Hi guys I was ment to be increasing insulin to 1.25u today after been on 1u for a few cycles. How ever this morning Sox has surprised me with only been 10.6 pre shot. Should I stick with the 1 unit or still increase it to 1.25u. http://www.felinediabetes.com/FDMB/threads/help-with-tonights-dose-please.206500/ this is link to other post regarding increasing insulin. Thanks guys
Hi Becki. I'm sorry no one was able to reply to you when you posted. Did you give a shot? It looks like you did according to your spreadsheet. Have you tested Sox again since?
No shot Becki! We normally say don't shoot at a number of 11 or lower unless you have loads of data and know in advance what a dose at a number like that is likely to do. Your best bet is to wait for half an hour, don't feed, and test again to see if bg has risen. If it is clearly rising, you could give a dose - how much does depend again on your previous data and what that tells you. If you're concerned, you could give just a token dose, say half the usual dose, but keep monitoring. If the number hasn't risen, still don't shoot but again keep monitoring - bg can be very unpredictable as you know. The problem of course with not giving a shot at usual shot time is that it throws the cycle out - then it's more or less a matter of tweaking the next shot times as appropriate, something you can only decide at the time. In an instance like this I'd suggest posting on the main forum as well as this one, as you'd probably get more eyes. I only saw this thread myself as I was looking at the forum lists and happened to see this. And there aren't many of us in the UK to see an early morning thread, let alone rest of the world members who are either fast asleep or getting ready for bed!
@Crista & Ming I did give him the 1u. I was due to do a curve today so will be keeping a close eye on him now. And test every 2 hours. I have my high carb food on hand if I need it. I did wonder about if I should do that. And with the time I have to give the insulin I know lots of people will be asleep. Would there be anything particular that made his preshot today do different to other mornings?
Could you do a test now just to see where Sox is at? From my experience and understanding, sometimes cats are just being cats. A good dose won't stay good all the time and you either have to dial back or up again. Sometimes they're starting to get used to being low and won't bounce as quickly or at all. The more data you gather, the more you'll be able to understand your cat's patterns. If you look at my SS, you'll see that on 11/9/18, Ming suddenly had a low PS. But I still held the dose and still increased eventually. I don't know why he did that but he did it and hasn't done it since. But keep in mind, I'm using lantus and there are different rules and results with it compared to ProZinc. I'm just showing you an example and you definitely shouldn't try to analyze Ming's SS. It's all over the place Edit: Hopefully someone with PZI expertise can answer your question better. I'm just giving you an example. If they tell you to change the dose, I'd listen. Again, Lantus is different. When I was on PZI, I also suddenly got a low PS number and I skipped the dose. The next dose, I reduced. But eventually increased again.
All sorts of things can make pre shot numbers different to what you expect, bg is never really fixed and you're likely to get a few surprises along the way. This is partly what makes treating FD such a potentially complicated process, as you have to be on the ball all the time. So you gave him 1u at a PS of 10.6 - yes, monitor very carefully now and have your hypo kit ready just in case. You may be just fine and he was planning in shooting up again just after you tested - anything can happen, these are very early stages of treatment so you can't even guess really. If you do see a steep drop in the next hour or so though, do post on Main Health as this is a one-off situation.
Yes definitely I totally believe that. Sox has always been one for keeping me on my toes. I will do indeed. And will definitely keep a close eye on him today. I've never had this situation in the mornings yet so really wasn't sure what to do. Just knew I wasn't going to be increasing the dose today.
I’m tempted to say continue to test since you were going to do a curve today anyway. Were you going to test ever two hours or every hour? Maybe Diana will have something better to suggest It looks like Sox drops starting around +5 so I would definitely do hourly tests once that time rolls around like you did a few cycles ago.
