Mogee needs some help

I really need some dosing advice again for Mogee.

He has been throwing me some really low numbers lately, since July 2nd. All of a sudden, he seems to be low almost every PS and nadirs in the green.

Based on all the data I haveon him, I have tried to keep him on a sliding scale based on his PS but even with PS in the high 200's he is going in the green, or in tonight's case hypo, when sometimes with the same PS and dose, only goes down to around 100.

I know this is part of the dance but I just don't know what to do. He eats, drinks, and uses the litter box the same. Any advice helps.

Please see Mogee's spreadsheet and as always we appreciate all of you!

 

Well with tonight's dose he has earned a dose reduction due to dropping into those lime green numbers. If it were me I would try doing 2units at both AM and PM times instead of the different doses. Hold that for a few cycles and see how he does.

 

I suggest you keep a 2 u dose AM and PM for several days to see if he'll settle. The 2 u seems to give you decent numbers but no scary lows. If a kitty is volatile or becomes volatile the sliding scale dosing can increase the volatility. It generally works better for kitties that are more "moderate" in their response to insulin.

You have enough data now that you can experiment with shooting the full dose (2 u for now) on PSs that are under 200. How far under is hard to say - that's where the experimenting comes in. Try, say, 190 to see what happens. If that works, try 180 ,etc. The goal is to keep a consistent dose AM and PM for a while.

 

I agree with Ashley and Kris. 2u looks like a good place to start, and the sliding scale approach looks like it's creating more instability than it's helping. Kris has given you a good suggestion for how to test out giving bigger doses on some of the blues. On occasion a cat needs a sliding scale, but most of the time a lower PS number is just a matter of timing - a few minutes earlier or later and the number would have been very different, so changing the dose isn't necessary since onset is a couple of hours away. If you start to follow the guided experiment that Kris explained and it doesn't work, of course we can all figure out a different way, but most of the time that's a good way to figure out the boundaries for your cat.

 

MOGEE!!! I missed you. Adam, since you have been away for so long, you owe us a photo of Mr. Mogee Pickles. I believe that consistency is very important. Every cat is different, so that sliding scale stuff probably works for some, but I can only imagine the havoc it would wreak with Mia, and I have seen enough other cases here where it causes instability that I do not think it is a good option for a lot of cats. So, I agree with everyone else. Try a 2u consistent dose. I believe in holding the dose consistently at least two full days before changing, with the exception of if they go way too low. If 2u gets him too low, drop to 1.75 and so on.

If you get to the point that you get great mid-cycle numbers, but the pre-shot numbers are always higher than you like.. but if you up the dose, the mid-cycle goes too low.. you could consider longer-lasting insulin, if you want. I ended up switching Mia to Levemir.

 

Thank you for all the responses. I moved Mogee to 2 units after reading your advice.

I just tested him @ +4 and he is 59. He was 96 @ +3 and his PMPS was 264.

I am super worried tonight as he was about the same tonight @ +4 as he two nights ago where he went hypo.

Should I consider 1.75 or 1.5 units? I can't keep doing these super low numbers. He is acting okay now. It was weird how he was flat all AM too.

Any additional advice?

Hi @FurBabiesMama missed you too!

 

I suggest you go down to 1.75 u.

 

I agree with Kris about going to 1.75. It is great that he seems to be needing less insulin. Don't get overly scared and pull back too quickly on the doses. Those 50s were too close for comfort but technically still not too low. Hopefully, the drop to 1.75 will be just enough to back that up a little but not too much. Time in those 'dark green' numbers is great! As far as staying flat during the day, it is possible that is some leftover impact from him going down into the 50s and even 40s a couple nights ago and doing a bit of a bounce. You could see something like that again after tonight. It will pass/clear. Just try to hold your dose consistent to the extent possible.. that helps with smoothing things out. Hopefully, the trend will continue with his insulin needs decreasing more and more.

Thanks for the photo. He is still a pretty boy.

 

Yep, 1.75 seems like a good plan to me too.