What does today look like to you?

Hi. I am trying to learn to understand what is going on with Mia's numbers, but this gets so frustrating. Yesterday was her first day staying between yellow and green. Today, we started out that way but her PMPS was back in the red! I did not get to test her at +5 /+6 this morning. I did +4 where she was higher than I expected by that point in the cycle and +8 where she was lower than I expected at that point. So, I am thinking maybe she got low enough between those two that it caused her to 'bounce' up a bit to the higher number at PMPS. This is what it looked like a couple of days ago too. Is that what you think? Am I looking at this correctly?

I also found it odd that she stayed 122 for +4 and +6 yesterday after the PM shot. I was thinking maybe that was good though, hovering at the same level for a longer period than normal. Is it?

I will be doing a curve in the next day or two, so there will be more data, but I wanted to seek your thoughts on this. Thank you.

 

Wow! Yeah that looks like a bounce to me. That's pretty late to have a green in the cycle, so I'd assume she was low in the middle of the cycle and that PMPS is a bounce response.

Yep, staying in safe, healing numbers like last night is a good thing! It gives her pancreas time to rest and heal, which is what we're going for!

 

Nice greens = big bounce!

 

Thank you for confirming. I wish she was not such a bouncy girl.

 

Have you ever looked at Teasel's or Chuck's SS?

 

@Rachel @Kris & Teasel @Yong If any of you are on.. help! Mia's PMPS is 168. What in the world? Vet's previous instructions were to still shoot the full dose. She said if it was low to be sure to feed her some before giving the shot but to go ahead. But, I'm scared. On 7/30, I shot 2 u on 198 and her numbers actually rose afterwards. Your thoughts, please??

 

Blues are great but scary as a PS. You can stall 20 minutes without food and retest. If she's rising you can give a full dose. This stalling can be repeated in 20 minute increments up to an hour. No food though. If you don't have the time you can lower the dose - maybe try 2 u? The third option is no shot but it's better is she gets some insulin.

 

I waited 15 mins and retested, BUT she had some shredded chicken breast. It was 207. I went ahead and shot the full 2.5, but I will be checking her.

I specifically talked to the vet about a 'no shoot' number. I told her everything I have read says not to shoot if its 200. She told me to feed her (opposite of the stall and wait method) then go ahead and shoot the full dose. She wants me to keep the dosing the same and not change it up. I 'fired' the first vet because she did not seem to know anything, and I was not comfortable with her recommendations, but this one seems better so far. This issue of shooting on a low number worries me though. Maybe she does not know it is okay to vary the doses with ProZinc??

 

Vets tend to follow a simpler set of dosing guidelines. The recommendations you'll find here have been learned by many people with many cats over many years. Generally, keeping the same dose AM and PM is a good way to do it, numbers permitting. The main priority here is to keep kitties safe and that's why we'll recommend stalling or reducing the dose or not giving a shot at all. As time goes on and you feel more confident in your knowledge of Mia's responses you'll be able to make these decisions for yourself more comfortably.

 

The reason we say to withhold food when stalling is because we don't want to administer insulin on a food influenced number. Hence, why we say no food 2 hours prior to any PS test. Looks like Mia is doing OK with the full dose given at 207. Make sure to change your SS to reflect you gave her 2.5U on the 207 and put the 168 note in the note section.

She might be clearing the bounce from greens . If she continues to give significantly lower PS's after previous, she may need a tiny reduction to try and even them out.

 

I understand, but the vet wants me to still give the full dose, so she told me to make sure she eats before I do it just so the rise caused by the food will start prior to the shot kicking in. I retested so I could at least know that some type of rise was starting, but since the plan was to give the shot anyway, I did not want to withhold food. I think that once things start to make a little more sense and I get more experienced/comfortable, I may buck those instructions, but for now, I am trying to give them a chance and see.

Done. Thanks. I had done it backwards.

 

ProZinc is slower in onset than some other in and out insulins so you have a little leeway time-wise for her to come up on her own. I know you want to follow your vet's instructions closely right now. That doesn't preclude stalling and retesting to see if she's going up. If her BG is too low, though, I'd post here before shooting.

 

It's tough when a vet tells you something and a bunch of "crazy cat ladies" on the internet say something else, I know. I do agree with your vet and Kris that you want to keep the dose consistent if you can. We always say to feed before shooting since you want the food to help soften the insulin drop.

What do you think about the stall and retest option? It might help you to feel better too since you'll be able to see that she's rising. That way, you're still following your vet's instructions, but just being sure that the number is rising when the number is a bit lower than you'd like.

 

I am fine with it. I guess next time I get a number under 200, I will try that.

