PMPS 179 - dosing question. Need to shoot in 30 minutes.

Hi, Well Timmy was high this morning at 404 at AMPS. Now PMPS is 179. Do I skip his dose tonight? I don't know what dose would be safe for him now.

 

You'll get better help soon. Has he eaten? Is this unusual for him? What would his "average" numbers be?

 

Stall without feeding and retest in 20 minutes. If necessary, stall for another 20 minutes up to a total of 60 minutes if needed. If he gets above 200 you could try 1 u and test again at +2.

 

He has not eaten for two hours. He hasn't had blue numbers at shot time very often. He was high this a.m. so I posted and got help. Now I'm posting because he is too low. Ugh.

 

I suggested 1 u based on what I see on your SS. I don't think 0.5 u is enough if he goes above 200. If 1 u worries you, eyeball 0.75 u on your syringe.

 

Okay, I will test again in about 20 minutes. Just was rereading the earlier post from today to get a better handle on the night doses.

 

@MrWorfMen's Mom @Larry and Kitties. ETA was the test done 12 hours from his shot? If so, stall for 30 minutes retest and if it's under 200 do not shoot. 1 unit even .5 unit could cause him to go too low. Better high for a day than too low for a second.

 

Test now is 215. So 1 unit or .75 unit is safe to give him now?

 

Has it been a full 12 hours?

 

Yes. Give what you're comfortable with. Feed, wait 20-30 min as per our recommendation for Vetsulin and then give the dose. Test again at +2 to see what he's doing.

 

Test of 215 was stalling for 20 minutes. Shots are 12 hours apart with no eating 2 hours prior.

 

He drops pretty fast and can go low. I have been on this board for awhile and I am not comfortable giving you dosing advice at this low of number.

 

If you feel the least bit uncomfortable giving insulin at a PS of 215, don't. Or try 0.5 u. Please post what you decide to do.

 

With the 20% variance we could be looking at 170's or 255. If you want to give him anything I'd go .25.

 

I am not understanding his numbers. How could 20 minutes ago he be in the blues and questioning dosing and then now yellows, without food.

 

You gave 0.5 u on an PMPS of 244 on 01/28 and he was fine. You have other examples of giving 0.5 u on numbers in the 230s and he was in yellow or pink at +2 or +3.

 

This happens because the AM dose of insulin has worn off and the BG is beginning to rise on its own. That's the reason for the stall technique. It helps you see where you are in the waning of the dose. The thinking is that by the time you've fed and waited 20-30 minutes there's no more of the AM dose left and the BG is rising because he's a diabetic with no more insulin in him and also there's food on board.

I'm sorry if the different dosing advice you're getting is confusing you. Ultimately it's up to you. If he was my cat I'd be giving him insulin this evening.

 

Thank you for the explanation. It really helps. I have collected a good amount of info on Timmy, but I am not sure how to read it. That, and my brain gets stuck because he is my fur baby and I am afraid I will do something wrong. I will be giving him a shot tonight though. I just tested him and he is 235. DH says 1.0 unit. Yes?

 

Please make sure you test at +3 and possibly +5. ETA keep us updated

 

Is that 235 after another 20 minute stall? If so, he's definitely on the rise and should be fine with 1 u. I'd test again at +2 to see if he's heading down too soon/quickly. You can steer with food if that happens.

The only way to get the BGs down into blues and greens is to push the dosing envelope a bit when it's safe to do so. You only have one green so far on your SS so I don't think he'll dive really low.

 

You're also adding a new situation to your data log, something you can refer to in future. I truly understand your worry about Timmy.

 

When you add the BG and dose to your SS for this evening, make sure you put in the BG he was at after all the stalling, not the low one that brought you here. If you like, you can put that number in the +11 cell.

 

Yes, that was after another 20 minute stall. He just ate so I'll wait about 10 minutes and give him the 1 unit. I will definitely be testing him at +2. Thank you for your help today on both posts. I am learning a lot and I appreciate it so much.

