10.8 PMPS

http://www.felinediabetes.com/FDMB/threads/no-shot-this-morning.206663/#post-2293086

Morning guys link above is too my other post where we've touched on no shots breifly at the end but thought it was getting a little long.

This is the second morning now that I've woke and Sox is to low to allow a shot this morning.
If I or my husband were in I'd be happy to administer a lower dose with us at home to monitor him but that's just not possible with us both working yesterday and today.
My morning schedule does not allow for me to stall so I've just had to skip both.

I am not working Saturday or sunday so if I get these kind of readings then would you suggest I try 0.50u or 0.75u he normally receives 1u 2x a day.

Do you think he could possibly need a lower dose at night?

I'm hoping I'm not causing him harm not giving the shot but it's just not an option at the moment while no one is in and I have no data yet of shooting that low numbers.

Thank guys any suggestions.

 

Oh very exciting! I’d try 0.75 at night

 

Hi Becki,
It may be that the dose is now too high and you're getting some 'carryover' at the end of the cycle (duration of cycle extending beyond what is typical).
Or it may be that Sox's little pancreas is pulsing out some insulin of its own at times, and is able to hold the numbers down once the injected insulin has dropped them a bit (sort of, 'picking up the ball and running with it', so to speak.)

Reducing the dose may make it possible to give two shots a day, so that you can keep insulin in Sox's system for more of the time, and keep that healing process going.
At this point I agree with the suggestion of 0.75...

I agree with Janet that this is very exciting!

 

Okie dokie I'll try 0.75 tonight.

Yeah that's what I'm worrying that he's not getting enough in his system through the day.

If I do 0.75 tonight and numbers are back to what I'm used to in the morning would I still give the 1.0u for the day time and 0.75u at night?

 

I agree with the others. I would go with .75 and hold it for at least a couple of days (only exception being if you see it taking him too low during a cycle). If one pre-shot of the day is consistently too low to give a shot but the other is not, the dose being given is probably too high.

 

would you do PM shot 0.75u and then tomorrow AM shot at 0.75u. Or AM at 1.0u if AMPS is back up to its normal range between 16.0 to 20.0?
Can you have 2 different units given a day?

 

I’d keep it the same both times and see what happens

 

Ok then that sounds like a good plan.

 

Consistent dosing goes a long way in helping level things out. Stick with the same dose for a couple of days then re-evaluate based on your test results during that time.

 

Thank you I'll keep that in mind

 

Yes, some do give different doses AM/PM but that's generally used only when a cat isn't able to get shots at 12/12 or we have data showing that the cat just needs that. If you ended up giving 1 unit on a normal preshot, you'd probably just end up with the too low response again.

Even if you notice that Sox's BG numbers are higher than usual, I'd definitely stick with the 0.75 for several cycles and see if that helps to level things out more for you.

 

Yes definitely I'll start on the 0.75 tonight

 

This is indeed very exciting. Go Sox!

 

Yay Sox! I hope he or she is on the way to healing

 

AHH yes... He likes keeping on my toes.

I'm hoping so too. Can they start to improve that quickly. He's not even been on it 2 weeks yet.

 

That is beyond my area of expertise as I am still struggling with getting my girl regular but the others here can probably answer that. Have a happy thanksgiving

 

Sox is doing wonderful after a short time! It is not unheard of for a sugar baby to respond so soon but we still wouldn't say it's the "norm". Still, great news whenever it happens! It's possible you caught it earlier than some, which can contribute to earlier response times .

What kind of syringes are you using? Standard Prozinc syringes are U-40's to match the insulin but you can use U-100 syringes with a conversion chart for finer doses. Those finer doses can help set up a longer remission. I literally got to the dose of half a needle of the syringe for a while before my boy went OTJ . Looks like he isn't quite ready to stop insulin yet, so you may need to consider finer doses for those lovely blues .
It looks like the 1.0u in the evening is carrying him over more than 12 hours so he's blue in the morning. You could try lowering the dose to 0.5u. Ideally, while on insulin, you want to be able to give the 2 shots each day. Numbers always permitting!

