Panter is in trouble

Discussion in 'Prozinc / PZI' started by Panters-mom, Apr 13, 2020.

  1. Panters-mom

    Panters-mom Member

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    Panter didn't show up for his morning shot yesterday. He had eaten his nightfood though, at around 2-3. So up to this time everything is normal. Found him under the bed later on around 18-19, not in good shape. Don't know how long he has been there. But strangely his BS was 21.2 (+12) - like his 'normal'... He didn't want to eat or drink, just laying still. I made him a litterbox, but he didn't want to use it. He wanted to go out several times. In the end -in the middle of the night, I had to follow him out, and he disappeared in the dark...hasn't returned... and I'm soo worried... The strange thing is that I kind of thought we were on the right track with this new insulin - he is still high, but it has started to work, he is down in yellow, sometimes blue area on nadir. And he is - was - in good shape, hunting, playing, purring, friendly, very normal. I'm afraid it is something else. Organs failing or something... Any thoughts?

    Best regards, Gøril.
     
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  2. Panters-mom

    Panters-mom Member

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    He is getting his insulin very regular every 12 hour at 7am and 7pm. And he actually normally meets up everytime, ready on the table. Been taking this extremely good. The other numbers you see are just testing BS to make a curve.
     
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  3. Panters-mom

    Panters-mom Member

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    My big worry now is, as our vet is afraid of, that it should be more than diabetes, and the condition of acromegaly. He been very well - with other words, acting very normal, but with high BG. We've been struggling to get the BG down. The reason for that we changed insulin from insulatard to PZI. And it was going in the right direction. But suddenly, yesterday, he crashed. Anybody that has experience in acromegaly?
     
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  4. Panters-mom

    Panters-mom Member

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    He hasn't come back. We are out looking for him every 15 minutes... we've called all our neighbors...
     
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  5. Lisa and little

    Lisa and little Well-Known Member

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    Praying he returns soon
     
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  6. Panters-mom

    Panters-mom Member

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    Panter is home, and he is in pretty good shape and very humgry - as normal...very strange. Maybe it was something he ate... I don't know. Anyway he is home safe. BG high - 24.2, not a surprise though. Thanks for the prayers.
     
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  7. Lisa and little

    Lisa and little Well-Known Member

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    Please try to keep him in for a few days at least so you can keep a close eye on him. So glad he’s back!!!
     
  8. Panters-mom

    Panters-mom Member

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    To be on the secure side for now, should I reduced the insulin back to 3u again - in case this incident had something to do with a bounce too low too fast...? He was on 3u for two weeks, but still up in red and purple area and purple and yellow mostly on nadir, then we increased to 3.2 (8u in a 100syringe) - but maybe too high? He was down in blue area on nadir - but maybe too fast...?
     
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  9. Panters-mom

    Panters-mom Member

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    YES for sure - they know how to make you worry...puhhh... :) Unfortunately I have never tested keytones. Don't know how, as he has never used a litterbox... I tryed to ask for this double tester (BG+keytones) at the farmacy, but he didn't know what I meant...
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    Hi Goeril, haven't seen a post from you in a while. Hope all is well with you and your husband there in Norway, and your other 2 kitties.

    Not really. That is something that is said far too often, that too much insulin looks like too little.
    If Panter does have ketones, resetting the dose to 1U is the absolutely wrong thing to do.

    As too little insulin + too little food + infection/inflammation in a cat is the classic setup for DKA (diabetic ketoacidosis).

    Panter is getting down into the blue range numbers (5.6 - 11.1 mmol/L; 100-199 mg/dL) with the 3U of Prozinc, so I do not think you want to reset the dose, or decrease it at this point.

    Using U100 syringes with the conversion chart, actually lets Goeril adjust the dose for Panter in finer increments. We've had a conversion chart to do that on our website for decades. Or you simply multiply the U40 dose by 2.5 to get the amount to measure in the U100 syringes. Since Prozinc insulin is a U40 insulin and is less concentrated than a U100 insulin, it's easy to use U100 syringes to measure the dose. There is even a printer friendly version of the U40 to U100 conversion chart.
    http://www.felinediabetes.com/insulin-conversions.htm

    Since Panter is an outdoor cat, he does not have a litter box inside and uses the outdoors to urinate. Impossible for Goeril to use a urine dipstick to test the urine.

    Goeril, could you order a blood and ketone meter by mail order? Plus the test strips to go with it?

    Pre-shots are the very last numbers to come down with Prozinc, and with most insulins. It's the mid-cycle numbers that we use, in conjunction with giving the pre-shot numbers a little bit of consideration, for dose adjustments.

    @TempestsMum You might wish to look at the Prozinc dosing protocols sticky, that was re-written and updated in February 2020.
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Difference of opinion. It's why we are a peer reviewed message board, so people can give their different points of view.
     
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  12. Deb & Wink

    Deb & Wink Well-Known Member

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    Please don't bow out. There are too few people here helping on the Prozinc ISG forum.

    There needs to be multiple voices here, helping people out. Please keep lending your opinion. I certainly don't know everything, and never will.

    Since the main advisor, @MrWorfMen's Mom left in January 2020, due to the death of one of her cats, there wasn't anyone helping. NO ONE was helping! Members were left hanging, with absolutely no help, and I said to myself, that I never wanted that to happen again. I reluctantly stepped into the breach, and tried to learn and study as much as I could to help out the Prozinc users (and the Vetsulin/Caninsulin users). Took me a while to come up to speed. But I made tons of notes, read a lot of Prozinc threads and looked at a lot of spreadsheets, and studied and studied some more.

    Still don't know everything. Life is a constant learning experience.

    Not misdirected, simply a difference of opinion here.

    Panter will never be happy as an indoor only cat, and Goeril has told us that in the past, in another thread. When does curtailing his outdoor time negatively impact his quality of life is what she asked? That is up to Goeril, and she does not want to keep him locked inside, all day and night. I understand that decision. So sometimes, Panter will "go walkabout" and can't be found for mid-cycle testing. It is what it is.

    He's a great hunter of mice and other rodents outside Goeril's home in Norway, they live in a rural area surrounded by nature. Which must be such a source of comfort in this time.

    There was a post from long ago that I bookmarked. It was titled "Some Bad Advice for Newbies", and talked about the meme of no food = no insulin. But that can cause so many issues, like DKA, that it's something that we discourage saying.

    Here is that thread, from Think Tank http://www.felinediabetes.com/FDMB/threads/some-bad-advice-for-newbies.9070/#post-1363950

    Something similar holds true, for setting the dose back to 1U. I see that recommendation all the time in the various facebook groups. It's like a game of telephone. Where one person heard something, or read something or says something, then that gets passed along, and passed along to the next person and it isn't the best solution for all cats. People give very short and cryptic answers on facebook. Without the justification to back things up and explain why a certain answer is being given.

    p.s. As you can see, I'm horrible at short replies. ;):joyful::p
     
  13. Panters-mom

    Panters-mom Member

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    Dearest Deb and Tara - thank you so much for helping out! I really appreciate it. I really appreciate the time you've used to accumulate knowledge about this issue. A fantastic resource for us concerned cat parents. And I don't feel misdirected at all, I'm listening carefully, learning more and more!
    I kept Panter inside last night, he nearly ripped the cat door out, howling and complained and totally refused to use the litter box. We both stayed up more or less the whole night, me carrying him to the litter box, he bouncing back to the door... but have to be said, he was back to pretty good and normal shape. ;) After his shot this morning, after more than 15 hour no peeing I let him go. He came back til a +9 test - happy and 'healthy' :) .....and I think this just will be our way of life for a while at least til we figured out a smart plan;) But the forest is calling these days, so much activity and sounds... But I will try to get hold of that double tester for BG and ketons, maybe ebay..? And I will stick to 3u for a while and try to get more BG tests in the mid nadir area. Have a great day! Hope you are all okay where you are. We are good!
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

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    How is Panter doing?
     
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  15. Panters-mom

    Panters-mom Member

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    Hi Deb, thanks for asking. Panter is doing great! Back to his 'old self'. He is hanging around - doesn't go very far I've noticed. And been coming for his shots on time - at least almost everyday ;-) And the BG is pretty 'stable', high of course, but all over lower, purple area, in the +12. and down in yellow at nadir. The spring is here, the sun is shining, and the garden is a great place to be for us all. Hope you also are doing good in these difficult times.
     
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  16. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Is Panter an outdoor cat? If so best to keep him indoors until you get a definitive diagnosis. A week of being back to his old self is not enough.
    I know it's not that easy and I've had many outdoor cats over the years so I'm not preaching to you. Best of luck.
     
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  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Goeril, I think you may want to increase the dose of insulin. I'd suggest going back up to 3.25 U. Same dose AM and PM. The 3U (units) of insulin does not look like enough. You want him to be down in the blues 5.5-11.1 mmol/L (100-199mg/dL) at the mid-cycle.

    Yes Dickson, Panter is an indoor/outdoor cat that has been on insulin for months. Panter and his mom Goeril live in Norway, in a very rural area. She has decided his quality of life would be too negatively impacted by trying to keep him indoors all the time.
     
