Morris

Morris is a senior? cat we adopted from animal control 9/22/2016. Could you please look at his spreadsheet and give me your opinion? One question I have is dosing. I know start low and go slow per this site but we didn't start low.... And then there is all the talk about bouncing... So I'm sort of hitting the overwhelmed wall about what I should be doing. Do you ever go back and start all over at a low point and go from there? Thanks in advance.

 

It looks like starting a bit higher worked out for you. That was good luck! I think the dose you're at should be held for a bit (another cycle or two?) because his blue number today isn't too low. I like that your recent increases are only 0.25 u. Doing this makes it more likely you won't skip over a good dose. That red number for PMPS could be a bit of overreaction (AKA bounce) from the lower midday number. The curve you did on 10/25 shows that you were justified in raising the dose.

Yes, sometimes we advise going back down to start over when it's obvious the earlier doses were too high. You don't need to do that. Looking good so far. My main advice would be to get a preshot BG test done before every injection and aim to get a scattering of other tests through the cycle when you can - eg., weekend, day off, through an evening.

What are you feeding Morris? Low carb wet food is best and grocery store brands are fine. If he eats any dry food that can keep him in higher BG numbers.

 

Welcome Pati and Morris! Congrats on getting up your spreadsheet! That will keep Morris safe. I agree with Kris. The dose looks pretty good. The blue today probably caused a bounce this evening. Just for reference - the first goal is regulation which we generally consider mid 200s for preshot and low 100s or double digits for nadir (but above 50 on a human meter and 68 on a pet meter)

This is a small, friendly forum. If you ever have an emergency, post here and on Health so you'll have more eyes. Have you seen our protocol and beginner's guide? They are in my signature in blue.

 

Thanks Kris and Sue.

Morris is on Tiki can chicken or chicken/salmon, Purely Fancy Feast chicken can, and some fresh foods (ground chicken backs/wings, egg yolk, beef heart, ground beef, chicken liver), Wild Salmon oil, lysine, and taurine.

Yes I have been reading the guides and the message board to learn.

 

Sounds great! Low carb high protein wet food is the best, just avoid canned food with sauce or gravy. They're good to have on hand, though, in case Morris goes too low and you need to boost his BG. A teaspoon or two of the sauce/gravy works well for this.

 

Ok. Thanks.

 

The two times I've done Morris throughout the day he was lowest at +6. Does this mean I should keep checking at +6 or does that not necessarily mean he will always be lowest at +6? Thanks.

 

Generally the low point for ProZinc is in the vicinity of +5 to +7 hours but it can float around a bit. I'd say that testing any time in that range should give you an idea of how low he's going.

 

Thank you.

 

Opinion please?
"Old" bottle of insulin started 9/23 but I know it got shaken once instead of rolled and I didn't know not to pull way back and squirt the excess back in. New bottle this am I gave 2u (was giving 4u on old) and pretty much have same nadir today as I've been getting.
And to throw another thought out there, I haven't been sticking to a strict diet but giving him some fresh food in addition to his Tiki. So chicken liver for example does contain some carbs as does beef heart. Are some so sensitive to even a tiny amt of carbs that it would strongly affect their numbers? In which case I've been changing two variables at one time (insulin dose and diet).

So go with the new bottle and give 2u like this am or finish the old bottle and go back to 4u or ?

 

If 2 u from the new vial gave you the same nadir as 4 u from the old vial, that certainly suggests the old vial is past its "best buy" date. I'd go with the new one. Do another cycle or two at the 2 u dose from the new vial and then adjust from there.

Yes, some cats are very carb sensitive and it affects their numbers. My guess is chicken liver and beef heart would have only a very small amount of carbs. They mimic a cat's natural diet. You're right, though, about it being best to adjust only one variable at a time. The insulin is the more immediate issue.

 

Thanks!

 

How cool is this?
PMPS 257
AMPS 239
Excited to see his numbers today!

 

Looking good!!

 

+2 269
+4 139
+6 83 fed small amount regular diet

 

I am glad you can watch him. If you are using an AlphaTrak, 68 is hypo range.

