Dose Advice needed

When you're using the AlphaTrak, any number under 80 signals a dose reduction.

What meter got the 79?

 

Prior to diagnosis he was eating natural balance limited ingredients (wet) and a tiny bit of evo (dry) each day. I thought he had a food allergy because he was extremely itchy when I got him and I did trial and error with food. But, he either never had the allergy or grew out of it.

Fingers crossed that the diet change makes a big dent in the problem.

The 79 was with the Relion.

 

Could well be! D you think you can get more tests in this weekend? It would be great to see another low and a dose decrease again! (Although his bounce may last through tomorrow)

 

Not sure. I have a ton of things I need to get done out of the house but will try to get mid-day tests.

 

Pretty please? Or maybe do a before bed test (stay up a little later) then set the alarm for middle of the night for spot check... Could be SO worthwhile if you catch a low!!

 

I know, but I need to start balancing me vs him. The last 2 weeks have been all him and it isn't something I can keep up. And I'm not 100% comfortable testing in the middle of the night because I am afraid of being less than delicate when I am tired. But I'll see what I can do. If he wakes me to play I will try and sneak a test in.

 

Lol that will teach him to wake you up at 3am!! I know how you feel but look on the bright side.. Touch wood anti jinx, he keeps this up and you go OTJ and you don't need to worry about him any more!

 

So his amps was 174 on the human meter. I must be out the door in 45 minutes and will be gone for about 2 hours. I just fed him. Am I correct to retest in 30 mins to see if he goes above 200 for a shot but skip it if he doesn't?

 

Morning,

I cannot offer dosing advice, but someone should be along soon to answer! Have a great Saturday, hope you get your running around done. Looks like it was raining in the city (Watched Today Show, LOL)

 

Thank you. He got nervous when I put his food down because I was in the kitchen so he didn't eat and probably won't until I leave. I suspect I will end up skipping the shot. Everything went so smoothly yesterday I was bound to run into a hiccup today anyhow.

Rain has stopped, thankfully.

Updated: shot skipped. Didn't want to chance it.

 

Another option to skipping the shot can be a reduced dose, for future reference.

I had skipped a couple shots at the very beginning of Frog's treatment (we ARE still newbies, so take that into account) and after seeing how the skip really caused havoc on his numbers, I've decided if the low numbers show up again, Ill go with less insulin rather than none.

 

Thanks. He only gets 1/4 unit as it is so reducing the dose is tricky because I am already being imprecise. I skipped a few doses at the start due to fur shots and I got to see how his numbers go wonky from it so I expect some his numbers today I to tomorrow. But, and particularly when I need to leave right after I give him the shot, I would much rather err on the side of caution.

He ate some while I was out and he is up to 427 now so I guess I will just use today as a way to try and see how food impacts his levels.

Now, here is the question of the day: shot time last night was 9:30 and I was going to move it back to 9 tonight (need to get to 8 by Wednesday). Since I skipped this am, can I still move it or should I wait until tomorrow for that? Can I move it more than 30 minutes and just go to 8 (which would be 22.5 hours after the last shot) tonight and keep that schedule or would I run into issues with the insulin that is still in his system?

Oh, and one last thing: I know I probably could have put the 911 badge on the question this morning and gotten a quick answer, but I was 99% sure I had already made the decision and didn't want to take attention away from someone with an urgent problem. So, that's why I didn't (figured I would leave it to chance).

 

Skipping a dose does give you the chance to change the shot time. If he's high enough at +22.5 (I think that would be your 8:00pm), then go ahead and shoot. I would do a test at +21 (6:30pm, if I have your plus numbers right) to compare that test to the PM shot test. So, you could get right back to your desired shot schedule, tonight.

 

Great, thanks. I will do a mid-day test and also see where he is at +21. I'm going to guess it will be in the 500s but he has surprised me before (little freak of nature that he is).

Much appreciated. I'm slooooowly getting the hang of this. This board has been so helpful I can't even describe.

 

No apparent bounce today even after skipping the morning shot yesterday. Hoping that is a positive development.

I also checked ketones yesterday and the result was much closer to negative than the prior tests where I was never quite sure. So I'll keep checking but am feeling good about those as well.

 

Nice, fast recovery from the bounce.

 

Yep he sounds like he is doing well!

 

I think so, yes. His PMPS is 101 so it looks like I will be skipping the shot again. Just fed him and I'll test again in an hour, but I think this is the first time I have seen 2 normal pre-shot numbers in a 24-hour period.

 

Bounce, bounce, bounce.

