amps 370 pmps 157 - low BG, could vomit be the cause?

My boy has IBD and I have been confronting with weird number every few days, mostly after vomit episodes, his BG checks lower than usual before next shot. Im at a loss and I feel I play so much with his dose of fear of these vomits, I dont know what would be a safe approach. I lowered the dose quite a lot so that when these vomitepisodes appear, he would be out of the danger zone (hypo).
How should I look at these numbers? Could there be another cause for these oscilations?
How to manage this and also regulate him? My vet is more in the dark than I am. She suggested to lower dose which I already did (a lot)
Any input would be helpful, thank you!

 

Hello and welcome. We determine the Lantus dose based on the nadirs, or how low it takes the cat. Due to the nature of the Lantus depot, we will give the same dose each time, unless the numbers tell us kitty either earned a reduction, or needs an increase. It looks like you are dosing based on the preshot values. Take a look at the two dosing methods we use here, Tight Regulation protocol, or Start Low Go Slow method and decide if one of those would work for you. Following one of the dosing methods makes it easier to determine what dose to give and when to change it.

Lack of consistent dosing and not seeing how low the dose is taking the cat by not testing in the middle of the cycle, can produce wonky numbers. If Porto is going low on a day you can't test, he could be bouncing, which temporarily produces higher numbers.

Do you have all the vomit episodes marked in the spreadsheet? If he didn't digest any food after the vomit, it could cause him to go lower,

 

Hello! I know about Nadirs but I can not make a curve and calculate Nadir because I dont know which day is the correct day to calculate the dosage. He is high three days and low the forth. Or so. There havent been seven consecutive days without any episode, except for when I lowered the dose from 3 u to 2 u and he was giving high numbers almost daily. I do try checking at night, between the shots, before going to bed.
Could you have a look at my sheet? Could these last numbers, three days high, one day low, could be bounces? How long is this temporary show of high numbers because bounces? Hours? Days?
Is the dose too high? When I lowered it from 3 to 2 because of the same issues, his numbers preshot were in the 400 and peak, 300, not oscilating much. Now, with 2, I get this low number again, before shot.
What I did notice is that everytime he had a low BG some vomit was involved. I have the vomit marked as V on the sheet and the loose stool is D. His stools are alright, lately, but the vomit keeps coming back every three days. Could be coincidence because I feed right after but it is odd.
This morning, before the am shot, he vomited but only liquid, no food. And now 12 hours later, this, 157. Should I keep lowering the dose?
I have the rules of slgs well printed to my memory, and they are clear about uping and lowering in 0.25 - 0.5 units and I dont feel alright with changing th dosage from one day to another but the numbers before the shot force me to lower more, if I want to be in a safe zone when the peak reaches.
I have so many questions. I appreciate any help. Thank you so much!

 

By morning for sure his BG will be up again, before the shot, then what should I shoot? Should I go with 1 UD still or go back to 2 UD if his numbers are high? Tonight I did 1 UD because of the low BG before pm shot. I couldnt have shot 2 ud according to the rules in SLGS, his preshot number being lower than usual and in 150s... But I also shouldnt change the dose so much between shots. Which rule should I follow? I am at such a loss...

 

Also, to mention, that we are changing diet, from RC kibble to Ziwi Peaks air dried and wet from Ziwi Peaks. I have to mix them so I can get a good response in stools and go easy. I was expecting a drop in BG but Ziwi venison is quite high in dry matter carbs, 20%, and RC kibble was 26% so maybe it didnt make such a difference.
Maybe I am wrong and the high numbers are false because of bouncing and the BG did drop and this is how they would show when shooting a higher dose than required?

 

There is no correct one day to calculate the dosage. Rather we look at either a week of data on the same dose (if following SLGS), or a minimum of 3 days/6 cycles if following TR. I did look at the spreadsheet, but you are dose hopping around so I can't tell what would be a good dose. The depot is being interrupted all the time. My suggestion is to pick a dose and stick with it, follow the guidelines of SLGS if that is what you are using and follow it for the required times, then evaluate the dose. The one exception is if Porto earns a reduction by going below 90, in which case you would reduce by 0.25 units. Maybe try 2.0 units, youndid start to get some data on that dose. But first a question, has Porto ever tested positive for ketones? You should be testing daily when he is in high numbers. If yes on ketones, then a higher dose may be appropriate.

If you can't get mid cycle tests during the day, then at least get a before bed test at night. Many cats go lower at night anyway, so it's a good time to try to spot those lows.

The answer to shooting lower numbers depends on your experience, the data you have gathered, and your ability to monitor that cycle. In the beginning you may skip, but as you gather data you lower your nonshoot number. As you have observed, he will shoot up the next cycle if you skip.

 

Thank you so much, Wendy! You cant imagine the feeling of someone looking at the sheet and commenting on it. Very helpful everything you say!

So, if the nadir doesnt fall below 90, I dont reduce?
I want to be thorough so english not being my first language, I want to ask my question right, hoping you could answer.
If the preshot number is way lower than the preshots before, but the nadir wasnt lower than 90, I shouldnt reduce? I was doing 2 ud on 400s because with 3 ud we had a very low peak after a vomit (55 at 6+). So I got scared and I lowered the dose with 1 ud to stay on it for a while and see how it goes. I was also planning to change the diet, I figured it will be a safe dose in case vomits appear. And then, 5 days into 2 ud, and after a vomit at +3 am he got to 260 preshot (after staying in the 400s for the last days), i reduced with 0,25 not knowing where this is going and that gave a nadir of 129. then, the next preshot number was lower than the one before, 188. So I only gave 0.50 because I got too scared to shoot 2 ud or 1,75 like before. Should I have kept shooting 2 ud given that he still didnt reach 90 in nadir? I would like to know if there is logic in my questions, if I understand it correctly. Sorry if I am annoying, just want to get it right.

I may be too scared to shot if the preshot is low. Now I feel safe shooting 2 ud if the numbers are in the 300 or higher but going lower I get scared of shooting the same dose because of unexpected vomits but I am past shooting nothing. We had one ugly emergency hypo vet visit after a sudden vomit at shot time so I am quite scared of these unexpected vomit drops. I also dont want to take steps back in helping him get regulated. I want to proceed with caution but it seems Im doing worse...
I do test the ketones but the way I do it, I stick the strip under the pee and wait a few seconds, pull out and then check. It was always negative. They also read glucose and the glucose does get coloured so I assume they work.

He is sleepy today, more than usual, losing a bit of fur again, not seeming himself. He had a bit of a flare up, I think, last night and he may still feel the aftershock? I pray it has passed, since the new diet, they seem to get less serious but now I need to care for the diabetes and I am at a loss... Thank you so much for trying to help us!!