What dose for what #'s?

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Meridith and Zeke, May 27, 2017.

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  1. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    I have just started monitoring Zeke. I am really confused on what dosing for what #'s and when to not give a dose. Any and all help on this will be much appreciated!
     
  2. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Kudos for home testing Zeke! Just peeked at Zeke's SS and I think the dose needs to be lowered! On the 25th Zeke's BG was 69 at +6 on a dose of 2.5u. With fast acting Novolin, I would try to keep Zeke's BG from dropping below 90 so you allow some wiggle room to deal with low BG numbers. Right now I think Zeke is coming out of a bounce and wonder just how low he might have gone last night on the dose of 3u with a pre-shot of 124. I would not recommend using a sliding scale until you get more data to see exactly how Zeke is reacting. Does Zeke have any history of DKA? If not, based on the drops you are seeing, I would drop the dose back to 2u and hold it there for at least 6 cycles providing that your pre-shot readings are high enough (300 or higher) and your mid cycle tests are not taking BG below 90. If pre-shot is lower than 300, post for assistance. I'd test at +3 post shot to see where Zeke is heading and then you can use food to steer him if he is dropping quickly.
     
  3. JanetNJ

    JanetNJ Well-Known Member

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    When you were first diagnosed did the vet start at 1? I agree your dose is too high.

    If Zeke were my cat I would start over from scratch. I'd do a few days at 1 or 2 units and see what happens. If it is not enough I would raise it by no more than half a unit at a time.
     
  4. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    No history of DKA. He was diagnosed after a drastic weight loss over 1 1/2 weeks time. So drop to 2u? And by cycles, is a cycle a day or 12 hours? I can test at +3 tonight but during the day tomorrow I will probably be out of town and my daughter can't test by herself since he still isn't liking it so well. We have also started a small meal around peak time during the day because having problems getting him to eat enough. How will that affect his #'s and insulin during the day?

    @JanetNJ
    The vet started us a 1u. We were on that a couple weeks then he raised us 1/2u a week until we were at 2 1/2u last week and the new vet said to go to 3u.
     
  5. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Meridith, the problem with vet numbers is that they are often if not usually elevated due to stress. Our felines generally get pretty worked up at vet appts. Good to know the dose was increased gradually although we usually adjust doses by 0.25u rather than 0.5u when increasing or decreasing as small changes can cause big changes in BG and it's quite possible to skip over the ideal dose even with half unit adjustments.

    Yes I'd drop the dose to 2u or if you prefer take it back to 1u although I don't think you need to go back that far unless readings indicate it in the next cycle or two. A cycle would be 12 hours....each day has 2 cycles.

    I would probably drop the dose tomorrow morning to 1u if your daughter cannot test on her own just to be on the safe side and you really haven't honed in on the ideal safe dose for Zeke yet. We all have lives and sometimes we have to compromise to meet both our and our kitty's needs.

    The meal early in the cycle, before peak action is reached, provides more food for the insulin to work with and slows the drop down so there is less of a dramatic drop all of a sudden which can cause a bounce. It's something that you can experiment with a bit timing wise now that you are testing because your goal is to keep Zeke in the best numbers possible for as long as possible in each cycle without having him drop too low.
     
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  6. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    I think we will do the 2u. Zeke was actually eating better when he was at that dose. He was eating 2 1/2 cans of FF 2 times a day when raised to 2.5u and he decided he wanted to only eat 1 can a meal. We have him eating about 1/2 to 2/3 a can of friskies for dinner and breakfast and the mid meal we are trying 1/2 a can. Also trying different flavors to see if we can find one he likes a lot.
     
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  7. AlphaCat

    AlphaCat Member

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    Wow, just checked out your spreadsheet. (I know we were talking food the other day, lol.)
    Your numbers are way lower than mine.
    (Again, I'm pretty new to this too.)

