Mar 3 Eddie's curve advice on dosage

Please see Ed's spreadsheet. Nearly done his curve. Not sure if I should hold out a few more days at 1 u or go back to 1.25u.

 

can you put in the dose amounts? I can't tell how long he's been on any dose - the last dose info added was 0.25u on january 30th.

i'll check back in an hour so you have a chance to do it. someone else may see it sooner, but if not, i'll look again.

 

ah, i see you've got the more current readings on top and the older ones on bottom of the ss. i looked to the bottom, usually that's newest.

I'm not seeing numbers for today. go ahead and update numbers - it's really hard to tell what's up with things partially done. the last date i'm seeing is 2/27 - unless i'm missing it.

 

Hmm. For some reason the US SS looks a little wonky. Looking at the World version, I'd say hold the dose at 1U. You are getting some green nadirs today (59 or 3.3) so I would hold the dose.

Here are some of your recent posts on Health so people can follow the history. Eddie went OTJ in 2012 and is back now. :cry:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=114192&p=1203123#p1203123
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=114744&p=1208582#p1208582

 

thanks wendy!

 

Yes that spreadsheet is wonky, for some reason 2 years ago what I charted was not at line 1, it was much farther down. When I put his numbers in this time, they start at line 1, so are ahead of what was plotted 2 years ago, and to complicate things he went OTJ at roughly the same time of year as when he started. Please check the date, everything is there from today so far. Just getting to 7 pm so will be giving tonight's insulin. My concern is he is fairly high in the morning and the evening. He eats at roughly 7am 5pm and 10 pm. When he was on 1.25 he was getting pretty low but also going higher in the morning.

 

Here we go, AMPS 17.1 1u given about 15 min after he ate, then check every 2 hours. 10.2, 3.6, 4.0, 10.9, 15.9 and he ate then 15.3 at 7. So far he has been pretty happy when low and happier still when I feed him. He is a bit of a gourmand.

So, everyone vote to hold on a few more days? Would like to see his am and pm sugars lower.

 

i don't feel qualified to advise you with the mmol numbers. i'm sorry. i see on the world ss you got a 3.3 at am+4, and it's colored green, but when i look at the color coding across the top the greens are in the 20's and the lower numbers are grayed. then when i switch to the US ss, it's completely wrong, doesn't even have today on it, and the color coding key across the top is also wrong.

the spreadsheets are supposed to be set up so that you enter numbers in the world ss and the exact translation appears on the US sheet. I don't know if you are up for doing a new spreadsheet so that the US page works, but most people here "speak" in US numbers.

I can say that we dose by the nadirs, so if that 3.3 is green, you would hold the dose for at least 6-10 cycles before increasing it. it's important to let it settle in to see what it does.

i would also add that Wendy is familiar with the world numbers and i would trust her judgement completely.

 

A question first, what is your name? I'd like to call you more than Eddie's Mom. ;-)

A suggestion, perhaps it would be easier if you created a second spreadsheet for numbers this year. That way other members could look at correct US numbers and help with suggestions. In case you've forgotten how to do this, here are the instructions. I found it easier to create new spreadsheets for each of year for Neko. There aren't many numbers in Eddie's SS for this year, so it should be an easy cut and paste.

I suspect that Eddie is doing a bit of bouncing. His body (and liver) have gotten used to slightly higher numbers so is reacting to the low numbers. There is a good description of bounces in the second post here. For example, last night you started at 14.8 (266) and at +3 he was at 3.8 (68). That is a very fast drop. Fast drops can also cause bounces. But more importantly, I would have gotten a +4 test. It is highly possible that Eddie dropped below 50 (2.8) last night and in fact needs a reduction.

Altering your feeding schedule might help flatten out Eddie's numbers. If I understand correctly, shot time is 7AM and 7PM but you are feeding at 7AM, 5PM (+10) and 10PM (PM +3). It's best to feed at least part of the meal at shot time so there is food on board when the insulin onsets. That could explain some of the fast drops you are seeing in the evening. Also, it's best to not feed much in the last half of the cycle when the insulin is waning and to not feed anything for 2 hours before shot time. The 5PM feeding is probably raising his PMPS numbers. Any chance of moving to 4 meals, say at shot time and 1 or 2 hours later for each cycle? I have a timed feeder that helps me with the after shot meals.

 

Hello Cordelia!!

I agree it's totally possible Eddie's getting too much insulin!

He's dropped below 50 several times ...twice on 2/27 and at least once on 2/28 (and those are just the tests you caught)

Any time he drops below 50 (2.8) he should be getting a .25 reduction and then seeing how the numbers go after at least 6 cycles.

I also agree it'd be much easier if you just started over with a new spreadsheet and got it working correctly so you can take advantage of the experienced eyes that are here to help you. Having to constantly convert as well as having missing test results (and even missing days on the US version) make it really impossible to get the best we have to offer you.

Please don't increase for now. The higher numbers you're seeing are probably "bounces" from him going too low. Read the information Wendy linked for you about bouncing and then see if it makes more sense. If it's still a mystery, let us know! We can explain it several different ways until one of them "clicks"!

