? Dosing advice for Sam

Hi everyone. I have been here a few months now and have learned a bunch but I'm still a newbie. I was hoping I could start a running thread here to get help with Sam's dosing. We still haven't found her optimal dose yet and are experimenting with .5 units of insulin twice a day. My signature and spreadsheet is up to date. If there is any information other than that you need, please let me know. I feel like Sam can be pushed into remission now that she is on LC wet food.

Her numbers are a little bouncy but fairly low overall. I am expecting to see an unusual number for her PMPS in a little while. Will some of you be online about 5:30pm Central Time? Thanks in advance!!

 

Of course you can!
I can't 100% guarantee I'll be on at that time but I'll try to hop on as close to it as I can

 

Thanks Yong! You have been such a big help from the beginning! I'm not sure if she will be low or high for her PMPS but I'm hoping to be able to give her .5 to keep this train rolling.

 

I'm in the Eastern Time Zone, so an hour ahead of you. I can check in around 6:30 PM, 5:30 PM your time.

 

I'm in Central Time though not always on at 5:30. I'll try to be around too, though just in case Kris or Yong can't be!

 

Sam is at 207 and eating now. I assume she got a big glucose dump and is coming down from that. I will check her at +4 or so tonight. Thank everyone

 

+4.5 is 208. Hasn't dropped but hasn't gone up even though she ate. Curious to see if her AMPS tomorrow will be low again.

She seems to hit the onset a little late and NDAIR late and into her next shot

 

Sometimes a string of flat yellows can come just before a drop so keep an eye. I have a cat who nadirs whenever he likes too.

 

Thanks. I wasn't aware of that and will definitely keep an eye out. Hoping for a blue number this PMPS . My wife and I aren't home from 7 am to 5 pm so I got a timed feeder to make sure she isn't eating 2 hours before her AMPS and PMPS since she likes to graze.

 

It's not a rule just an observation that many people have made. I've seen it with my guy.

 

I gotcha. Any experienced info is welcome and appreciated. I keep adding to my mental diabetes encyclopedia.

 

Yup my boy has done that too . Those one colour cycles can mean something's a brewin'

 

Same exact PMPS as yesterday 207. Will give her .5 again and see what her +4 looks like tonight.

 

I like to say they're giving you lottery numbers when they do that

 

Now if only we could win the lottery from those numbers!!!

 

She might need a little boost to 0.75 u soon. Give 0.5 u another cycle or two though.

 

She was 247 this AMPS. Not sure what's going on. Seems like she was dropping lower on .25.

 

Yes, she was. She might be bouncing more on the higher dose. I'll retract what I said. Stay with 0.5 u for now.

 

Bouncing was my initial thought but she doesn't appear to be dropping much at all from +1 to +7 to make a bounce. Not trying to challenge you but bounce ideas around and make sure I am getting a correct grasp on all of this. lol She is eating 1 whole can of FF Classic Chicken now for breakfast and dinner instead of A/D which was higher carb.

 

Bouncing can also be reflected in flat cycles so I think you might want to hold 0.5U for a few more cycles

 

Wow...just when I think I have gotten my head around the different scenarios you throw another one in the mix. Lol

 

Weirdly consistent numbers the last two days. Almost identical for AMPS and PMPS.

She is eating the same amount of food every day and getting the same dose but those numbers are crazy!

 

Keep the 0.5 u for a couple more cycles to see what happens. Aim for a before bed test if you can't get one mid day. If nothing changes, she might be getting stuck in these numbers. A little increase can shift them if that's happening.

 

I will get another +4 or +5 tonight. I can't get anything later than that.

 

+5 was 246 last night's +5 was 236

 

She's running the same AMPS and PMPS numbers for a few days now. Think I should up her dose to .75 or wait until this weekend when I can run a curve with the .5 dose?

 

Six of one, half a dozen of the other ... You could increase to 0.75 u today and then run a curve on that dose this weekend.

 

Her pre shot tests have been so consistent and no drop I have started questioning if I am actually giving her the shot correctly. lol

 

Cats do everything they can to confound us! Any dose decision made?

 

I think I want to go to .75 so she can start getting a drop. I want to be patient but I don't want her to keep running high numbers and damage organs etc. She has been over 200-250 for a while now. I may wait until Friday or Saturday to start so I can be home and do a curve that day and make sure she doesn't drop too fast.

 

Good plan!

