? Tonight's dose - falling numbers after stalling. Advice please!

So Alfie is trying a new trick tonight! His PMPS was 18.1 so I stalled without food for 20 mins and now he's at 17.3. I did his first test at what was really +11:45 and the retest was 5 mins past shot time. So I could wait another 20mins and retest? (Poor Alfie's ears!)

What should I do with his shot? Whole dose or reduced dose? If reduced, reduce to what? The other night he hit 3.9 from a 20 PMPS so I don't want to tip him over the edge!

 

Stalled another 20mins, now at 16.9 so still falling.

I've had to feed him now as he's starving bless him. I'm inclined to either do 1U or no shot?

But equally, he's making good progress so I don't want to mess it up by changing dose too much!

 

Not sure with your insulin. Abd feel uncomfortable giving dosing advise. But you fed him lc or mc? Test 20 mins.

 

I've just fed him his normal LC

 

Where are you in his cycle? +1 +2+3? Is he carb sensitive? Do you have karo or honey in case you need it?

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)Test again in 15 – 20 min. Depending on the numbers, give more HC food.Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.Test in an hour and follow the same steps. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours.
This was for Lantus/ Levemir insulins.

 

He might or might not go as low on a PS of 17-18 as he did the other night. My guess is he won't because he's still bouncing. I think I'd keep the same dose and test at +2. If that worries you, go to 3 u.

 

I don't get the conversion because I'm in the US. But that seems like a high enough number. Your just concerned with him going down to fast? Do you know his Nadir value? Prozinc is a fast in and out insulin. I don't use it so hoping some others more pro eyes will see your post.

 

Ty Kris. I was tripping over my own feet.

 

I'm at the start of his PM cycle. He's not low, just lower than his usual PM pre shot. I'm in the UK so I'm using mmol/L measurements.

 

That's ok, thanks for your replies!

Yes, was concerned he'd go too low after a low nadir the other evening on a higher preshot.

I've gone with a reduced dose of 1.5U as didn't want to wait too far past normal shot time, better too high than too low! Guess we'll see how this cycle goes.

Thank you

 

When you have a bouncy, unpredictable kitty you can't assume that a PS that came before an uncomfortable low on one occasion will result in the same the next time. You just have to make a reasonable decision and be prepared to test at the critical times and intervene with food if needed.

 

Yes always better high than low! your welcome just didn't want you to think you were alone. hope he stays surfing safely. head bumps from phoebe

 

Your peace of mind ranks up there with Alfie's safety.

 

Do you have some neosporin for his ears?

 

Polysporin in UK I believe.

 

I didn't want to get too far past normal shot time so just had to make a call! Wish I'd been braver now, live and learn! Typically it's a night when aim low on test strips, picking up more in the morning. Wasn't expecting to have to do three PMPS tests!

For next time, how long can I wait past his normal shot time and still shoot?

 

No, but I use arnica cream that seems to help. I'll only do one mid test tonight to give them a rest!

 

We usually say up to an hour. Any longer than that and the interval to next shot gets too short and you'd have to move its time as well then slowly back up both times to your regular schedule.

 

Great, thank you! I'll be braver next time with the lower than I'm used to pre shot numbers. And more patient if I need advice! Every day is a school day on this journey!

This board is such a lifeline, I honestly don't know how people manage without it

 

Ok, I assumed he'd be riding high after a reduced shot and have just tested at +3.5, he's at 3.5!!!

He's eating pate food now. He's really hungry! I haven't had a chance to double check the test in case it's a faulty strip.

I've got no idea what's going on if that's accurate.

 

Just verified with a retest, he's at 3.7

He seems fine, very hungry! Have given him a small amount of food in gravy so he's very happy!

Will test again in 20 mins

 

Oh Alfie! . Can you retest, Jen? To make sure it's not a wonky strip.

 

I've done two tests, the first was 3.5, the second 3.7, so I don't think it's a wonky strip. He's eaten loads of food and has just run upstairs to play!

I've given him a little bit of food in gravy as he's still two hours away from his nadir!

 

Whoops cross posted . Couldn't type fast enough because Maury decided to lay on my left wrist in front of the keyboard and right hand has to go over his tummy
Proof:

 

Ha ha, oh what a sweetheart!

 

Ok hopefully he didn't eat too much to fill up on. He's probably OK but we still don't want him going much lower since you're using the AT2 . Hopefully you can catch him and retest in thee 20 minutes

 

Hold off on giving him anymore food. In case he drops more, you're going to need him to be willing to keep eating.

 

Ok, will do.

 

Good thing you gave a reduced dose tonight! We call that mama instinct!

 

Just retested and he's at 5.8 so food has obviously kicked in, phew. How long should I wait before another test?

 

Conventional wisdom is that you retest every 20 minutes, withholding food. If it goes down, you give food, if it goes up, you keep retesting until you have three rising numbers in a row.

However, you are still a ways from nadir, and it sounds like he just ate a bunch, so you could probably test in 30 minutes and re-post. Then we can figure out what to do from there. I'm thinking you might want to test every hour until nadir, or until the rise looks really solid without additional food.

