1/17 Spicey PZI Dosing advice Pmps Coming up

Hi everyone Look at spicey's spreadsheet for the curve test. Her Pmps is coming up soon. And I am just concerened after (i can't remember a name? that spicey's #s might be too low. So I am thinking that i sould do 1 of 2 thiings possible,
1 - wait until the bg # rises but i don't think it is going to rise enough.
2 - Give half of the dosage.

:?
Any ideas or suggestions please. I am not panicked Just trying to figure it all out.
David

 

Well I would wait and see what that +12 number is. 211 is not particularly low and you might be surprised at how fast the numbers can go up once the PZI peak is over.

That 0.5 really is working. I'm inclined to agree with what Kimmee mentioned earlier about the thought that it might just be a little too much. Will you be able to get more spot checks tonight?

 

yes i can do spot checks.

 

Oh good, because whether you shoot the 0.5 or cut it in half it would be a good idea - particularly with the later than "normal" peak and hang time on that last shot.


ETA - sorry - the peak was actually "on time", it's the hang time that I noticed.

 

What are you most comfortable doing?

I would suspect if comes up to around 240-250, a reduced dose would be okay if you can keep an eye on things.

We have seen the numbers climb over missed doses in the past, so I would be inclined to give something as opposed to none or to wait too long and the levels start to soar again.
However, you have been the one up through the night on hypo watch, so whatever you decide to do that feels comfortable, is good.

Have you tried a pancreas test?
Feed a little low carb food after getting a test, about 90 minutes later, test again and see if the level has come down indicating some pancreas action, or if levels have stayed the same, also indicating some pancreas possibilities.

If the levels have risen , then still work to do to help a pancreas heal and you know insulin still needed.
cats do very well on several smallish meals a day so as not to overwhelm the pancreas as well.

 

Here is a great guideline if you have not already seen this from the Faqs..


Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin.

Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.

Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

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

Lantus and Levemir users: Because Lantus and Levemir are gentler insulins, you may find that these guidelines are stricter than you need. If you have some data on how your cat responds to insulin, please read Jojo and Jill (Team J)'s guidelines at FDMB (http://www.felinediabetes.com/phorum5/r ... 22,1017956).

 

Spicey's Pmps 227. She hasn't eaten anything yet. I am thinking if she can eat within the next 2 hours. I might be oj=k to give her the .5 unit or i can wait another hour and see what her # is. Hmmm. Decision time. David

 

Dosing decisions should be made based on peak values and preshots. Have Spicy's peak values been too low (below 50) on the .5 unit dose?

 

looking at the spreadsheet. I might be ok with .5 unit. I will definitely have to watch the #s though.

no and i was looking at that earlier as well.

 

no not all.

 

And what happened last night from a preshot of 287? What happened on 1/15 from a preshot of 241?

Sometimes you just have to trust the pattern. If you start reducing the dose every time she makes progress, you'll never get anywhere. The pattern doesn't always stay consistent, but most of the time it does.

 

Yes, dosing decision are made based on peak numbers and preshots. If you are okay shooting the 0.5U and will be spot checking then you should do that IMHO.

Just a thought for you, since this is your first curve on the 0.5U - many people here have a "do not shoot" number and/or a "shoot a reduced dose" number. If you choose to shoot the full dose or the reduced dose you will get more info on Spicey's reactions - either way.

 

On the 287, Someone thought I might have a misshot. On the 241 I can't remember. I don't have anything andd it looks like i didn't do any tests. According to the monitor and my notes.

 

David... after looking at your spreadsheet it appears that both times you gave .5u on a preshot around 230 Spicey went up. It could be that her body does panic on this dose when the numbers are lower.

It was me who said you might have had a fur shot... but looking at the log now, I see that when you have shot .5 in the yellow, she's gone up. But like Terri said, you don't want to lose progress. So, if you can test, I would say try the .5u one more time at this level and keep testing. If her BG rises again, you'll likely have to lower that dose.

With what decision are you comfortable?

 

It looks like it is too early to tell since she has not been on that dose for very long. And If i did have a misshot and the #s are close, i will never know if i change the dose. So it will be .5 unit and I promise I will get at least 2 more tests tonite.

Thanx guys.

 

Great.... that's what I would do, David. I know what Kimmee's talking about when she says the dose might be too high... but I also know from my own experience that a more consistent dose (if you can stay to test) is better at times when you need to see the pattern develop. You'll know by the numbers tonight what you need to do next.

 

Thanx and I do feel comfortable with keeping it the same. This spreadsheet really helps.

 

Just figured out on the 241 ehy therer was no other tests. I had to work and couldn't get any tests that day. :sad: