? Worried about going to uni tomorrow

Hi,

Sorry I am posting so much but I have a concern about tomorrow. I am going to uni tomorrow (0800-1300) but after such a drop this morning (from 24 to 3 in the space of four hours). Do I put out high carb and hope for the best tomorrow? I did consider shooting at 0600 tomorrow but that would mean giving her the insulin without letting the previous cycle end. I feel like I'm in a bit of a conundrum!

Advice please!

 

I really wonder if that +4 was a valid test....to go from 434 to 59 and then back up to 175 in 2 hours is pretty unusual, especially if you only fed some low carb Sheba at +4

Next time you have a test that's so "out of whack", make sure to get another test in...occasionally we get wonky numbers due to a bad strip

What time did you shoot this morning? What time do you have to be "out the door" tomorrow?

 

Don't worry about asking lots of questions. None of us mind - we also asked questions when we were starting out. What might be helpful is if you get a +11 in the morning (one hour before her usual shot time) and ask for help if it's lower than you are used to.

To be prepared . . . do you have a way to leave food out for her? You don't necessarily need to leave high carb, but you can. If in doubt, you want to err on the side of conservative, but with a recent history of DKA getting some insulin in is a good plan. It's a balancing act - not enough insulin puts her at risk for DKA again, too much insulin puts her at risk for a hypo. With the recent DKA, one choice would be to go ahead and give the regular dose and leave out the high carb, as you mentioned.

If the DKA weren't so recent, skipping would be an option, but that's riskier in your case.

I would not shoot an hour early when you have to leave afterwards. If this is going to be a regular time you leave, you may need to adjust her shot time so that you're shooting at +12 as much as possible.

I think posting at +11 in the morning would be a good plan. In your subject line put "shooting help" so people know that you need help soon. But consider now what your choices are and be thinking about what number you would feel ok shooting in the morning.

By the way, we use mg (US) numbers as our common language on FDMB - there will be people who won't understand the significance of mmol numbers. You might want to look at your US page in the ss and post those numbers.

 

I did maybe think I got a bit of a 'mingled' test! My thumb had rivulets of blood rolling down it (I thought I really made sure that I got her blood but could be wrong).

I shot at 8am this morning, I will be shooting at 8pm all being well, so I guess 8am tomorrow.

I'll start to bring her back until I am shooting at 6am, that'll give me time to get a +2.

 

Here is a thread "Where Can I Find?" that has some links that might be helpful to you. There is one on "getting back on schedule" in the second half of the initial post. That can give you some guidance on shifting shooting times.

 

Well if we had several days, I'd suggest slowly changing your shot times. If you could work your way back to a shot time of 6am, that would let you get a +2 before you left for the day which can really help you know where Lily might be going on later in the cycle. You can change shot times by moving them 15 minutes per cycle or 30 minutes per day (in the direction you want to go)

We've found that +2 is a pretty good "predictor" of what might happen later in the cycle (I think I wrote this to you last night?)

Since it's too late for tomorrow though, I think the best you can do is get a +11 or +11.5 and then post for help...with her recent DKA, we really don't want her skipping her shot, so depending on where she is in the morning, you can always leave out plenty of food for her to eat if she needs it. Most cats get really hungry if their blood glucose drops too low, so leaving food down will give her a way to "help herself"

Try getting a +2 tonight too

 

Please don't shoot an hour early - overlapping the cycles in that way is risky in that it could result in unexpected lows.

Looks like PMPS is coming up quick (you are 5 hours ahead of US east coast). See what the next cycle brings.

 

PMPS 387. Shot 0.5 u, I have a feeling her numbers will be similar tomorrow morning in the 400s.

 

yeah Like gatos numbers last night

 

Darn....wish I had caught this. It actually would have been perfectly fine with that PMPS to shoot an hour early tonight since you would be there. That would easily put you an hour closer to moving your shot time back to 6 a.m. since it is not w good idea to shoot early and then leave.