Do you have a lot of test strips? Is your DH around to help?

 

Yup food is working. I would still retest in 20 - 30 minutes and don't feed him anymore HC right now. Let's see if next test he'll start rising on his own. Is he at +4 now? He should be closer to nadir, seems like PM is around +6.

 

I just re-read that, and I think I didn't explain it very well!

Short answer, test in 20-30 minutes and post.

 

yes, he's at +4:15 now. Will retest at +4:30.

Fortunately DH went to pick up strips from the vet hospital as I was flapping! So we've got plenty. Hopefully the food will keep him up for a bit. His nadir always seems to be +6 so we're not too far away.

 

Never a dull moment with bouncy Alfie!

 

I did give him a spot on flea treatment tonight, I've no idea if that's had anything to do with his numbers or if that's just coincidence. The vets said I could keep treating him monthly as normal without any issues.

 

Do you mean flea treatment?

 

My goodness!! He sure surprised us! I think you're getting to his good dose range but it's happening quickly and he throws in some bounces just to make it interesting. You did the right thing by lowering his dose.

 

Yes, I did, that makes much more sense! I've corrected it now!

 

Yes, so now what to do going forward? The 3u dose wasn't enough. This feels like a smidge too much. Fat 3u? Skinny 3.25u? Or was the 3u the breakthrough and it wasn't enough two days ago, but will be plenty now? Ah for that crystal ball....

 

Looks like I did, but totally by accident! A few hours ago I was beating myself up for probably giving him another high cycle. It's exhausting!

 

Or is this some weird flea medicine reaction and tomorrow will be back to normal?

 

Jen, no need to ever beat yourself up during this process! It's always a bit of a guessing game, and we never know if we did the right thing until after.

 

Yes, that was my next question! What happens tomorrow. All you amazing people are fast asleep when I'm doing my AMPS

 

What time is your AMPS?

 

Just retested, +4:30, he's at 7.6 so on his way up. He ate a lot, he was starving! I thought it was because he'd be super high, oops

Retest in 30 mins or do you think I can leave it an hour? He's fast asleep like he's had a big dinner!!

 

6am UK time. Though he didn't get his PM shot tonight until 6:40pm because I stalled him twice, so might do AM at 6:30am tomorrow. I've been looking for an excuse to move it a bit later!

 

So something like this so far, yes?

+3.5 = 3.5
+4? = 5.8
+4.5 = 7.6

He's blue now, so if it was me, I'd probably wait 45min to an hour, but I'd of course keep an eye on him, and test earlier if curiosity or worry got the better of me.

The lime greens do tend to wear them out! Hopefully the nap will do him some good!

 

Yes, sorry, lots of numbers tonight that are hard to record in the spreadsheet. Tonight we've had:

AMPS. - 18.1
AMPS + 20min stall. - 17.3
AMPS + 2nd 20 min stall. - 16.9

1.5U shot

+ 3.5 - 3.5 and 3.7 (Immediately fed both HC & normal LC food)
+ 4 - 5.8
+ 4.5 - 7.6

I did think it was odd his pre shots were falling. Maybe it is an odd reaction to the flea treatment.

 

Wow! I missed the PJ party I guess!

 

The PSs can also fall is a bounce is clearing.

 

He is faaaast asleep (why he's sleeping in the corner of our guest room, who knows!). At least he's not in the kitchen begging for food for once!

I'll retest in 15 mins which will be +5.5. If he's up again do you think I'm safe to go to bed or should stay up anothe hour to be sure?

And any advice in advance for tomorrow morning? I can't be around to monitor so would rather play it safe. But he's generally been higher in the mornings so I'm usually less worried, but after this evening, who knows!

I guess it depends on his AMPS, if he's in the 30's then 3.25U will probably be fine.

 

Just fashionably late .

The only one that might be on is Djamila. 06:00 UK time would be 22:00 PST / 01:00 EST until Daylight savings.

 

After this lime green tonight, I might suggest lowering to 2.75U in the morning (numbers permitting) since he may be a little insulin sensitive and you won't be around. Let's see what the others think

 

Just so you can all see who you've been helping!

This is him tonight, it used to be a pretty standard position for him until he was diagnosed and just wanted food all the time!

 

He looks very relaxed.

 

Re tomorrow AM: it's hard to know because he went to lime green with only 1.5 u. Yong has suggested 2.75 u. His lows are at night so this could work as a daytime dose.

 

Ok, so just retested at +5.5, he's at 14.9, so I think I'm fairly safe to go to bed!

Things I've learnt tonight:

- High carb food straight away at the first sight of lime green numbers might be a slight over reaction

- The food in gravy we've got in the house really works to get his numbers up!

- Flea treatment might have some weird magical blood sugar lowering properties (but probably not)

- I can't assume what any cycle will do at the minute and just have to play it by ear!

- We can get through an almost hypo event with the help of all you lovely people!

Thank you all so much for all your help. I'm off to bed and hope I sleep as soundly as Alfie bear is doing right now! I will update you all tomorrow. Night night

 

That looks like one sleepy kitty!

