? Finally! BG below 150 - dosing advice for tonight?

Discussion in 'Prozinc / PZI' started by shelaghc, Feb 14, 2018.

  1. shelaghc

    shelaghc Well-Known Member

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    So after days of high numbers for Jester's AM/PM PS and mid-cycles, I crept his dosage this morning to 1.75u and his +6 dropped to 113 after a +4 of about 200.

    Knowing that I use generic strips which register lower than OEM, this still means he's likely below 150 on a pet meter.

    So how seriously should I take his PMPS tonight when it comes to his dosage?

    The last time I reduced his dosage in response to a lower PMPS, his mid-cycle later showed I could have kept him at the higher dosage.

    I realize some of this is guesswork and trial and error. Any wisdom for me for tonight?

    Jester's PM shot will be around 8:00 or 8:30, if anyone can be available during that time frame.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Unless a PS is telling you BG is too low to give insulin more weight has to be given to mid cycle numbers. The 113 today is a nice number. If the PMPS is above 200 keep the same dose but be prepared to test at +2 to see what he's doing.
     
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  3. shelaghc

    shelaghc Well-Known Member

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    tyk

    And if the PMPS is below 200, any suggestions on how much I might want to reduce the dosage?
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Under 200 you wouldn't unless you have a lot of data. Then, you experiment with giving the same or a reduced dose on a slightly lower PS. It's a trial and error process that you undertake when you know you can monitor. There aren't any hard and fast rules and you rely on what your SS tells you about his responses.
     
  5. shelaghc

    shelaghc Well-Known Member

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    I really don't have much data on this high a dosage at all. I've rarely given Jester more than 1.5u since I started home testing in earnest.
    The last time was Christmas day and his BG dropped like a stone immediately, going down to double digits in his +6. Mind you, he popped back up to the 300s for the next morning. But that was likely because I chickened out and dropped his dosage to .5u Christmas night.

    Before that, you have to go back to November when the vet had Jester on 2u for over a month starting in October. His BG was high at that time, but he was dealing with a UTI too. I had only started home testing around then, and only a few times a week at mid-cycle - no AM/PMPS until mid-November.

    This month is the first he's been on anything over 1u regularly while I've been keeping track of his numbers more diligently.
    And I really can't do the kind of testing you all want because of the expense of the equipment.
    I'm nearly out of test strips and probably won't have the new batch until next week .
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You can only do what's possible for you. That means you should err on the side of being cautious so you (hopefully) don't get into an intensive monitoring situation. We all have to work within different sorts of constraints. :)
     
  7. Djamila

    Djamila Well-Known Member

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    You're getting enough tests to assess the dose, and keep Jester safe. You're doing fine. Kris has given you good advice on dosing for tonight. It's great to see that 113 for your mid-cycle test today! Hopefully there will be more of those in his future!
     
  8. shelaghc

    shelaghc Well-Known Member

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    Is there a word missing in this sentence?
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Oops! It should read, "Under 200 you wouldn't shoot ..."
     
  10. Djamila

    Djamila Well-Known Member

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    Under 200 you wouldn't shoot unless you have a lot of data. :)
     
  11. Djamila

    Djamila Well-Known Member

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    LOL...Hi Kris! and Shelaghc, sorry for the double post. :D
     
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  12. shelaghc

    shelaghc Well-Known Member

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    So if by some chance Jester is - say - 190 for his PMPS - even considering the generic strips usually registering about 10-20 points lower than OEM strips, I should give him a pass for the night?
     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    When it's that close you can try a slightly reduced dose, say 1.5 u. If that worries you, try 1.25 u.
     
  14. shelaghc

    shelaghc Well-Known Member

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    And I'm not being critical. I genuinely want to know and be safe.
     
  15. Djamila

    Djamila Well-Known Member

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    It's really a judgement call. I think you have enough data showing that he needs his insulin, that if he's close, I would probably shoot at least something, if not the whole dose. And as you said in your original post, you do have data showing that a couple of times when you reduced, you didn't need to. He could have handled a bigger dose. The problem is that there is risk involved and it will be up to you to monitor and steer and keep him safe. So it's hard for us from far away to tell you to shoot a low number when all of the risk and responsibility falls on you, not us.

