Need dosing advice please ...again!

Discussion in 'Prozinc / PZI' started by PatJ, Apr 13, 2019.

  1. PatJ

    PatJ Member

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    Sep 23, 2018
    My cat has started to go into low numbers after I've been dosing him at 2.75 but when he has started the day with low numbers and I give him token doses he always ends up in high numbers again and I'm really not sure what dose I should be giving him. He tends to go to hypo numbers and can keep going lower right up to and beyond his PMPS sometimes so I get really nervous when it comes to dosing him. Would anybody mind having a look at his spreadsheet for me and give me some idea of a good dose for him (or maybe he's on a good dose already?) Sorry to ask but it's scary when he's low in case he hits those hypo numbers again. Thanks.
     
  2. Djamila

    Djamila Well-Known Member

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    What you're seeing is actually really good, but it's going to require adjusting your thinking about dosing, because it looks like William is entering a new phase of his journey here. You're seeing some really good overlap, and that's what you want to see in order to get him regulated. It means shooting on some of those lower numbers though, and then monitoring without getting too nervous. You really want him to be down in the 50-80 range as much of the day as possible. And since you're able to test so much, you can be sure he's staying safe. So next time he gives you a blue number, try lowing the dose just a little maybe down to 2u, and collect data. If he does okay, then try just lowering to 2.25u, and if he still does okay, then next time you can keep him at the full dose, or just go "skinny" on the dose, but not a full reduction.

    Of course if he drops into the lime greens, then you give him some food to bring him back up, and then you know that you need to reduce the dose a little more than that next time.

    It's going to take some trial and error to see what will work best since every cat is different. But you can see on the AM cycle of 4/8 and 4/9 that you reduced the dose and the numbers were flat-ish or went up. That tells you that it wasn't enough insulin on those mid-blues, and you could have stayed closer to the regular dose. Every time you collect data, think about what it's telling you: hmmm....that was too much. Or hmmmm.....that was too little. Then use that to help guide you the next time. I sometimes even add notes into the spreadsheet to remind myself so when I get a similar number again, I can look back and see what I've done that did work or didn't work and use that to guide me.

    It's looking hopeful that he might be heading into some solid yellow/blue/green ranges, which would be great!
     
  3. PatJ

    PatJ Member

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    So even on 6.0 or 7.0 or less, it's still all right to give him 2u? They are the numbers that really scare me, because I'm terrified of overdosing him then, and I worry that he'll have too much insulin to come back up again quickly enough, or doesn't it work like that?

    Thanks so much for the information. I've taken your advice and given him more on a blue number. Hope it was all right to give him 2.50 because I looked at 8/4 and he didn't go high enough. Maybe it won't be so stressful once I've got used to these low number doses. I just live in dread of these hypo numbers he's so fond of giving me!!!:arghh:

    Thanks Djamila, I really appreciate all your help.:)
     
  4. Djamila

    Djamila Well-Known Member

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    In theory, yes. Of course it depends on William and how he decides to respond to it, but so far it looks like he'll handle it okay. The only way to know for sure is to try it, collect the data, and see. If he goes a little low, a snack should be enough to bring him up, and you monitor him enough to see if it's going that direction. Of course don't try it the first couple of times on a cycle when you won't be around!
     
  5. PatJ

    PatJ Member

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    Sep 23, 2018
    No, I won't!! I always thought that you had to give a token dose on a low number and I could never really work out what it should have been. Thanks for clearing that up. Hopefully, his shot times will be a bit easier now. Thank you!:)
     
  6. Djamila

    Djamila Well-Known Member

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    When a cat is newer in their journey, then it's true that you want to lower the dose on a low PS because there just isn't a lot of data, and often newer folks aren't comfortable testing a lot if their kitty gets into trouble. Also, the newer the cat, the more likely they'll give some wacky response. If a cat isn't in remission after six months, then the rules change a little because you're a pro at this, William is fairly stable, and you can handle it if he does decide to dive. So you can try working towards the full dose and see if he can handle it. I rarely adjust a dose for Sam based on the PS anymore. I'll only lower a smidge if I'm suspicious he's heading towards a dive and I know I won't be around for a few hours. Otherwise I shoot whatever the mid-cycles indicate and kind of ignore the PS numbers.
     
