Wilson PMPS 29.5. Reduced insulin.

http://www.felinediabetes.com/FDMB/threads/wilson-post-hypo-dose-advice.191523/#post-2136880
Wilson's gone low again after 2.5u last night. I need to miss his shot again. Not sure how low he went last night as I only did one test at +1.5.
@Tuxedo Mom I will post after work numbers to work out what to do tonight.
Definitely needs a reduction.

 

YIKES!!! DEFINITELY skip the shot since you won't be home to monitor. With a low preshot like that it is very possible he went even lower through the night. I think he went high last night because of a combination of the low numbers the night before causing a 'bounce' as I talked about previously and the skipped shot. Looks like he 'broke' the bounce very quickly and the 2.5units was definitely too high. I may not be awake when you get home from work but given the numbers over the last few days, and the fact that I am VERY conservative with dosing advice I would be looking at no more than 1.5 units....depending on his reading at PM shot time. Even if it is high...which is very possible with a skipped shot, I would still consider the 1.5 units for the next shot and do some extra monitoring,

Tagging @Bobbie And Bubba who has also been following your thread to get some other feedback.


ETA With Lantus if you can only do one test at bedtime getting a +3 will give a good indication on whether Wilson may drop during the cycle. The +1.5 test you did would have still been food influenced, but a +2 or +3 test with no food after the initial feed at shot time will show whether it could be an active cycle. Rule of thumb is if a +2 is the same of lower than the preshot, the cycle could be active.

 

Wilson's number last night were high because you had skipped the dose in the morning. And he was probably bouncing from the night before. However, it's important to take reductions when a kitty earns them. Without any other tests last night, we don't know if he went lower than 86 or if he just had a late nadir, which is quite common with bounce breaking cycles. On Lantus, Neko was known to occasionally give me a nadir at +13. The good news is that he's getting over his bounces very quickly.

With SLGS, the guidelines are to do down by 0.25 units when a reduction is earned, but I think it would be reasonable to go down to 2.0 units. I wouldn't want to go much lower or you might put the brakes on Wilson's progress. Having skipped the last two AM shots, the larger depot should be well drained so that shouldn't be a factor.

 

The SLGS guidelines are more of a suggested approach

"Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.'

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

The recent diet change could very possibly be coming into play with the numbers. Diet changes do not always show immediate results so it can sometimes take a week or 2 before the effects of the diet change show. There are a number of factors at play right now...not taking the reduction last night, the possible bouncing, the diet change, the skipped shots. As I said I tend to be very conservative with my dosing suggestions, especially if the caregiver is not home to monitor when changes seem to be happening. My suggestion of 1.5 units is based on being safe. If the numbers are staying up after a few days then the dose could be fast-tracked upward and a curve done when Tanya has a day at home. Avoiding a potential hypo for a day or two is better than trying to keep on track with suggested guidelines IMO

 

I used the word guideline on purpose. A guideline is just that. It is not manditory.

And if you read the spreadsheet, you would see that Wilson is now snubbing the raw and back to Fancy Feast cans, so his carbs have gone up. Plus today is Friday in Australia, which means (hopefully) a day off work tomorrow and a chance to stay up or monitor tomorrow during the day. I would rather see what 2.0 is doing now, when you can monitor on the weekend, than go to a lower than needed dose and increase after a few days when you are back to work and cannot monitor.

 

Thank you for pointing this out Wendy . I didn't factor in the day/time change for Australia, and IF Tanya is off tomorrow then she could hopefully do extra monitoring through the evening and during the day tomorrow. If this is the case then the 2.0 unit might be a good starting point to see what a good dose is for Wilson. As I said there are so many different factors at work right now and I DO tend to be very conservative with dosing suggestions.

 

Wow! Sorry I was not on all day, getting ready for vacation. I think it is lucky that this is happening the night before a weekend otherwise I would be inclined to shoot less than 2.o units also. Even with Wilson being back on FF that is still less carbs than the MD dry he had previously been on.

Monitor him well tonight Tanya as he is on a mission.

 

Hi. Well Wilson's PMPS was 29.5. I only gave him 1.5u. Again this was expected after being so low last night and no AM shot. Fingers crossed that he will be a nice number in the morning. Not too high or low. My 1/2u syringes finally arrived today. They are so my easier to use. I'll test him in a couple of hours. Thank you all again for the advice. Couldn't do this without the help from everyone.

 

The high PMPS was to be expected after lower numbers last night and the no shot. Do you have a day off tomorrow? It would be good to be able to get some mid cycle tests in to see exactly where Wilson's numbers are going. My suggestion of 1.5 units was based mostly on the fact that you may not be around to do some in between testing and Wilson has been doing some lower numbers. With Lantus it often takes a day or so for the depot to 'fill' properly in order to see how a dose is working. For tonight if you can get a +2.5 or +3 it should give some idea on whether he is going to drop much on this cycle. It would be wonderful to find a dose that keeps the numbers down safely so that you can give shots both AM and PM. Hope this makes sense...I am just having my morning coffee and am not totally awake yet I'll check in a bit later and see how Wilson is doing.

 

I am home tomorrow so can monitor all day. I was too nervous to give more insulin after the last 2 nights. I'll post his before bed number tonight and update AMPS in the morning. Enjoy your day.

 

Get a test in a couple of hours and see where the numbers are going. Hopefully Wilson will come down decently, but not too quickly or too low tonight so you can get a good sleep and then do some extra monitoring in the morning. Getting a dose that works and you can shoot both AM and PM is the goal. Good luck with tonight's cycle!

 

@Tanya & Wilson I don't know if you are still up. If you are could you get one more test in. An extra test would be useful to see if he is still falling through the cycle. from the +2 test. With Lantus when the +2 is the same or lower than the preshot there is a chance that the cycle could be active.