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  18. Panters-mom

    Panters-mom Member

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    Thanks for the advices! And sorry I'm so late in responding. Lots going on the latest days. Okay, Deb - I will increase the dose from tomorrow. Panter is still good - great mood, playing and hanging around us in the garden :)
     
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  19. Panters-mom

    Panters-mom Member

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    Strange - we've had a couple of days where he didn't show up to his insulin on time. First day he came in +18 - got his shot, the next was at +17. For sure I thought he would be high, but surprisingly he was 'just' 21.7 - then at +8,5 down to 6.5 ! - never been this low, and then at +12 - 14.7, never been this low at +12 - so I actually didn't dare to set his insulin... waiting an hour or two... Any thoughts?
     
    Last edited: Apr 26, 2020
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  20. Deb & Wink

    Deb & Wink Well-Known Member

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    I hope you went ahead and gave Panter his insulin shot. As @TempestsMum said, that pre-shot number was high enough to give the insulin.

    From looking at your spreadsheet, it looks like you may have. But it's difficult to tell, since you prefill the Units cell with the dose.

    You want Panter to be down in those blue color ranges 5.5-11 mmol/L (100-199 mg/dL) at mid-cycle, or even down into the high tree green BG levels >2.7 <5.5 mmol/L ( >50 <99 mg/dL).

    Shoot/no shoot number can be lowered from the 11 mmol/L (200 mg/dL) if you are able to get some PM test data. I don't think you have enough test data in the evening (PM) cycle to know how Panter does during the nighttime cycle. So for now, I don't think you want to shoot much lower than that 11 mmol/L (200 mg/dL) for now.
     
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  21. Panters-mom

    Panters-mom Member

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    Thanks for the response! Things are deffinetly happening/going differently... I gave him his shot 3.1u at +14 last night the BG 19.6. This morning at +10.5 - he was down in 9.4 - I gave him food, then 1.5 hour later at +12 his BG was 17.7. Do I understand right, that I should continue with the same dose 3.1u as long as the BG is over 11?? I'm so afraid of getting him to low... I will do some more testing in the PM cycle. But isn't it strange that he got this low number as 9.4 so late in the cycle +10.5, must mean he has been pretty low around +7 - I believe this can be the nadir....
     
    Last edited: Apr 27, 2020
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  22. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, as long as Panter's pre-shot BG level is >=11 mmol/L, continue with the same dose.
     
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  23. Panters-mom

    Panters-mom Member

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    I must say - very nice to have your support. Very comforting not to stay alone in this. Thanks a lot!!
     
  24. Panters-mom

    Panters-mom Member

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    Okay...we're down i low...very low...2.9 at nadir (+7). He is surprisingly in good shape. I gave him one bag of food (100g) at +6, he was the 4.2 - one hour later, down in 2.9 - I have given him another bag of food - and he eats it with no problem.... now I'm watching closely... I'm a bit worried...
     
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  25. Panters-mom

    Panters-mom Member

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    ...+8 - up in 5.5 - but a lot of food (2-250 g) ... so now I wonder what to do tonight...same dose or...??
     
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  26. Shelley & Jess

    Shelley & Jess Member

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    Hi Goeril. I'm sure Deb will be along to advise about tonight's dosing too, but it looks like you are only a couple of hours away from your PMPS.

    Just in case she doesn't pop in on time and you are unsure about the dose I would refer to the STICKY: PROZINC DOSING METHODS
    - Your spreadsheet indicates that you are using the SLGS method for dosing.
    - When following the SLGS dosing method the protocol says "Anytime the BG drops below below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"
    - When following SLGS Panter earned a dose reduction with that (Green) 2.9 today.

    If you are still unsure and as Tara just posted, Post to the Feline Health (Welcome & Main Forum) and ask for help.

    And of course, before giving the dose, make sure Panter's pre-shot BG level is >=11 mmol/L
     
  27. Panters-mom

    Panters-mom Member

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    Thanks! Just tested right now at +11, and he is back at 12. Will test again in an hour and maybe I reduce 0.25 to 3u (special since it is the PM cycle, harder to monitor. Thanks again!
     
  28. Shelley & Jess

    Shelley & Jess Member

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    Goeril, if you do a .25 reduction that would mean your new dose is 2.85 units.

    Are you able to measure that with your U100 syringes? Have you done a 'fat' shot yet?
     
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  29. Shelley & Jess

    Shelley & Jess Member

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    @Panters-mom
    I see that you are micro dosing Panter.
    But don't see that you've discussed earned reductions with Deb.
    Just concerned. That's all.
    @Deb & Wink
     
    Last edited: Apr 28, 2020
    Reason for edit: tag deb
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  30. Panters-mom

    Panters-mom Member

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    At +12 he was actually up in 15.3, so first I thought to keep the regular amount 3.1, but then I didn't dare and I reduced it to 3u. On the 100u syringe I can adjust with 0.1 - like 7.75 is 3.1 and 7.50 is 3.0, 7.25 is 2.9.....
    'Fat shot' I don't know much about - I just came across it on the sticky page...
     
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  31. Shelley & Jess

    Shelley & Jess Member

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    I use the U100 syringes too and I agree they are great for those finer doses.