    I find it helps to nose around and peak at other people's spreadsheet. (Not to emulate their dosing, but to better understand.)
    I know you recently started home testing. There was a learning benefit for me to do the curve with my Fabby.
    The every 2 hours got her more of the salmon treats and more incentive to put up with my testing and learning...
    It also showed me the cycle she is supposed to go on with our insulin. (Vetsulin is a fast acting one like your Novolin.)
    So perhaps if you can get in a curve this weekend?
    For my cat she tested at 450 at diagnosis. She's been about there at AMPS with fluctuations +/- 100 roughly.
    Our big goal is remission.
    We'll settle for well managed.
    But out short term is just stability...
    Remission to me means her body goes back to managing her glucose correctly and she doesn't need insulin anymore, though she will always stay on low carb now.
    Well managed means insulin dependant, but that our numbers stay consistent and I don't have to test 4x a day. (Just 2x before insulin).
    Stable means consistency in numbers and hopefully trending downward.
    Right now Fabby seems to be bouncing. I'm getting really low numbers then really high numbers.
    I'm happy when the numbers are blue on the spreadsheet. The optimum goal is to stay around 120.
    Other key numbers I remember are:
    below 60 = hypo need food/sugar immediately.
    Below 200 = do not give insulin. (Skip dose)
    High numbers can be worked with, low numbers = attention necessary immediately.

    Check out my spreadsheet just for info. Then check out the spreadsheet of others (and make sure to see a couple that are in remission like JanetNJ's cat).

    For comparison I'm only on 1.25 units 2x a day, and my numbers are way higher than yours. (Considering changing to 1.5 soon... The jury is still out.)
    And you're already double what I am in insulin.

    Also, I think it's a real good idea you get more food in Zeke at the nadir time especially if he's dropping into the 60's. (Like we discussed on your other thread.) But, personally I'd be worried about the nadir that happens when you're sleeping.
    I saw on your spreadsheet that you don't always dose 3 units at night. It seems like that would be a good indicator that 3 units is too high in general... But I'm new. That's not fact or experience speaking, just gut talking... So listen to these other folks on that portion as they have the experience.
     
  8. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @AlphaCat
    Yeah, we are lowering the dose and I will probably see if we can do a curve on Monday or Tuesday. He is still fighting us on testing so I don't want to stress him too much. I'm hoping his appetite will pick up with the lower dosing.
     
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  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Those extreme drops in BG may very well be making Zeke feel unwell. Our extra sweet furkids get used to being at elevated numbers and then think something is wrong when they hit even normal numbers initially so if we can slowly but steadily ease them back to more normal numbers, I think it's not only easier on kitty but also on us, their caregivers.;) On the other hand, appetite is quite often a sign of how well BG is being controlled but both high and low BG will often cause them to be ravenous. Has Zeke been on Friskies since he started insulin or is that a more recent change?
     
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  10. AlphaCat

    AlphaCat Member

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    I'm able to keep my treats in my glucose kit. Fabby associates the glucose kit with treats and extra petting. My curve within the first week of testing helped the association stick. Since I feed her after every test now I don't always treat anymore, but her association is still there so if I pick up the kit she comes running.
    Perhaps you can keep treats in your kit and do some fake outs... (Don't actually test, but break out the kit, give extra love and treat.) I always try to massage her ears for a minute before I poke them. Both to simulate the blood flow and to have her not angry with me every time I touch her ears. (Because the association is good and pain.)
    After my curve and with me testing 4x a day her ears were getting a little rough. I got the Neosporin + pain relief and I use that on both ears each time I test (Even though I only poke one ear.) It's helped so much! There's no more swelling, and she's not griping at me as much during the process.
    Good luck on your potential curves!
     
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  11. AlphaCat

    AlphaCat Member

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    Side note: @MrWorfMen's Mom - you have a glorious spreadsheet!
    I hope mine begins to look like yours eventually! All those yellows and blues - and all while lowering your insulin!
    You're amazing!
     
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  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    You should see last years. The colour scheme was quite different. My girl was gulping 16u of insulin twice daily due to IAA a secondary condition which makes her a high dose kitty! She just recently decided wet food was edible and I am still trying to find her ideal dose given her new appropriate diet but we'll get there. :D:rolleyes:
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    Sounds like a good plan.
     
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  14. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    The move to friskies is more recent. We were feeding one of the higher carb FF's since we were never told on that, just to feed FF. The change to friskies was mainly on trying to find a food he would eat and that is what we were feeding our other two and although he was eating his, he always seemed to want theirs more. As we have learned more on the foods, we are also working on getting them all to eating better carb ones though they hate pate. Not every time but most times they are all eating the flaked with tuna and tuna with egg. Which seems to be mostly pate.
    Slowly lowering the numbers does make sense. It is amazing how little vets tell u and how wrong much of the info is that they do.