 

This is a ECID (Every cat is different) thing. We often tell folks this is a marathon not a sprint. It's more common for it to take longer to hone in on a good dose but there are some lucky kitties/folks who get there pretty fast.

 

I'm currently using the prozinc u40 needles but have got a few u100 on the way to try to see how I get on with them.

Think I'm going to try dropping to 0.75 tonight see how we go.

What does OTJ mean?

Fingers crossed Sox is a lucky kitty.

 

OTJ - Off The Juice. When they are in remission

 

"OTJ" is short for "Off The Juice"! Playful way to say diet controlled!

 

Ahh ok thanks guys for clearing that up for me

 

Started on the 0.75u last night an numbers were back in the yellow this morning so was able to give him his morning injection. Going to stay with the dose now for a few days and see how we get on.

 

Already getting a nice blue number mid cycle... Keeping fingers crossed this is a good dose

 

Right guys so I managed to get insulin into him this morning. But again tonight he's to low to give his PM shot.
Should I try 0.5u in the morning?

 

You could try that. The situation tonight is on the edge of "How brave are you?" You could have tried 0.75 u or 0.50 u tonight. At some point you need to push the PS envelope to see how many skipped shots you can avoid. If you're home to monitor, have plenty of test strips, gravy food or syrup just in case, then go for it!

 

I am home tonight but I'm at work tomorrow day. I've have him 0.5u. how many times should I check him?

 

It's always your call - whatever your comfort level is. Maybe try that experiment on a day off when you can monitor without losing sleep.

 

I've given him 0.5u. my husband's off tomorrow so he can check in the night. How often should we check him?

 

I'd get the usual +2 and then if he is pretty much the same, grab a +4. If he is dropping albeit slowly get a +3 and if he is dropping quickly, I'd suggest giving him some medium or high carb food to slow him down and test again in an hour or so to make sure he's coming up. Testing after the last scenario will really depend on just where his BG is.

 

Ok his +2 is due in 10 mins so I'll update my sheet then.

 

Just tested and he's 13.8 is that normal to go up after giving insulin shot?
When would you test again now after it going up?

 

It's ok... that happens. He may be bouncing a bit from that beautiful mid cycle 6.5. I'd check him again around +4 and see if he's staying relatively the same or up and if he is, then call it a night. If he is coming down again then I'd check again at +6 unless it's a big drop at +4 in which case I'd give him some food and check again in a hour.

 

He's due his before bed feed any way now so did wonder if I could feed now do a +3 go to bed and then check at +6.
Or is missing that +4 An important reading to check?

 

Frgot he gets a before bed snack so yes I think your plan would work just fine.

 

Lol yes he won't let me forget his bed time snack
Great will try that then will get my +3 then do a +6. Thank you

 

14.8 looks like bed time is good to go lol

 

So I'm off out tonight Sox will have his normal feed and jab tonight if his numbers allow. I'll set cat feeder for his night snack but won't be able to do my usual +2 test.
I could do a +1 test but then wouldn't be back till about +7.
If he's got good numbers he should be fine to leave shouldn't he.

 

I think you should be fine. I'd grab the +1 (I'm OCD) just so you know if he's dropping at all/faster than usual and if you have any concerns, you could leave a higher carb food in the feeder for his snack.

 

Good idea thanks

 

Hi guys so Sox seems to be settling with some nice blue numbers now on the 0.75u in the day time.
Do you think I need to take any more reading during the night as I'm only seeing yellows as majority of tests are +2 hours when I go to bed.
So was just wondering if you think we need to know about more about what's going on in the night cycle?