    A "fat" shot may not make much of a difference @ 2 or 3 units. My doses are low/0.6 units - so "fats" and "skinny's" make a difference for me. We'll have to ask Deb about that.
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

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    Goeril, glad that @Shelley & Jess and @TempestsMum were both able to help you today. I was away from home almost all day.

    The dosing protocol for Prozinc is written for using U40 syringes, not the U100 syringes that you use.
    So when it says to reduce by 0.25U, that means 0.25U on a U40 syringe, which would be 0.625U on a U100 syringe. (0.25U times 2.5 = 0.625U reduction).

    Goeril, you only reduced by 0.1U, not by 0.25U. Panter "earned" a full 0.25U reduction today, with that low of 2.9 mmol/L (52 mg/dL). Any time Panter drops below 5 mmol/L (90 mg/dL), the dose needs to be reduced.
    The dose needs to be no more than 2.75U with a U40 syringe, which would be 6.875U on a U100 syringe. Round that down to 6.75 units for safety and ease of measurement.

    It's ok to still use the U100 syringes to measure out the U40 dose. But the dose reductions need to be by the amount you would measure in the U40 syringe.

    It can get confusing. So please let's be clear on what you need to do, ok?

    p.s. Let's not get into doing a "Skinny" or a "fat" dose at this point. Lets' make sure Goeril first understands the amount to decrease the dose, when Panter gets such a low number at mid-cycle.

    Fantastic job by the way Goeril, on catching that low and knowing to feed Panter to get his blood glucose levels back up.
     
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  33. Panters-mom

    Panters-mom Member

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    Thanks Deb! Got it! And yes, I'm afraid he then (maybe) got a bit too much yesterday pm and this morning am - I gave him 7.5 (3) - went down only 0.1 as you say. But again - this morning he was up in 18.6. Hmmm... very strange. Like something new is going on. And can 0.1 (from 7.5 to 7.75) make this much difference....? And he is acting perfectly fine... strange...
     
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  34. Panters-mom

    Panters-mom Member

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    We're dipping again down to 2.8 at nadir +7 (or I just tested, and it was more like +6,5)....so I keeping my eyes on him and I gave him a bag of food + a bit dryfood.
     
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  35. Shelley & Jess

    Shelley & Jess Member

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    You need to test him every 20 to 30 minutes to make sure he's coming up. Can you do that please? And keep us posted.
     
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  36. Shelley & Jess

    Shelley & Jess Member

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  37. JanetNJ

    JanetNJ Well-Known Member

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    There is nothing in his numbers that says acromegaly to me. The dose isn't super high and the numbers come down. My cat is acro. She was up to 13 units. I typically shoot about 9 units now.
     
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  38. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Have you retested again yet?
    What type is food did you feed...low carb or high carb?. Do you have canned high carb. That is better to give than dry food.
     
  39. Panters-mom

    Panters-mom Member

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    Thanks everybody! He is going up again - 4.1 one hour later +8. I gave him some more food again. Will test in half an hour again.
     
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  40. Panters-mom

    Panters-mom Member

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    I fed him the regular felix and Iams ('low carb') and some diabetes dry.
     
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  41. Panters-mom

    Panters-mom Member

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    Going up - 5.8 at +9. I will decrease the insulin tonight - down to 6.75...
     
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  42. Shelley & Jess

    Shelley & Jess Member

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    Thanks for the update! :)

    Another test or two wouldn’t hurt - if it were me I’d keep testing to make sure his BG is still rising - we don’t know when the food you fed will wear off.
    More tests will also tell you if he is still on the rise when you take his PMPS.

    And please keep an eye out for any replies from Deb or Bron. They may have a little more advice for you than I can give at this time.

    & Just to clarify
    - you are planning on giving him 2.7 units of Prozinc U40 insulin noted on your spreadsheet
    - you are using U100 syringes
    - so that Prozinc dose of 2.7 units is what you mean because it measures 6.75 units in a U100 syringe.
     
    Last edited: Apr 29, 2020
    Reason for edit: Clarify dosing so no one is confused.
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  43. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    I'm sorry I am not an expert on giving advice on dosing , for dome reason I can't see your spreadsheet, wishing you all the best
     
  44. Shelley & Jess

    Shelley & Jess Member

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    Thanks Diane. I was worried Goeril may have needed some guidance or advice and wanted more eyes on it.
    (I'm no expert on dosing or have experience giving advice either - I just try to point in the right direction)
     
  45. Deb & Wink

    Deb & Wink Well-Known Member

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    He's "Bouncing" Goeril. Which means his body is trying to keep him safe by releasing hormones and stored sugars from the liver and pancreas to keep Panter at a safer number. That will often cause the BG levels to increase quite a bit, later in the cycle, and early the next cycle. Those "bounces" can last anywhere from 1 to 6 dosing cycles and can keep the BG numbers higher throughout the 12 hour cycle.

