? Happy 4th of July!!! Need some sage advice please...

Yesterday: http://www.felinediabetes.com/FDMB/...-65-us-4-5-59-us-5-61-us-7-67-us-9-76.197829/

Happy July 4th to everyone and their kitties!!!

@Wendy&Neko @tiffmaxee @Olive & Paula @Tracey&Jones @Bellasmom

Thank you all so much for your encouragement, it really means a lot! After the crazy day I had yesterday, it was so nice to see your comments.

You know I’m flying by the seat of my pants though right? I have no clue what to do now that Leo’s numbers are low.

When I look at all the reductions and NS’s lately, it makes me hopeful that his pancreas has been working along with the insulin.

How do I get him back to 2 safe shots per day?

What would you do if you were in my situation?

I’ve read in so many places not to do NS’s, but why is that? I don’t understand. Should I stop giving NS’s and give one unit maybe?

Sorry for all the questions, our lives are being majorly disrupted these days as we have a about 2 months to sell our house and buy another one 4.5 hours from here. My husband is opening a warehouse close to Montreal so I’m responsible for getting our current house up to snuff which means painters, window washers, carpet cleaning, packing, realtors, lawyers, bank etc…

Yikes! Reality hit yesterday when every time I turned around it was time to test Leo, how am I going to pull this off? LOL

 

How do I get him back to 2 safe shots per day?

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if a cat is lower then usually the best option is to wait until they are at a shootable number to shoot. What constitutes a shootable number will vary by cat, but we don't suggest or recommend shooting a preshot number less than 50. While you’re waiting, the depot is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

What would I do?
I would shoot any number any number above 50, as you are shooting the nadir not the preshot number, when you skip a shooting it is draining the depot, I’ve seen and also done a lower dose, but I’ve only skipped 1x and that was in the beginning
This is what I do, cause I work full time
I test at 4:45am, shoot at 5, do a +2 at 7am, if he is looking like a active cycle, I leave him some MC, hubby gets home by 2:30pm he tests, do pmps at 4:45pm, shoot at 5pm and will get a test before bed, depends on that number if I will set alarm to restest

 

He did earn a reduction yesterday to 2u

 

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

• When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
• If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
  • --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

 

Sonia,

Correct me if I'm wrong here, did Leo have DKA at some point? If so that is why skipping shots is not good. Not enough insulin, not eating and or infection can set off DKA very quickly.

Unfortunately I have not had to worry about shooting a low number with Olive. I have had to shoot her higher doses (over 5 u) when I knew I wouldn't be around to monitor, that is what I have a problem with. I think 1 time I gave 1/2 the dose. But I had enough data to know she would still be safe as long as her food was out. That's the key, having the data and knowing how your cat reacts. I'm lucky husband is home to keep an eye and can feed (he over feeds though) he doesn't test which is the problem. I have taken her with me when it was a real possibility of her going way to low.

You do have your hands full with the house. I had to empty out and sell my father's house which was 3 hrs away. And move my father near me. His house was so dated and in disrepair. I didn't even try to make it look good, cleaner yes. Anyone buying that house would gut it and remodel. It still had shag carpet from the 70's. The pink 70's bathroom. AC didn't work. Stained dirty carpet in the kitchen. Appliances 30 yrs old. Kitchen alone was from the 60's. Not open concept (but isn't my style anyway) though most people today want that. I only took care of what was required by law. Priced it low. We had 8 offers in 48 hrs of it hitting the market. There was a bidding war. It sold more than listed price. It was right before Xmas and I closed on it February 1st. The location was prime, lot was good size and square for that area, school system is one of the best for that county. I didn't have the time or energy to take care of it from a distance. With winter starting I didn't want an abandoned house where pipes could break, or house is burglarized because its empty. I wanted it gone. No matter what the price was my father would make a profit as he only paid $35 k for it. And it was a large house.

Good luck.

 

Generally, what I tell someone who is relatively new to managing their cat's FD is that any number over 50 (if following TR) is shootable. However, I would not suggest doing this until you have the confidence to shoot low numbers. In other words, you want to work yourself down the number scale by progressively shooting lower and lower numbers. It looks like you've sort of been doing this. Previously, you shot a 101 (6/29) and the only thing I would have done differently is gotten additional tests during the PM cycle. Likewise, you shot a 56 yesterday. Again, for the safety's sake and in order to know how your cat is responding, I would have gotten a +1 test. (I also had a cat who was known for her early dives into low numbers so I would test early and often so I wasn't surprised.)

The only other observation regarding Leo's spreadsheet that I would make is that you need to stick with a dose. There are a few recent instances where you're taken a dose reduction based on intuition and not based on the numbers. If there's a way for you to get a "before bed" test every night, that may help to see if numbers are dropping or if a reduction is warranted.

The problem with skipping shots relates to the way the depot works. Any change in dose (increase, decrease, or skip) has an effect on the depot. Dose changes generally have the least effect since the change is 0.25u. A skipped shot has the greatest effect. Any change means the depot has to catch up and thereby has an effect on numbers. It can take 3 days/6 cycle for the depot to level off. There's no "rule" for how numbers will respond other than to say they may be atypical due to the depot not being full or being overly full. The bottom line is that Lantus and Lev like consistency. A depot insulin works best if shot time is consistent (i.e., an early shot acts like a dose increase and a late shot acts like a dose reduction) and if the dose is consistent.

 

I see you got some great responses already so will just give you these

And Happy July 4th!

 

Hi the re

Much of our 21 month journey was spent flying by the seat of our pants.

Coming down the dosing ladder can be much more emotional than going up. It can be difficult to do gracefully, depending on how quickly insulin needs change. It can feel like trying to rein in wild horses.

Keep the following time honored maxim in mind:

Better a day too high than an hour too low.

This phase will not go on forever. Try not to let any wide open spaces (areas with no data) form on the ss and the numbers will be your best guide.

 

Hi. You have gotten lots of advice. Some of what we say is based on personal experience. Max was one who didn’t onset until +2 at the earliest so a -+1 told me nothing. The more you test the more you will learn about Leo. To me the fact they Leo has continued to do well despite skipped shots means although not following a protocol the skips were likely necessary. I think he was possibly started out too high a dose and at some point you will find a dose you can shoot every cycle or else he will fly down the dosing scale.

Happy 4th!

 

Hi Sonia
My Leo has a similar pattern. He tends to nadir at AMPS+10 to AMPS+12. Part of it is from his a.m. prednisolone. Part of it is just fluctuation.

If you review my Leo's spreadsheet, you will notice two things:
- I do not keep Leo at lower numbers like many on the forum do
- Leo gets a reduced dose every P.M.

Yes this produces some fluctuations itself. But my objective is to avoid hypos. One goal I have with Leoberry is to keep him under renal threshold as possible. I have learned a lot from this forum, and many helpful members. But TR and SLGS doesn't work very well for Leoberry.