 

Sam was at 239 so I bumped her dose to .75 this morning since my wife will be home to monitor her all day. Hoping for some blues at NDAIR!

 

Let's see a blue around nadir, Sam!

 

We have a blue! She is at 153 for +7.5. I'm curious to see what her PMPS will be because she seems to drop late and into her next shot.

 

Cool blue!!!! Nice job, Sam!!

 

Sam is at 141 for her PMPS. I have given her a shot below this before but only .25. I am stalling right now and will retest in 20 minutes.

Should I give her .5 or something like that or skip? I would rather not skip. @Kris & Teasel @Yong @Rachel

 

Have you shot yet? I'm here, looking at your SS.

 

Looking at your SS, I see you gave a 0.5 on a 147 preshot before..and it kept her in safe numbers. Can you monitor tonight? Do you feel confident with steering IF she ended up going lower than you'd like? If the answer to these is yes, I'd shoot 0.5. But you MUST get some tests in to be sure that she doesn't go too low (not saying she will, but she MIGHT since she stayed flat).

You could go with 0.25 if that makes you nervous..still get some tests in to be sure all is well, though.

 

She just ate and I was thinking about giving .5 since it looked like she never really dropped on that dose but maybe even went higher after eating.

We were going to go see a movie in 2 hours and wont be back for 2-3 hours naturally.

I do feel confident on steering but we wouldn't be here. I will skip the movie if you think we should stay so we don't lose ground on her numbers. If she drokopped 50% with a dose of .75 she would still be ok but I am trying to avoid starting a bounce.

 

So could you get a out the door test in an hour or 2? If you could get a test to be sure she isn't dropping too much, I think you'd be okay. I don't want to tell you to skip the movie...we need lives too!

My only concern is how flat the numbers stayed today. Doesn't necessarily mean anything, though and she's eating sooo...2 options:
1. Give 0.5 and get a test before heading out the door. Be prepared to abort plan if she has dropped a lot...and then get a test when you come home.
2. Give a lower dose of 0.25...still get whatever tests you can.

I think if it was me....aw heck this is hard! I'd go with option 1 and get a test on the way out the door and on the way back in. She SHOULD be fine based on past data and I hate to see you lose ground. BUT you have to go with what makes you most comfortable.

 

Could also leave out some food so she can eat if she feels like she's dropping low.

 

Yea option 1 is what my wife and I thought would be best but I wanted some experienced opinions also. Thanks for chiming in. I will do option 1 and post here after we test

 

Sometimes, just getting someone who agrees with you is a big help! Looking forward to seeing what your numbers look like!

 

So true! lol.
Apologies Andrew, my new schedule will have me checking in on the forum 10:30/22:30 your times. Some of the others should still be available around your times though . Looks like you got to go to the movies though! What did you guys see?

 

No apologies necessary Yong. I saw you had a new job starting. Hope you like it and your new schedule.

We saw Dunkirk in IMAX. I'm a history nerd and I like the director Christopher Nolan so I had to see it before it left the theaters.

 

254 for her AMPS this morning. Hoping for another blue NADIR and similar AMPS and PMPS for a few days.

 

Just checking for clarity: did you give 0.5 u or 0.75 u on the blue PMPS last night before your movie outing?

 

I actually gave .75. I she usually didn't drop at all with .5

 

Back after a few days of craziness! Sam seems to have adjusted to the .75 dose. I got blues for AMPS and PMPS finally. Unfortunately she started wiggling around this morning and I think I got a fur shot!

Hope she doesn't shoot back up for her PMPS. Just were finally getting some blues!

 

Looking good! You'll get her back.

 

Getting more consistent blues for AMPS and PMPS daily. Hoping the slow trend downward in numbers continue. Would be nice to start getting some greens at NADIR.

 

If there are a couple of cycles you could monitor (get a few mid-cycle tests), you could try a little increase to start bringing in some greens.

 

I agree with Djamila.

 

Yea I'm normally not able to do so other than weekends and every other Friday. I will do a curve this weekend and get a good picture of the current dose and then maybe go to 1 unit after.

 

I have given Sam .5 unit with an AMPS of 147 and .75 unit at 152 before and she stayed in safe numbers. If I start Sam on 1 unit tomorrow and her PMPS would be 147 or lower would you suggest we start a sliding scale and give her .75 unit instead of a full unit or give her the 1 unit and see how she responds?

 

The best person to ask about a sliding scale is @JanetNJ.