    Here is a good explanation of bouncing, from another post:
    "Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

    Yes, yes it can make that much of a difference in the blood glucose levels.

    Something seems to have "clicked", to have made a difference, in Panter's body, to make the insulin cause these lower numbers at mid-cycle. I've got the feeling that Panter has been low before this, and you simply have not seen that, because you did not test at the time, to see those lows. It's not feasible to test all the time, but a few more tests has helped you see that Panter has been dropping low and needs a reduction is his insulin dose.

    In fact, you may want to set an alarm and test Panter during his PM cycle, around the +6 to +7 time frame. He may go really low again.

    I'm thinking that Panter will need another dose reduction, very soon.

    The higher carb food, to bring his BG levels back up, also contributed to the higher BG levels. Both yesterday AM and PM, and again this morning.
    Panter's mom does not have the tab with the SS as the first tab in the spreadsheet. You have to go to the right, and select the correct tab for the SS. Goeril, it would be helpful if you could move the SS tabs over to the left side of the SS. Drag the US tab to the left, and it should move for you. Then drag the World tab where you are entering the data so that tab is directly to the right of the US tab.

    Would you also update your User Id "Signature", to correct the insulin you are giving now? It still says Insulatard, and you are using Prozinc. A short comment in the Signature, that you use U100 syringes would be helpful also.

    So "Prozinc with U100 syringes" or something similar.
     
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  46. Panters-mom

    Panters-mom Member

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    Thanks Deb. I updated the signature and tried to fix the spreadsheet. Please let me know if it didn't work. Up in 21.7 at pm (more exact +13), (as you know he doesn't use the litter box.) You are probably right that he is bouncing. I decreased the insulin to 6.75 tonight.

    But I don't understand, when he was on 7.5 (3.0) for about 10 days, he was pretty steady moderately high - purple on the +12 and yellow on nadir - but yes, he did have some higher red numbers once in the while at am. So what is going on at night that causing this bouncing? If he eats mice, as I know he does the BG should go up or what? And he is eating his night meals every 4 hour...
    And then - with an increase to 7.75 (3.1) he is doing this big dive, bouncing from purple to green...? And this is in the daytime - and I know what he eats and does at this time of day... I'm very confused now... But I will try to get his BG at around +6-7 at pm.

    Thanks again Deb, and everybody, for helping. :)
     
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  47. Deb & Wink

    Deb & Wink Well-Known Member

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    Signature looks better, but it should be Prozinc. Prozac is an anxiety medication or used for depression, and I don't think you meant to say that.

    SS tabs are where we expect them. Thanks for doing that.
    There is one more minor SS change, on the US tab, at the very very top in the pale orange colored box. It still says Insulatard. Please change that to say Prozinc and the date you changed, just like you have on the World SS tab. Thank you.

    But you don't want his BG levels to be that high. You want the BG levels to be down in the the lower ranges, in the blue and green ranges at mid-cycle. The pre-shot BG levels are the last of the BG numbers to come down to more normal numbers. So they will likely be pink, red and yellow for some time.

    Panter is very active at night, as he is wandering around catching those mice. More activity needs more energy so it uses up more glucose. So he may start the PM cycle in the higher BG numbers, but then probably drops low, and he bounces in the morning, back up to the red, pink and yellow ranges.

    So, what is different about the last 2 AM cycles? More active? Weather has been bad and he hasn't been going outside to hunt? Eating less food?
     
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  48. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Well thanks - I guess I will save that one for another time... Fixed! :)

    Well, yes - the weather has been bad the last two-three days, heavy rain, and he has stayed much inside less active, but in general he is always less active in the daytime - difference with nice days is that he has his outdoor sleeping spots... He has been eating regularly. He eats about every 4-5 hour, and eats the whole bag - and the leftovers from his brother... And no other changes...
     
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  49. Panters-mom

    Panters-mom Member

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    PM BG numbers after reduction to 6.75 (2.7) last night: 7.4 +5, 8 +6, 10.8 +7. Little strange that it is this low at +5... And yes - he is very active at night! I kept him inside this three hours - and he was going nuts. Changing from trying to dig through his cat door to sitting next to my bed shouting... He ate at insulin time, then a mouse at +1 (that he dragged in to show me, or he tried to trade...), out again, came back to eat at +5 - I testet BG before he ate, gave him one bag regular low carb wet food, tested +6, he got a small treat l/c wet food, then tested +7 and he got 1/2 a bag again. To add, we are on a delayed schedule after a few 'no show up at time'. So our +5 last night was at peak hunting time at 2.30. With other words, very active.
     
