? Vacation dose advice?

Hi, all--

I'm going to be leaving tomorrow morning and returning Tuesday evening, which will mean being absent for 6 shots. My petsitter has given injections in the past, but she has never done testing. She's coming over tonight to learn; I have no idea whether it's going to be possible for her to do them (I don't know how he'll behave for someone other than us).

I am not sure what to make of his numbers recently. He goes so high in the mornings and then is comparatively low at PMPS. His current dose (only on it for a few days) appears to be getting us some greens, finally. But I'm not sure I want the sitter to try to measure something that's not a half/whole unit, and I don't want to do anything hazardous if it turns out that he won't let her test.

I was thinking .5 might be a relatively safe (but not pointless) dose for the times we're gone. What would you all advise? I hope that everyone is having a good day!

 

Hi Vicki, hope the lesson on testing goes well tonight and she will be able to test him for you. I am with you on keeping a dose on a line like a half. You could shoot 0.5 tonight and let the depot start to drain. ( actually today AM would have been a good time to start draining the depot for the vacation dose but, you shot all ready.

Assuming that your sitter is able to test him, have a NO Shoot number discussed with her. And make sure she understands how to steer him up if needed.

 

OK! I have detailed instructions about steering and hypos for her. I was thinking about using 150 as the no-shoot number; what do you think?

 

I think that is a good number. When you get a chance, can you fill in you SS for today so others that want to weigh in can have a better idea of what is happening in today's cycle.

 

Unfortunately there's not going to be much data until tonight--I'm at work (and had to leave early because it's my Special Hell Week), and my husband is probably not testing. I'd like the sitter to actually test him, so we should have something around 6 for sure, and then I can do more tests tonight...

 

OK, I have a little more data in the spreadsheet. I'll start the lowered dose tonight. The sitter seems more worried about her ability to catch him than her ability to do the test.

If she can't do the injections for whatever reason, how awful is it for him to miss 6 shots? Is it "avoid that at all costs; he MUST get the injections," or "it would really be good to get them if possible; it's worth trying hard," or "it's not great to miss them, but it's not critical"?

Does the small amount of new data change anything? I greatly appreciate the advice!

 

Your last post here: http://www.felinediabetes.com/FDMB/...anagement-plan-skipped-evening-thanks.182307/

Can you remind me why you went up to 0.75 units? Misha got to the 50's on 0.5 units, which didn't leave much for an increase, so that might be cutting it close as a vacation dose.

 

Well, we did the .5 for 10 days, and his nadirs generally appeared to be in the mid-100s--I don't know what was up with that one day where he went low, and since it only happened once, I thought maybe I had given him a little too much. I thought I was supposed to be aiming for nadirs in the low-100s, or the normal range, with the TR protocol. But I may once again have been wrong. I had difficulty understanding this part:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

I interpreted that as "hold the dose for 3-5 days if the nadirs are less than 200, and then after that, go ahead and increase the dose by .25 unit." I didn't see a "if the nadirs are in the 100s, do [whatever]," so I thought that if he wasn't headed down much after holding, I was supposed to go up.

When I was having trouble with interpreting things, I once again went to Tilly's page and read this:
"Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days."

Editing because I inadvertently hit return...the next part I thought applied was "When the cat first begins to have daily nadirs in the normal range of a healthy cat (50 to 80 mg/dl) and spends significant amounts of time in this range each day, stop increasing the dose and switch to Phase 3. " Since he wasn't having daily nadirs in that range/spending time there, I thought I should be increasing the dose.

Is that not the right interpretation? How do you decide whether to increase a dose? How long should I have left him on .5 before concluding that he needed a little bump?

 

I missed that 53 on a .50 dose on 8/11. Wendy has a really good point of 0.5 possibly being too much. Maybe .25 units which I realize you don't want to have something not on the lines. You could use tea or colored water and make a sample syringe for you sitter to see what .25 looks like.

It is optimum for Misha to get insulin twice a day. A skipped shot here and there won't be a huge issue but, I am afraid you wouldn't want 6 skipped shots.

Could you close all the bedroom doors so that getting under the bed and hiding would be eliminated?


I agree that the protocol as written is confusing. We are aiming for green nadirs. When we get one, we hold it and allow for any bouncing to clear ( which could be as much as 3 days or 6 cycles).

 

If it seems at all dangerous for him to be getting .5, I would think the best course would be to just skip these shots. That would certainly be less distressing for him, since the sitter wouldn't have to drag him out for testing and shots. (And it would be less distressing for her as well, and I wouldn't be worried as much, though I hate the thought of losing progress and having him spend a lot of time in the 200s.)