Ok so 9.9 at +2 is pretty much the same as the ps number so no immediate need for concern but it's when the insulin starts to kick in ("onset") that you'll need to be specially vigilant to make sure the drop doesn't happen too fast/steeply. Keep those hypo supplies to hand just in case - and have a read again of the beginner's guide so you'll know the theory of what to do if it starts to look worrying. This is also a time when you can post on the Facebook group as well - we always direct Facebook people over here for a full explanation of FD and how to manage it, but the FB group tends to be busier as many people find it easier to use on their phones, so you'll sometimes find that you get more replies there. Just seen what Crista has written above - yes, hourly tests at expected onset time definitely, but I'd test hourly before then too, just in case the dose at a lower ps number will cause a faster than usual drop. In a situation like this it is always best to be extra careful.
Also I would read up on how to deal with hypo. I’ll type out what I’ve done the two times it has happened to me: When I saw a number around 3.8, I retested in 30 minutes. If it continued to lower, I gave a tsp of high carb food and retested in 30 minutes. I repeated this until I saw that Ming was rising again. Sometimes I tested every 15 minutes just because he was REALLY low. He was at 1! If they get really low, you can either rub honey on their gums or add it to their food. When Ming was at 2.8 and 1.6, I added honey to his food. I melted honey in hot water and mixed it with his wet food. Don’t feed too much at first because you don’t want Sox not to eat if he goes lower. If he doesn’t eat, then you’ll have to rub honey or syrup on his gums. High carb foods can be anything around 15-20% carbs. Fancy feast gravy flavoured cans are a good option as well as any dry food or treat you have.
Thanks guys I've got my gravy food, high carb treats and honey on hand. I'll keep my spreadsheet up dates as I go. Should I do a +3 or wait till +4 do that one and then test hourly from there?
It wouldn’t hurt to do a +3 test Paws crossed Sox just floats nicely this cycle! I’ll check in later if I can. It’s 2 AM here and while I don’t feel like sleepy right now, I know I might randomly pass out. But from experience, I know @Rachel may be online in 2-3 hours. Again, post in the Main Health forum if you don’t get a response fast enough!
You made a wise decision to stay at 1 u and look at the beautiful curve you have! I'm glad others were here to help. It's difficult when you're in a very different time zone ...
@Kris & Teasel thank you. It is... I don't think there's many of us uk'ers here. Do you think with +5 reading I'm ok to wait and test him at +6 then feed him his mid day snack. The +6 test is due in 15 mins?
Just got home after a few hours out and yes - lovely curve so far. Will be interesting to see how the rest of the day pans out. Just shows how ECID - every cat is different - as you could have been looking at a different scenario! Always best to err on tje side of caution.
Okie dokie just was a bit scared if he might have dropped to much between the +5 and +6 but he seems ok at the moment.
I've just fed him his mid day snack. It usually varies between half 12 and half 2 for him. Say today he wasn't going to have got his mid day snack till half 2. Would his BG likely to carry on dropping (past 3.8) untill he got the food?
Becki - lovely curve today, and really great decision going with the 1u this morning! It's really just a guess when you get an unusual number like that, but you guessed well! Hopefully Sox will have lots more blues and green in his future! It's good that you were vigilant today since this was his first day showing you numbers like this. That being said, in a healthy cat who is getting species appropriate food (low carb wet food), their bodies have a built in way to keep themselves from going too low. The liver simply dumps glucose into the blood stream to bring them back up. Now that is assuming a reasonable amount of insulin, of course. And you know from previous cycles that the amount of insulin you're giving is reasonable. So if the snack was delayed, he might have gone a little lower, but it's very unlikely that he would have gone into dangerous territory unless there was some other health issue interfering. How many hours past his shot time are half 12 and half 2? I do recommend giving snacks before typical nadir, and again around typical nadir, just to make sure he has some extra fuel available if he starts to drop. Many cats will seek out food if they are dropping too quickly or too low. Just like for us humans, when our BG goes low we feel hungry and seek out a snack. Again, really great job today with your dosing decision and your testing. I imagine it was a bit of a stressful day for you, but you did great!
The half 12 shot was +5 and I'm just waiting on the half 2 shot (+7) that is due in 25 mins. Thank you... I was a little stressed with it pre shot this morning as I didn't know what to do for best... Knew I didn't want to give 1.25u but thought if I stuck with 1u I could at least keep a close eye on him. I do worry if I get a number like that pre shot and I'm due to go to work and not observe... Maybe then would you drop to 0.75 just to be on the safe side. I just wonder about the food as Sox does not get a meal through the night he normally just gets a meal before we go up to bed... Is that pre bed meal ok or should he have a meal through the night?
