I just updated my SS. Preshots are at 6. 6 am and then pm. Tuffy was 425 this am. Gave him 2.25. I just checked and he's 124. I was going to wait till 6:30, and check him again. If it goes up, depending how much, I was going to poke him. If it goes down I'm not sure I should. Tomorrow I will get some preday shots. What should I do? If he says about the same should I poke him? I can stall till 7 pm without interrupting my schedule, correct?
Okay, so I went back to rethink and evaluate my situation. I'm thinking I should give him a little insulin, but not a lot. A " token dose" if I remember correctly. Now, would an amount like this be like 1 unit, or even less?
I'm sorry I saw this too late. you did great though. I see you gave 1.5 u and I think it'll be OK. Because you had to lower the dose both last night and tonight I'll suggest trying 2 u tomorrow AM to see if that works better.
I'm finding it hard not to overwhelm myself, however once I get myself to CALM down and THINK, I feel better and a little stupid for getting nervous. I will do 2 units in the morning. Let me try and understand this better. So, the idea is not to have to skip insulin, but to give enough to keep him within normal range for longer without giving him so much insulin that I have to keep stalling. I want him in the good number zones. I want his BG numbers under 200, preferably 60-120? The fact that the duration of insulin is lasting longer (seems like) is possible result of his body needing less? Why does it seem that now I'm giving him too much insulin? I'm learning, but slowly. I just need to breath.
It is complicated. -You don't want to skip insulin if you can help it. -Sometimes you have to skip. Both of those are true. You can actually see in your spreadsheet right now a perfect example of why skipping is not ideal. When you skip or reduce on the evening dose, there isn't enough insulin to last through the night, and you end up with those super high AMPS numbers. Then on those super high AMPS numbers, you give insulin (which is now too much insulin), so by PMPS, the number is too low. So then you have to reduce....which results in a higher AMPS again. And the cycle continues. So the goal right now is to find a dose that allows you to give the full amount at both AM and PM. Kris suggestion of trying 2u seems like a good guess to me. There is a lot of trial and error in all of this, especially when a kitty is getting "fussy" about the insulin dose. Your decision to try 1.5u was a good one. If you can get a test later in the cycle, that will be helpful so we can see if it's enough to bring the BG down, or if he keeps going up (which will tell you that he could have handled a little more). Trying things, collecting data, and then moving forward are exactly the right thing to do. So while this is all rather complicated sometimes, you're doing a really good job!
So its better that his numbers are in the blues, but I just need a smaller dose so I'm not skipping the dose and making his numbers high again. However, I still want his BG to go down to hopefully a normal range cat.
So this morning Tuffy was at 306. Would I be correct to say I probably could have given him more than 1.5 last night. Next time if I need to give him a partial dose I could try 1.75? Last night I tried to get another number before bed, and I planned on waking up to do so, but that didn't work out.
The best answer is ... maybe. These situations are tricky and you have to address each individually. What you do can be influenced by what came before and what you've learned from your SS data, Here are some examples of the thinking and analysis you'd go through: Was he showing a longer trend of dropping BGs? Have you encountered previous low PS situations and have a lot of data showing the results of your dosing decisions? Are you going to be around to monitor after the shot? Does your kitty tend to response fairly predictably to insulin or is he a bouncy kitty with volatile and erratic responses? As @Djamila has said, dosing ProZinc is part art and part science. That's so true. Over time you'll learn what works best for Tuffy and that builds confidence. Continue with 2 u for today and we'll see how he does with that.
Thank you. I have noticed that he's more energetic (particularly this morning), his fur is less greasy, and he's not always hungry. I could benefit from. Studying his SS more. I learn so much here. How long should I be staying on a particular dose? I know I asked before and I believe it's 3 or 4 cycles, but I if I stay on a particular dose too long will he be more resistant to it?
You want to move doses after 3-4...or sometimes up to 6 cycles, if the dose isn't giving the results you want. However, sometimes a dose will work quite well for longer than that. If it ain't broke.... So sometimes you can stay at a dose longer, other times you need to keep tinkering. As far as your posts #6 and #7, yes to pretty much all of that. With the exception of your question about last night's dose - in that case Kris' "maybe" response is a good one. I might even go as far as "probably". It doesn't look like he was headed too low, so my hunch is that you could have given more and been just fine. It is nice to see that 306 this morning though! If you squint a little it's almost a yellow .
I'm a little confused after looking over his SS . I would think that the lower, blue numbers would have been his best week, but they aren't because I wasn't good at adjusting his dose and it resulted in some jumps. Am I looking for a week more like the 21st because it's more even? Do I actually want him to be in the yellows for preshots?
You can't control all the ups and downs unfortunately. I would judge a cycle to be a good one if the drop from PS to nadir is around 50% and the nadir is dark green or very low blues. I would judge a week to be a good one if most of the seven days had cycles like this. That would be good BG regulation. The problem is it can take a long time to get there and some cats are much less likely to have that degree of stability. If you look at a lot of different spreadsheets of kitties that have been in treatment a long time you'll see some that are a sea of blue and green. Then there are others like mine that are more like a rainbow. For Teasel, he's doing well. He'll never have a sea of blue and green on his SS. I'm OK with that after three years, three different insulins and two episodes of DKA. He's an extremely complicated kitty.
So as far as my dosing goes, I should leave it at 2u and see how that works out. Then adjust as needed?
Sort of. You'll leave it at 2u for two or three days to get him to even out again. Last week was a little wonky, so you want to aim for two fairly even cycles right now. As soon as that happens, you'll need to start moving the dose again because his numbers aren't really ideal yet. This is a dance. A little bit forward, a little bit back. If you look at my spreadsheet over the years, you'll see that the dose goes up and then goes back down, then up, then down, over and over. and you can see that even right now with things relatively stable, I'm still fine tuning the dose from cycle to cycle. As far as what numbers you ultimately want to see on your spreadsheet - it's really up to Tuffy to show you what he needs. I can keep Sam in lower numbers than Kris can keep Teasel because Sam stays pretty stead with his numbers. Teasel will suddenly make really dramatic dives. So to keep him safe, Kris has to keep his "normal" numbers a little higher. That's where the ECID thing comes in. Time and data have helped us figure out where the best range is for our cats. It doesn't mean one of us is any better at this - it's just the physiology of the cats we live with. So eventually Tuffy will settle into his good range. When you cant' get him any lower or steadier, you'll know you're there. And then of course he'll change it up on you....because cats
I feel better now. I was a little defeated when I had the blues, but then it didn't last. Thank you so much for helping me understand.
Look at those nice yellows today! And it looks like a good cycle tonight too. He seems to like the 2u dose today . Unless he suddenly goes even lower, I think I'd stick with it for tomorrow too.
Djamila, where Tuffy seems to run higher in the morning does that mean that the insulin doesn't "last as long"? I am not sure if it's so much "lasting" as the correct term, but for lack of better words. Also, should I still just sit on 2u, or do you think tomorrow I should up it to 2.25u?
This can be what's called "dawn phenomenon" where body hormone cycles cause an increase in BG in the AM. I think you can try 2.25 u now.