    @AlphaCat
    What we have started doing is having either his treat (even when we are about to feed) or his meal ready to give him immediately after. Will also try giving him a treat without testing to see if that helps him associate it with good.
     
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  15. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Even a change in the % of carbs between higher carb FF and the lower choices will make a difference. I can tell the minute my girl pilfers a tiny bit extra food or worse yet gets into the kibble her younger brother gets periodically as a treat now. In the past, a drop of 7% in carbs in her dry food didn't seem to make any difference at all. Admittedly I am dealing with a fairly rare secondary condition but it suggests to me that carb sensitivity can not only be different for each cat but possibly also for different food types in my world.
     
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  16. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    I'm hoping I can find that balance for Zeke soon. We have been at this for almost 6 weeks now and I feel like we are really just now getting started. I know we really need to stay below 10% carb, but what is a safe give when it comes to giving him food that he will eat?
     
  17. Yong

    Yong Well-Known Member

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    Just to help you feel better, I'm going on Month 6 and still working on the balance :bighug:
     
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  18. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @Yong
    Wow, so this could be awhile lol
     
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  19. AlphaCat

    AlphaCat Member

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    Not helpful... lol.
    (Kidding... mostly)
     
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  20. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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  21. Yong

    Yong Well-Known Member

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    Sorry if I'm losing track of which thread but I think MrWorfsMom was suggesting dropping back to 2.0U for a bit?
     
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  22. JanetNJ

    JanetNJ Well-Known Member

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    if you can't decide cut the difference.... 2.25
     
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  23. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @Yong
    She also said to post if over 300 before dosing and he is so close to that number wanted to ask before dosing.
     
  24. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Correction, she said post if lower. Too easy to get confused, that mean I should do only 1.5u to keep him from dropping too low?
     
  25. JanetNJ

    JanetNJ Well-Known Member

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    At 269 2.5 got her down to 69.... Not hypo but low. If you are awake and want to steer you could do that again. I'm more inclined to recommend 2-2.25 so you have more of a buffer.

    If you are feeling like being more conservative the go with 2.
     
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  26. JanetNJ

    JanetNJ Well-Known Member

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    What do you think? Ultimately it's your decision.
     
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  27. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Thank you @JanetNJ. After dosing him too high last night because of confusion, want to make sure I'm getting things straightened in my head first. Much rather be cautious then send him into hypo like I almost did last night.
     
  28. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    I am going to go with 2u and then test at +3.
     
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  29. JanetNJ

    JanetNJ Well-Known Member

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    I think that's a good plan... If he's lower then you'd like then you can safely feed him a bit.
     
  30. JanetNJ

    JanetNJ Well-Known Member

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    I'm always inclined to dose on the more conservative side at night in case you can't wake up to test
     
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  31. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    That is my issue. I can make it to midnight, but by then I have to take my meds or I'll never get any sleep myself.
     
  32. AlphaCat

    AlphaCat Member

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    I'm so sorry Meredith!
    I know this schedule of the testing +3 at night is difficult.
    If it's any consultation... I'll be there with you. ;)
     
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  33. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Lol, I'm just thankful I can finally sleep, though it will be great when I can without having to take a handful of pills first.
     
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  34. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Sorry! I took a quick break to get some grub and tidy up and just now saw your message but I see you were in good hands with Janet. I agree with giving 2u tonight and checking Zeke at +3. Post if you have any questions at +3. I'll probably be up 'cause one of my all time favourite movies, Mr. Roberts is on TV. :)
     
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  35. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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  36. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    His +3 is 213. We had to do it a few minutes early because of the storms that came through. Lots of surges so didn't want to try testing him by flashlight lol. Right after we tested him, lightening struck behind the house next to us hitting a power line and then in front of the same house hitting a tree! Then the storm was over lol. Fun night in the okie state! :D
     
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  37. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Just checked Zeke's SS and saw the 213. That's a decent but not extreme drop so if you are off to bed, give him a snack now to keep him dropping slowly.

    We've had rivers of rain here lately but no storms that even come close to what you folks have been enduring. I feel for ya! Glad the lightning didn't strike the house and the tree didn't get uprooted and hit anyone's house. Stay safe!
     
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  38. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Thanks, he already has had a snack of chicken. These storms have been nuts lately. Luckily no huge twisters so far this year *knock on wood* and we are almost outta our storm season. Should start slowing down soon thankfully.
     