 

Hi Sue.
Yes that is why I fed him. This is new territory for us. Thanks for looking out for us.
I just gave him some of his regular food not high carb.
+7 was 190
+8 187 Fed normal +8 meal.

I presume if he keeps going that low I go slightly backwards on dosing?

 

It is up to you. He didn't drop dangerously low at nadir and your feeding him likely helped him go up a little. So 3.25 units looks like a good dose IF you can monitor those cycles and are prepared to bring up a low number if you get one. If you are not going to be around, I'd be tempted to drop back a little - maybe a fat three units? (Pull up 3.25 and let out a drop or two). It's a tricky part of the dance - you want to keep his momentum without putting him in any danger.

But good news!

 

Ok. Thanks. Yes can monitor. He was asking for food at +6 (normally fed small meal at +8). I would usually just give a very small piece of beef heart to tide him over. I was worried about the 89 going lower though. Ok to see if it would go lower as long as I'm watching closely or does letting it get much lower set him up for a bounce in which case feeding a small amount early was a good idea? I should add that he is no longer the very underweight boy we adopted and doesn't need to gain any weight. Asking for food is not unusual.

 

It depends. He may bounce from lower numbers, but - in general, you want him to get used to lower ranges so he quits bouncing. It is a delicate balance and varies with the cat. Some bounce constantly; some seldom bounce. Some bounce for a few hours, for a cycle, for 3 days. The trick is to find his pattern.

In general, we think a cat is regulated if they are in the mid 200s at preshot and in low 100s or double digits at nadir, but not below 50 on a human meter or 68 on a pet meter. Once regulated, you try pushing a little to get a little lower overall. We consider a cat in remission if they range from 40-120, off insulin, for 2 weeIs.

 

Thank you.

 

NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L}

Well darn. Should have reviewed instructions earlier.
AMPS 213 FS strip. Gave 3.25u

 

If you've just started using FS strips in your AT meter you should know that they read a little higher than the AT strips. I've done comparison testing on the same drop of blood and generally get a difference of 3 - 7% higher for the FS strips. You should do your own comparison testing to verify those numbers for yourself.

It would be a good idea to monitor a little more today seeing as you've given 3.25 u on a lower dose after measuring BG with a strip that gave you a higher number. My guess based on my strip comparisons is that his BG would have been closer to 200 if you'd used an AT strip. No need to panic, just do more tests and give him a little snack of his regular food if he's lower than you'd like around +4 or so.

 

Ok. Thanks. So does this mean I should go back a little such as 3u (or fat 3u - don't have U100's yet) or adjust based on the number or just stay at 3.25u since we're getting a response?

 

Can you do testing through the day today and give a snack if he goes lower than you'd like? If so, the data you get from giving this dose at the preshot you had will be very good info to have for future reference. By the end of today you should know whether the dose needs to be changed.

 

Yes

 

+4 100

 

So far, consistent with what you saw on 12/5 when you gave this dose on a slightly higher AMPS. Nadir will probably be around +6. I think you could either wait to see how low he goes with no intervention or, if he's making you nervous, give him a teaspoon or two of his regular food to see if he'll hover around 100. If he "surfs" (as we call it) around 100 you might prevent a higher bounce number that could happen if he dips low-ish. It's this sort of experimenting that generates the data we can refer to in future situations.

 

Ok. Thank you. Thought I would check every 30. He is asking for food (unusual for +4) but we're cutting up meat to make dog food so it could just be that.

 

If you can check every 30 min and Morris is agreeable to that, it would give you a great picture of how this dose affects him.

 

So AMPS 213 gave 3.25u
+4 100
+4.5 109
+5 94
+5.5 81
+6 98
+6.5 108
+7 127
+7.45 154 and fed usual small meal

 

Nice curve!

 

Very good!

 

PMPS 246
Stick with 3.25u?
No shoot #?

