? 9/25 Indie AMPS 114... Need dose suggestion.

She was 114 at AMPS. We keep jumping around with her doses. I will not be home from +1 - +6 today. So I need to get her at a safe dose.

Then all week am back at work Mon - Fri and am gone 12 hours a day. So I need to find a safe dose to give.

As you can see from her spreadsheet I haven't been sleeping much. I need to get a good night's rest and know she will be safe.

Please help! I so appreciate your recommendations.

 

Yesterday am shot you have her 1.5 and pm 1.75 or was that a typo. Re read SLGS protocol. I believe you hold a dose for. Week before changing. Before you increase you want a full curve done also. I'm not one of the experienced vets, however i follow the same SLGS and since she's dropping to the 90s befpre her nadir I would give her a dose reduction to 1.0. especially since you will be working. Hold this for a full week and do a curve Saturday. This is how I would handle it. Hope you hear from others! Also hope this bumps you up on the list again!

 

Also I never shoot under 150. I'll monitor for a hour without food test again and if it's still not 150 I'll either no shoot till pm or give 20% only
Of her dose.

er

 

Okay thank you for responding!

I feel like I am clueless at this point. Nothing is cut and dry anymore.

 

You're right. Definitely all over the place. If there's one thing I can tell you is that there is always constant change. Recently DaisyS BG has been in the hundreds. But then became constipated. And was getting sick and throwing up. We have her at 1.5. Took her to the vet gave her some meds. She was running in the high 400s. I was thinking about giving her a dose increase. Then last night she went to the bathroom. This morning she read in the 249 for her amps And +3 144. If I had increased her she may have dropped too low. I also read in your last post that people were in your house, possibly redoing it. Whenever I have lots of people in my house OR the environment is changed, Daisy usually runs high because she stressed. However the next day when I go to work and it's just her she gets back in her normal numbers . I work just like you long hours over 40 hours a week. So I also purchased an automatic timer feeder. She get snacks at eight, 10, 12, three both during the day and throughout the night. Just helps mama with the stress of possible hypo.

Hope I'm helping and not just blabbing

 

Daisy is consistent at 1.5 dose is only changed if she is too low at preshot bc I work all day. But this hasn't happened in forever. I think you may be responding to jessica and indie

 

It increased as need by SLGS

 

I just woke up. Sorry. I'll delete the comment.

 

Well was 114 at +11.5 to give me time to post and wait for suggestions so that I don't getvoff schedule.

Thats my goal here but her numbers keep changing so what is deemed a safe dose? Thats my question. I do not feel comfortable giving 1.5 and leaving her for most of the day. I will 100% shoot because every one says to. But what dose? Do I just stay at 1.5 another two days? I can not do a curve till next Saturday.

This is torture. I just wanna protect and care for my baby the best way possible. Am so tired and sad and overwhelmed. I need help

 

What is the Carb content of the food you fed last night at +5.5?
Had she eaten all of it by morning? Do you know when she ate it? Is there any chance that the morning reading is influenced by food (ie has she eaten less than two hours ago?)

Your options are

1) Stall without feeding, you could test again in 30min and see where her BG is heading, you may find that she has come up significantly.
The problem with stalling is that it can see you get of schedule, and you will only be able to get back on schedule by 30min a day (or 15min per cycle)


2) You could skip the shot this morning and that will drain the depot keeping her safe.

3) You could choose to shoot a much reduced dose (reducing by 30-50%) (maybe 1u), problem with that is that there is no guarantee that she won't drop even with a reduced shot.



@Sienne and Gabby (GA)
In Fairness to Jessica, with the dosing, I think there has been some confusion, with Indie getting dose reduction numbers quite close consecutively, it was discussed a couple of days ago that maybe the reductions were coming too close together, and that it might make sense to hold. However, Jessica didn't see the comments took the reduction then read the comments and took the dose up the following cycle (hope that makes sense), hence the dose coming up and down.

 

This is awful as I have to run out the door and haven't shot.

 

If you feel most comfortable at 1 and she's getting into low greens at 1.5. Personally, not a vet but a full time worker like you, I would do 1 and curve on Saturday. Throughout the week spot check as much as you can. Say you get home and can spot check +11 then grab that number. But I'm not a vet.

