Drew Up 4 U But Now Hesitating. - Still Active -

This is so unusual territory for G. We reduced the dose to 4 U last night and this morning I am now facing an AMPS of 229. I am hesitant to give 4U not knowing which way she will go. As the spreadsheet indicates she spiked more than likely due to no insulin for 24 hours, but she is definitely responding now.

Any suggestions? Another modest reduction - or stall -

Thanks in Advance -

UPDATE: End of First Stall - BG Holding at 221

Any Suggestions?

 

Just a second...checking spreadsheet...

 

How is your day looking? Will you be able to keep an eye on her? You gave 4u on a yellow PS the other evening and she was okay. If you can be home, I think I'd suggest giving the 4u and watching her - you know how to feed her if she starts to drop too fast.

However, if you need to leave today, just aren't up for it, or have a funny feeling about it, you could reduce a little more.

 

With the antibiotics and other meds apparently really kicking in and healing her from all outward appearances -

Her response to insulin is dramatic at this point. I know this is still in the range but she is now showing BG of 205 - I am approaching the end of the 2nd stall (about 10 more minutes) If she drops below 200 - Would a reduction to say 3.75 be appropriate? Otherwise, I'll continue to 4 U and make arrangements to be around her all day.

Thanks so much for being here. I want to keep her in the good numbers and it appears she is not staying high like she was in the past. The correct antibiotics are also having a dramatic effect and her outward appearance is improving.

 

I'm so so so glad to hear that she's feeling (and looking) better. And thank you for the reminder about that change. Yes, in light of that I think the 3.75 could be a good idea. Although still with an eye on her since we aren't really sure what she will do at this point. If she continues to drop at your next test you might even consider 3.5u. Right now all of the numbers you've seen are in the same range, but I might be a bit more cautious if she is trending downward.

 

Just ended the 2nd stall - Initial reading was 171 - retested with a 202. I think the 3.75 or as you suggested even 3.50 might be the way to go with me still monitoring her today.

 

While trying to squeeze out down to 3.75 went a bit too far - gave a 3.50F this morning with an AMPS of 202.

Bless you @Djamila - I know I speak for many others when I say you are much appreciated.

 

That happened to me once and I decided it was the universe picking the dose .

 

I missed the action but I agree with the lower dose. She's making great progress!

 

You know - Those were my exact thoughts when it happened...

 

Ah - However, you have been a huge part of her journey...

 

@Djamila and/or @Kris & Teasel - Not sure if either of you are still around - Just giving you an update here - Bit of a rough go at +4 but made it through I believe. Still a few hours to go but she is on the rise following high carb treats given at the low number.

I guess my next question is what reduction to give tonight (7 hours from now). Looks like I need to bring it down even more to possibly 3 U. This vial is definitely having an impact. And G has never gone by the rules...

 

Wow G! Well you'll probably see a higher number tonight...combo of bouncing and the high carb treats (which you had to give so don't feel bad about that!) could make the number higher (I know you know this, but I like to repeat it so you won't worry ). I think I would lower it to probably 3 and see what that does for you. It might not be enough and if the number is high at PMPS, you might be in for a bounce cycle no matter what you do, but you can always go back up if needed.

 

Normally I would have given regular food however with the number so low early on and I was unable to check at +3 and did not know how long she had been in that state, I felt the need for a bigger hammer to stop the drop since it seemed like a continuation of the AMPS. Based on her history I was expecting a high number at PMPS (2 hours from now).

I was looking at 3U as well but she has thrown so many things at me I was unsure which direction to go.

For future reference how long would the high carb treat stay a factor?

Thank you so much @Rachel. You are another great mentor G and I owe our health and sanity to.

 

Oh G! Looks like a good thing that dose ended up a little skinny from what you were intending!

How long the high carbs impact them really depends on the cat (as does nearly everything around here). Some cats are free of their influence almost immediately, other cats can be wonky for a couple of days afterwards. My hunch with Goma is that the low will impact her more than the treats did. Her PMPS is red, but not any higher than "normal" for her.