    Stalling is usually the best way to go if it's an unusually low number. If you stall without feeding and re-test 30 minutes later, you can see if the AM dose is really wearing off and he's rising. If so, then you can be more confident that it's okay to shoot since Prozinc takes a couple of hours to start working. Of course while you are stalling, Jester will likely make you feel like you're the meanest human ever to make his dinner late, so you might need to go for a walk or take a shower during that 30 minutes so he doesn't pull your heart strings too much. ;):cat:

    A Prozinc dose only very rarely lasts more than 14 hours, and onset is usually around +2, so even if they are a little low at shot time, it's reasonable to think that the new dose won't kick in until the old dose is done. However, the problem comes when it does last longer than +14, or if you have a cat (like mine) with a very early onset. Then you can end up with too much overlap and as you've seen with Jester - a cycle where he drops like a rock.

    At this dose, given his recent cycles, it seems unlikely. My bet is he would be safe. However, this is a new dose for him, and even a drop or two can make a difference with insulin. Which is why the decision to shoot lower (if he had a lower PMPS) is really up to you. I hope that helps at least a little. If I just ended up confusing things, please ask for clarification, or just ignore me. ;):D
     
  16. shelaghc

    shelaghc Well-Known Member

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    That was exactly what I needed. Thanks so much.

    Particularly the shower suggestion. *g*
     
  17. shelaghc

    shelaghc Well-Known Member

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    Well crap.
    PMPS is over 400.......

    No wonder he's so sleepy right now.
     
  18. shelaghc

    shelaghc Well-Known Member

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    What the *bleep* could be causing this?!
     
  19. Djamila

    Djamila Well-Known Member

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    He's bouncing from the unusually low number. His body isn't used to hitting low blues, so his liver dumped a bunch of glucose into his system. It sucks, but it's normal. Dose as usual tonight (1.75u), give him some love, and try not to worry (easier said than done, I realize). And if applicable, pour yourself a glass of wine ;). He'll likely be high and flat for a few cycles after this. It can take awhile to clear all that extra sugar out of his system.
     
  20. shelaghc

    shelaghc Well-Known Member

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    Can't afford wine right now, unfortunately.
    The only bottles I have are a couple that were a 2016 Christmas present that I've been saving for a special occasion.
    And only one bottle of beer left. Saving that for the next time I might be able to afford a Friday pizza.
     
  21. shelaghc

    shelaghc Well-Known Member

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  22. shelaghc

    shelaghc Well-Known Member

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    I emailed today's numbers to the vet and these are his exact words:

     
  23. Djamila

    Djamila Well-Known Member

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    Maybe the vet has been drinking the wine ;)
     
  24. shelaghc

    shelaghc Well-Known Member

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    Then he needs to share....
     
  25. shelaghc

    shelaghc Well-Known Member

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    If I were to pick a time to check Jester again tonight, would +5 be good?

    Or should I not make him and me crazy. save a BG strip, and just chill for the night?
     
  26. Djamila

    Djamila Well-Known Member

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    I think +5 could be good. Or you could sleep. Every time I decide it doesn't matter and skip a test, come the next cycle I am kicking myself and really curious what happened. But as far as safety, he should be fine tonight.
     
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  27. shelaghc

    shelaghc Well-Known Member

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    I'll see how sleepy I am come midnight.
    +5 is about 1:30AM.
     
  28. shelaghc

    shelaghc Well-Known Member

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    1:3am - BG 273. Not great, but not horrible.
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He came down fairly well from that red PS all things considered. I'd stay at the 1.75 u dose for today.
     
  30. shelaghc

    shelaghc Well-Known Member

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    AMPS is 206!
    Figuring for the generic strips, that's more like 220ish.
    Should I stay at 1.75?