I follow SLGS, everyone suggestions and what's best for ME and daisy. My vet always told me week in 200s if you can't test till weekend when you change dose is better then hypo. Not everyone will agree. Long periods of 200s is not ideal so that why we address it on the weekends after a FULL WEEK of giving the same dose. Kitties body's take time adjusting to meds. And when the dose is initially changed you may see some
Weird numbers.

 

What may be a strategy to consider is to lower the dose to what you think will be safe. If the numbers aren't in a range that ends up being too high, you can increase. Getting spooked by a lower than expected pre-shot then dropping the dose followed by shooting what "should" be the dose will keep Indie bouncing around.

What would you be comfortable with? 1.25u? Ultimately, trying to get you to a point where you feel Indie is safe and you can shootis the goal.

Gil's suggestion to drain the dose by skipping has merit if you're comfortable with it.

 

If there's a chance she ate some food in that 2 hour window since you last tested, and the numbers are food influenced, the safest thing to do would be to skip, and then reset tonight.

 

Thank you all!! Yes, she did eat. So I am going to skip this dose even though ideally I would still shoot, skip my day and stay here and monitor her but I have been doing that too much lately and life is being severely impacted. All worth it but I must keep my job and commitments

I will skip and test at +6 and start her tonight at a dose I feel comfortable with (likely 1.25) and stick it out all week and curve on Saturday.

 

Sending love! I would have done the same ❤️ Have a good day'

 

I'm still a rookie myself, and leaving cat after shot before work for nine hours before testing. If it helps you any, I would give 1.5 at this point. The 114 amps is above the 90's he tested midcycle so cat isn't dropping fast and there is no indication from past few cycles that he was anywhere close to the 30's. The cat won't feel anything bad in the 50's to 80's and this is what I might expect happening as the worst if I couldn't test for the cycle.

What I do if I feel like the dose should be ok but feel a bit scared, is that I would give a lesser dose. If that chart belonged to my cat I would feel ok with the 1.5 dose and testing him at +2 and +5 or +6 in just one of the cycles per day.

 

I'm not sure that we can say that for sure, take a look at yesterdays cycle, started
amps 151
+2 121
pmps 247
What happen between +2 and pmps???
Sure Indie might have crept up and up, but when I see a +2 that's lower or about the same as PS, it makes me think that the cycle is likely to be active, so I think it's also possible that Indie dropped into green that cycle, how low, is anyone's guess, she may have dropped low enough to trigger a bounce to yellow.
Or maybe that reading was a dodgy test strip. Or maybe she got into some food after +10, o the workmen did scare her and we have a stress influenced number there.

Indie has been earning back to back reductions on SLGS, seems like something may have changed with her. With Jessica being so new to the dance, it's important for her to get to a place where she is comfortable shooting consistently, as at the moment the inconsistent dosing is likely muddying the waters.

FWIW, I don't think Indie did drop into the 30's, but there is always that niggling doubt.

 

Just got home and Indie is 107 at +8 with no shot today. Is thst because the depot?? I thought she would be much higher but maybe she stayed flat w/no shot?

 

Possibly, there's still 4 hrs till pmps, so she may still come up some by then, don't be surprised if she zooms up.

If you could grab a +11 and post with the result, it will give you some time to get some advice.
It's 11pm for me now so I won't be around, but others will.

ETA try to take all food up by +10, so that Indie gets no food in those 2 hours just before the shot. It's important to know that the PS number isn't food influenced.

 

Her +11 was 158 with no food for certain 30 mins prior. Per your advice, am not going to let her eat for one hour before +12 so we have a good number for her PMPS with no food for 1.5 hours prior.

 

It's best to not feed for 2 hours before testing, as carbs can last that long. I like Sienne's suggestion of 1.25 units, now that you've had the day without insulin to drain some of the higher dose depot. Of if you feel more comfortable with 1 unit, go with that. It would be ideal to get a dose you can stick with, they increase up if needed.

BTW, we usually just do one condo a day and modify the subject title if we have new questions, otherwise it's too hard to keep track of what all the cats did each day. Here's the link to the other post, but try to keep comments on this one. http://www.felinediabetes.com/FDMB/threads/9-25-indie-pmps-162-help-need-dosing-advice.165609/

 

Okay thanks. I gave her 1.25. Honestly I feel comfortable with 0! I have no way of knowing how low she will drop!