It does look like the music has changed in G's dance recently. It's going to take a bit of guess work for awhile now. You're doing great!

 

Well, we felt the dose was decided by the universe. Here we are at PMPS +3 and another 200 point drop to 285 from 482. Looks like I'll be up another night. This is on 3U.

 

I suggest you drop her to 2 - 2.5 u at next dose. If it proves to be too low a dose you can go up carefully.

 

Thank you again. It really is great having experienced eyes giving me much needed help. I’ll reduce as you suggested.

 

This is the hard part...backing down on the dose is hard to know how much! I like what Kris suggested.

 

This is hard - I am now at AMPS and she is showing bg of 210 (entered in +11)- Not sure what I should be giving at this time. I am beginning stall # 1 - I'd like to see if she will begin rising or going back down again as what happened yesterday. I am leaning towards 2U however...I am so out of my comfort zone with this...

End of 1st Stall - BG holding at 219 so I am going to go with 2U this morning. Entering AMPS of 219.

Thanks everyone - As always the support is superb and gratefully accepted.

 

That felt very strange giving such a small amount - Been 2 months and that was a precautionary measure back on 4/4

 

I think 2 units was perfect.

 

Yes, 2 u should give you some breathing room.

 

Never thought I would be saying this, but I hope this past 2 cycles are a bounce from the lower numbers. I am hoping I haven't reduced too much (as they say hindsight is 20/20). I am prepared to up the dose to 2.25 this evening should the days numbers prove identical or near so as the past 19 hours. And continue increasing after a few cycles until I can get her back down again. I don't want her to settle into those high numbers again.

 

I agree. If you don't see better numbers today, I'd increase the dose this evening.

Unfortunately, hindsight is all we have around here.

 

2.25 tonight after 3 disappointing cycles for G. If I could take her place, I'd gladly do so. She is doing well otherwise with her appetite back and continuing to heal from whatever creeping crud she had. Follow up appointment on Monday. Have another feral I'm bringing along to the new vet with what appears the same skin condition.[/QUOTE]

 

These “transitional” dosing periods are stressful and challenging - lots of guesswork. You’re doing great!

 

I'm going to make another plug for talking to the new vet about Lantus or Levemir. My hunch is they might work a little better for G.

 

I had already spoken with him about a change and he advised that until this infection is controlled it would not matter what insulin I gave. I wanted Levemir due to her skin condition and the “sting” associated with Lantus but he still feels we should not make any changes at present. He is not ruling it out but wants to get this fungus/infection situation controlled. I agree that a change is in order but, while she is improving, there’s a long way to go. And my understanding is that any infection will impact the effectiveness of insulin. I’ll bring it up again on Monday.

 

Yes, I do agree that once she is healed you'll be able to see better if a new insulin helps. And I realize you've just started a new vial, so my thinking was to start the conversation and make the change when you're ready (and of course when G is ready). I'm glad you've already started the conversation and it sound like your new vet is a tremendous improvement over the previous one.

You mentioned you have a feral that may have the same condition. I wonder if it's contagious? Sending healing vines for G, the new feral, and all of your clowder!

 

Not sure that it is contagious with all the others showing nothing. It appears the same but could be a multitude of things, recently read for example that a food allergy may not show up for a long time. Hopefully the vet can identify it.

Also, not sure what rules/protocol I have now broken, but after 2 cycles at 2.25 I increased the dose up to 2.50. Numbers progressively getting worse and nothing else has changed other than dosage. I seem to be making rather poor decisions lately, and this may prove to be another one. But I don't see that her numbers will miraculously drop by leaving her for the 3rd cycle. Will monitor tonight and hope that I see some positive movement again.

 

The three cycles is for cats that show some volatility in their responses, take a few cycles to respond, or when moving to a new and unknown dose. You've been in this territory before with G, so you're really just catching back up to where her dose was a few days ago -- it's okay to move a little faster. Two cycles is good because you aren't just jumping her back up in one giant leap, but you aren't dawdling either. It's a nice balance. I think it was a good decision.