 

Try 145 and above 1 unit 130-145 0.75

Provided you can monitor. If you can't go more conservative with 0.5

 

I think she'll be OK with the 1.0U and if it does prove to be too much, you could try a fat 0.75U. Also if the sliding scale doesn't bode well with her. There's always a chance it can result in a kitty having more trampoline time , ECID though.

 

I gave her 1 unit this morning. Her AMPS was a little higher than it has been the last few days. I will monitor her throughout the day. She doesn't seem to hit NADIR until late in her cycle. Somewhere between +7 --- +8. So I will definitely check then.

 

I have an AMPS of 131 and I'm currently stalling. Yesterday she was 131 and after a 20 minute stall she was 163 so I gave her the full 1 unit. I'm expecting the same today. Should I stick with the 1 unit if she doesn't go up any or give her .75? I can come home at lunch to check on her but that will be the only time she can be monitored today until it's time for her PMPS.

 

Checking your SS, brb. Are you getting another test in a minute?

 

I got 128 after the stall.

 

Ohhhh...I mean that's good, but she didn't rise at all. Can you stall any more? If not, I'd be tempted to skip. I hate to say that, but she isn't going up at all, and she's right at that 130 spot where I can't recommend a shot.

 

You could also try 0.25 if you want and leave some food out for her...what time in the cycle could you come home for lunch?

 

I gave her 1 unit and left some extra food for her. I will go home at lunch and check her which would be +6.5 or +7. That seems to be when she drops. It's a bit aggressive but I haven't had her hit a green number for NADIR yet and she only seems to drop 40-50 points. The more I look at her SS I should of maybe gone with .75.

I think she will be ok there. I'm always nervous and second guess when I have to change her dose but she hasn't given me a scare on the Prozinc yet.

 

Definitely get some mid cycle tests today - they're essential in knowing what the dose is doing. I know you badly want to see green but this is a process that can't be rushed.

 

I would really recommend that you get a curve as soon as you have a day when you can. You don't actually have enough data to know for sure how she drops right now. The last curve you had was on a 0.25 dose which was too low. She could be hitting lower numbers at a time when you aren't testing.

Also, looking at your note, her first test was 118. A non-diabetic cat is between 50-120, which means they don't need insulin in those ranges.

Based on the data you do have, and since you left food out for her, I think she'll be alright (though please do go home at lunch to check on her!), but if this happens again, I would recommend giving a reduced dose or skipping unless you'll be around to monitor more. Sam's numbers aren't so bad that you need to be overly aggressive in your dosing right now. She's below the renal threshold most of the time, and her numbers are coming down, which usually calls for a more conservative approach.

 

I will go home at lunch to get a test. I work half a day tomorrow so I can get mid cycle tests then and this weekend.

I was worried that what I said may have come off as I was really pushing for greens but I meant that she hasn't hit any yet so that is why I figured she would be ok with 1 unit. I'm not trying to rush it, I'm in it for the long haul.

 

The first test and second test were within 1 minute of each other because I wanted to make sure it wasn't a bad strip.

I appreciate all of the advice. I may not have many full curves but I have tested at +3 and +4 a decent amount and she doesn't seem to drop until after at +6 or +7. Not trying to argue, but just have an open conversation about why I chose the dosage and why you make your recommendation for the sake of learning more on my part. I just want to take the best care of her possible by learning as much as possible. Please don't take my comments as being argumentative. I know is hard to interpret meanings and attitudes via text sometimes. I like to know how and why as much as possible so I can be as self reliant as possible.

She seemed to not drop much or at all on the .75 sometimes so I decided to try 1 and see what happens at a low number. Almost waited till tomorrow to try 1 unit if she had a low preshot. I will update everyone at lunch. Thanks so much for all of the help to this point. If she has a PMPS of 130 or so and does ok today, would you recommend .75? I'm asking in advance because a lot of times I can't get an recommendation in time for her shot.

 

Hmmm...maybe I'm confused. I don't see +3 and +4 data, but you said you tested at those times a decent amount, and that the drops happened later. I'm also not seeing cycles that show the +3 and +6 in the same cycle to see the drop at this dose. Which cycles should I be looking at?

Most cats don't hit nadir until +5 to +7, so likely her nadir isn't until sometime in that range, but again ECID. Mama-sense and papa-sense are real things, so you are most likely exactly right, but since we are out here on the internet, we have to rely on the data we can see to draw conclusions.