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  39. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    We've been getting rain day in and day out to the point where lakefront properties are sandbagging and praying and some neighborhoods have had pumps going for weeks now trying to keep their homes from flooding. The Toronto Islands which are a tourist destination have been shut down completely and the folks who live on one of those islands have a ferry standing by in case they have to be evacuated. The amount of rain has been crazy. We are expecting some thunder storms tomorrow overnight. Hopefully nothing too severe! Well, I'm going to call it a night. Sweet dreams Meridith & Zeke!
     
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  40. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Yeah, with all these storms, been a lot of flooding. We don't see it so much where we are at but could really tell when we were down by Talahina last weekend for an event at the Choctaw Capital.

    His morning amps was 390. He is starting to eat better already, ate a full can without any coaxing or bribing, shredded parmesan works great when we have to. We are working on getting him more used to the test by giving him treats when it is opened up. At least he doesn't run into hiding anymore lol. Last night he even sniffed of the kit as I was pulling things out for his test lol
     
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  41. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Great to hear he is eating better and getting more compliant with testing. Bribery works wonders! Less extreme up and downs are likely making him feel better even if his numbers still need to come down. Slow and steady wins the race in this game. I know you are going out today (hope the weather is good for you) but if you can grab another test before you go, it will tell you what he is up to and let you determine how much food to leave out or have your daughter give Zeke later on.:)
     
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  42. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Will do! Hubby helped with the test this morning and Zeke definitely struggled more, so possible this amps was a little high because of stress. Was his first time helping. Now if I can get our fat boy to loose weight lol. He is about 20 pounds and almost as wide as he is long! He only eats the same amount as my little 10 pound one, but not a drop of weight coming off. Maybe over time that will change.
     
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  43. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Yep. A little testing resistance could certainly cause a bit of stress elevation in BG.

    I know all too well the struggle to get them to lose weight even when they don't seem to be an out of control eater. I stupidly thought my efforts to slim my girl down were starting to pay off and then realized she was losing too fast in comparison to my efforts and that's when I found out she was diabetic. She managed to regain everything she had lost and then some and now we are once again on the weight loss treadmill. In the early days, I wouldn't be too concerned about his weight. Just try to keep him steady and not gaining. When he gets a little more regulated and you have a better idea how he is reacting to insulin, you can ease back on his calories gradually. An unregulated diabetic can't get the nutrients out of the food and as a result, tend to have big appetites sometimes to the point of being continuously ravenous.

    Have a good break today! :)
     
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  44. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    The fat boy isn't my diabetic kitty lol. My diabetic should be closer to 18 with his build. The fat boy should probably be closer to 12 or so. We had to keep him in a small room when I had to stay at my mother's for a bit because of a dog and so he went from a high energy kitty to overweight quickly.
     
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    OH! LOL! I was kind of wondering how Zeke had managed to maintain his weight so well but they are all unique individuals and often don't follow the rules! I think the trick is in getting them to exercise along with reducing calories. Unfortunately, some, like my girl, are not much into the play thing. Mine goes on short forays of running around the house like she's possessed periodically but she'd have to do her laps a lot more frequently to make it count toward calorie burning! As for interactive play, her attention span seems to be very short!:rolleyes:
     
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  46. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Lol. Our one that is nicknamed demon child is the one that daily has to run back and forth across the house and loves doing spinners in my bedroom lol. The fat boy is actually starting to want to play. Before he wouldn't.

    Zeke was 302 at +2 so dropping good.
     
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  47. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Love the nickname demon child. My Menace got her name for good reason too! She may not be an overly active girl but when she gets going, she's great at finding lots of mischief to get into! :cat:

    Zeke is looking good with no big surprises! Now you can have a "relaxing" time out today. :)
     
  48. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    It's renaissance time for us, hubby and I go every weekend when possible. Lasts 6 weeks hehe. My demon child is also called gremlin too because he makes gremlin noises lol. Our fat boy Max is the only one who makes "normal" cat meows lol. Zeke is full of silent meows and very weird sounding ones when he is following his food bowl lol. Demon (Grayson) "talks" to us and does is gremlin noises. Then we have our hotdog who is the referee! She doesn't like Max and Grayson playing at times so stops then.

    Here at Ren fest so I'm our till this evening! Have a great Sunday!
     
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  49. JanetNJ

    JanetNJ Well-Known Member

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    Huzzah!
     