    @Kris & Teasel @Djamila
     
    Last edited: Feb 15, 2018
  31. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Here's where the rubber hits the road! The only way to know how he'll respond to getting a full dose at a PS like this is to try it. If you're at home today to keep an eye, try the full dose and test at +2 for sure to see where he's heading. Post here if that +2 test is 50+ points lower. It'll mean you should "steer" with little snacks. If you don't have enough strips to monitor, should that be necessary, then try a 1.5 u dose. Experiments like this are the way to get your kitty's BG under better control but they're stressful.
     
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  32. shelaghc

    shelaghc Well-Known Member

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    According to Amazon , I should be getting those new test strips tomorrow.
    I'm home most of the day. So I'll give it a try.

    Will you be around if I need to panic
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'll be here for the next 3+ hours. Will check in. You might not need it but do you have some higher carb gravy style wet food and/or honey, karo, etc. on hand? Not trying to alarm you ...
     
  34. shelaghc

    shelaghc Well-Known Member

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    Jester starts his day with as much low carb pate as I can get him to eat - usually around 1/4 to 3/8 of a 5 ounce can.

    After that he'll only eat medium carb Friskies shreds - around 14 - 15.

    I have honey in the place too.
     
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  35. shelaghc

    shelaghc Well-Known Member

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    Is it weird that Jester's BG went *up*?

    His +2 was 221.....
     
  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Not weird. Those two yellow numbers are essentially the same, allowing for meter variance.He hasn't dropped so that can mean you won't have an active cycle. I'd get a +4 just to have data. He might be going into a spell of flat yellow numbers. It's a common pattern after a low like yesterdays' blue. A drop will sometimes come after a yellow flat streak - for reasons unknown. It's a common observation so we pay attention to it.

    It's a good exercise to go back over your SS data to see if you can spot his patterns. That way you can learn to focus on overall trends instead of individual numbers - unless one is lower than usual, of course. The goal is to learn to "read" your cat so you can make safe dosing decisions when you can't get a response in time here.
     
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  37. shelaghc

    shelaghc Well-Known Member

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    Jester's snoozing in his favorite hard-to-reach kitty bed right now. I hate dragging him out of there for a test and it's next to impossible to test him in it (it's a very dark corner of the room).

    Do you think a +5 would be okay?

    It's possible he might come out on his own between the +4 and +5 too. I just don't want him to start associating his favorite place with something uncomfortable.
     
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  38. shelaghc

    shelaghc Well-Known Member

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  39. shelaghc

    shelaghc Well-Known Member

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    I missed this last night.
    Might need to use it tonight if Jester's BG stays good tonight.
     
  40. shelaghc

    shelaghc Well-Known Member

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    +6 is 157.

    Although he's not as hungry as I would have expected at this point. He's been nibbling after each test and not much more.
     
  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He's doing really well today! You got up the courage to shoot on a lower than usual PS and it paid off. :)
     
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  42. Djamila

    Djamila Well-Known Member

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    What a great cycle today! Go Jester!
     
  43. shelaghc

    shelaghc Well-Known Member

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    PMPS 290 - so I gave him yet another 1.75u.

    I'll check him at either +4 or +5 depending upon how sleepy I am again.
     
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  44. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Very nice cycle today! :smuggrin:
     
  45. shelaghc

    shelaghc Well-Known Member

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    I deliberately stayed awake until after 1AM so I could get a +5. Little brat found a hiding place and it took ten minutes to find him! Frankly I was about to give up and just bag it for the night when I finally found him on a dining room chair pushed under the table.

    Last BG of the day was 231 and he'd only eaten about half an hour before.

    Tomorrow I only have OEM strips - a batch I saved for emergencies and to use as controls when I doubt the generic strips - which tend to give a slightly lower reading than the OEM strips.
    My delivery of generics is due sometime tomorrow , but I think it'll be less confusing if I just use the OEMs all day.

    Does that sound logical or am I over-complicating things?
     
  46. Rachel

    Rachel Well-Known Member

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    Sounds logical to me!
     