    Last edited: Apr 30, 2020
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  50. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Puhh...to have an wild outdoor cat with diabetes is a bit complicated I have to admit... now he probably is annoyed with me as I kept him inside - he really goes bananas, so he doesn't want to come home...so insulin time has past...and more delays... I'm out there calling for him, and I honestly believe he hears me, but ignores me...
     
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  51. JanetNJ

    JanetNJ Well-Known Member

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    Make sure the neighbors know not to give him any dry foods. They might see a cat running around and think they are helping by feeding him. Does he wear a collar?
     
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  52. Panters-mom

    Panters-mom Member

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    Well, there he comes... at +14.5 and 22.9... more delay... I gave him the reduced amount 6.75 (2.7).
    How long should I keep him on the reduced one do you think?

    And today I'm a bit pessimistic I guess... with these delays... that means that we ending up medicating at night...can't do this in the long run... what do we do then?... Like now, maybe it would be better to not give him and wait for his pm shot, but then again, we will never have curve to 'trust'.... yes many thoughts...
     
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  53. Panters-mom

    Panters-mom Member

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    Yes he has a collar. And the neighbours know - at least the closest ones. Matter of fact, Panter belonged with one of them earlier.
     
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  54. Shelley & Jess

    Shelley & Jess Member

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    Good job getting those tests in last night!
     
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  55. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    I'd keep him on the reduced dose until Deb can have a look. She thought yesterday that he might be due (earn) another reduction very soon.

    It looks like he's bouncing again and you need to give the new dose a few cycles & a chance to settle in.

    Hold that reduced dose for now unless he earns another reduction - then you immediately reduce the dose the next cycle by .25 units (U100 .625u)
    Any time Panter drops below 5 mmol/L (90 mg/dL), the dose needs to be reduced.
     
    Last edited: Apr 30, 2020
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  56. Panters-mom

    Panters-mom Member

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    New numbers today - yellow on nadir at +5 to +7 and up in purple at +10. I will give him 6.75 (2.7) tonight as well.
     
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  57. Panters-mom

    Panters-mom Member

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    A bit frustrating - I'm mom to a two-legged too - and my sweet two-legged just let Panter out through the patio door just now... after I closed the cat door to make sure he gets his pm shot... Things doesn't work very well right now...
     
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  58. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    Oh dear! Betcha Panters happy though (even if mom's not):(

    We back on to a bush and let ours out too. Every chance they get - out the door they go! My civie Seger brought me the mouse this morning he's been stalking all week. (It wasn't pretty):woot:
     
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  59. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Yes, you and we knew this could get complicated with Panter, the mighty hunter. Especially now, there are probably lots more mice and voles around for him to eat. Plus frogs, salamanders, birds and lots of other prey that gets his hunting instincts going strong.
    Life happens. Young children don't understand that cats need medicine and testing sometimes.
    Hold the dose for several more cycles. As Shelley said, looks like Panter is bouncing, so hold the dose steady for now. Until he earns another reduction by going below 5 mmol/L(90 mg/dL).

    Goeril, skip a shot to get yourself back to a normal dosing schedule. Since you have gotten so far off schedule, I'd suggest you skip a dose the next time that Panter doesn't come to you for several hours.

    If you have a bag of dry treats you can maybe shake, so Panter comes to associate that sound with your calling him to come back inside to eat? Or some other sound you can make, so he comes running. I do that with my cat, make a kiss-kiss type sound and call her name, when it's time for her meals.

    Yes, the 6.75U U100 dose (2.7U U40 dose) looks good for now.

    Maybe @Panic has some ideas on how to get Panter to come to you, since she also has a diabetic cat that goes outside.
     
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  60. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    Hi Goeril :)

    Sounds like Panter is a lot like my younger cats haha. I've had indoor-outdoor cats for years, some that will do anything to come inside and others that will do anything to get out. About two years ago we bought a new mobile home and put it on our current property; the cats were understandably freaked out and 4 out of 6 of them refused to come in at all. Panic was one of them that never wanted to come inside until she got sick and diagnosed with diabetes. I sort of used her rampant hunger as a way to convince her to come inside more since inside = food.

    At this point, I've now successfully convinced all 6 of the cats to want to come in again and it's basically just letting them in to eat and not "trapping" them inside after. If they decided to chill a few minutes great, otherwise I let them back out. In Panic's case, I do not feed her outside hardly at all, mainly just because the other cats eat higher carb food so I feed them outside and her inside. I imagine she strongly associates the house with food/treats. She also interestingly, after 10 years, no longer associates the shaking of dry food with meal time, so she ignores it when I shake food for the others. I also have bought her little catnip mice toys and every once in a while she indulges herself into a little playtime.

    I make a point to know where Panic is most of the time as well. We have a couple acres of land with lots of hide-y places. Her current fad is inside the old boat in the backyard, but recently has been switching to the carport out front since it's cooler. Sometimes she stays under the back porch. Since I test and feed often, I come outside a lot to call her and I find she's usually near the door waiting on me to let her in for another snack.