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  50. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Zeke is 185 tonight, so not giving his dose. How could he be at 390 this morning, then that low tonight? He has even been getting treats of chicken today, and he had a can of FF. Hopefully we can have him stressing less soon so we can get his curve going. Would hate to have seen what tonight would have been if we had still been doing 3u.
     
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  51. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Huzzah! :)
     
  52. JanetNJ

    JanetNJ Well-Known Member

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    Wow great preshot! Good call not shooting. In the future when you get a lower than expected preshot you can stall for 30 min without feeding and retest to see if the number is risin. If it is you can give a partial dose.
     
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  53. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Wow! Was just checking in to see what Zeke was up to and so happy to see that 185 pre-shot. I agree with Janet about stalling and giving a partial dose if BG is rising. It will be interesting to see what his BG is this AM.
     
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  54. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @JanetNJ @MrWorfMen's Mom
    His amps was only 266 this morning! :bighug:
    Only gave him 1u since I would much rather under dose then over. I was really amazed it was that low. I expected it to be much higher after a shot last night. And now that he is on lower insulin the last couple days, his appetite is definitely better! :bighug:
     
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  55. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Oh, and his pmps was actually about 30 late last night already because we were running behind getting back from Ren Fest.
     
  56. Yong

    Yong Well-Known Member

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    Not bad after NS last night! Too bad you didn't get a before bed test but I can be a data junkie :smuggrin:. Glad to hear his appetite is improving!
     
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  57. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @Yong
    I was so tired when we got back that after we got kitties and hotdog settled, my booty was in bed lol.

    We are going to give him a couple more days to settle into the tests then gonna go for a curve. I think I am also going to need one through the night too since the amps and pmps seem to stay so different most the time.
     
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  58. JanetNJ

    JanetNJ Well-Known Member

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    Great
     
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  59. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Whoo Hoo! Good boy Zeke! Good calls on dosing Meridith. You are making great progress! What a partnership! :D:cat:
     
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  60. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    Have done a +4 and +6 and going to go ahead and do a +8. With only 1u this morning, he is almost below 100 at +6! o_O wondering if tonight is going to be another NS or maybe 1u. I do like that his numbers aren't way up and down, more steady with slow transitions. That is the goal right? Did get a wonky reading so went ahead and grabbed another strip to do another without having to reprick. The wonky one was 336 so didn't make sense with his +4.
     
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  61. JanetNJ

    JanetNJ Well-Known Member

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    Perfect!
     
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  62. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    hapydafhf.gif Getting more impressed by the hour! This cycle is a thing of beauty at this point. What he'll do for pre-shot tonight is anybody's guess. He may bounce a bit given the 108 at +6 or he may not. I think it's safe to say he doesn't need more than 1u and may need even less in the coming days. Go Zeke! :cat:
     
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  63. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    And thank you both! Yall have been a big help. Don't know where we would be if I never found this site, but have a feeling that it wouldn't have been pretty. I love that it looks like we might get to stick with much lower doses then the vet last said! Home testing has made this possible. :)
     
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  64. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Meridith, vets get very little training about feline diabetes, usually have few diabetic feline patients and obviously aren't dealing with them 24/7. We see all too many cats arrive here, on the wrong diet and getting too much rather than too little insulin thanks to ill informed vets. There is nothing like hands on experience and home testing to make this sugar dance a lot easier and you have proven that with your decision making last night and this morning. A lot of this dance can be mastered by knowing your own cat and having ongoing data on which to base decisions. Unfortunately many vets have yet to appreciate the value of regular home testing vs. clinic visits.
     
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  65. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Sadly, the vet who diagnosed him said they had their own diabetic kitties, yet with what I have learned, it really is hard to believe that now.

    His +8 was 265. I think he was stressing a bit though since we have tested him so frequently today. Tomorrow will only do a +8 other then the normal PS's as long as the normals are similar to today.
     
  66. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Well that's an interesting tidbit about the vet. How old is the vet? In days gone by, no one home tested and people just blindly shot every day. Some cats obviously did fine but I can't help but wonder how many suffered through hypoglycemic events or worse.

    Wouldn't worry about that 265. He's bouncing again but it will take his body some time to get used to those lower readings so just hold the dose for now barring any pre-shot surprises. Tomorrow, I'd check around +5 or +6 instead of waiting until later if you can. From your current data, he seems to get peak action (nadir) around +6 and that's the number you need to focus on along with having a safe pre-shot of course. :)
     
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  67. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    The vet is about mid to late 40's and his wife who is also a vet there is a few years younger. So young enough to know better. I understand on the older Dr's, same with people ones too. My son can't take amoxicillan thanks to one, because of over prescribing.

