Kitty, pmps 16.3, +3 15.7, +6 14.8, amps 5.8 - adjust the dose?

As I've written before, I've had a hard time regulating the dose of insulin after Kitty got ill. We have been on 1.25 a few days. Now she has a surprisingly low bg, and it's shot time. Is it time to reduce? She has not gone below 50 and haven't "earned" a reduction that way, but considering how much she has dropped this cycle, I just don't know. I am hoping she will need less as she gets better from her lung infection since pancreatitis.

Any advice?

 

Have you shot yet?

Hopefully you haven't fed yet either and can re-test to see if the number is still coming down or on it's way up

 

Just fed. The went down to 5, then up to 5.4

We are 45 min post shoot time, but it's no problem to adjust schedule later.

Should I shoot a lower dose?

 

Had to make a decision. Shot 0.5, and will see if anyone have advise for dose adjustment from here on

 

Sorry....had a problem at home I had to deal with.

Next time, if you get a number you're not sure about, don't feed....test again every 20-30 minutes and see if the number starts to come up....if it does, it's probably OK to go ahead and shoot the scheduled dose but the first few times you shoot a lower numbers, it's always a good idea to get a +1 and +2 so you can intervene early if you need to.

The thing about Levemir is that a lot of times, their nadir is their Pre-shot......but you usually have 3-4 hours before the next shot is going to start to "kick in", so it's usually going to be OK to shoot.

Also, the advice we give will be based on which dosing method you're using, so you need to be working on deciding which one you're going to stick to. Tight Regulation or Start Low, Go Slow....You can always change if the one you choose doesn't seem like a good fit.

 

Are you able to get any inbetween tests during the day, or do you work? The last few days you don't have any inbetween tests in the am cycle.
It would be useful to see ifKitty drops at all during the day. It is not unusual for cats to have a cycle where the numbers drop down lowish and the following cycle where they stay up higher. If this goes on for days and you are testing the "higher" cycle you won't know that the numbers go down in the other cycles. So it is a good idea to try and get some tests in each cycle if at all possible.

 

I did that (withheld food and kept testing every 30 min) for 1,5 hours. It was going up. I had to make a decition due to schedule and the time.

Don't be sorry, I'm just happy someone can chime inn when they have time

 

Yes I can do that To be honest, with syringe feeding every third hour throughout our awake time, I figured the numbers were high enough for both me and her to get some sleep through that cycle. Until tonight, when the ps test was low.

I am always at home in the am cycle (it's our night) and can put alarm on to test

 

You need your rest too but if you could get a few tests in so we can see what is happening now that she has had a low number that would be helpful.
I didn’t realise you were syringe feeding. That can be exhausting.

 

Here's your previous post (we put the link to our previous post into our current one so it's easy to go back and see what's been going on)

Well there a couple of things to remember.....especially with Levemir and it's later onset, you're shooting the number he's going to be at in a few hours, not the Pre-shot number

Also, since it's a depot insulin, even shooting a greatly reduced dose may not keep him from dropping too low on that cycle because the depot is still going to be releasing at the higher dose rate.

A lot of us will shoot anything over 50 (2.8) as long as we know our cats well, have all the supplies necessary and can test them as often as necessary throughout the cycle. (but this is only after we know our cats very well, how they respond to food and insulin and have enough data to know)…..and only if we're doing Tight Regulation. Since you have dry food still in the picture, you have to use the SLGS dosing method which means 90 (5.0) is the point where you'd reduce/not shoot

I'm going to tag @Wendy&Neko too. She has a lot of experience with Levemir and may be of some help.

Is she still not eating on her own at all?

ETA...clarification on reduction/no shot point on SLGS vs TR

 

I will be testing throughout the night, as she was 4.2. Syringe feeding takes a toll on us, but luckily Kitty is used to it from previous years, and doesn't seem to act up or hold a grudge

She is eating dry food on her own just fine now, and have done so for a few days. I try to keep her from having a 100% food intake being dry though. Since she seems to take quite lightly on the syringe feeding these days, I've kept it up.

I got glucose and honey to rub on her gums, some gravy food and high carb treats. But I feel it's a bit early to pull out that stuff just yet (4.2)?

If you didn't have more to go by than I have, would you have not shot at all, even though numbers were going up? Just so I know for next time.

 

Yes, it's too soon....that 76 is a nice number but you might want to get some regular low carb food into her to encourage her to surf and not continue to drop.

Also, since she's still eating dry, she needs to be reduced because she dropped below 90 (5.0) so her next shot (if she's high enough) should only be 1U

ETA.....she's got a long cycle still to go with Levemir's longer action so I'm glad you're going to be up and able to test throughout this cycle.

 

I probably would have done what you did and given the reduced dose.....at this point, it's all good data to learn from.

 

Got it! Yeah she has been eating about 20 % dry. I am trying to remove it, but I serve her some to check that she still have an appetite. It has become an important aspect while she has been ill, to know if she has no appetite or just being her wet food hating self.

 

When Sheba had pancreatic flares her appetite disappeared and sometimes the only thing she would eat would be dry food. I didn’t like her having it but I was just thankful she would eat anything.
Have you tried some gently poached chicken breast.? She might like the juice it is cooked in too.

 

Kitty despises anything resembling meat She is the only one of my cats that won't eat chicken fillets when I cook them, and won't even lick gravy off my plate when I'm done eating. All the others loves these kind of things.

We are working on it though.

Last time I had to syringe feed her, I used Hills I/d. She ended up actually liking it, eating it on her own. Even screaming for me to come with her into the bed room where I used to feed her. Unfortunately I didn't maintain it (it's 3 years ago). This time I syringe feed her one type, but I keep offering her other types, just in case she gets bad associations to what she is being syringe fed.

I haven't given up

 

Following SLGS for dosing (due to the dry food), we wait to reduce until we see an under 90. It's not uncommon for Levemir cats to have their nadirs around shot time, so you do have to get used to shooting low. Neko's Lev onset was late, around +5, so I had plenty of time to get food in her after shot time, before the numbers would come down again. Worst case if I was worried about her going lower and interrupting my sleep, I would give her 8% carb food, which was higher than her usual, especially when I got to the phase where I had to syringe feed.

 

We have had two cycles seeing numbers under 90 now.

I feel a little uncomfortable trusting the protocols 100%, and that we might need bigger decreases, as this is a cat who's number spiked when she got ill (she was on .1 and .2 before this) and they might drop just as fast when she gets better?

Only gave her .5 the two last circles and we are still under 90.

 

The last couple of cycles on 0.5 units look nice, but the chances are the 1.25 unit depot is still influencing the numbers. After you reduce, the depot can influence 4-6 cycles after the reduction. I agree a bigger reduction was needed, since you just went up briefly to handle some medical issues.

 

Thank you (all of you) for all your advice. It is so appreciated <3

Do you think I should stick to 0.5? It's still a little time before the preshot test (40 min), but the test 2 hours ago was 4.9
On a good note, Kitty has eaten about 100 ml of wet food on her own today!

 

I would keep the same dose, unless the numbers start creeping up. Yeah for eating on her own!

 

5.3 now! Maybe .5 is too much?

 

5.5 which you shot yesterday isn't much higher than 5.3. If you are following TR, have plenty of high carb food and test strips and can monitor, you could try shooting 0.5 units. When you shoot low, the cycle is typically much flatter.