  47. shelaghc

    shelaghc Well-Known Member

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    Bumped back up to 320 this morning - even considering it was with the OEM strips, that would still be in the upper 200s for the generics.

    :(
     
  48. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Just a bounce. Stay the course. :)
     
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  49. shelaghc

    shelaghc Well-Known Member

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    Oh, I am.
    But I don't think I'll need to test quite as much today. Plus I have an appointment around 11:30 today and need to leave at 11:00. Likely, I'll just do a mid-cycle at +5 (around 2:00PM). That seems to be a good middle of the cycle point.

    I wish I could afford to buy the OEM strips regularly though. Unfortunately, they're about $1 apiece. The generic are way more affordable, but I have to mentally adjust the reading up to what it might be on the OEM strips and then again to the pet-calibrated meters.

    My life is governed by adjusting numbers......
     
  50. Kris & Teasel

    Kris & Teasel Well-Known Member

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    One mid cycle test is fine.
     
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  51. Djamila

    Djamila Well-Known Member

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    It's really not necessary to try to guess what the numbers might be on the different strips. Basically all we need to know is too high, too low, and the amount of change between pre-shot and mid-cycle. So whether it's up or down by some random amount really doesn't make any difference. The only time it might matter is around 50. If you get below that, you could grab the OEM strips to get a more accurate read. But whether a number is 290 or 320 really doesn't make any difference in how we decide on a dose. Either way it's too high. And if the difference between pre-shot and nadir is 120 points or 90 points really isn't that significant either. So I would say to just stick with the generic strips (once they arrive) unless there is a low number, and not drive yourself crazy thinking about what it might be on a different strip or different meter. There is enough to worry about with managing all of this without adding to the stress :)
     
  52. Rachel

    Rachel Well-Known Member

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    I'm with Djamila. It's hard enough to handle this without all the adjusting numbers. To an extent, what we're looking for is patterns so the numbers don't matter as much unless they're too low. Other than that they're so similar it really doesn't matter which strips you use as much.
     
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  53. shelaghc

    shelaghc Well-Known Member

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    +5 is 197 - right after eating.

    I'm a little disappointed about that, tbh.
     
  54. shelaghc

    shelaghc Well-Known Member

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    Even more disappointing - PMPS was 339.

    We're back to high numbers again.

    What could be causing this?
    I raise the dosage, his BG goes down and within a day or so it starts going back up again.
     
  55. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He's sensitive to the lower mid cycle numbers so he bounces back up for pre shot. It's a fairly common pattern with bouncy cats and its their unique physiology that makes them bouncy. Not much you can do about it. Some calm down eventually and some don't. Mine is one of the latter and I've learned to live with it.

    The mid cycle numbers are still blues so that means you can try an increase to 2 u whenever you feel ready.
     
  56. shelaghc

    shelaghc Well-Known Member

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    I just started a new thread about a possibility that a vet and I were discussing back in December - that Jester's insulin might not be effective enough.

    He just wasn't this dramatically bouncy before the new vial we started on 12-20.
     
  57. shelaghc

    shelaghc Well-Known Member

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    Today's AMPS is about the same as yesterday - 285. I just wish it would go down to the mid to lower 200s and stay for a while.....
     
  58. Djamila

    Djamila Well-Known Member

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    Well, yellow is better than pink, but looking at your mid-cycles, I would suggest moving up to 2u whenever you're ready. I know it sucks to do increases, but sometimes they start getting a little insulin resistance and the increases can break through and bring them back down again. At least that's always the hope.
     
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  59. shelaghc

    shelaghc Well-Known Member

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    166 for mid-cycle. I was out for a few hours so it's fasting.
     
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  60. shelaghc

    shelaghc Well-Known Member

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    It's going to get harder to do increases in about two weeks unless it's on a weekend.
    I'm starting a job the first Monday of March and won't be able to monitor during the week.