    I will do a +5 tomorrow and see how that one is looking then.
     
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  68. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Meridith, I'd keep an eye on Zeke tonight. Not sure why you opted to give 2u instead of 1u but I am assuming it was because of the pre-shot number. It would be better to hold a dose for at least 2 if not 3 days rather than shooting more insulin when it appears Zeke is likely bouncing. When I said "barring any pre-shot surprises, I meant if he had a low unshootable pre-shot. If the bounce breaks and you've given more insulin than he needs, you simply start the bouncing all over again or you could find yourself having to monitor more intensely and steer him to keep low numbers up. I'd check his BG around +3 to see what he's up to tonight. Slow and steady wins this race. :)
     
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  69. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Just seen this. So I need to stay at 1u? I was thinking 1u for 2-300 and 2u for >300. How can u tell when they are bouncing or u need to shot for the number? Confused on that. :(
     
  70. Yong

    Yong Well-Known Member

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    You don't want to double the dose if he's >300, would just be a slight increase like 0.2U on U-100 syringe or 0.25U on U-40 syringe.
    This was written by Kris&Teasel, maybe it can help you too :)

    Here's how bouncing works:
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    7. Many vets have little/no understanding of the bouncing phenomenon.

    So for your most recent example, yesterday, AMPS was 266. Since his BG went below 133 (which is half of AMPS) it caused a bounce. Usually don't want to increase the dose based on a bounce number but hold it like Linda said, unless it's a no shoot number, like she also said :smuggrin:
     
  71. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Unfortunately, this sugar dance can be totally counter intuitive and we've all been through this period of confusion at some point or other. Once you have a somewhat regulated cat, and lots of data so you understand how kitty reacts to different doses, you can dose based on pre-shot numbers. The first step however is to find a dose that gives Zeke a smoother cycle to keep bouncing to a minimum and yesterday at a dose of 1u, Zeke sailed through the cycle beautifully even if he did bounce a bit at the end. That beautiful cycle followed a skipped shot which suggests that Zeke needs less insulin than he was getting and that he has been bouncing.

    Throwing more insulin into a bounce can just muddy the waters more by raising rather than lowering pre-shots. The bounce yesterday was expected given the 108 he had mid cycle. His body is not used to those lower numbers and he is working against the insulin to keep his numbers up. If you throw more insulin at the higher number, you just set up a circular pattern of more insulin higher numbers. If you can get the cycle a bit flatter then the pre-shot numbers should come down on their own. I looks to me like Zeke needs a dose in the neighbourhood of 1u but whether it's a little less or a little more remains to be determined.

    We generally only change doses by 0.25u at a time because tiny changes can make considerable differences in BG in most cats. Holding a dose for a few cycles to ensure any previous bouncing has passed before increasing is the way to go. It may mean you don't get as low a mid cycle reading but it will keep Zeke in more optimal numbers for longer through each cycle and allow his body to get used to being in lower numbers which will help to eliminate a lot of the bouncing. That can take time. The hardest part of this dance can be having the patience to follow Zeke's lead rather than trying to lead Zeke. Zeke is in charge and you have to use ALL of his moves to make decisions which means basing doses on pre-shot and mid cycle numbers in combination rather than just on pre-shots.
     
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  72. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Ok, so then If I am understanding correctly, basically I need to just stick with the 1u dose for several days and see how he does? Only change his dose if he goes below 200 where I would want to skip a dose? Is that why his +5 we just did so high? He is still bouncing? He does get 1/2 a can of food at about +4 since he doesn't eat all he needs in just 2 meals.
     
  73. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    I am so glad yall are patient lol. This will definitely take some time to get the full hang of it lol.

    Now here is a big question that I have. On the 10th of June, my daughter and I will be going out of town and we will have to leave by 6am. With the first vet, he said everything was cool with being a couple hours early on his shot, so was thinking this would be a simple thing, just shoot before we leave. Now though I am seeing that isn't going to be the case. We can test before we leave, and even feed them, but how would it be best to do the shot? And would feeding that early really affect him? My hubby could probably run home from work and give him his shot at around 8am so that could be on normal time, but he will not be able to test him, unless between now and then Zeke finally lets us without one having to hold him still. My stepson will be here, but he is mentally disabled so unable to safely hold him without hurting him (can't control his strength very well). So we test and let him know on shooting or not, and then no shot at 8pm? We probably won't be home til at least 10pm that evening.
     
