Do I shoot?

Should I give insulin to Lola? Her PMPS bG = 8.9 mmol/L (160 mg/dL), and it’s right - the blood drop was a good size, so sample size definitely wasn’t the issue.

Could I give a partial dose be in order? Or should I stall and try again in a couple of hours?

Edit: I’ve decided to stall for ~2 hours (I have to go out) and then test again. Will post results when that happens.

 

Have you fed yet? If not, don’t, and test again.

 

I already did, yes - I always feed first, and then I test immediately before I’m going to give insulin. Should I be doing it the other way around?

 

Typically we test first. Just in case you need to stall without feeding. But if you tested within a few minutes of eating, it should not have influenced her PMPS number. You could either stall at this point, or give a reduced dose if you can monitor tonight. This number isn’t much lower than what you have shot before, and is above 150.

 

Okay, I stalled for what turned out to be 3 hours (which I know isn’t ideal... life circumstances make me crazy), and now her bG = 8.9 mmol/L (160 mg/dL) still, literally exactly the same as before.

I’m leaning towards skipping the dose because I can’t stay up to do spot checks (got an essential videoconference in the morning). I know another option would be to give a token dose (~25% of a full dose) per the prozinc protocol - does this have added benefit over skipping, and could I still do her routine at the normal time in the morning despite being late tonight?

Edit: Looks like a nodded off there... but just an update, I opted to skip. Let me know what would’ve been ideal, though, so that I know for next time~

 

Ideally, you would not stall for more than 1 hour with Prozinc. There is that much leeway in the times you dose with this in-and-out insulin, that 1 hour would have allowed you to stick to your schedule for the next cycle.

After 1 hour of stalling, it's time to make a decision one way or another. Shoot the full dose, token dose, or skip.

Skipping usually means your cat will bounce, and have high numbers. That is why a token dose can help, to keep those numbers from bouncing through the ceiling so to speak.

But looking at Lola's SS, doesn't look like she bounced much at all. A bit surprising there.

 

She did it again tonight - her PMPS bG = 8.1 mmol/L (146 mg/dL). So same question again - token dose, partial dose (maybe half?), or skip? I would rather not skip another in such a short time frame, but this value is definitely too low for a full dose.

I’m wondering if maybe she is running lower and the higher number this morning actually was a bounce from skipping last night.

Also, relatedly, is a dose reduction to 1.75 units in order going forward?

 

Noel,

Do you have plenty of test strips? Can you stay up to monitor? Do you have your hypo toolkit with medium and higher carb foods? Those all come into play when you are deciding what to do.

I can't stay up with you to guide you, if Lola runs low tonight.

I'm fighting an illness, already stayed up too late waiting for the heating company tech to come get my furnace working.

 

I can’t stay up to monitor tonight unfortunately - I’ve got another videoconference first thing in the morning. So I think it’s a question of token dose vs. half dose. Which do you think is the better choice?

No problem, and good luck with your furnace! I’ve been through that recently myself when mine died over a long weekend... really sucks.

 

I'd go with the token dose.

Would you please remove the 911 prefix from your thread title?

Once you receive a response,that is what you should do.

 

Done and done. 0.5 units injected.
Hope you get well soon

 

Hope Lola doesn't bounce too high in the morning.

Thanks.

 

Luckily she hasn’t bounced at all - her AMPS bG was 10.5 mmol/L (189 mg/dL). I gave 1.75 units in hopes that she’ll show a more ‘normal’ PMPS tonight. I’m also trying to catch her nadir today - she’s down to 8.9 mmol/L (160 mg/dL) at +4.

Also, her ketones were a little elevated - she’s at 0.4 mmol/L with the blood ketone meter. I’m not sure if this is because of the skipped and reduced doses the last two nights, or if it’s because she’s got a massive abscess, as I know infections elevate ketones. Or some combination of those two factors. I’ll continue to monitor. Do you think the dose reduction to 1.75 units was wise?

 

Won't hurt. Time will tell. Hopefully, the reduction will let you have the confidence to shoot lower numbers if that happens at next pre-shot test.

Lola is a remarkably non-bouncy kitty. I know many people that would drool over Lola's SS and wish their cat stayed so even, BG level wise.