    And the vet doesn't believe in giving doses higher than 2u - he prefers increasing the number of dosing instead to every eight hours. There's literally no way I can do that if I have an eight hour a day job.
     
  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    All I can say is that this is nonsense. Many, many cats are on doses above 2 u. Dosing every 8 hours is very hard on the owner.
     
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  62. Djamila

    Djamila Well-Known Member

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    Umm....yes, that's just bad advice. I wonder how many of his clients can manage that?
     
  63. Rachel

    Rachel Well-Known Member

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    That's just silly. You need and deserve a life...and dosing every 8 hours isn't likely to work with that. You'd never get any rest! I'd say increase instead of going to every 8 hours personally.
     
  64. shelaghc

    shelaghc Well-Known Member

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    I'm still crossing my fingers that Jester's BG will come down before I need to do some totally contrary to what the vet says.
    He's on 1.75u now and the numbers aren't horrible.
    Since the vet is mostly seeing both Jester and Bastian for free (and they work with me when there *are* costs), I'd rather he not know if I'm not actually listening to him.
     
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  65. Teenuh

    Teenuh Member

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    Apparently he thinks his clients don't deserve a life, or have responsibilities.
     
  66. shelaghc

    shelaghc Well-Known Member

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    I'm wondering if he's just suggesting that as a very short term thing to get Jester's BG lower and more under control. I've brought up how difficult (or impossible) such a schedule can be and he just says to either go for 2u every 12 hours or something like 1.25u every 8 hours.

    All these conversations are via email though. It's hard to get hold of him because he's semi-retired and only works a few hours each week. And that can make a meaningful conversation difficult.
     
  67. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Why not follow the advice of people here on the forum and carefully increase his dose while sticking to every 12 hours dosing? Almost every one of us here had to go against vet advice in order to get our kitty’s BG under better control. Better numbers on your SS can be the evidence later on if you feel you have to justify what you did.
     
  68. Djamila

    Djamila Well-Known Member

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    And if you're emailing with the vet, you don't have to tell him - at least for awhile. See how it goes and how Jester progresses and then if you need to later you can talk with the vet about it.
     
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  69. shelaghc

    shelaghc Well-Known Member

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    Well, I do send him a simplified version of the ss in pdf format including Jester's dosage.

    Speaking of which, I just reluctantly increased him to 2u today. His AMPS was 299.

    :(

    Part of me wonders if I should try 3 shots a day for just a couple of days while I'm still unemployed and readily available. Obviously I wouldn't be able to sustain that for long - or I'd have to adjust after a while to no less than eight hours between.

    It's a thought anyway....
     
  70. Djamila

    Djamila Well-Known Member

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    It is possible if you want to give it a try for a couple of weeks. What 8 hour intervals will work for you - make sure you can do those times every day between now and then. I'd recommend starting tomorrow since you only have until the beginning of March, and it takes a few days for their bodies to adjust to the change in hormone flow, and also it will take some experimenting to find what dose works best for him at those intervals.

    Make sure you have a large supply of testing strips and lancets. You will need to do frequent testing during this experiment, and you can only shoot when you know he's rising since 8 hours is before the typical duration of prozinc - which means you'll need to find his new nadir, and also be testing enough to be sure he's on a rise before the next shot. I would say a plan on at least two mid-cycle tests each cycle. That includes the middle of the night cycle. That can be decreased over time, but since we're only talking about two weeks, it's unlikely that you'll be able to do less than that.

    Here are the directions from the sticky:
    DOSING EVERY EIGHT HOURS

    If your cat is consistently having an early nadir and the level is consistently rising 6-8 hours after the shot, the insulin may not be lasting long enough. You might consider shooting more often than every 12 hours. BUT PLEASE BE AWARE: This method is very hard on the caregiver because you need to be available to monitor more often and to shoot every 8 hours. If you can’t make that kind of commitment, don’t try shooting every 8 hours. But if you do decide that your cat’s situation warrants trying this, here’s how it’s done:
    • First, divide the total amount of insulin you are already giving over 24 hours by 3.
    • Then divide your 24 hour schedule into (3) eight hour sections.
    • The first time you attempt this it’s wise to do start during a curve, checking the BG levels every 2 hours.
    • If, by +8, the levels are rising, no longer falling, and to a level above your No-Shot range, you could give another shot.
    • Then wait 8 hours, test to be sure the level is rising, not falling, and is above your No-Shot range and give another shot.
    Often this method is not long term, but allows the levels to stabilize in a few weeks. Make sure you only try this method with the guidance of this forum’s members and your vet.