There are a couple of theories on the cycle after a hypo.
1. reduce the dose right away to the last safe dose. (3u)
2. reduce the dose more than the last safe dose because he may be insulin sensitive (as Yong said) (2.75u)
3. hold the higher dose for one more cycle since it will most likely be a high flat cycle, and then reduce for the cycle after that (3.25u for the next cycle, 3.0u for the cycle after that)

Now here's the really lousy part. We don't know which option is best. It's one of those things where you kind of have to try one and see how your kitty responds and then know for next time. Although of course since they are cats, next time might be different. But it at least gives you an idea.

If you can't monitor tomorrow, then I'd lean toward option 2 and reduce the dose for the next cycle. It may leave him a bit high tomorrow, but it's the safest option.

Of course all of that is dependent on him giving you a normal or higher pre-shot in the morning. If it's lower, you're going to have to really use your best judgement and definitely give a much reduced dose, like one unit.

Sleep well!

 

I agree with the idea of reducing the dose since you can't monitor. Until you know what your kitty is likely to do, it's probably the safest option.

 

Yes, I agree. Assuming I get a normal (20's or 30's) preshot I'll give him 2.75u just in case he's more sensitive after tonight. If it's lower than usual I'll go with 1u. I can monitor more closely tomorrow night so we'll just have to see what he decides to do tomorrow! Thanks again all!

 

AMPS 40.2 Neg ketones

Gave 2.75u. I figure if he's in for a black cycle then no amount of insulin will help, and if he does respond then that will get him out of the very high numbers without us worrying too much while at work today! Will test at +2 to see how he's doing.

Might go back to 3u tonight if he has a normal PMPS.

 

Not unexpected after his low lime green He's very bouncy so the drama is Alfie being Alfie. It's important with very bouncy kitties to pay more attention to how low they go and give only a nod to the high bounce numbers. Your dose shouldn't change immediately in reaction to a high bounce BG. Let it run at the "normal" dose for a few cycles to see where you land when the bounce clears (usually - but not always - in up to 6 cycles).

 

Yes, I knew he'd be bouncing quite high after yesterday's adventure. He'd come down at +2 though and I've managed to come home this afternoon and have tested again at +8 and he's a little bit lower still.

Understood, I won't do any dramatic dose changes in response to bounces. But have we decided that 3.25 is possibly a bit too much? Should I go back to 2.75 or 3u as the 'normal' dose for a few cycles and see what happens? Assuming I get a normal preshot number of course.

Can they just become more responsive to insulin once they've seen better numbers for a while?

 

I think Alfie's just going to be tricky for a bit here. If you look around at lots of different spreadsheets, you'll see that kitties go up the dosing scale for awhile, and then they slide down, and then sometimes they go back up, and then slide down again...rinse and repeat. Or sometimes they just slide down and go into remission. That's what we all hope for, but sometimes just getting regulated is hard enough!

So this is the trial-and-error phase when you're going to have to just try some things, and monitor, and some will work and some won't. I think I'd go with either 2.75 or 3 for tonight - leaning toward 2.75 since he nearly reached 50% today. Then maybe consider doing a slightly different AM and PM dose. So maybe 3u AM and 2.75uPM Or 3.25 for the AM cycle and 3u for the evening cycle and see what that does. He's still way way too high during the day, but those evening cycles are a little stress-inducing.

Curious what everyone else will say, since again, this is kind of a guessing game.

 

Oh...yay! I was afraid you were going to say that!

I'm thinking I should back off to 2.75 for tonight too (providing he gives me a pre shot in the mid 20's or above) and just see what happens. I've not idea why his day and night cycles are so different, I know some kitties run lower at night but he's quite extreme! Though when he started on Prozinc he was the other way around for a little bit. Go figure!

 

Lol...they have to keep it interesting for us, right? Kitties loooove attention!

Sam spent a lot of time with different AM/PM doses. He mostly runs lower at night, but there was a phase in the middle where he was lower during the day. Alfie's might be caused also by the lows at night, and just having a high-flat cycle as a response to the big drops. It's sort of a safety mechanism for them since the low makes them release stored glucose (or so I've read) which causes the next cycle to run higher. I keep thinking he's going to get a low AM cycle one of these days, but then the dose keeps needing to be adjusted. Sigh...all in good time, right?

 

Oh yeah, wouldn't be any fun if they made it too easy for us!

Sam's numbers look great, I'd be super happy with all blues and greens right now! Wanna swap?

 

Lol...I'll keep his numbers, but he's having terrible diarrhea today, so that I will gladly trade!

 

Oh poor Sam, luckily that's one thing Alfie doesn't suffer from. I used to have a cat with terrible digestive problems, it's hard work!

 

PMPS 30.2

He was super playful and energetic just before his test, I was convinced it would be unusually low.

Sticking with 2.75u so he can try and settle down again for a few cycles without a repeat of last night so we can get some sleep!

Increasing his morning dose slightly to 3u, as @Djamila suggested, does seem like a good move, since his morning numbers are still so high. What do you all think?

Or, as suggested, maybe his high mornings are just caused by his low nights at the minute, and we'll just end up flipping him round to low mornings and high nights!

 

Sounds good to me