Rusty #2 PMPS 116...stalling...help?

[SantaCruzSPCA]

We have lowered him to 4 units but his nadir is seemingly coming near the end of his cycle. We are stalling for 20 minutes and will check again. If he is going down we will most likely need to skip his shot tonight, if he is going up...what number is safe to shoot? 200? We are on a sort of modified SLGS regimine.

@Wendy&Neko if you're around

 

[SantaCruzSPCA]

We have lowered him to 4 units but his nadir is seemingly coming near the end of his cycle. We are stalling for 20 minutes and will check again. If he is going down we will most likely need to skip his shot tonight, if he is going up...what number is safe to shoot? 200? We are on a sort of modified SLGS regimine.

@Wendy&Neko if you're around

20 min later he dropped to 101. Unfortunately staff can't stick around and I can't go back in so we are skipping the shot tonight. Any thoughts on my dosing tomorrow? Stay at 4? Go down to 3.75, 3.5?

 

[DebG]

I am not sure what to do so hopefully @Wendy&Neko or someone will be able to advise. Too bad Rusty can't go home at night so he can be monitored and that might bring his numbers down instead of them spiking and dropping.

 

[SantaCruzSPCA]

I am not sure what to do so hopefully @Wendy&Neko or someone will be able to advise. Too bad Rusty can't go home at night so he can be monitored and that might bring his numbers down instead of them spiking and dropping.

I know. I struggle with wanting to take him home but he would have to be in a crate and it may stress him out. Plus he would have to go back and forth to work with me since I'd need to monitor him during the day too. Here at the shelter he basically has his own room! I'm doing my best to find him a foster but it's a bit of a hard sell unfortunately. I need an angel to come along.

 

[Wendy&Neko]

Sorry I wasn't around. I hate skipping with the recent history of DKA, but I can see you had no choice. A blue number is shootable, but maybe not when he's going down so fast. So we have to try to find a dose you can keep shooting both cycles. This is where the switch to wet food is having a big impact. I would try 3.5 units next. My reasoning for the decrease is that he got down to 101 on the AT, even with the skip disrupting the depot two nights ago. I'd rather he run a bit higher (if he does) and go up if the dose is too low, than skip again.

Looks like it's been a while since a ketones test. I would make that a priority tomorrow.

 

[SantaCruzSPCA]

Sorry I wasn't around. I hate skipping with the recent history of DKA, but I can see you had no choice. A blue number is shootable, but maybe not when he's going down so fast. So we have to try to find a dose you can keep shooting both cycles. This is where the switch to wet food is having a big impact. I would try 3.5 units next. My reasoning for the decrease is that he got down to 101 on the AT, even with the skip disrupting the depot two nights ago. I'd rather he run a bit higher (if he does) and go up if the dose is too low, than skip again.

Looks like it's been a while since a ketones test. I would make that a priority tomorrow.

Thanks for being so patient with my situation. I wish it were better I will definitely get a ketone test tomorrow. I asked them to get one over the weekend but apparently it was an extremely busy one. Staff reported him to be acting normal and his appetite has been very good. I feel like the bounces are not lasting as long and I'm seeing fewer red and blacks. Maybe it means we are getting closer to the right dose? I'll start the 3.5 tomorrow and hopefully stay in the shootable pre shot numbers. I really appreciate your input and feel a little more equipt for the these situations because of it.

So, with depot insulin, if you don't shoot for a cycle, does the cat still recieve some insulin that's been stored in their fat cells from previous doses?

 

[Ella & Rusty & Stu(GA)]

So, with depot insulin, if you don't shoot for a cycle, does the cat will still recieve some excess insulin that's been stored in their fat cells from previous doses?

It can help to keep the keel more even, but every cat reacts differently. Keep in mind that some of the insulin in the shot you give after a skip will have to go into replenishing the depot. Therefore all of the insulin in that shot will not be working on the blood glucose. It's a tricky balancing act!
I agree with Wendy: take his dose down to 3.5 and see what happens.
You are doing so well in difficult circumstances. Hang in there!

 

[Wendy&Neko]

Ella brings up a good point, sometimes the impact of a skipped (or reduced) dose is seen in later cycles.

I agree that he does seem to be getting over bounces faster. Switching to wet food will ultimately help him, we just need to make sure he's safe. You guys are doing a great job. I once worked part time at a shelter and there is no way they could have looked after a diabetic as well as you guys do. For one thing, there wasn't anyone there a full 12 hours to get two shots a day in, much less testing regularly. And yes, I know how it can be a lot busier on the weekends.