Can you leave food out for him? Or do his siblings eat it all? I feed my kitties dinner, and then leave out food when I go to bed. Occasionally Sam will wake me up in the night asking for food. When he does that I'll usually sit up and grab a quick test to make sure he's okay, and then give him a bit more food if he's run out. Over time I've learned to trust him - he usually lets me know what he needs. So all that to say that if you can't leave food out at night, just pay attention if Sox is fussing. Ideally it's good to give him access to some food at night as well - especially if he's active at night like my cats are!
I can only manage a bed time meal for Teasel because his siblings eat different food (by necessity). It seems to be OK for him *most* of the time.
Yeah I struggle leave food out as Sox just eats everything all in one go. And the others would eat it too. The cats also sleep down stairs seperate to us due to house alarms. Half 2 shot (+7) 4.8 would I be ok to go back to 2 hour testing now?
WoW! What a nice cycle Sox is having. Great decision making on the dose Becki! Multiple cat households are a bit of a pain when it comes to food particularly when there is a diabetic or other special diets in the mix. Dropping the dose is always an option you can use to keep Sox safe and your sanity intact. You could also try feeding food that is a bit higher in carbs to slow down his drops but that is something you'd be best to experiment with when you are home to see how that works for Sox.
Yeah they do seem to be... They have never been fed in the night so that's something different for me too. Maybe a small about if dry food mixed in at night to make the affects of the food last longer? I think dropping the dose would work easier for my sanity yes so I know he's ok while we're out. Yes he's been a very good boy today. I did panic abit this morning but just thought I'm here all day so can keep an eye on him.
Looking at your ss, the nighttime data doesn't seem all that differernt from the daytime data so far. So based on that, i don't think you need to change up what you're doing at this point as far as the nighttime feedings. Sox seems to be managing fine at this point.
Yes, he may well be rather high and flat tonight. Time will tell though - he didn't do too badly the last time you had a green.
Dropping the dose is always better for your sanity, Becki... you and Sox have done really well today, especially considering that we'd normally advise not shooting at a bg of lower than 11. You've certainly got a nice curve going on, just always bear in mind that Sox might not respond in exactly the same way another time... I'm sorry to be the one urging caution and far be it from me not to celebrate with you, but your nadir isn't actually far off what we would be worried about and you just never know what's going on inside a cat! So again, think carefully when you get an unexpectedly low PS number and make sure you'll be around all day if you're going to dose. And as I said early on, you can always stall (without feeding) and test again to see what direction the bg is going in. I think you and Sox both need some nice treats today!
If I get that again then and im not able to stall due to work would you either drop dose or not give insulin?
For peace of mind, in that instance, I would skip the dose. You can't leave the house and be at work for hours worrying about whether Sox is going too low or not. It's better to be highish for a few hours than low for an unknown length of time. As time goes on and you get more data, you'll be able to judge with more confidence what number is ok to shoot and what is probably not - the trouble is, even then a cat can throw you a curve ball at any time so it's really a matter of using your best judgement. A lower or token dose is often a good compromise so there is at least some insulin in his system. These are still early days, remember - as time goes on you will get a better feel for what to do for the best.
Ok thank you. Im hoping it does get to a point where it gets easier to know what I'm doing. If he still below 11 tonight I'm best to go no shot? If he's 11 or above should I give the 1u again or give 0.75u. I wouldn't be able to stall tonight as I need times to be 7 and half 7 in the morning due to work.
I think you already have a very good handle on what you're doing, Becki, as I said on your Facebook post last week. You understand the basics and the theory, it's now a question of collecting data and applying what you've learnt to your own cat! As far as dosing tonight goes, see what the experienced Prozinc people here suggest. I may be in the minority in being reluctant to shoot. Really, that's what these forums are all about, asking questions and getting different members' replies so you cam weigh things up and make a decision. Some questions will elicit a definite "do this or that", others are more borderline.
