight.

I assume this was the correct way to start over- not to decrease slowly, right?
Any help with this, or a heads up on what to expect would be greatly appreciated.

Thanks for all your help!

- A&W
 
Hello! I am a newbie here but my first thoughts will be that you want to be sure to test for ketones during this decrease. Others will come along shortly I am sure to tell you more.

As you decrease the insulin the high BG numbers may cause ketones to be produced. Do you have any ketostix's? You can buy them at the drug store.
 
Welcome back Alexia.

I would just start at the 1.0u dose. There will be some carry over due to your having been giving larger doses due to your having built up a depot (we call it a "shed") which is basically a means by which a certain amount of Lantus is stored in your cat's system. If you look at the permanent notes at the top of the board, there's one that discusses the shed. As a result, you will not get a sense of how Wednesday is doing on the 1.0u dose for a few cycles until the shed is depleted to the new dose.

Paige is correct -- it's helpful to check for ketones whenever a cat is running high numbers. However, ketones are not the result of high numbers by themselves. If Wednesday is eating well, there is less of a chance for ketones to develop unless there is an infection of some sort present. However, most of us check for ketones even if our cats have good BG numbers.
 
Thanks so much.
I seriously don't know where I would be without this site.

I have been checking her for ketones, since she was first diagnosed with DKA, and she had chronic pancreatitis.

So, I will just continue with this and follow the protocol.

Thanks again.

- A&W
 
Alexa, I don't think you should start over at 1U. I don't think you've hit the break through dose yet. Sometimes you have to go up quite a bit before you start coming down. 2.5U is a decent amount of insulin, but with Wednesday's numbers it may not be enough.

I'm going to see if I can alert one of the people with more experience to look at your SS and let you know what their thoughts are. It may be you need to do bigger increases.

Please hold off and check back here soon, k?

You are doing a good job!!
 
Ah! Alright, standing by.

Perhaps if you want to see my old posts you will get a better idea for why I decided to drop the dose tonight. A few days ago I posted about how she hadn't has any change in her numbers, I heard varying things-- but eventually decided to increase. I went up 0.25U and 4 days later I went up another 0.25 U, to 2.50U.
Still no change.

This is frustrating. When she first got out of the hospital (12/01) she was dong great on 1U.
I understand doses need to be increased, but the increases are hardly doing anything.

standing by for someone else's advice.

Thanks!

- A&W
 
Alexia, when was Wednesday diagnosed? And how long ago was the DKA? Any other medical issues currently or recently? Any other medications?

On first glance I'm with Jen, I don't see any indications that Wednesday is over dose. However, if you can give more information that will help us get the whole picture.
 
No other health issues.
She seems fine.

She was first diagnosed with DKA on 11/24. She was deathly ill (I was out of town for 3 days and had a cat sitter who didn't go lookng for her, thought she was just shy, but really she was hardly responsive!).
She has been ketone-free since then. No other issues, except some vomiting the first week home from the hospital.

Here is a long post I wrote about a week ago when I was first wondering if I had overshot her ideal dose. This has more info on her history (the very first post).
viewtopic.php?f=9&t=4715

- A&W
 
thanks for the link, that helped a lot.

I really don't think Wednesday is over dose. You're worried about being at a high dose, but truthfully 2.5 units is NOT a high dose around here (it does seem that way when you read Health, on some of the other insulins that would be a high dose, and some of the people there aren't that familiar with how we dose Lantus and they assume they are all the same). We do usually start at doses closer to 1 unit, but if the 2 unit doses were too high we would be seeing some clues on her spreadsheet that she is dropping lower and then bouncing high, and I don't see that. My opinion is that she just hasn't reached her breakthrough dose yet. In fact, I would probably *increase* the dose to 2.75 units (actually the protocol would have you increase to 3 units, but I said 2.75 because it looks like your schedule is challenging so slower might be better).

Carolyn wrote it all much better in the 1/31 post you linked, but I think you're on the right track. I *would* prefer to see some more daytime spot checks, but I know you work very long hours. Get spot checks whenever you can - right before you run out the door, right when you come home, ALWAYS at shot time, before you go to bed or as soon as you get up, etc. Any spot checks you can get will help fill in the picture. As Wednesday gets closer to a dose that gives her some "action," we'll be needing more spot checks on which to base dosing recommendations.
 
Thanks!
I definitely get AMPS and PMPS, but with this schedule is is really hard to get spot checks aside from the weekend.
Will probably consider having a friend come over while I am away. Next month won't be too bad, actually. But 2 months after that I am on surgery, long days!

I increased her dose, will at least give it another chance. I guess I just really hoped she would go into remission faster than it is going to happen. When I see the dose creeping up, I think the worst.

Will learn how to make a cat condo and then won't need to keep making new threads.
Thanks everyone. Off to the ICU!

- A &W
 
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