  7. PatJ

    PatJ Member

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    You've helped me so much with your advice the last couple of days. I haven't panicked half so much giving him higher doses on a lower PS and he's dropping to the green numbers!!! :joyful: Thanks Djamila, very much.
     
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  8. Djamila

    Djamila Well-Known Member

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    Wow! Look at that beautiful cycle today!!! Looks like he handled it just fine! Way to go, William! (and good job, mama!) He surfed those greens for a long time today! Hopefully this will start to bring both of his PS numbers down into some nicer ranges too.
     
  9. PatJ

    PatJ Member

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    Sep 23, 2018
    His morning PS today was 6.4 so I was a bit nervous about giving him 2.50 so gave him a skinny 2.0 but I should have given him more because he's been higher all day,so that's taught me!!! so will increase it in the morning if it's low again.
    Thanks for looking in on him.:)
     
  10. Djamila

    Djamila Well-Known Member

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    I probably would have done the same thing! Now you know, so next time you can try 2.25 or even 2.5 (you can let a little gut instinct help decide). It's really great seeing him so stable after his earlier diving and bouncing.

    I just realized you're in France! Are you anywhere near Paris? I'm gutted about Notre Dame. :oops: I lived in Morocco for many years and often traveled up there. It's been a decade now since my last visit, but I cannot imagine Notre Dame without her spire.
     
  11. PatJ

    PatJ Member

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    We're about 450 kilometres from Paris and I've never been there! Not strictly true, we drove through it when we came to live here but my husband has been a few times and he always says what a beautiful city it is.

    It almost seems like there's a curse on Paris these days what with all the terrorist attacks and now this terrible fire at Notre Dame. 850 years of history demolished in a matter of hours! It doesn't look like terrorists did it this time. It was being renovated so it's highly likely to have been caused by accidental carelessness. They say that it would only have taken another half an hour for it to be irreparably destroyed. They're going to rebuild it, but it won't be 850 years old.
    You must have felt so sad to see the spire falling. What a wicked waste.
     
  12. Djamila

    Djamila Well-Known Member

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    Paris certainly has been having a tough go of it lately, although my memory of it is that it's always been rather tumultuous. Paris has tremendous history, but personally I prefer the south of France - warmer and much kinder. Although you really should visit at some point while you're living there!
     
  13. Djamila

    Djamila Well-Known Member

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    Oh my goodness! I just saw that you shot on a 99 today! Guess what that means???

    You have now earned the B.O.S award:
    upload_2019-4-17_18-5-3.jpeg

    Balls of Steel - given the first time someone (wisely) shoots on a green number.

    We don't give them out if someone shoots on a green when they shouldn't, but your data from yesterday's cycle which was only a smidge higher than that, showed you that he would likely be okay. He did skim pretty close to the edge down there, but he hung on in the safe greens and had another nice long surf.

    How are you doing? That must have been a little anxiety-inducing!

    I also see that you reduced a little tonight, despite the red. I think that was a really good decision and will hopefully give you some less stressful morning numbers and maybe a little less steep of a curve. You're doing a really great job of handling this new phase of William's journey! :bighug:
     
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  14. PatJ

    PatJ Member

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    I've got to confess to you that I totally panicked when I saw him go down so low, because he just lay there and when I poked him he didn't move. I gave him his normal low carb hoping to steer him away from a hypo number when he was at 3.3 (he got there much quicker than usual) but in less than an hour he had gone down to 2.9 and his nadir was a few hours away so I gave him some dry biscuits to hopefully get him back up again. It did the trick but now look what I've done because now he's too high again!:banghead: I really thought that I had done the wrong thing by giving him too much in the morning, but you really cheered me up with those B.O.S.:)but do you think that he would have been okay if I hadn't interfered? If he's low like that again, should I still shoot the same dose and see what happens? Do they always avoid a hypo if you get to them in time? Every time I think about hypos killing them it makes makes me a nervous wreck.