 

I am doing a curve today. The starting number was clearly a 'rebound' high from the low yesterday evening. The PMPS test will be about an hour and a half from now. I have a feeling, this is going to be one of those cases where the number is in the 200s. If it is, I will do as suggested and stall and test again in 20 minutes. Let's say I stall a time or two and her numbers are still in the 200s (even if rising slightly), would your recommendation be to then shoot a lower dose? I have really been good about following the vet's instructions about staying at the prescribed dose, but this is just getting stupid. I can see that when I shoot that much on a lower number it usually (but not always, which adds to my confusion) ends up sending her low then bouncing her high. So, I am considering giving a lower dose this evening. I would then continue the curve into the PM (it's not like I have had even one good nights sleep since all this started anyway) to show the results (and possibly get data to prove to the vet that the lower does was a wise choice). Could you please give me your thoughts on dosing.. say she is in the 220s, should I drop to 2 u or down as far as 1.5? Thanks in advance for any guidance you can give to help me decide the best course of action.

 

Here's what I see/think:

• 2.5 u is a bit too high because it gave you a 68 (almost a lime green) on Aug 22 and a lime green last night
• dropping low like that causes more extreme bouncing because she's dropping to a nadir that's less than 50% of the PSs - a nadir of around 50% is a good rule of thumb
• one way of getting her a bit more settled is to reduce the dose a bit - maybe try eyeballing 2.25 u?
• shooting different doses depending on the PS can be done but it's best to wait until she's more settled. Until then it can add to the erratic numbers.
• if she's 200 or higher I'd try 2.25 u
• if she's just below 200 try the stall with no food and retest technique. Give the full dose if she's rising and be prepared to monitor. A +2 test is often useful.
• if she's well below 200 but had a shootable PS 12 hours before, that's a sign the dose is a bit too high. Don't shoot and reduce the dose slightly for the next cycle. The goal is to have a shootable PS both AM and PM.

The above are only general guidelines. I wouldn't be comfortable doing what your vet wants. I think you have to adjust the dose if the data is showing numbers that are too low.

 

Thank you @Kris & Teasel

 

PMPS 233 - gave 2.25 u

 

+2 = 276
+4 = 347
Rising post shot.

 

No problem - bouncing from the blues today.

 

This morning's AMPS was 113 (yikes). I stalled and re-tested in 20 mins, and it was 141. I stalled and re-tested in another 20 mins, and it was 186. I went ahead with the full 2.25u and will monitor.
This is a wee bit stressful.

 

In a case like this you might want a +1 and a +2 this AM. The most learning takes place at times like this.

 

We are up to 480 this morning. Last night was the first time that I did not do any mid-cycle tests. Mia and I needed a rest, and her PMPS was high enough that I sure was not concerned about her going to low.

If things do not start to look better, I guess this dose is not correct either. May have to throw in the towel on the ProZinc.

 

She's bouncing from those blues. It's OK to take time off from testing when her numbers are higher. She might do better on Lantus. My guy bounced a lot on ProZinc and is still a bouncer on Lantus but it's less dramatic overall.

 

@Kris & Teasel Mia's AMPS was 119. I waited 30 mins (no food) and re-tested, and it is 137. I plan to retest after another 30 mins without food, and if she is still rising at all, give the full dose. Do you agree with that? I am scared of causing another bounce if I give too much, or having her go high again anyway if I do not.

 

My guess is she'll still be some distance away from 200 after another stall. I agree that she should get some insulin. Two choices:

1. feed her, wait about 45 minutes, retest and give the full 2.25 u dose if she's well above 200 (I did this successfully with Teasel when he was on ProZinc and have suggested it to others who found it worked)
2. give a token dose of maybe 30% to 50% of the usual.

 

After another 30 mins, it was 196. For better or worse, I went with 2u.

 

I had just decided to go ahead and make a call since we were at a few mins past an hour of normal shot time. I appreciate your note though. I pull this thread up and look at the things you have said when trying to figure out what to do. So, I will add those thoughts to the mix for next time.

 

i think lowering the doses is going to calm some of that bouncing. wayyyy too much up and down.

 

Amen.. tell me about it!

 

She'll be OK. You'll get some data on the 2 u dose and you made the call on your own. It's stressful to do that at first but you'll be an old hand in no time.

 

oOoO looks like you might get to work down the scale again

 

She is 67 at +5. I have given her a few kibbles of Hill's m/d dry. So help me understand, please. Does this indicate that I gave her too much this morning or?

 

It was too much for that low of a preshot, yes. So now you know next time its around 200 give a little less.

 

Lots of learning happening! It's the only way to sharpen your FD skills.

 

Okay, it's me, the annoying student, back again. Mia's PMPS was 424. I gave her 2u rather than going back up to 2.25, even though the number was high. Grade me - was that the correct thing to do? Or, let me phrase it this way, is that what you would have done? First inclination with the higher number is to give the larger dose, but if the higher number is the result of a bounce caused from the previous dose being too high I was not sure that giving the higher dose was a good idea. I know that once a bounce is triggered, her numbers will be screwy for a bit anyway.