    I'm leaving on a trip for work tonight, so will likely not be online a ton over the next few days (although I might if it turns out the conference is boring ;)), but if you're going to do this, I would suggest getting started asap since you have a limited window before you start your new job. (congrats on that, by the way!!!)
     
  71. shelaghc

    shelaghc Well-Known Member

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    Crap - I just increased to 2u and planned to see if that made a difference in the next few days.
     
  72. Djamila

    Djamila Well-Known Member

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    Well honestly, if it was me, I wouldn't do the 3 times/day thing. But if you want to do it, we can help you give it a go.

    Personally, I think 2u twice/day is the better route. :)
     
  73. shelaghc

    shelaghc Well-Known Member

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    It just seems like I increase marginally, his BG goes down for a day or so, then starts going back up again as if his body gets used to the mini-increase.

    I just took his +2 and he's barely gone down at all.

    I feel like I need to do something drastic - like a larger increase to sort of shake things up instead or this 3x a day thing.
     
  74. Djamila

    Djamila Well-Known Member

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    You can do increases every 3-6 cycles, so you could move up more quickly if you'd like. Many folks like to do increases on the 4th cycle so that they are always increasing in the morning.
     
  75. Djamila

    Djamila Well-Known Member

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    You're really not that far off right now. A good cycle is about a 50% drop from the pre-shot number. More than that and you can end up with bouncing. Also, for many cats a +2 test is recommended, but I tend to prefer a +3 so there is time for the food bump to clear and the insulin to begin its work. A +2 is great if you're leaving, because you can see if there is something dramatic going on, but if you're going to be home anyway, I like waiting a little longer.

    It also really depends on the cat and how long it takes your specific kitty to start to respond to the injection. The +2 is a good barometer of upcoming storms, but the +3 is sometimes a more interesting number. It's really just up to you which serves your purpose better, which matters most for your kitty, and whcih fits your schedule and plan for the day.
     
  76. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    Funny thing - I was just thinking this morning that I'd rather +3 and +5. But +2 and +4 seemed to be the standard.

    Do you think a +5 would be okay now?
     
    Last edited: Feb 18, 2018
  77. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Why not??? All data is good data.
     
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  78. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    +2 and 4 are pretty standard, but every cat is different, and every bean is different, so it's okay to shift those and see if it will give you more helpful info.
     
  79. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    134 at +5 fasting.
    This is now pretty standard.
    I increase the dosage by .25u; his BG goes down to yellow / blue numbers for the cycle. And I fully expect in two days to be getting pink numbers again.....

    :(

    I was so excited about Bastian's good news and hoped things would start looking better for Jester too.
     
  80. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    Instead, it just seems to keep getting worse.
    I just took a +4 on Jester. PMPS was 283; +4 is 328.

    This is nuts.
     
  81. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Give 2 units a chance...you can always increase if it doesn't work. And if you decide you want to try 3x a day, let us know and we can help you figure it out.
     
  82. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    311 this morning.
    218 at +3
    Nothing new. This happens every time - in fact, generally he used to down to blue numbers.
     
  83. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    +5 was 143
    PMPS was 302

    Neither were out of the ordinary for what's been happening on a new higher dosage.

    Planning to do a +3 to see what's up before bed tonight.
     
    Kris & Teasel likes this.
  84. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    This makes no sense to me.
    I just did a +3 and Jester hasn't eaten for about two hours.
    The reading was 332!

    How can his BG be *highet* than his PMPS?!
     