    As long as you can convince Panter to come when called I wouldn't worry too much about keeping him in, especially if he doesn't like it. If possible, sometimes I just test outside wherever Panic is at rather than dragging her inside. I really don't struggle to find her at all, I just need to already know her hiding spots. There have been just a couple times where I was a few minutes late with a shot because she was out, but it was only because it was raining outside and I'm sure you know how difficult it is to convince a cat to come out in the rain. :woot:

    Also noticed that Panter wears a collar - I had a very cute collar customized for me from Etsy with Panic's info and DIABETIC written on the collar itself. I bought some medical warning tags originally but figured she wouldn't appreciate them dangling on her haha.
     
  61. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Thank you Deb, Shelly and Elisabeth - thank you for all the encouragement and you made me smile/laugh! That felt good!:) I'm so glad you understand. And yes, Panic sounds like Panter! He even has the same hiding spots:) - unfortunately he has the bigger forest as well (he was basically more or less living in the forest his first 7 years until he came to us) as well as maybe the most difficult one - and of course his favoritt - under the roof where we can´t get hold of him. That's the place he will lay and sleep and ignore me - if he is not hungry though:) I know this because suddenly he pops out of there stretching and purring and like 'I've heard nothing'- after me calling him for an hour or two..:) But like you say, the problem comes when I lock him in - like to test in his nadir time or something - and absolutely worse - at night time - he goes nuts... So I'm hoping we will find his insulin level - as the matter of fact is that - so far - when he feel free, he even comes on time, sometimes he just comes like a clock... but again, soon as he feels some things up and that he might be locked in... nope - don't like that...
    I'm thinking, could it be better to keep him a bit high, like in yellow/top blue in nadir time - then its not this big panic of him dropping too low and all the close monitoring that is then needed - what's your thoughts about this?

    As we speak he just bumped down from the roof...

    Another one - as mentioned, we are far of schedule - the insulin time today is 1 o'clock and pretty hopeless. Should I just skip this one today and than start a new one at 7 as before? (as you mention Deb). And if I should catch up on time, will one hour at the time be too much - if the BG is around 17-21 as it normally is at +11?

    Have a great day you all! :)
     
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  62. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Also, can I ask, what feeding schedule do you use? Panter eats about six times a day - more than 600g of wet food. He was very skinny, no I will say a bit less than normal. The idea of often feeding is to make him come home often - and it has worked very good - well up to now... And he would likely be more and more outdoors as it gets warmer - so should I feed him more less times.... just some thoughts in process...:)
     
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  63. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    I skipped the am shot and I'm starting over at 7 pm. Thinking - I will try to give him a 85g bag/box at +12 after shooting, then a big meal 150g just before nadir closing in +5 - the idea is that he will have some food in his stomach when nadir 'kicks in'), then put out a snack 50g daytime (maybe 100g at night as he is more active) +8, maybe even from +7 (6/7 is the nadir) ...but not too much food here though, then he want show up for his shots... Does this sound like an idea?
     
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  64. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    I totally agree with this. I think you did the right thing.

    You have to take care of yourself so you can take care of Panter and your family.

    Looking after yourself is just as IMPORTANT too.
     
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  65. Shelley & Jess

    Shelley & Jess Member

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    Jan 23, 2020
    I can't offer any suggestions about feeding and/or feeding times. My diabetic kitty was diagnosed as 'likely' IBD (definite sensitive stomach issues) and I feed smaller more frequent meals.

    I'm sure others will chime in about feeding suggestions & I'll be keeping an eye out for any updates on You & Panter. :)
     
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  66. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    I love cats but sometimes I have to scowl at them when I know they've been purposefully ignoring me LOL.
    We are surrounded by woods as well (we may have a couple acres but most of it is still covered in pine trees!) but luckily the cats don't go past the tree line often, unless they've spotted a rodent of course!
    I'd recommend either making that "under the roof" spot accessible to yourself (ladder perhaps?) so you can pop up there to say hello/offer treats or if not, blockade it. Do take some extra time to go out often and say hello and leave him be, he may start associating you with food more.

    I've mainly based Panic's feeding schedule off her onset/nadir, so she gets mini meals at +2, +4, and +5, both daytime and nighttime. She gets snacks of chicken or cheese at test time usually, and I usually end up giving her small bites of her wet food after nadir if she asks. She was eating probably double of what she eats now at first, but she was down to 4 lbs at the time.

    Does Panter get fed inside/outside/both? Does he have any high value treats he really loves?

    I'd say the tricky thing about insulin is you can't always gauge where to keep him BG-wise ... a perfect dose can suddenly nosedive into hypoglycemia for no reason, and you alternately wouldn't want him running too high. It's very inconvenient. I will say that when we were still using Prozinc there were days where I couldn't monitor at all and Panic would throw a lower-than-average number, I'd either lower the dose for the day or skip entirely.
     