 

If you were going to stay at 0.75u, then I can see why those tests might not feel all that helpful. However, I think it's about time to move to 1u, so when you're ready to do that, then you'll want to keep an eye on those +2's so you know if he's heading into an active night. (I don't like getting +2's either - even though I understand how important they can be)

 

@Djamila Is it worth going back up to the 1.0u though as I only recently reduced it because the 1.0u I was giving at night time was leaving Sox to low in the mornings for me to give him his AM shot?

 

Ugh. That's right. It's so tricky sometimes. The 0.75 is giving you PS numbers that are too high. But you're right, the 1.0u was giving you AMPS's that were too low.

Have you considered switching to u100 syringes? That way you could split the difference and try a 0.8 or 0.9.

 

If we stuck with the 0.75 might those pre shot numbers gradually come down as his body get used to the regular 0.75 dose?

I have got some u100 syringes but not braved trying them yet.

 

I was really nervous to try them the first time too. Take your time.

As far as holding at 0.75u...it's hard to say. Sometimes holding longer does bring better numbers (Kris has to do that with Teasel). More often though you just end up with them getting "stuck" and then you have to raise the dose a few times to get them moving again. The only way to know is to try it. Give it a couple more days and see what happens.

 

Yeah definitely as with humans it always takes time to get the perfect dose I remember from when my nan was diabetic.

Maybe if he does get stuck I will try the u100 needles and try either 0.8u or 0.9u

 

Let us know if you have questions about the u100s. I wasn't comfortable with them at first either but I got to the point where they were all I would use!

 

So Sox has been doing really well on 0.75u the last few days. +5 readings have all been in blues past few days apart from today.
Think Sox might have possibly ate some of his brothers dry food and now he's not dropped as low today.
Question is should I just keep the 0.75 for the upcoming cycles and see if he drops back into the blues. Or do we think he needs a little more juice anyways as his AMPS are always a little higher?

 

The effect of the dry food will pass. Based on the blues you have mid cycle I suggest you go to 1 u next dose. He has room to drop comfortably. You could wait until the AM to do that if that suits. He had lovely dark greens on 1 u several days ago so you need to watch for that. He won't necessarily repeat that this time though - too predictable for a cat!

 

@Kris & Teasel do you think 1u? Or a little less. I only ask that as back last week some time I was giving 1u at night and his numbers were to low to inject in the morning.

 

You could draw up 1 u and expel a tiny drop so that you have a little more than 0.75 u but a little less than 1 u. Tricky to be consistent though.

If these tiny fractional changes are what Sox needs, your best bet is to use U100 syringes with the conversion chart. It's not nearly as complicated as it seems: http://www.felinediabetes.com/insulin-conversions.htm

 

Yes I do have some u100 needles to try so will try them when I feel confident.

What is it I'm looking for with regulating Sox.
Am I aiming for yellow numbers in the morning then nice blues and greens in the day. Or are the pinks ok in the morning as long as I'm getting blues and greens in the day?

 

Ideally you want to keep them no higher than the low yellows - under 220 is good. A well regulated cat can stay in blues and greens most of the time. If you scroll through Sam's spreadsheet you'll see months where he was almost all blues and greens. Not all cats get to "well regulated"

 

@Djamila So I need to try and get rid of those morning pinks then ideally.

 

Yes, but it does take time and patience. As they get used to the lower numbers, you'll start to see longer duration and more and more yellows show up at PS time. And it's usually a bit of a dance as you're already experiencing: lower the dose...wait...raise the dose...wait...lower a teeny bit....raise a larger bit....and on and on. Just doing the best we can to respond to the numbers and be patient all at the same time.

 

So do you think maybe stick with the 0.75 abit longer or try maybe 0.80u or 0.90u rather than going straight back to the full 1.0u after that was keeping him low for abit longer than the cycle?

 

Haha yes indeed it is @Djamila

 

I tend to slide Sam into his new doses instead of jumping to a new line. So I might go to your usual 0.75u, and then just a smidge more, then a smidge more, and then 1.0u. Each little "smidge" just being for one cycle (unless something surprising happens with the numbers). So call it 0.75F, 1.0S, 1.0 with the F = Fat and the S = Skinny.