Yeah it really has been a good help. I didn't really get much other information off the vet. Should I wait and see if I get any other reply on what to do tonight in this post or ask a new question on the forum? I have 2 and a half hours before my PMPS.
Still time for people like @Kris & Teasel , @Rachel and @Djamila to get back to you - I'm sure they'll all have good suggestions. You could also post on the main forum and link this thread so you're not starting too many new ones.
If he's around 11 tonight you can try 1 u again. Get a +2 after that. If you see similar tomorrow AM you can try 0.75 u for your peace of mind. Another thing to try would be 0.75 u tonight to see what sort of AMPS that gives you.
Yes hopefully I'll post on once I've took tonight's pre shot BG. @Kris & Teasel think I'd be happier with 0.75 tonight just as I won't be up to watch him through the night. If you think that's ok. If he's 11 and below maybe not give a shot?
Yes to sleep on the night before going back to work! Your peace of mind is paramount and it's early days so using 11 as your no shot boundary is fine.
My hubby is also off tomorrow so if Sox is around the same pre shot as he was this morning I'm happy to give him .75 and my hubby can keep a watch on him. If I'd have give him 0.75 this morning he still probably would have had decent green numbers wouldn't he. But maybe just not as low.
I am in the camp of being more aggressive with dosing. There are a couple of reasons for that. First of all, while I have seen many many cats on here die from ketones (too little insulin is a key factor there), I've never seen a healthy, reasonably dosed cat even get into danger from dropping a little low. I know it's possible, because anything is possible. But it hasn't happened over here in prozinc-land during my time here. I've seen a cat with a secondary health issue get into trouble on another forum, and a cat that was receiving ridiculous levels of insulin without monitoring. But a cat who is being monitored and dosed well? It's just never been a problem here. But too little insulin? that has taken many of our kitties. So personally I'm more afraid of under-dosing. Second, the window to get a cat into remission is fairly short. A cat that is on a low carb wet diet, and is dosed well, has a 60-70% chance of remission within six months. After six months, the odds go down to about 20%, and after a year, it's a long shot. (I'm sorry I'm having trouble finding the article that cited that right now). So my tendency is to recommend careful monitoring (which you're doing) and a more aggressive stance on dosing to take advantage of the early days of a diagnosis. I'm not talking about going crazy here. I think aiming for low blues and high greens is good - I'm not suggesting aiming for 50, and certainly not suggesting being reckless in any way. But I think what you did today, and the numbers you got, were good. Ideal really. And I think it shows that she can handle 1u at a number like that. At least for today. When a cat decides to go into remission, they usually do it fairly quickly (at the beginning), so it does require care and wisdom. All that being said, if you feel more comfortable with 0.75u, go for it. I do believe that sometimes the caretaker has a sense about things, and if you're feeling like a reduction is needed, do it. Trust yourself. If the cycle ends up too high, you can go back up in dose tomorrow. But your mama-sense might know what your kitty needs better than anything/anyone else.
Yes, that rise is okay. It's a normal reaction to being lower than normal - her body just released a bunch of glucose and it takes a little while to clear it out of her system. Second, Prozinc lasts 10-14 hours in a typical cat, so steep rises in those last hours are pretty common as they run out of insulin. As she gets better regulated, the insulin lasts longer and you'll get more overlap.
Thank you @Djamila Now I've seen his bloods go up tonight I'm happy to stay with the 1u for tonight and test +2 before bed. My worry was just if he was still in the 10.0 to 11.0 range I didn't want to give him anything to high and risk him dropping too low while I'm asleep. (Its playing up my anxiety a little) But I'm definitely good with the 1u tonight. Tomorrow if he's still in the yellows I will do the 1u again. Bit think if he is close to preshot this morning I'd be happier with the 0.75 just for piece of mind while I'm at work. Hubby is on nights to night so can keep an eye on him from mid day tomorrow.