 

Yeah, that’s what I was hoping for... alas, if today’s nadir is any indication, it looks like 1.75 units isn’t going to work. She went back up to 11.2 mmol/L (202 mg/dL) on her +6 test. That’s a pattern I’ve kind of seen before on 1.75 units in the curve on 3/24/2020.

She’s always been lucky that way with having relatively steady bG values. I’m wondering if using a semi-sliding scale again might be a good idea because she doesn’t have problems with bouncing, which I believe I read was the main problem with sliding scales.

My logic is this. Doses lower than 2.0 units don’t seem to give her nice curves like the one on 3/27/2020, so I want to give her those nice cycles whenever possible if her pre-shot bG indicates that it’s safe to do so. Then when her bG is too low for a full 2.0 units, I can give less.

I would think this requires some trial and error with mid-cycle tests, mostly at night because her PMPS tends to be the low one, to figure out how she responds at different lower pre-shot values to different lesser amounts of insulin. With enough data maybe some decent thresholds can be established that I can use to inform future dosing decisions when I can’t stay up. Would this be a good idea?

 

Too tired for a coherent response tonight. Would you tag me in the morning, so I can respond then?

 

Sure, no problem. By the way, her PMPS bG was 9.3 mmol/L (167 mg/dL), which is a little low but should be okay with the slightly lower dose, so I’ve given 1.75 units for now.

 

@Deb & Wink Tagging you this morning as promised.

 

Learning to shoot at lower and lower pre-shots is definitely a matter of data gathering, to see how low she goes after a particular dose. There is even a sticky in the lantus ISG, about becoming data ready to shoot the lows. Yeah, yeah, I know you are using Prozinc. But the same theory applies to the Prozinc MPM method.
So, some "homework" for you.
Sticky Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers

I think you need to learn to shoot those lower pre-shots for one, the ones <150 mg/dL (8.3 mmol/L). As you get lower blue pre-shots, and shoot lower than that, after a bit of a stall, to see if the numbers are rising or falling, you could shoot those lower blue pre-shots, under 130 mg/dL(7.2 mmol/L) or 140 mg/dL (7.7 mmol/L), as long as you can monitor.

That is where testing at +11.5 each cycle could come in handy. That would then let you get those +12 (pre-shot) tests and know if Lola is rising or falling.

Not seeing much green at all on Lola's SS. That is where you want her BG's to be, at mid-cycle. Lola really does not get much movement on the dose. Maybe a 20-35% drop. She could drop a bit more, up to 50% and probably not bounce.

If you used the MPM (Modified Prozinc Method), that would allow you to make dose changes more quickly, and would likely be more successful than a sliding scale for the insulin. Dose changes would be every 3-6 cycles, based on the nadir.

Getting those nadirs are key to knowing what a particular dose is doing for Lola. I know that work probably does not allow you to get nadirs during the day some times. I know that setting an alarm and getting up at +5 or +6 or a +7 at night is a pain (PITA) and can be exhausting, but you need to do that on occasion.

Thank You for the tag.
Really busy today doing stuff at home, so didn't get on the board until late this afternoon.
Let me know what you think.

 

Thanks for all the information - I’ll read it over and think it all through. I do know I’ll have to do some +5/+6/+7 tests to gather data, and have done a couple now. It’s easier right now because I’m working from home due to COVID-19, but it’s unfortunately impossible during the week when this is over and I’ve gone back to working in person. Tests during the day would also be impossible during the work week then too. Getting one +6 test on the weekend is about the best that can be hoped for when that time comes.

Because of all that, I don’t think the Modified ProZinc Protocol is an option for managing Lola, thus why I’m leaning towards a sliding scale. There are going to be a lot of cycles that I can’t monitor, but I can’t be giving her token doses that often because I’d be undertreating her if I did that. I’m hoping that with this data gathering period I’ll be able to get enough information to support shooting at lower numbers, but there’s going to be times where her pre-shot bG is too low for a full dose, and in those cases I’d like to give more than just a token, while also not giving the full amount so as to not risk hypo.

Also, to be frank, I’m in pretty poor health myself, and working plus commuting takes almost all the energy I have... which makes this more difficult than it would normally be. That’s not anybody’s fault, it just kind of is what it is.

This thread is getting pretty long, so I’m going to make a new one about her most recent test results that really aren’t good. Thanks again for your continuing help