 

Just stopped at home for lunch as sometimes I can do that. I had DH feed Eddie a bit before he left for work after 9 this am.

Eddie started at 14.2 this morning and is now 5.6 which is 6 1/2 hours post insulin. I guess one strategy is to feed 'em before they get low. When I work I can't feed before about 5:30 but DH leaves for work later than me so he can give ed a snack before he leaves for work. Overall I think Eddie is feeling better. Over the past few days there has been less barf (almost none) and less howling.

Another issue we have with feeding is that Eddie has a cat named Oliver who will let Eddie eat all his food. Also Eddie tends to sleep a fair bit and hasn't noticed that food was left out when I have left it.

Cordelia, one of Eddie's people, And mom to Anna who is eddies best bud.

 

Hi again, Cordelia!

If you'll convert your numbers for us (at least until you can start a new spreadsheet that will work correctly) it'll help since most of us are in the US and we aren't as familiar with the numbers in mmol. If you just take your number and times it by 18, it'll help a lot

Today's numbers really aren't that bad! That's a nice drop!
Your AMPS was 255
+6.5 was 106

I think you should probably stick with the 1 unit dose for now, especially until we can figure out your numbers better.

You might want to consider getting an autofeeder, that you can set to open to give Eddie another feeding no later than +6 if you're unable to be home. We usually try to get most of the food into them before +6 so as you're going into the last half of the cycle and the insulin is wearing off, you're not adding food too.

 

Cordelia - is there any chance of you getting some later night time checks on Eddie. I see that last night you started out at 15.3 (273) and at +2 Eddie was at 6.0 (108). That is a huge drop in a couple of hours. I'd be really worried that at that rate of dropping he would have gotten below 2.8 (50) last night which means he might have earned a deduction. The +2 test is a really good test to get. If there is a large drop between PS and +2, you should get more tests that cycle, even a +3 or +4, or if you are working it might be best to leave higher carb food out in case he gets low.

Some cats (like mine) go a lot lower at night that during the day, which is why we try to encourage additional spot checks at night. In those cases, I set my phone alarm and it takes only a few minutes to get up, test and go back to bed.

 

I am not so sure about testing later without disturbing those who I sleep with. Also, I cherish my sleep. Eddie is fed before I head to bed, usually around 1030, last night it was earlier as I was quite tired. If I happen to be up in the night I can check him. No idea what the issue with the spreadsheet is, even when I switch between mmol and mg/dl it drops stuff. Today's numbers look a bit better.

We have 2 cats, so leaving food out isn't a great option and if there is food, Eddie the glutton will eat it is he knows it's there wheat her he is hungry or not. I tried frozen food once and Ed just kept licking the frozen lump until it was gone which was pretty annoying to us, who were trying to sleep in the next room.

So for today, amps 14.2 (256) +6 5.9 (106) +10 7.8 (140). Eddie ate this morning at 7 and a bit more after 9, and a little bit more at +6 and dinner at + 10.

Yes I too find it difficult relating to glucose levels reported in mg/dl as mmol/l is all I've ever known. Kind of like temperatures in Celsius, today's temperature was about 4 C and it rained a lot plus a bit of snow for added interest. I'm not sure if he moderators would ever consider updating some of the info stickies here to include mmol as well as mg/dl as it would make it easier for the rest of the world.

 

Cordelia, here's a chart with all the reference numbers that BJM posts often. Sorry if you haven't seen it yet! I put the mmol numbers in bold to help you find them. Hope this helps!

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *


How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300.(16.7) It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL.(11.1) You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. (Anything below 2.2)ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

In a cat that's been OTJ before, anytime you get a reading below 2.2 or 3 readings below 2.8 on 3 separate cycles, it earns a reduction of .25 unit

Edited to correct....Sorry for the confusion Cordelia! I knew I'd see Eddie had returned from the Falls, but it just totally slipped my mind when I was doing this. Sienne and Marje are (of course) correct that because this is a return trip for him, we tend to be a little more aggressive.

 

The information that Chris has provided regarding reductions is for cats that have been diagnosed for less than a year. For longer term diabetics, a reduction is given if numbers are below 40 (2.2mmol/dL) or if numbers fall into the 40 - 50 range (2.3 - 2.8) on three separate occasions. We make it a bit harder for a long term diabetic to get a dose reduction.

I agree about the evening tests. If you are seeing that Eddie is at 41 (2.3) and it's around your time to go to bed, I would be very nervous giving him food and not testing further. Personally, I would want another test in 30 min. and yet another after an additional 30 min. It's entirely possible that Eddie's numbers continued to drop.

You observed that Eddies numbers are higher at AMPS. One scenario is that his numbers are dropping at night and your seeing some bouncing by the morning shot time. The only way to know for sure is to get some additional tests at night.

If you can't test further, might it be feasible to move Eddie's shot time any earlier?

 

I agree 100% with Sienne but would also like to add that if you are not able to test Eddie at night when he's at such a low number as he has been a few times, I would strongly urge you to drop his dose back to .75u to keep him safe for the time being. Other dose changes might need to be made based in how he does on that dose.

Many of us have husbands, partners, etc that have to work and many of us work but we find a way to get those nighttime tests in when kitty is running so low.