  74. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Exactly! That higher number now may be partially food influenced but is likely also a bit of bouncing. We don't know how low he went last night even though he wasn't that high this morning. I think the bounce mechanism can become more over reactive so stick with 1u for now barring any low pre-shot. If you get a pre-shot lower than 200, you can do a few different things.
    1. you can stall for a half hour without feeding and get another reading to see if he is heading up and high enough for a shot
    2 skip the shot
    3. give a token dose AKA a big chicken shot (BCS). The amount would depend on how close he is to the 200.

    As for your question about what to do on the 10th of June......by then you should have a better idea of how Zeke is reacting and what his ideal dose is. Vetsulin is flexible enough that you could shoot early that morning as long as the pre-shot is not too low or you could start backing up his shots gradually by 30 minutes to an hour a day to get to a 6am shot time for that day, give his night shot when you get home and then back him up the next couple of days to get back to your normal shot times. For example:
    7th June - shoot 7:30am/pm
    8th June - shoot 7am/pm
    9th June - shoot 6:30am/pm
    10th June - shoot 6am and 10pm
    11th June - shoot 9am and 9pm
    12th June - go back to your regular schedule
    I am suggesting 30 minute differences before your day away to try to keep things as close to normal as possible and then a faster return to your normal times when you will be home to monitor.

    The other option would be to skip the morning shot on the 10th and shoot when you get home and then adjust back to your normal times.

    We all have times when our activities don't jive with kitty's schedule and we are firm believers here that caregivers need to make sure they look after themselves as well if not better than they look after the furkids. Zeke will be fine no matter what you decide to do.:)
     
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  75. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Ok, that sounds workable. Also, you mentioned Vetsulin, Zeke is on Novolin, are they similar?
     
  76. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Oops, sorry...my bad. Was just looking at someone else's condo who uses Vetsulin.:facepalm: Both Novolin and Vetsulin are "in and out" insulins and offer flexibility of dosing times that some others do not. So yes, they are similar in many ways. Difference tends to be when the expected peak of action occurs and in some cases duration of action.
     
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  77. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Ok, was just wanting to make sure lol. I get too easily confused on this stuff right now :) Slowly but surely I will get there though!
     
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  78. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    You are obviously not the only one who gets confused! :blackeye::woot:
     
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  79. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Hubby got stumped tonight lol. He was at a loss on Zeke getting lower numbers with a lower dose! And Zeke is definitely starting to feel better. He has been been playing several times today and instead have laying most the time under the bakers rack, he has been laying out in the open like he used to do. I love seeing him like this!
     
  80. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Now that his #'s are starting to level out, how long do we need to sit at this dosing before we consider changing and how much would we adjust and which way?
     
  81. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I'd hold the dose for another couple of cycles before deciding what to do next. Looks to me like the bouncing from those lower blue numbers is now breaking so hold the course barring any low pre-shot readings and see what he does. :)
     
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  82. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Okies, will do.
     
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  83. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    @MrWorfMen's Mom
    Ok, he is definitely starting to stay pretty close on his numbers so I would think it is safe to say he is not bouncing anymore lol. Do I need to go up .25u or .5u?

    I did jinx us when I said he was eating better. :D We had ran out of chicken, so opened up a can of tuna for his treat after testing and we unleashed a monster! He would just run through anything that was between him and the tuna, including us! He decided that was all he wanted to eat and we had to really fight to get him to eat his normal food lol. We aren't doing the tuna for treats anymore after that, but I do know now that I can mix a spoon of that into his food and he eats wonderfully!
     
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  84. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Love the description of Zeke running through anything to get the tuna! Good to know what to use if he gets fussy on you!

    As for dosing, I'd suggest an increase to 1.25u. Doing tiny adjustments ensures you don't pass over the optimal dose and those little adjustments can make a big difference for some kitties. He's been pretty flat the last couple of days so up his dose tonight or tomorrow morning. I'd get a reading about 3 hours after the shot when you adjust. Personally I don't make dose increases at night because if the new dose does lead to a more active cycle needing more monitoring, I'd rather be bright eyed and bushy tailed. This Mama needs her beauty sleep.....even it doesn't do anything for my looks, it does improve my disposition! :woot:
     
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  85. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Thanks, sounds like a plan then. I gotta have my sleep too lol. I am getting new syringes in today since the ones I am using now doesn't have half marks, will make it easier to eyeball 1.25u. Probably will even mark some to make it even easier if I have a pen that will mark those easily lol.