 

Oh, sorry, just saw that. I can ask her to aim even lower than the .5; she'll be willing to try that, and she's not new to caring for diabetic kitties, so I trust her to be really careful.

 

I'm blockading all the hiding places I can think of and will actually close the door to the bedroom, but he is super-stealthy and might manage to find a place behind furniture from which he would have to be hauled. I think he'll let her do that; his usual response to being afraid and not being able to run is to curl up in a ball and shake. It's very sad

I guess I just really don't have a good sense of what is the lesser of the two evils: risking a dose that's a little too high (especially when testing is not 100% guaranteed to be possible) vs. letting his numbers go high while we're away. We were gone earlier in the month and he was in the 200's when we got back--he actually ended up having some greens right after that. That was four missed shots. I don't know why he went back up again after those greens...

 

Basically I don't have a good enough understanding of all of this. I'm sorry. I've asked my somewhat-savvier-with-numbers husband to read everything here and have a look at the spreadsheets, and he's going to graph them, but he hasn't yet had a chance.

 

I think after this, I will not be budging from town until we have him in a good place--either OTJ again, or on a very consistent, predictable dose that's keeping him well regulated...though I suppose nothing remains predictable forever. Stupid eclipse, coming at a lousy time for both work and kitty care.

 

I think you'd be really sorry at the havoc it would do to his numbers and you would lose momentum and reining him back in won't be easy. Also, since this is his second rodeo on insulin, each time gets harder to get them back into remission. If it were me, I would go with the .25 dose and keep him nice and safe. Is your sitter going to be able to do any other test other than pre shots? If not, I'd go with the .25

Leaving them in the care of someone else and all the worries that go along with it are hard on us. I can relate. I was supposed to take my mom and go to the OUter Banks the end of September but, now with Bubba back on the juice....... I don't know if I can.

 

She can't do additional tests, unfortunately; she's super busy this weekend (because apparently tons of people from here are traveling for the same reason we are). So the .25 is better than nothing? And the .5 seems hazardous?

If we go with .25, do you think the testing is still important? Twice a day? Or could she get by with less, if she's having a hard time getting him to cooperate? This is the first time anyone but me or my husband has tested him, and I just don't feel 100% confident in predicting that she'll manage it every time, though I know she will try hard.

This is making me want to just skip the trip and stay home, but that would really upset my husband. The health of my kitties is the most important thing to me, but I don't want to start feeling completely trapped (well, ok, I guess I don't care that much if I am, for a while, but the husband thing is an issue).

I do hope you're able to take your mom to the Outer Banks--it's so beautiful there, and late September should be very pleasant, weather-wise!

 

I guess I'm going to go ahead with the plan of trying to get a test before each shot and aiming for .25 rather than .5, with 150 as the no-shoot number. I'll leave a syringe with colored water and revise the little video I made for her showing the process.

When I get back...how will I know when (or if) it's time to increase the dose? Would I just hold him at .5 indefinitely even if he rarely goes below 100 and is often in the 200's--would he then just gradually decrease over time? I think I get the "lower the dose if X happens" part of things now--I hope so. But I don't get the "raise the dose if Y happens" part.

Thank you all for your help. This is so hard. I feel like I'm going to be letting someone down no matter what I do.

 

It's time for his shot right now--I guess I'll do .25? Or should I do one more instance of .5? @Bobbie And Bubba, @Wendy&Neko , what do you think?

 

Well, he's resolved that for the moment by fleeing in terror to an as-yet-unblockaded location when someone knocked on the door--a spot where I totally can't reach him. Having the petsitter come by to learn about testing freaked the poor guy out.

 

I would reduce to .25 tonight so that the depot can start draining and you won't have to be so nervous about him going too low while you are gone.

 

I so get it, Bubba is easily spooked too.

 

OK--thanks--hopefully he comes out soon. I may have to try tuna.

 

When you get back, return immediately to his pre vacation dose.

Just in case the petsitter cannot test, but can shoot 0.25 is much safer. It is much more dangerous to be low for a short period of time than higher while you are gone. You want to be able to relax while you are gone.

 

OK--I think the .25 is definitely the way to go, then!

Do you think the pre-vacation dose should've been .75. or .5? I'm not sure now how to decide when/whether to raise a dose--if I go to .5 and he doesn't seem to be improving, how do I know when to go up? Sorry for asking so many questions...

 

I would go back to 0.5 units, hold for six cycles, then evaluate what to do next. You can always post here if unsure.