Sam hasn't shown dramatic drops (at least not that we can see), but her numbers are wiggling down, which when you consider the overall pattern is an indication that caution in dosing is appropriate. Cats on their way down can surprise you in a way that cats on their way up don't. And when the insulin grabs hold of an already low number, it will sometimes just cause the kitty to surf in a good range, but sometimes it will cause a dive. Since we can't be there to help ensure a kitty's safety, we error on the side of caution. As I said before, based on the data I can see, I'm guessing she's fine today, even if the full dose isn't what most of us would advise for an un-monitored cycle. We often use the phrase, "you hold the syringe" around here. You are always welcome to make whatever decision you think is best, regardless of anything anyone here suggests.

 

Thanks for the extra info. I will update the thread when I go home in an hour.

 

Those blues are lovely though! Excited to see your curve on this dose

 

Sam was at 183 for +7. I'm sure she got a glucose dump because of the lower than normal numbers. Curious to see what her PMPS will be. I will post here again then.

 

We have a PMPS of 159. I assume 1 unit would be fine?

 

I'd say so. Can you grab a before bed test tonight?

 

Yes. I can get +4 maybe +5

 

Cool! She'll probably be fine since she doesn't drop much, but any data you can get to be sure she's staying safe, and to see what the dose does, is good!

 

Hmm.. 209 at +5. Hopefully she has an ok AMPS. May be bouncing around a little after the low number this morning.

 

Sam is at 144 this AMPS. Should I give 1 unit to try and keep the consistency and let her adjust or go with .75 to see if she will stay about level or small drop since she is almost at a normal range?

 

I went with .75 and will try to get a curve today and see where she goes with her BG.

 

Good call I think. It's surprising that she didn't have a much different PMPS yesterday after the NS in the morning. She appears to stay very flat and the curve today will be interesting to see.

 

210 at +3 I figured it will be higher than the AMPS because she has eaten and the insulin hasn't started yet but that is a good jump for LC FF.

 

That's not really too bad. I think that's within the variance (though I'm not a math person, so don't quote me on that!). I'm sure it will come down in a bit.

 

looks like she only went up from her AMPS until now. She will be getting tested in the next 30 minutes. If she is still around 200 I will give 1 unit for sure. If her AMPS tomorrow is 140 or less would you say go with 1 unit or do you think she had a bounce from the 140 and it wasn't necessarily too low of a dose?

 

Dosing based on bounce numbers isn't a good idea. Sam doesn't seem to be particularly bouncy, though. You have to judge a dose on both PS and nadir values. I tend to focus a bit more on nadir because too low is riskier than too high. She might have been OK with a 1 u on this AM's PS but it's hard to know for sure. I'm basing that on the flatness of her responses to date.

 

I will give 1 unit tonight and see what she gives for AMPS tomorrow. Do you suggest .75 again tomorrow if she is 145 or less to see if she was bouncing today?

 

Hard to decide because she doesn't have a very distinct nadir. If she was mine and I was able to monitor carefully, I'd be tempted to try 1 u on a PS similar to this AM's.

 

That's what I'm thinking. She hasn't seemed to drop very far on any dose so far. Once or twice a while back. I think that was on Vetsulin also and she wasn't eating normal amounts of food yet.

I do have some things I have to leave and take care of tomorrow but I should be home to check on her throughout the day. I will probably give 1 unit and monitor her. I feel pretty confident in steering her if she drops too low.

 

Sam manages to stump me again. I have no idea what is going on with those numbers

 

Most of those are within the 20% meter variance, so essentially a flat curve. You can increase to 1.25 u soon on a day when you can monitor.

 

I agree with what Kris said

 

Thanks. I will have to wait until Friday or Saturday to up the dose. I'm curious to see if her pre shot numbers start coming down again until then.

 

Sam has been bumped up to 1.5 and she is dropping a little earlier after the shot but still not dropping much and staying kind of flat. Hoping she will start dropping throughout the week. If not, I will go to 1.75 this weekend when I can monitor. Let me know if anyone is seeing anything different on her SS.

 

I think it's time to increase her dose. It's her pattern to stay quite flat but the whole curve can come down some.

 

Yea I'm thinking she will probably end up around 2 units. I was hoping she would be able to be a lower dose than that.

 

It's very possible. Maury has flirted near 3.0U a couple times and doesn't stay there long