 

Your results today suggest that you can give 3.25 u with a PS like this. As for no shoot number, it depends on a number of things: how much data you have to go on, whether your kitty tends to nose dive or not, how experienced you are in "reading" trends on the SS, whether you are able to be there to monitor and steer with food if necessary.

At the beginning the no shot number will be higher, eg. 230 - 250. As you go along it might drop to 200 or even 180 once you know your kitty very well. One thing to do if your BG is low at PS is to stall without food (so it's not affecting BG) for 20 minutes, then retest. This can be repeated in 20 minute intervals for up to an hour or so, depending on what your schedule permits. Once the BG is definitely on the rise, you can shoot. You might have to lower the dose a bit. How much to lower it is a matter of judgment that comes with experience.

 

Ok. I understand. Thank you for all your wisdom today.

We've been getting a lot of practice at stalling. Morris doesn't like daylight savings time.

 

You're very welcome! Glad to help.

 

I don't know what to do.
+6.5 246 during the night
AMPS 165, 123, 181
Did control solution and got 149. I don't understand what it is supposed to be even after reading the directions.
20 min stall Morris 170
These are all the new FS strips. I don't have any AT strips. Yes I realize the consequences now.
How do I trust any of these numbers?

 

After 2nd 20 min stall
206, 204 different FS lots
Went ahead and fed
Still debating what to shoot.

 

Gave 3u
Home all day

 

Hi Pati,

I'm just seeing this now. Congratulations on getting through the ordeal on your own! Not fun but experiences like this help you to make the judgment calls that build confidence.

You can trust the FS strips. They'll read a little higher but still give you good data for decision making. Get another vial of AT strips as soon as you can and do some same blood drop comparison testing for your records. If you look at my SS there's a page where I have data like that recorded.

Lowering to 3 u was a good choice and you'll be around the monitor so he'll be OK.

 

So 3 different drops of blood at roughly the same time could give me 165,123,181? The 123 is more than 20% difference.
And what also confused me is the 246 in the night why he would be lower this morning? I expected higher than 246.

 

Yes, three different drops can give different numbers like that. The 20% factor is just a general guideline so it's possible for a number to deviate by more than that. As for the AM number that was lower, who knows? They can throw us a curve ball once in a while. That's why we recommend focusing on trends in BG data rather than individual numbers. It's almost impossible to explain each and every number.

 

Got it. Thanks.

 

Agreed. It is crazy making. At some point, you just have to pick a number, decide if it is in the range you want to shoot your particular dose, shoot and monitor.

The good news is that he is generally in lower ranges, which is great!

 

Ok. Thanks Sue. And here I was so excited with my first 200's a few days ago. Got to go work out to burn off this am stress.
I understand knowledge is key. I can't thank you all enough for your time and patience in teaching all of us.

 

Gained lots of experience today. First 3u was too much for am shot on his 206.
Then when he started going too low I probably over did it. Lowest was 48. His PMPS is 343. Do I now resume my 3.25u? Or do I take in consideration what he went through today and all the high carbs I fed him today that should be wearing off at some point?

 

Gave 2.5u. Probably too much a reduction but "I" probably need that right now. Obviously the 3.25u was becoming too much and needed reduced in the first place. I guess I was thinking do I dose the number vs looking at the reason he got there in the first place.

 

Good job! Yes, when you give carbs and he clearly bounces, you probably want to lower the dose a bit.

 

Thanks Sue.

 

Advise please. Stick to 3.4u and see if my yellows come back, go to 3.5 because he has room to drop at nadir, or go to 3.2? When I got my better numbers PS recently should I have stayed my dose or dropped it slightly? I'm still confused about when too much looks like too little.

 

Yes, he can afford to drop a little midcycle. The blues are very nice but still on the higher range. If you will be around, you might try a fat 3.4 and see. (Draw up 3.5 and let out a drop or so until it is just above your 3.4) I think he needs a little more but not a lot. Moving up slowly to a fat 3.4 and then maybe 3.5 if he is still in the higher blues after a few days.

I think you might consider a lower dose like 3.2 on a low yellow, 3.4 on a higher yellow and the higher dose on a pink?

 

Thank you Sue.