FWIW, absolutely what I would do, Becki. Djamila makes some excellent points about dosing and we all want to see our kitties improve as soon as possible. I think it's just that unexpectedly low numbers fairly early on can be a tad scary until we have dealt with them and know it's going to be ok. 10.6 wasn't "low" as such but borderline for shooting given your previous data and as it happened, all was well. So today has been a useful exercise. Giving 1u tonight at 10-11 was going to cause you anxiety, understandably, but as it happens Sox has gone up to a level that you're more relaxed shooting, so in that way you've ended the day ok. Another time you may feel braver about shooting lower numbers. As Djamila says, you'll develop your own mama sense of what is right for Sox.
Yeah I understand and I think now I've given 1u at that reading I'm feel ok giving 0.75 if I get that reading in the future. That's true it is scary cause I think knowing if you dose to high you can make kitty poorly by doing so. Don't want to push him into those 2.0 I'm hoping so... It will just take some time I think.
Morning guys @Rachel, @Kris & Teasel, @Djamila, @Diana&Tom. So after my intended switch up of dose yesterday which I did not go ahead with in the end due to Sox giving us a nice low pre shot number and nice lows during the day we are still on the 1u dose. Been as though I am also back to work today I can't up the dose again now till the weekend. Do we think we're ok to stick with the 1u to see how we go after yesterday's numbers?
Hi Becki - the others you've tagged are better with dosing advice than I am (I tend to post about more general stuff) but as I'm the only one in the UK and therefore the only one seeing this for the moment, I will offer my two penn'orth which is yes, stick with 1u for today at least. You've probably done that now anyway. He should certainly be fine with that on a PS of 18 so you won't need to feel too anxious while you're at work. Try that today anyway and see what reading you get later - by then the others will have seen your post and the bg reading, and can advise on a PM shot. I know it's a dilemma, and maybe you're getting conflicting opinions, but you're well on the learning curve and taking it all on board and the main thing is that Sox is getting insulin on a regular basis. I'd say, for dosing, err on the side of caution if you're going to be out for several hours, and be brave and try a slightly higher dose when you're home to monitor. It's all trial and error, there are no right or wrong answers. It does take a while to get where you want to be, but that's ok!
I think 1 u is fine for now. If you get home from work a few hours before it's evening test/feed time it's worth getting a BG number then to add to your SS. It fills in the picture over time. Couple that with a before bed test and you have a little more data for work days.
Yes that's what I was thinking at least he is getting the insulin now so even the 1u he is getting is helping. It is it's a learning curve and untill we know how Sox reacts we won't know the amount he needs or doesn't need. My husband will be taking a +6 reading as he will be at home for that one so least we will get a mid cycle test. I've forwarded the spread sheet on to my vets and she's very happy with the amonth of data I've got ( I am a little over the top lol) But she also seems happy with the 1u at the moment and agreed that the 1.5u brought him to low on the 1st day. She's told me to stick with 1u for another week and update her with this week's data next week.
Well at least for this morning, while there may be different philosophies, we are all in agreement on the dose. I think 1u was a good decision today. Sox got a really nice cycle on 1u yesterday, and what you're seeing now (the higher numbers) are most likely a fairly normal response to those greens - staying higher and flatter for a few cycles. The other option is that yesterday was an anomaly and he'll stay high and flat. If it's the first option, then in a day or so we should see another good cycle. If it's the second option then in a day or so you'll need to increase. But either way, sticking with the dose and taking a wait-and-see approach is the best thing to do at this point.
I was wondering if that could be a possibility today if he may be slightly higher because of yesterday's lows. Yes I agree... The vet is happy that I try this again for another week then reassess the dose after we see how this week goes. She's also booked me in for December the 3rd for a fructosemine test and to check his weight.
Was just checking in to see how you and Sox are fairing and delighted to see that beautiful cycle yesterday. Those bounces can be frustrating but they are just part of the sugar dance. You are doing a great job Becki!
@MrWorfMen's Mom yes we had a good day yesterday just surprised how low his pre shot was though compared to the few days before. I'm hoping giving him more time on the 1u dose he may get good cycles on this once his body get used to the lows time will tell. Thank you. I feel a lot more comfortable at the moment giving him the 1u now I know how he reacts.