    I had thought about ordering some of the animal digest stuff to put on his food, but now that we can just add the spoon of tuna to get him to dig in again, would much rather do that. Adds some protein without adding something that he probably don't really need anyways.
     
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  86. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Since you will still be eyeballing the dose to a degree, you could use a trick some folks use when they are going away and have someone else giving shots in their absence. Make up some coloured water and draw up a dose as a sample syringe for comparison. That way your dose will be consistent even if not precisely at 1.25u. Those quarter doses drive me crazy and consistency is more important than being spot on. There is also a paper ruler I can send you but it is only good for BD syringes and you'll get a better price on the Relion brand from Walmart. If you do get BD syringes and want the ruler, just let me know.
     
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  87. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Good idea on the sample one. Sometimes I have either my daughter or hubby get it ready for me when I am in the middle of coaxing feeding, so will make it easier for them too.
     
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  88. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    With his number this morning, elected to stay at 1u a little longer. Starting to look like his numbers are slowly dropping on this dose. He was only 239 :)

    Does this mean we might actually need to lower his dose instead? Given a few more days of course.

    We are going back to Ren fest tomorrow (last day of the season so cant miss it lol), so probably a better idea also to not raise with his current number. We will do a test about +2, right before we leave since we won't be getting a peak.
     
  89. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    That's a nice pre-shot number. I don't think you need to reduce and he may need a bit more. Enjoy your Ren Fest and see what he does in the meantime on the 1u. If he's staying in roughly the same range and pretty flat, through the weekend, then I'd take him up to 1.25u. I'll be watching to see how he's doing. :D
     
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  90. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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  91. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    With the way his numbers have been going, if tonight is like his peak (192) would you recommend NS or maybe half his dose? I wouldn't think full since it would already be just below 200 so don't want to drop him too low. But with his numbers staying this way, I would think no dose might throw him off, correct?
     
  92. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    When you skipped on the 185, he didn't do terrible on his own :). If he is around same number as nadir, and you skip, I would suggest a before bed test again to see how he's doing on his own. In contrast, you could try a small dose like 0.25U, and definitely get a before bed test. Both situations will give you extra data ;)

    *This is just my thought*
     
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  93. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    192 is a much nicer number for his mid cycle but he's still got a few hours to go and will, I expect, be over 200 at pre-shot so I don't anticipate you are going to have to reduce tonight. If however his morning pre-shot is lower tomorrow, then by all means either a reduced dose or skipped shot might be in order since you will not be home to monitor. If you have to skip, you'll get him back on track in short order so no worries. I'll be around tomorrow morning so I'll keep an eye out to see what he's up to before you leave. The goal is to get those mid cycle numbers to within normal of 50 to 120 and while I'm not suggesting you aim for 50, it would be nice to get him down into the 90-120 range mid cycle.
     
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  94. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Thank you both. I am loving that his numbers are lowering the way they are.
     
  95. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    So are we! We rejoice at each other's improvements and successes around here! :joyful:
     
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  96. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    I know we wouldn't be getting there if I hadn't found this site!
     
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  97. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    He was a little higher then I expected tonight, but then, about 10 minutes before I tested, caught him sitting in a pan that my hubby had sat some partially grilled bacon wrapped chicken, so not sure how that affected it. Will be testing him again before bed so will see where he is sitting then.
     
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  98. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    What a picture that conjures up! Hope he enjoyed the contraband! :D:rolleyes::smuggrin:
    He's still looking good despite his pilfering. Have a wonderful time at the Ren Fest today!
     
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  99. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Thank you! We had a blast as always. Today was the last day of the season so will be 10 months before we start all over again hehe. :)

    Lol, yes that was a surprise with Zeke. I was at the stove and turned around cause I heard something! Luckily hubby had already got the meat outta the pan but he had so much grease that he was lapping up as fast as he could lol. I think he really enjoyed cleaning his feet after that too lol.
     
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  100. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    On the bright side, may not have to worry about any hairballs for a little bit :woot::p
     
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