I think it would be safe enough to just jump to 1.0, but it might be less dramatic to sneak into the increase. Especially if you're not feeling really comfortable with the idea of going back to 1u. It gives you a little more time to make sure everything is okay.

Eventually you'll be able to shoot on those blue numbers, but it does take some trials and data to know what is safe and helpful for Sox.

 

Ok great thank you.
So maybe do 0.75u possibly 0.80u tonight. Then go with the 0.80u a few days. Then 0.90u for a few days then see where we stand then before going back to the 1.0u

I can't see there been much difference in swapping from 0.75u to 0.80u tonight would you think?

 

Well, sometimes they surprise us . There are three options when responding to a dose change (even a very small one):
1. no real change (most likely what will happen going from 0.75 to 0.8)
2. a dramatic response followed by a return to the regular response (and then you have to increase again)
3. an increase in BG for a cycle or two, and then finally responding to the increase in the 3rd or 4th cycle

Sam often goes with option 3, but sometimes he'll choose an option 2. Because why would they be predictable?

With the very tiny increases (less than 0.25u), and Sox' current data, I wouldn't think you'd really need to hold them for a few days. A cycle or two is likely sufficient. Again though, it's up to you and what you feel comfortable doing. And of course up to Sox and what he decides to do.

 

I'm happy to give the 1u again the only problem I have is if he's too low on the AMPS I have to skip the dose for the day as no one there to watch.

Unless I try 0.9u tonight.
What do you think what would you experienced guys do

 

15.2 PMPS do you think I should brave 0.9u or stick with 0.75u?

 

Can you draw up 0.8u? I think he needs a little boost but I like Djamila's idea of easing him into it. His PMPS is a bit lower tonight than the last few days.

 

I can I have some u100 syringes

 

@MrWorfMen's Mom I think I need better glasses though to see the markings there so small lol

 

I hear you! Been there....done that! Just do the best you can. It might be a good idea to grab a used syringe and draw up some coloured water to where you perceive the dose to be, then use that coloured water for comparison to draw up the insulin. Consistency is more important than absolute accuracy.

 

Yeah I've been having a good play with them so found the 0.8u alright to draw up

 

I had to get reading glasses to help with the syringes and blood tests too. I don't need them for anything else (yet), but they really helped with accuracy with those tiny lines!

 

Well now! Look at that pretty little green sneaking in there in the middle of the night!

 

I second that emotion about the sneaky green!

 

Think I might be needing a pair too

I know it panicked me a little bit going back to sleep after it. I'm just hoping he's not too low in the morning to shoot.

 

What a nice green!

 

And he's given you a nice cycle today too! It's so nice when they don't bounce. Looks like Sox likes baby increases

 

Yeah I'm getting my hubby to do a curve on him while he's home today.

It is Just need to sort them pesky pink AMPS numbers out and then I think the 0.8u might give him quiet a nice cycle day and night.

 

Alas, doses don't usually stay the same for long. Cats like to keep us on our toes

 

Sox is a big one for that.
The +9 was a suprise today didn't think he would go that high. Could that be either not enough juice so not lasting him long enough or just a bit of a bounce from last night's green and today's blues?
Stick with 0.80u again?

 

Sorry I think we missed your PMPS Becki! Looks like you did 0.8? I think that was fine. Let's see what happens tonight and if he doesn't drop low, you can probably do the increase to 0.9 if you want to do that small increase to try the easing him in to it thing.

 

@Rachel not sure what the reading was in the night as I didn't get up and check.
But he was quiet low this morning so have told Brad to do a few checks on him today to as he was 12.1 and I still gave him 0.8 so hoping for some nice numbers today.