@Kris & Teasel, @Djamila @MrWorfMen's Mom Ok guys Sox is 11.4 tonight. I reteseted straight after and he was 12.6 Should I still do 1u or would you reduce to 0.75 for over night?
I vote stay the course and give the 1u. Do the usual +2 or +3 before bed test and decide then if he needs a little food boost and whether another test is needed.
@MrWorfMen's Mom okies. I can do that. I was just a bit scared of him dropping as low as he did yesterday day time and I won't see him cause I'm in bed
Okie dokie. You wouldn't think it would be so scary would you. Would you do an alarm for +5 or +6? Which time is the best for giving results or they both about the same?
Either one is going to let you know what Sox is up to and both are around the time he usually starts getting close to or at his lowest BG of the cycle so pick whichever one is the least disruptive for your sleep.
@MrWorfMen's Mom ok thank you. thought we were settling into a pattern the other day but docks just likes to be cheeky and keep me on my toes. Just out of interest do bloods drop differently in the night compared to how they drop in the day? Or they both drop around the same?
It really depends on the cat. Looking at Sox SS, and from the testing you've done on night cycles he doesn't look like he's not prone to going low at night. It's still early days though and this is the lowest PMPS you've given the 1u. It gets so much easier after a few weeks of testing because you can then see patterns that make it easier to 2nd guess their reactions.
Yeah that's what I was thinking with the patterns I did start to see a pattern with the night times when his PMPS were higher. Sox just sits there so chilled not knowing the stress he causes his mommy
Just tested before bed and he's 11.5. fed his night snack. Think we will be ok to not wake up in the night or would it be useful to get a +6 hour test just for future knowledge?
Yeah that's his brother Luna. We ended up checking in the night lol and he was 6.7 didn't feed a snack as I thought he was at the half way point of cycle and wanted to see for future reference that he was ok through the night at that number.
@Kris & Teasel, @Djamila, @MrWorfMen's Mom Right guys I'm going to brave it for tonight and not set an alarm. Think his numbers seem pretty stable to the past few nights. Do you agree?
Sometimes a little rest is what you need! You have to take care of yourself so you can take care of Sox.
Yes definitely although I did still wake in the night but I just rolled back over Skipping Sox shot this morning due to him only been 7.9 this morning before I go to work.
It was... Would you ever give insulin at lower reading like that maybe a smaller amount? Or just never give a shot?
Becki that really depends on the cat and caregiver ability to monitor. If you could monitor Sox after shooting it would be Ok to give a dose (possibly a bit reduced) at that AMPS. When you can't monitor, best to err on the side of caution and skip. Sox is doing great thanks to the wonderful care he's getting!
AHH bless you Yeah that's what I though this morning. If we were going to be in I'd have give a little bit definitely not without any one there.
I think shooting on those low numbers also has to do with how long the cat has been diabetic. With longer term kitties, you can shoot on lower and lower numbers. But with a newly diagnosed kitty like Sox, a little caution on a low number is a good idea. If that happens again, and if your schedule allows it, try stalling for 20-30 minutes without feeding, and test again. If the number is rising, you can consider giving a small dose. You can stall up to an hour (if your schedule allows). This technique can help you avoid skipping a shot, and also help you figure out how long the insulin is lasting. The closer a cat gets to being well regulated, the more overlap you'll get from one shot to the next.
Yeah that's the only problem I have is that I haven't got much time that I can allow for stalling in the morning due to the times I have to leave for work. Weekends arnt a problem with me been off it's just week days are my awkward times... Unless my partner is off.
It is hard to manage all of this with a work schedule. It is nice to see her getting these lower PS numbers! I hope she has lots more of them to come!
It is yes. But I'm sure it will all work it's self out. My partner has just tested him now he's home from work. Sox is back in the yellow but thinking that's not to bad with been how he was in the blues this morning. I hope so too.
You're doing great Becki I hope Sox gives you interesting cycles when you have days off or days when you can monitor. I was EXTREMELY scared at first when Ming would give me crazy low numbers when I switched insulins. But now, I treat these instances as opportunities to gather data It gives me more confidence and helps me make sense of Ming's numbers for future reference.