Sorry to keep posting. I thought they said create a new condo each time. So I appreciate you telling me this I look like the that newbie I am!

 

Tonight try to get a +2 to see how much she has dropped and a +4 or 5. Just to see how she's reacting. I have to do most my testing at night bc of work all day. Plus gives you little idea how they amay be during the day. My
Kitty usually runs lower at night but today she switched the game up on me!

 

We're all newbies here at one time or another.. we're just in different stages of newbie-ness! For what it's worth, my biggest advice is Breathe..then Breathe again, a strategy I have found is good before doing anything in this dance!
Then it's easier to calmly look at the numbers at hand and make a decision from a better place! I clear each step with the folks on the board, the pros here have never steered Gussie and I wrong. Sometimes I just had to go with the advice without fully understanding the why, that came later when I saw the result and could put the pieces together..that's usually when the A Ha! Moment hit.
Hang in there, it's a lot to absorb especially when it's scary and you feel like you have to know it ALL right now to keep your kiddo safe. The folks here will help...it does get easier and less terrifying

 

(((Jessica))) this is hard, especially in the beginning. As you get so you can predict what Indie will do, it will get easier.

Just as a little perspective that might be helpful - this problem you are having is actually a good problem. She's responding well enough to the insulin that you are thinking she is too low to shoot. Except for that brief jump to 245, she's been under 200 almost constantly for the past 5 days. That's fabulous! I think you should be very encouraged by how well she is doing. We have plenty of caregivers who would love to have Indie's numbers for their cat! I know it's nerve-wracking for you, but enjoy how well she's doing if you can!

As far as moving ahead, I'm glad you've picked a dose that hopefully you can shoot comfortably. I think the best thing you can do is to figure out how to get food to her when you're gone to work. I haven't gone back just now and looked through your posts, but think I saw you say earlier that you have 4 cats, maybe, so it's hard to get food to her? What about separating her from the others and having a timed feeder? Or if you don't have a timed feeder, some people freeze cat food (mix with a little water and use ice cube trays or muffin pans) so that as the food thaws the cat, in theory, will eat it. I'd try that out when I'm home first so I could see if my cat would eat it or not. I have one cat that won't eat cold food.

You've gotten some good advice above about not feeding in the couple of hours before her shot. You want to have confidence that the preshot number isn't higher because she's just eaten. Food spikes, which is when the cat's blood sugar rises right after eating, wear off fairly quickly and you don't want her to drop unexpectedly because you've shot a food spike. So I'd definitely try to not feed her late in the cycle.

Notice in the SLGS guidelines below that there is a progression - it says "in the beginning" and then it tells you to analyze the cat's responses to being shot at lower numbers, then it says "with experience" you can shoot numbers as low as 90. If a person is hoping for remission for their cat, they would want to consider these guidelines and not get stuck in phase 1's "in the beginning" guidelines. In order for a cat to go into remission, their blood sugar needs to get back into normal range so their pancreas can heal. Now having said that, you don't want to shoot lower numbers and leave! When you have the opportunity, though, it's something to work towards.

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
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 these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.

• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.

• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

If the preshot number is near usual preshot numbers:

• Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.


I have a minor suggestion that isn't terribly important and you could get to it anytime, but I'm thinking it would help us see what's going on in her ss if the time columns weren't that bright green. That color is typically used when a cat drops into low numbers, like the 59 on 9/29 (although we consider low numbers to be under 50 on a human meter). Some spreadsheets are formatted to have it go to bright green with low numbers, some aren't. But at least for me, it's messing with my mind a bit because I look at the bright green and think low numbers. Those of us who help with doses really rely on seeing the flow of colors on the ss that tells us what the cat's blood sugar has been doing for the past several days. Some people use tan for highlighting various things and since it isn't a color that's also used to designate a blood sugar range, it's a great choice. I just think it would help to have a different color. Thanks!

Hope you have a great day at work tomorrow and can not worry too much about Indie!

 

Thank you so much for taking the time to respond! For whatever reason I missed the alert on this response. So am just seeing now.

I listened and have edited her spreadsheet to change the time column from green to grey. Hoping grey is okay.

I also have stopped letting her eat just before shot time to get an accurate BG reading.

Am going to start a new thread now as I did a curve today and am curious of where to go from here in terms of dosing.

Anyways again wanted to say thank you!!