 

Or not at +3 he had gone up to 14.3 fingers crossed for a drop maybe

 

It's nice that Brad is home and able to do some checks today! Let's see what happens, but I'm guessing you're going to want to increase.

 

@Rachel even if the past few days he's been getting nice blues on the dose?
Would you do 0.9u or 1.0u if so how do you do 0.9u on a u100 syringe?

 

0.9 x 2.5 = 2.25, so you'd need to measure half way between the 2 unit and the 2.5 unit mark. ...I can only see these kinds of measurements if there's a good light source behind the syringe...
.

 

I can imagine that's difficult to be fair I struggle with the lines as it is.

@Elizabeth and Bertie and ideas from yourself looking at the spreadsheet where we might go with dosing from here?

 

Becki, do you have the syringe conversion chart printed out and right beside you? U40 syringes hidden away? I agree that you can try 0.9 u. Those U100 syringe marks are tiny but having a pair of reading glasses (even if you don't normally need them) and a good strong light behind the syringe is very helpful. I always sit at my desk to draw up insulin to take advantage of my bright desk lamp. I then view the syringe against a white background - tissue, piece of paper, etc. - to check the insulin level.

 

@Kris & Teasel yeah I have it on my phone. Ok so i just need to go between the 2 and the 2.5 on the u100 needle to get 0.9u?

 

Sox is staying pretty flat today. I think I'd keep the 0.8u tonight just because it's a nighttime cycle, then I agree with Rachel and Kris about the 0.9u if nothing interesting happens during the night. The mid-cycles you're getting are pretty good, and there is still a fair amount of room below that to keep him safe. At this point you aren't trying to bring the nadir down as much as you're trying to build longer duration. And if the nadir does go down a bit, it's okay, as long as he stays above 50. A normal, non-diabetic cat will stay around 50-80 most of the time, with occasional dips higher or even a bit lower than that.

Now that being said, if he gives you a lowish yellow PMPS, and gets another green tonight, and another yellow AMPS, I might stay at 0.8u one more day. But if he gives you a pink PMPS or AMPS (or a high enough yellow that if you squint it's really closer to pink), I think I'd go to 0.9u

 

Okie dokie @Djamila that sounds like a good idea to me. I'm out tomorrow so may keep the 0.8u then but am in all day Sunday so could do it then and keep an eye on him

 

10.8 tonight. No idea what hes doing to me lol keeping me on my toes though

 

Sox has been pretty flat all day. Not much difference between AMPS and PMPS. You could shoot the 0.8u if you are game for a little more testing tonight should it be needed or you could reduce slightly if you are not up to monitoring or uncomfortable with the possibility of having to steer him a bit. That reading is not much below 11mmol and could be a tad lower or a tad higher when you take meter variance into consideration. Decisions.. decisions!

 

@MrWorfMen's Mom I think my meter is slightly on the lower side so think I'm going to go with the 0.8u for tonight test before bed then mid cycle.

He has been quiet flat all day so worth seeing what he does tonight.

 

I think that's a good decision. I'll be checking to see his before bed test.

 

BG gone up again after eating
I'll test again tonight at +6.
Think I'll stay with 0.8u tomorrow as I've got to go out and do my shopping so can't watch him all dat. And then depending on tomorrow test I do get I'll try 0.9u on Sunday

 

Sounds like a good plan.

 

He has been quite flat today, hasn't he? Reasonably good numbers though considering his usual patterns! I really like today's cycle, and I think sticking with 0.8u again was a good call. Curious what tomorrow will bring!

 

Me too!

 

He has and still sticking with been quiet flat through the night. Just done his +6 and he's 11.3 so sticking with the same pattern all day lol

 

Go back to bed and get some relaxing sleep!

 

I'm keeping my fingers crossed for a blue AMPS

 

Sox had quiet a nice PMPS but 2 hours later gone up quiet abit. I think Brad might be stressing him abit and Brad shouts at the TV when playing FIFA could that cause his levels to go up do you think?