    I think you've seen more of France than I have, although we're only about 3 hours away from the south of France I haven't been there either!!

    Pity the poor workman who didn't put his cigarette completely out!!!:oops:
     
  15. Jasper Blue and Jay

    Jasper Blue and Jay Member

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    Mar 15, 2019
    The dry biscuits are going to take longer to bring him up I believe... do you have any honey or something that would work quicker next time? Also the honey wears off much quicker than dry food. Do you have any medium carb wet foods? Those are a nice middle ground.

    If he's so lethargic that " he just lay there and when I poked him he didn't move" the next time he may not move and therefore won't be able to eat anything at all especially not biscuits, so you'll want to have something that will work very quickly that you can rub on his gums if he can't/won't eat.

    The high number could just be a bounce from having gone down so low so quickly, so don't beat yourself up about giving him carbs, he needed them.

    I panicked the first time I saw a low number and probably could have given less carbs and felt guilty too but "a day too high is better than a minute too low".

    I read that around here somewhere.
     
    Last edited: Apr 18, 2019 at 7:44 AM
  16. PatJ

    PatJ Member

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    I keep honey and high carb food especially for these occasions. My cat has a big tendancy to go to hypo numbers so I'm always vigilant, but I've been told by the experts here that you don't need to give honey unless they are actually having a hypo, not when they're just in the lime greens (because I always panicked and gave him honey), when it's best just to steer them away with their low carb food when they're not actually having a hypo. I panicked yesterday because I gave him a lot more insulin than I would have normally done when he had a green AMPS, and I was really worried because he kept going lower,but his BG did go up again, so panic over.Till the next time!!! It's ironic that when their numbers start to go low which is what we want, that then it becomes really stressful in case they go TOO low!! By the way he did respond after a few pokes!! I think he just likes to make me stress out sometimes.:rolleyes:

    It was really nice of you to get in touch and I do appreciate it. Thanks Jay:)
     
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  17. Djamila

    Djamila Well-Known Member

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    Pat -- you're absolutely correct about treating the lower numbers with low-carb food and avoiding the carbs unless they are actually needed. The carbs impact their numbers for a few cycles afterwards, which you're seeing now with the disappearance of the blues and greens. Don't worry -- they'll be back. It just takes some recovery time.

    That being said, I understand how scary it can be to see those numbers when you aren't used to them! And when you aren't sure if there is more drop to come, or if he's getting to nadir at that point. Wait-and-see can be hard in moments like that!

    So now we have the dilemma of figuring out what to do next time. The skinny 2u (on 4/16) wasn't quite enough, the 2.25 (4/17) was maybe a smidge too much. So next time maybe try a fat 2u? Sometimes the tiniest shift can make all the difference!
     
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree about tiny shifts having a significant impact in dramatic kitties. A fat 2 u is worth trying.
     
  19. PatJ

    PatJ Member

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    Thanks Djamila and Kris,

    He's had another low green about an hour ago so I gave him some of his food and he went up from 3.8 mmol/L to 5.4. I can't understand why he keeps dropping so low like this. He didn't do it when his levels were higher, he kept a nice steady pace, but as soon as he starts getting lower....!!:banghead:

    Thanks as always for the good advice. I'll give him a fat 2u tonight and see what happens. Thank you:)
     
  20. Jasper Blue and Jay

    Jasper Blue and Jay Member

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    Are you able to get tests at nadir at night?
     