 

You're welcome! Your +2 for me will be midnight so I won't be at my computer. If you need help steering with food at +2 and beyond you can post a new thread with the question mark icon in its title (icon is in the drop down menu to the left of the thread title bar). If he's dropping far too fast and it's scaring you you can use the 911 icon to get attention fast. I don't expect that will happen though.

 

I just checked your SS and I see that he was at 274 two and a half hours after his shot. Whew! I'm glad he didn't nosedive. I was quite confident that he wouldn't but you never know with kitties ...

Learning how to give doses when you're using an in-and-out insulin like Vetsulin is tricky because there are no rules that say if BG is x then give y or if BG drops to a certain number, reduce by a certain amount. So much depends on your own kitty's responses. I recall there was discussion on your other thread of sliding scale dosing versus consistent dosing. My opinion is that sliding scale dosing is a good approach to try once you've stuck to consistent dosing for a while and need to tweak your method to get better results. Some cats do well with it while others like consistency.

Your SS shows that you've varied the dose at different PSs when it might have been better to hold the dose or you've changed it too much in response to a different AM vs PMPS. It's tricky to know when to change the dose and by how much, especially early in the FD game when you're new to it and kitty's body is still adjusting.

Here are some ideas for your consideration:

• try a "not too high/not too low" dose for the next 3 days and keep it unless a dive in BG warrants a change. I suggest 1.5 u. You gave this dose many times on a pink PS and never on a yellow but 1 u last night on a yellow PS didn't send him diving. If 1.5 u makes you nervous on a yellow PS, try 1.25 u. If he's pink at AMPS, definitely try 1.5 u.
• some of the erratic BG behaviour is probably due to Timmy bouncing with the up/down dosing that's happened
• if he's a bouncy kitty - and I think he might be - calming everything down by minimizing changes should help.

I hope this helps. It's very confusing in the early days. It takes a lot of data accumulation and a bit of (safe) experimenting to learn your kitty's responses and you can ask for help any time.

 

Just saw tag this morning. Glad to see you got some great help last night.

I have to admit, I am not a big fan of sliding scale dosing in the early days of treatment. As Kris mentioned, some of what you are seeing is likely bouncing. Switching up doses frequently based on pre-shot alone obscures exactly how any particular dose is working for kitty and can make it more difficult to bring kitty down to more normal numbers at a slow and steady rate. Dosing really should be based on both pre-shot and nadir readings. The fact that you are getting more lower PMPS after 2u AM doses suggests to me that the 2u dose may be a tad too high.

I'm with Kris about minimizing dose changes. I'd be inclined to try 1.5u to 1.75u at both AM and PM doses for a period of 3 days, pre-shot and nadir readings permitting and see if that will smooth Timmy out so you have 2 shootable pre-shots without having to stall or decrease dose. It will take up to 3 days for any bouncing to clear, and then the dose can be re-evaluated.

Once you get kitty more regulated and understand how he reacts to any given dose, using a sliding scale may very well work for you but until you get more data, I think it's just confusing the big picture.

 

I does help...a lot. Thank you so much. We got through last night without any issues. Thank goodness! He is high this am, but I guess that is to be expected. I will go ahead and lower the dose to 1.5 units for both shots for 3 days and go from there. Giving the 1 unit last night without it causing an issue gives me more confidence, although guarded, to keep that PM dose constant.

 

Susan, as long as you get pre-shot numbers of 200 or more and aim for a nadir (lowest cycle reading) of no less than 90 to 100 right now, Timmy will be fine. If nadir drops lower than 90 or pre-shots are lower, it might be necessary to re-evaluate the dose. I'm suggesting 90 as low goal just to give you an extra cushion to avoid having readings drop too low until you get Timmy figured out.

 

Okay. Those numbers help so much. It gives us parameters for now. Thank you.