Since I have had to skip 2 shots in 2 days only to seem him jump back into the 500’s at the 24 hour mark, should I be thinking about reducing the dose again (I'm at 1/4 unit now) to try and find the level I could give twice a day? Or could it just be a fluke and I should stick where I am for a few more days to see if it keeps happening?

Is this a sign that his body is picking up more of the slack regulating on its own (and therefore that remission could be in the future) or does it happen sometimes for no real reason at all?

 

Hmm. I think you are going to have to start getting used to shooting at lower numbers. Its something we all have to do eventually because the goal with insulin is to get your cat into normal numbers all the time. That means getting used to shooting when he is in normal numbers.

We dont advise newbies to shoot under 200 because they dont have the data to know how the cat will behave. But over time and once they have data, they will need to learn how to do this. Gradually you reduce your "don't shot" number down from 200 to 150 to 100 and so on. I routinely shoot at 50 - the idea is "shoot low to stay low" which keeps your cat in normal (50-130) numbers all day long ideally!

Anyway here is advice on shooting when the numbers are low - read it now before you see your next low pre shot. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

I would keep on 0.25IU for now. Remember to not feed 2 hours before the shot. But next time you see a low at shot time - dont shoot and dont feed. Wait 30 minutes and test again. While you are waiting the 30 minutes, come on here and post 911 and have a member walk you through it. PM me and post on the Tight regulation board too if noone gets back in time. If the number has gone up in 30 minutes to above 200 then you are good to shoot. If not, the member will advise.

You should be prepared with extra strips, syrup and high carb gravy food just in case. Shooting under 200 typically happens at night (murphys law) and you can expect to have to stay up and test quite a bit - at least the first time - to keep him safe.

Wendy

 

I dont think he is ready for a reduction because he isnt going below 50 as far as we can tell but his body could be recovering a little which is why you are now on 0.25 instead of the 0.5 from before. Also the low carb canned will be helping. As soon as you see him going below 50 I would drop to 0.1IU.

Wendy

 

Ok, thanks. I will start reading up on the low number shots. If the situation arises again before I feel comfortable dealing with it I can always skip a shot again.

 

I'm thinking he still needs insulin. You do not want to reduce to zero. The next dose down is a 0.1U dose. I would suggest that as the new 'reduced' dose. I'd like to see him on that for at least a couple of days, maybe longer. It all depends on how much bouncing is going on.

If the reduction doesn't work, we'll take it back up to the 0.25u again. Need to wait a bit and see how it goes.

Remember these pictures? They are a few posts back but here they are again.

Pictorial guide using a U-100 syringe marked with half units:





Think you can shoot that 0.1 like shown in the second picture?

 

Ooof, thanks. I will go out and get a magnifying glass tomorrow and start practicing.

 

Sounds good but she hasn't earned a decrease yet... For now you probably want to read up on shooting low.

 

Oh, got it. I though that was part of shooting low. I'll make sure I read everything before I even attempt shooting below 200.

 

Sounds good but also come on here and let us know and one of us can walk you through it.

 

He went kind of low today.

His +3.5 was 48. I put food out which he ate some of. 20 mins later it was 51, and at +4.5 he was 61 (no additional eating since the prior test).

I did a 911 post (I hope that was appropriate. I got nervous because I have seen him go lower than the 3.5 mark before) but didn't get any responses so I deleted it so as not to clutter the board. I am hoping its ok to leave him because I am already late for something. He is not acting abnormal at all and I know he has dropped lower than this before at least once.

I have a work thing Thursday morning that I need all day tomorrow to prepare for and won't be able to do extra tests or pay close attention to him until Thursday evening (I wont be able to get any numbers other than at shot time). So assuming he is still on the low side this evening I hope it is ok to stay with the "no shot under 200” rule for another 48 hours.

If he is above 200 this evening, should I reduce the dose or stick where I'm at?

 

If you must leave, then leave food out. How long will you be gone?

If you're following the protocol, that 48 indicates a reduction. Can you manage to see that in the syringe? You're currently at .25u, right?

 

yes, .25 now. With a magnifying glass I am sure I could manage less than that. I have been eyeballing the .25 so I doubt I have been exact.

 

Well that was unexpected: +11 = 425

He was eating when I came home (just before the +10) but I didn't think it would jump like that.

Anyhow, now that shooting low doesn't seem to be an issue, what does would be appropriate tonight?

 

I'm thinking he still needs insulin. You do not want to reduce to zero. The next dose down is a 0.1U dose. I would suggest that as the new 'reduced' dose. I'd like to see him on that for at least a couple of days, maybe longer. It all depends on how much bouncing is going on.

If the reduction doesn't work, we'll take it back up to the 0.25u again. Need to wait a bit and see how it goes.