  85. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    He’s bouncing. The precise pattern of a bounce can vary from one bounce to another. His BG profile today was a classic smile shaped curve with nadir about 50% of the PS values. Yes, ideally the whole curve can come down but it isn’t bad. You’ll drive yourself nuts trying to figure out every number. Focus on trends.
     
  86. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    I guess I just don't see what you're seeing.

    All I can see is that no matter what dosage I give him, his numbers are staying nearly the same.
     
  87. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Actually your doses have all fallen within a narrow range from (mostly) 1 to 2 u. If you'd been going from, say, 1 u to 6 u and seeing very little change that would be a very different situation.
     
  88. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    The vet wanted me to go up by a half a unit. Everyone here told me to go up by .25 units.

    Are you saying I should have done the half unit instead? Should I go up to 2.5 next then?
     
  89. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    No, I didn't say that. I was just pointing out that the range of doses you've been trying and assessing has actually been very narrow. We recommend dose changes of only 0.25 u because a small amount of insulin can make a big difference in a cat. It's your call: if you want to increase tomorrow, try 2.25 u. You can also stay at 2 u a bit longer. If a cat is bouncy and volatile in his responses you won't often see a smooth progression up a dose ladder that gives you an ever better BG range. They respond in fits and starts, stay stuck for a while, leap ahead in response and throw a green, etc. That's the way it works for them.

    If you want to try for flatter and lower numbers you might have to move to a depot insulin like Lantus and, even then, there's no guarantee that everything will become simpler. I can certainly attest to that with my cat.
     
  90. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    Cautiously optimistic - +6 was 99.
    I could tell by the way he's been behaving this afternoon that something was different. Way more cuddly and hanging out in the livingroom more than he has been.

    I'm hoping this is the break Jester and I have been waiting for.

    @Kris & Teasel @Djamila is this anything to be concerned about right now?
    I have a doctor's appointment and have to leave in less than an hour. Won't be back until 6:30ish ET.
     
    Last edited: Feb 20, 2018
  91. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    He should be OK.
     
  92. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Exciting!!!
     
  93. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    PMPS coming in about ten to fifteen minutes.
    Crossing my fingers.....
     
  94. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    PMPS - 268

    Now the fun. He only wants to eat carby foods......
    Because he was over 200, I still gave him 2U and I'll check him at +3 - hopefully fasting since that's what he'll be doing overnight. But he left the eating area already having eaten just a smidgen of lower carb pate.

    I'll try to tempt him in a few minutes.
     
  95. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    @Kris & Teasel or @Djamila - Just did a +3 on Jester.

    PMPS was 268
    +3 was 246

    But he hasn't eaten much since I gave him his 2U of insulin.

    Do you think it's okay for me to go to bed on the strength of the previous numbers? Or should I hang around until 2:00AM for a +5?
     
  96. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Sorry we weren’t here! Looks like you skipped the +5? That’s what I would have done too...
     
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  97. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Just seeing this now. I'd have skipped the +5 too.
     
  98. shelaghc

    shelaghc Well-Known Member

    Joined:
    Jun 28, 2017
    I did - although I didn't wind up getting to sleep until after 2:00am anyway.

    And the good news is:

    AMPS - 193!

    So do I stay at 2u this morning? Or do I reduce?

    @Kris & Teasel @Rachel @Djamila
     
    Last edited: Feb 21, 2018
  99. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    That's a call you have to make. He's close enough to the 200 no shot number that you could reduce a little back to 1.75 u or you can try the experiment of giving 2 u to see how it plays out. Get that predictive +2 test of course and monitor more if it shows a significant drop. This "envelope pushing" is how we figure out how much we can lower the no shot number. Most of the time it can be lower than 200 after you have enough data.
     
    shelaghc likes this.
  100. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I’d be awfully tempted to stay at 2 if you can monitor. Now that you’ve got this momentum going I’d want to keep it up. It’s totally up to you but that’s what I would do if he was mine. :)
     
    shelaghc likes this.

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