  21. Djamila

    Djamila Well-Known Member

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    These are the numbers you want to see. A normal healthy cat spends most of their time between 50-80/2.7-4.5 So you really want William to spend as much time as possible in those ranges. Of course at the beginning and end of the cycle he'll be higher than that, but if he surfs along in those numbers through the middle of the cycle, then he's doing great. You want to keep him safe, but you don't need to be worried about the dark greens.

    And to clarify -- I meant the fat 2u for a dose when he gives you a lower PS number. I think the 2.25u might be a good dose for him on a regular PS. However, shaving that little bit off the dose tonight might be good for your stress level and let you get some sleep which is important too! :bighug::bighug::bighug:
     
  22. Jasper Blue and Jay

    Jasper Blue and Jay Member

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    Thinking of Mr. William tonight.

    Was hoping there would be some testing tonight. :(
     
  23. PatJ

    PatJ Member

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    Sep 23, 2018

    I started replying to you Djamila, but it seems to have disappeared!

    Just to say many thanks as always for all your help and I won't interfere on those low green numbers ( unless they're lime green of course!)
    I really appreciate the trouble you're taking with all this advice. It's certainly helping him.:) Thanks so much.
     
  24. PatJ

    PatJ Member

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    Sep 23, 2018
    Not to worry, Jay. I did test him last night but didn't put anything in the spreadsheet till tonight. He's fine. His nadir is usually near his next PS shot and occasionally just after it so to get his night-time nadir I'd have to sit up all night but I do test him enough to keep him away from a night time hypo. Thanks to the great advice I get on here - these girls are so clever.

    I hope Jasper doesn't get the same trouble with these hypo numbers!! Thanks for thinking of my boy!:cat:
     
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  25. Jasper Blue and Jay

    Jasper Blue and Jay Member

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    Mar 15, 2019
    I saw! William is doing so good!

    Don't panic and increase dose if he rebounds from these nice low numbers! lol

    And don't be afraid of medium carb wet food, Dr Lisa says our cats can eat 10% carbs every meal every day! She also says not to worry about a few % difference , as it's a negligible amount. So 13% carbs wet food , a small portion just once is not going to hurt him in any way, and there's no reason to risk a hypo/rebound loop again and again just to see some green on the computer screen! lol
    Honey clears so very quickly in fact that it's not enough during even mild hypo, so don't be afraid to give him just a smidge of honey if he needs it.
    The high carb food you're doing, is that dry? You said high carb food on the ss and mentioned "dry biscuits" here... dry high carb food doesn't help him when he's as low and lethargic/unresponsive as he was the other night, and it sticks around way too long.


    (This is all from the prozinc stickies, hypo stickies, and Dr. Lisa's page,etc.)

    Thanks for thinking of Jasper! He's such a good boy and has been so patient with all the poking, I'm so proud of him! lol He's doing great! He and William seem to be doing the same thing right now.. going lower and lower at Preshot test! Jazzy's numbers tend to be a little bit artificially inflated because he's underweight we let him eat as frequently as he wants, so a lot of time at test times throughout the cycle he may have eaten just an hour or so prior. Anyway, thanks for thinking of him, I told him about William over in France :D we have been sending William good vibes. :)
     
  26. PatJ

    PatJ Member

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    Sep 23, 2018
    into a cardboard box up in
     
  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'll echo Djamila: you WANT to see those lovely dark greens. If you feel the need to steer with food when he's running in that range, use LC food. Save the higher carbs for lime greens. :)
     
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  28. PatJ

    PatJ Member

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    Sorry Jay, just lost what I was writing to you and pressed the wrong button looking for it! I was saying that I think our cats are wonderful to put up with all this prodding and poking and that I had a cat in England called Jasper. He died about a year before we came over here. He was my baby. He and his brother had been left in a cardboard box as kittens. Happily they were found before they came to any harm! Some people just beggar belief:mad:

    William says to send his best wishes and commiserations to Jasper for having this rotten illness and thanks you very much for the good vibes.:)
     

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