Remember these pictures? They are a few posts back but here they are again.

Pictorial guide using a U-100 syringe marked with half units:





Think you can shoot that 0.1 like shown in the second picture?

 

Yup. I bought a magnifying glass. I will do the .1 and try to get a +2 or 3 tonight.

 

Sounds good.

What time, eastern daylight savings time, is your +2, +3?

 

Sounds like a plan..

Way to go on the dose reduction!! He is doing great!! You can probably expect another bounce for now but unless he drops below 50 again keep holding the new dose.

How is he doing generally as regards the 5Ps?peeing, purring, pooing playing and preening?

Wendy

 

He is doing fine on the peeing, purring, pooing, etc. And his activity level is higher than it has been in as long as I can recall.

I'm curious... Over the last week or so he seems to be eating faster. Instead of grazing all day he finishes his food faster now.

I thought 6oz of wet food a day was appropriate but I'm looking and at 11 pounds (his ideal weight, says the vet) he should need about 300ish calories a day. The chart says Fancy Feast has 90 kcals per 3oz can. Is it crazy to think he might be ok eating 3 cans (9oz) a day? I have been giving him 3 oz in the morning and 3 oz at night, but he eats it so fast I feel like he is always hungry. Today I gave him one can in the am and put another out when his numbers were low mid-day, and he ate that too. Now he is standing over the dish and giving me the "I'm starving" face.

His ketone tests are all the same (negative or maybe trace) and I know his blood sugar, so could increased hunger be normal or should I be worried? Because he always ate dry food as well as wet before the hospital, I don't know what a "usual' amount of just wet food is for him to know if this his hunger is increasing or just getting to what it would have been without the dry food.

 

I just got home and it is right about +2.5. So as soon as he sits down I will test him.

+2.5 is 218

 

An unregulated cat will be hungry because he cant process food properly although with the insulin it will be helping him. I would increase to 3 or even 4 cans for now.

But weigh him every couple of weeks and change it if he starts to lose or gain weight beyond what you want. (i just use a human weigh scale and weigh myself with and without holding the cat). Mark the weight in your notes section of your SS. Its a good practice to do with every cat or dog because its a good indicator of health since losing weight can be the first obvious sign of an issue.

FYI my non diabetic cat is 10lbs and has 2.5cans a day and its a good amount for her. Every cat is different.

Looking forward to AMPS because he was coming down at that +2.5. Hopefully you didnt miss out on a nice low.
Wendy

 

He ate a full 3rd can overnight and that's the first time I have given him one (I thought 2 was the right amount) so I will give him 1.5 cans morning and night and keep an eye on his weight. I've been going by feel (how much can feel his spine) but I will start weighing him more often.

Amps was up there (495) but that is still lower than I have seen him bounce before. I won't be able to do another test until at least +10 tonight, but I'm sure it will be a good number.

Edit: I was able to sneak a +2 in and it was 333.

 

This morning is a rush so I didn't have time to mess around and test before he ate. His +11 was 599 but that was about 20 minutes after eating. I feel like there is a tiny chance I had a fur shot last night. I thought the needle went in and didn't see/feel anything on his fur, but he also didn't even flinch when I gave the shot (which he has been doing lately). So, who knows...

edit: didn't flinch for his am shot either and I know it went in, so now I feel confident he got the dose last night as well

 

The relion said HI this morning so I double checked with the Alphatrak and got a 628. He seems to have peed a lot last night from the way his litter looks. I gave him the shot as usual this morning will do a +2.5 before I leave for work. I'm leaving for an hour soon but put plastic over the litter so hopefully he will pee while I am gone and I can do a ketone test.

 

Cool. Looks like he is coming back down which si good

 

Yes, and ketones were fine. Maybe he went low or ate too much overnight. He doesn't seem any worse for wear.

 

Amps was 246 and his +4 is 48. I gave him some treats and will test again in 15 minutes.

Where do I go from here? I'm already only giving him .1 units and he isn't really regulated in any way (still has big highs and, apparently, lows). Previously his BG has dropped at about +2.5, which would mean he was lower than 48 at some point today. But it has also bottomed out at +6, meaning he is on the way down now and I will stop it because I happen to be home. But, during the week I wouldn't be.

*so frustrating*

I have him some treats which I think are pretty high carb (whisker lickins', crude fiber max 3%) and he went to 73 after 20 minutes. Another 25 minutes later without more food and it was 87.

 

Hmm. I would go over to the tight regulation forum and post for dosing advice. They are pretty experienced. Put "newbie dosing advice " and a ? In your subject line.

 

Will do, thanks.