3/11 Sebastian PMPS 56 +1 73 +2 89 +3 102 +5 78 +6 62 +8 63 +10 75

What would be the reason for shooting a lower dose? The depot may be running the show. That 4.75 unit depot can still influence 4-6 cycles after a reduction.

When was the last time he ate?
 
Probably around +8 or +9.

The reason would be one of the bullet points in the dosing guidelines says a downward trend and a low PMPS is a reason to shoot a token dose. 5u got us down to 48. 4.75u got us down to 38. If the trend continues, 4.5 is still too much and we're going to get even lower into critical areas. What signs are we looking for exactly that we need to reduce dose quickly? The stories of needing that have been pointed out to me but not how those situations differ from ours.
 
Are you following SLGS or TR for dosing. Shooting a dropping number, if you have experience and can monitor, is a great way to take advantage of overlap to keep the numbers low and flat.

I see no signs you need to reduce the dose more quickly than normal, plus you have DKA in the recent history. It’s possible you are breaking through some glucose toxicity, which means reductions may come quickly.
 
The whole thing just has me very uncomfortable. We didn't start from 3 and work up, we started from 7 and worked down. I could understand if we were working up, we'd know what his numbers look like at the 3-4 range and I'd be a lot more comfortable, but we don't and I just don't understand why we're risking hypo if we don't need to.
 
Remember, Justin, you are in control with plenty of test strips, higher carb food and your monitor. Wendy is right about taking advantage overlap. Lantus is known for keeping low numbers flat. Look at Bubba's SS. He is making good progress and any unnecessary reductions set him back.
 
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Do you have plenty of test strips, at least 20, and a couple cans of high carb food around plus some karo or honey
 
Wendy&Neko said:
Do you have plenty of test strips, at least 20, and a couple cans of high carb food around plus some karo or honey
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>200 strips, case of HC gravy, and a bottle of honey.

Also, can you guys explain what you mean by take advantage of the overlap? I'm not clear on what that's referring to.
 
From the New to the Group Sticky Note:

A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus/Basaglar or Levemir:
  • Carryover - insulin effects lasting past the insulin's official duration
  • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Click to expand...

From the time stamps to your notes, +11 and PMPS are 15 minutes apart?
 
Also, I get what the overlap is, I'm just not clear on what we're taking advantage of. I've been told we'd actually like Sebastian's numbers to be a little higher, closer to the 80 range. Looking at Bubba's chart, that's where he's at. So I'm not clear on why, if Sebastian's numbers are low, and we're possibly breaking through IAA or glucose toxicity, we'd want a dose overlap? That seems like the exact opposite of what we'd want to get him into the proper range.
 
I just don't know if the data or circumstances aren't being interpreted right, or something is being blown out of whack, or what, but I just don't feel like his situation is being evaluated properly.

We started at 7 units on a high carb dry diet. We're now on a low carb wet diet and we've never evaluated how he performs at a normal dose closer to 3u. We did 3u for 4 cycles but that was right on the back of a 7u depot and probably a bounce so we don't really have any idea how he would have performed. To me it seems like it'd be much better to risk reducing too much and his numbers going high for a bit than to risk him going hypo. I know someone will say his DKA history but as far as I'm concerned DKA should be off the table when evaluating reductions. The only time he's ever gone DKA is when he was either getting zero insulin when he was first diagnosed and when he had p'titis and wasn't eating. Otherwise he lived in the 300-400 BG range for years and years with no issues. The ketones are something I monitor but unless his appetite changes the DKA is just not something I'm concerned about. What I am concerned about is having to take him to the emergency room because he's gone hypo, and the closest all night ER to me is 20 minutes away. So I just really don't know why we're risking hypo like this when we don't even have any data on the alternative.
 
73@+1. Happy to see a food spike, he didn't really get one last time he was this low at shot time so that makes me feel a bit better. I'll be checking every hour, at least. Got a big thing of coffee and early access for The Division 2, so I'm set for the long haul.
 
Justin & Sebastian said:
we've never evaluated how he performs at a normal dose closer to 3u.
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Why do you call 3 units a “normal” dose? There is no such thing. There is a dose that a kitty needs at a particular time. ECID and over time that number can vary. Neko’s good dose over the years went from 8.75 units down over time to 0.5 unit, back up, again over time to 7.0 units, then back down to about 0.25 units. All on low carb raw diet. Her body and insulin needs changed over five years and I changed her dose to suit her needs, all based on what her numbers told me to do. They said either increase, decrease, or hold the dose. Let the numbers be your guide. Yes there were times when the reductions came fast and furious, such as post radiation therapy and when her IAA broke. She also liked to nadir late, so I get how nerve wracking shooting those dropping numbers is. Fortunately, and with the type of data you are getting tonight, I could count on dinner to provide a boost.

Good to see that dinner bump at +1. Hopefully it means a slow start to the natural rise from the AM insulin shot. Which could keep him in good numbers until the next onset. That is a good overlap.

Not shooting earlier if kitty is low is just an additional safety mechanism. Some cats respond more than others to an earlier shot. My girl did not. Not sure you have the data yet to say how Sebastian responds to an early shot. You did have an option of shooting half an hour earlier tomorrow AM,. Paws crossed it’s a non event.
 
Glad to see the bump up at +1 and+2. Onset is around +3 it seems for Sebastien so let's see what the +3 shows. If he starts to go a bit lower, use some food to keep him surfing. Good job shooting tonight!
 
Justin & Sebastian said:
102@+3
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On the rise. I am so glad you shot the full dose tonight. Looks like he nadired at the end of the cycle tonight and often when they do that they start to rise again. Bubba used to be a late nadir cat which made shooting lower greens ( anything over 50 ) easier. Sebastien is still mixing it up some which keeps us beans guessing.

You would probably be okay to grab some sleep and maybe grabbing a test around +6 or +7 tonight.
 
Bobbie And Bubba said:
Looks like he nadired at the end of the cycle tonight and often when they do that that start to rise again. Bubba used to be a late nadir cat which made shooting lower greens ( anything over 50 ) easier. Sebastien is still mixing it up some which keeps us beans guessing.
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Yeah, looking at his past data it's kind of hard tell with all the bouncing but he does throw low numbers at the end of a cycle a lot. Not sure I would say that's reliable since he throws low around +5 pretty consistently also but there definitely seems to be a pattern there.

I'm all coffee'd up at this point and probably won't be able to get to sleep for a couple hours, so I'm just going to keep an eye on him until about +6 and then figure out from there if I can sleep the rest of the night or need more. I'll probably give him a break and skip the +4 and check back at +5.
 
78@+5. Coming down slowly and he's about to get second meal so hopefully he'll surf that a bit and we'll get some good numbers. I'll check again at +6 to make sure he's not still dropping and assuming that's not in the 50s I'll grab a few hours sleep and check back in on him at +9
 
62@+6. Bit more of a drop than I would have liked. Sat him down to eat most of the rest of his food so hopefully he'll start to surf a bit. He might drop a little more but I'm thinking he should be fine for a couple hours and if he's nadiring late I want to get the +8 to +11, so I'm going to grab a couple hours sleep now while I can and come back for the +8.
 
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