 

I would say the high preshot is a bounce from that 67 green that you had earlier today. Give her a day or two to see if the numbers settle in.

 

I feel sure it is, but what I am wondering is if I made the right call on the dose amount. Should the high number that is the result of a bounce be dosed high or lower since I know it is a bounce?

 

After a lime green like you had mid cycle a dose increase is not what you'd want to do. She's bouncing off that low. With ProZinc you look at both PSs as well as nadir to evaluate a dose. When a cat is bouncy it's best to give more weight to the nadir - as I learned with my bouncer. She'll be a bit more insulin sensitive after the lows so you might want to grab at least one evening test.

 

So, was giving 2 (.25 lower than dose she has been on but same dose I gave this morning) be the right way to go or should I have gone even lower? I am so sorry to ask so many questions, but I want to grasp the concepts of this so I can get to where I feel like I know (at least to a reasonable degree) what I am doing. Thank you!

 

You *could have* gone down to 1.75 u after that lime green but she should be OK with 2 u, especially because the bounce will keep her elevated for a bit. What I've learned in this FD marathon is that the best way to increase your dosing expertise is to try something reasonable and assess the effect. We've all made boo boos but you learn from those - not saying that's what giving 2 u is! As you log a lot of data and carry out many, many, many "I'll try this" exercises you get to the point where your instincts are stronger and your confidence is greater. We're always here to help but there's no substitute for making your own decisions once you have some experience under your belt. There are a few (long-ish term) people on FDMB who don't trust themselves to figure out a dose and then they panic if no one is online to tell them what to do. Not ideal ...

 

Yes, I have noticed that and wondered about it. I hope I will not fall in that category. I have been trying to follow the vet's instructions to keep the dose steady regardless of the numbers up until now, but that just does not make sense, so I am going rogue. So, this is extremely fresh for me, and the whole bouncy thing complicates it, so I am just trying to get some thoughts on the concepts so that I have enough info to even attempt to make the decisions. I consider this a good resource but have also read everything I can find both on this site and otherwise. Just trying to piece it all together. Getting your feedback after I have made the call at least gives me some guidance on what to do next time if what I chose to do this time did not go so well. Thanks again!

 

Kris is right that the best way to know if it's the "right" thing to do is try it, collect the data, and then reflect on how it went. I put a lot of extra notes on my spreadsheet so I can remember what I was thinking with different dosing decisions and it helps with the next one. Some people say to lower right away after a low number, other people say to wait a cycle or two and then lower the dose if it's a kitty who tends to go high for a cycle after a low number. It looks like Mia may fall into that category. So now that you have some data, it shows that you could have stuck with the 2.25u for the PM cycle last night. No way to know that until afterwards though, but it can help you next time it happens.

Complicating things even more, this cycle she went high after a low, but just a few days ago, she went low, and then still had a lovely curve on the next cycle. Especially since she's rather bouncy, it's going to be harder to predict. So as far as grading you, I would give you an A because you made a reasonable decision, and then you collected some data on it's impact. That's the best any of us can do in this journey. So well done!

Your vet is right that the steadier you can hold the dose, the better (understanding that sometimes you have no choice but to make a sudden change). And while the general recommendation around here is that you can change the dose every 3-6 cycles, with a bouncy kitty I've seen people get better results by holding the dose a bit longer between changes - like a week or even more - to give the cat time to settle at the dose before making any changes. And also to make only very small changes at a time instead of a full 0.25u change. You may want to consider switching to U-100 syringes and using the conversion chart so you can make teeny shifts that will hopefully cause less dramatic swings in numbers.

You're doing great! Learning to trust yourself is important, but it's always okay to ask lots of questions!

 

I just really do not know I am doing. So, yesterday, I thought I was at least going to make it through a day without seeing any red, then 'boom' red at PM +2. Bummer! For the last three shots in a row, the first test afterwards (+2 or +3) was a higher number than pre-shot. I think it has been three days since she went low, so I do not see how this is really bouncing. Any insights would be appreciated.

 

The red from yesterday looks like a food spike to me. She went lower after that, so it's nothing to worry about. That +2 number for most people is usually a food spike. Really, it wasn't THAT much higher than the PMPS and with the variance...I think you could call it effectively the same number.

To me it still looks like bouncing. That +8 last night was a lot lower than her preshot number, and it could have caused some bouncing. Today has been high and completely flat...which is classic after a bounce. Remember, going low doesn't have to mean going SUPER low...it can just be lower than the cat is used to. With a drop of over 200 points (and who knows...maybe she went even lower before or after that +8) I think a bounce is expected.

 

Ok, all of that makes sense. I am at a loss over the correct way to work things out. If every time her number drops we go through the bounce and its aftermath again, it does not seem that we will ever make progress - not sure what progress would even look like.

 

Mia has been in the blue for 24 hours! (With one green.) I want to have a moment of celebration before the good streak ends.