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  67. Panters-mom

    Panters-mom Member

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    Yes, been thinking about this...probably a good idea!

    Always inside. Always same routine. First up on the table. Wrap a towel just lightly around his neck, fast BG test, dry his eyes that runs, cuddle and look for tics - and he loves it :cat: - so he jumps up at the table by himself. Then food. He is actually amazing - except from the few times (but probably will be more) when he doesn't show up.

    Tonight at pm shot he was 20.5 and that was +18 - thats a change - I thought he would be higher. That's positive right? :)
     
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  68. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Hi Goeril,

    Good to hear you skipped a shot, to get yourself back on schedule and back to your normal sleeping and awake times.

    Ideally, you don't really want Panter's nadir BG to be above renal threshold, where excess glucose is dumped into the urine. That can result in frequent UTI's (urinary tract infections) but more importantly there will be slow but steady damage to his other organs.

    Plus, our diabetic cats rarely cooperate on keeping their BG levels up at nadir. If only they would be so accommodating!:)

    So somewhere above 180-250 mg/dL ( 10-13.8 mmol/L) is too high, above renal threshold for most cats. Each cat is different, and they do not have the same renal threshold. But it takes time to get cats BG's down lower. So don't worry too much about that at this point in time.

    I think you have to let Panter be Panter. And not worry too much about his BG levels and what might happen one day in the future. Panter is being a typical cat, and you have to go along with what he is doing.

    If he feels trapped, when you try to keep him inside, you'll simply have to let him indulge his wanderlust tendencies. So sometimes you don't get those tests. So sometimes his BG might drop lower at mid-cycle than is ideal. Many cats will naturally seek out food, when they feel their bodies blood glucose drop lower. Panter may come home for a bite to eat when that happens. Panter is too much of a free spirit to keep confined, especially now that late spring is here and summer is just around the corner. Let him wander to his heart's content, and love him when he comes home for those "pick the ticks off" sessions.

    You'll probably get off schedule with the shots again. But now you know what to do next time.

    Your plan sounds reasonable Goeril.

    You know he is going to catch more mice, and dine out at his favorite restaurant on his catches. You do what is possible for you and Panter, not some idealized feeding schedule, such as feeding only every 12 hours, that many vets suggest. I fed Wink 4 times a day, 2 breakfasts, 2 dinners, but he was strictly an indoor cat.

    I haven't had a diabetic cat in 3+ years, since Wink died. So no suggestions from me on changes to your suggested feeding schedule.
     
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  69. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Got it! I treated my CKD ill cat for three years. That was hard, though amazing what you adopt to. But I don't hope to do that again...

    Yes, I think you're right. I'm thinking, I will give him the best possible life the years he has left and that means I will have to give him his freedom and space to be in his chosen environment - the outdoors - with the extras of having a family to come home to. Then he is happy.:cat:

    Yes, probably. Thanks for all the advises. Very valuable. Feels less stressful now.

    To mention, today has worked good. He has been on schedule and hanging around, BG okay, and life is good!;)

    Thanks again!! Have a great evening - night time here.
     
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  70. Panters-mom

    Panters-mom Member

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    Jan 15, 2020
    Panter is showing up for his shots in good spirit. But two mornings he has been very low 10.7 at +12 and 6.4 at +10 - that probably means far too low at nadir... He also hasn't been eating his night food the last three nights - that is two meals he is missing - can look like this is a new habit for the time. Was thinking - could it be an idea to lower his insulin only at night? I did reduced the insulin tiny bit this morning... but only from 2.7 to 2.6 (6.75 to 6.5 100u syringe).
     
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  71. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Goeril, This is one of those "almost impossible to tell" what Panter is doing at nadir. But you are probably right.

    His not eating food at night would most likely cause the BG numbers to be lower in the morning. Since there isn't food to keep the BG levels up higher.

    If you look back at Panter's SS, you can see when he dropped into the blues and yellows at pre-shots, he drops much lower at nadir.

    I think I'd shave or reduce Panter's dose down even a bit more. Down by a full 0.25U (U40 measurement) instead of only the tiny adjustments you make. So from 2.7 down to 2.4 (6.75U to 6U in the U100 syringe). Recommend this mainly because of his change in appetite. Same dose both cycles, AM and PM. Insulins like consistency.

    Dose yesterday AM and PM cycle was what? 09/05/2020 in your date format. Nothing on the SS for dose. If you skipped the dose, please enter 0 in the units column.

    p.s. Please start a new thread, and link this only one at the top for history and continuity. This one has gotten very, very long.
     
    Last edited: May 10, 2020
    Reason for edit: p.s.
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