 

I will shoot at 8am tomorrow as usual but I will leave lots of food down (She is a little and often but I have noticed that when she starts to go low, she eats a whole tin!). I get back at +5 so I can test immediately. Obviously if it is a low number I will post here and ask for advice. I will also get a +11 tomorrow.

 

If you want to move her shot times to 6am/6pm, you could shoot in the morning as early as 7:30 (IF she's high enough) and then just keep shooting either 15 minutes earlier on each cycle or 30 minutes once per day until you're at 6am/6pm

 

I just think it'd be safer for her until I know that she is regulated for me to shoot at 6. I will just be one tired person with no social life is all!

 

I think what Chris is trying to say is that you can gradually start moving your shot time back in the morning.

Right now you shoot at 8 a.m./8 p.m. If you want to start shooting at 6, Here's how you could safely move it:

Monday morning shoot at 7:30 a.m. and 7:30 p.m.
Tuesday morning shoot at 7 a.m. and 7 p.m.
Wednesday morning shoot at 6:30 a.m. and 6:30 p.m.
Thursday morning shot at 6 a.m. and 6 p.m.

Sometimes when we get a high number at preshot when we know we will be home and we know it's not a dropping number, we can shoot an hour (or sometimes a little more) early to speed up the process above.

Does that make sense?

 

That does make perfect sense...There is so much to learn and navigate in order to feel confident with all this! Would you say that it is crazy rare for such a major drop, like todays? from the 400s to the 50s in 4h?

 

I totally understand!! I am NOT a "morning person" and never have been...I remember being in grade school and still being awake at 5am and knowing I had to get up at 7am to go to school

When China was first diagnosed, I figured, OK...every 12 hours? I can do that...I'll just shoot at 11am/11pm (since I'm always up until at least 1am anyway these days) .....that was fine right up to the point where she started going lower at night and I ended up spending the whole night sitting up and testing her.

I finally bit the bullet and changed her to 6am/6pm....I still HATE getting up that early, but as long as I don't have anywhere to go that day, I can go back to sleep if I want, and it allows me to get her PM shot done early enough that it's no big deal for me to stay up until +6 or +7 to make sure she's safe overnight....then the whole thing starts over at 6am the next morning

 

So would you say it is good to get a +2 or +3 normally? She is liking the testing in the big pad way more than the ears. I'm giving her little ears time to rest and heal. We had our first stress free test this evening and it was great! She didn't run away like I was an abuser!

I really don't mind getting up at 6am, it's just when I go to London I have to leave at 4 pm. Now obviously, I can not change her shots to 4am/4pm and I have no one to come over and give her the insulin. So, I could put her at midnight and 12 but then I would still have the same issue. Just a logistical nightmare. I am getting really down with all this as I obviously want her to get better and to feel well but I feel like I am literally trapped and chained to this flat now. I can't go out to regular things anymore, I've had to cancel two regular commitments. I'm okay doing this because she is my baby and to be honest, I treat her as if she is my human child...but I feel as if I am going to turn into a recluse, not to mention the fact that I am expected (by the military, so really no space to mess around) on a wednesday night in London. The only reason I have not been going recently is because I told them about the situation and they said they would be happy for me to stop coming until I got Lily regulated.

 

Yes there is a lot but we are all here to help you through it especially until you feel more comfortable....and you will. I'm always so happy to see how fast new members progress in just one month and I often suggest they go back to their first posts just to see how far they have come.

I wouldn't say it's crazy. We have some champion divers around here but I would have retested as Chris suggested. Any time you get a number that surprises you....high or low....retest.

Often when they drop that fast, they also bounce pretty hard so don't be shocked if she goes up even higher tonight but let's hope not.

The other important thing to remember is they don't necessarily drop a consistent amount per hour. You might be tempted to think she dropped a little over 93 mg/dL an hour as that's how it averages out. In reality, she might have not dropped much the first hour and then 150 the second when she onset and then less in hours three and four. It's not possible to know unless you test every hour, which I'm not suggesting you do.

I would suggest that you get a +2 test as often as you possible can no matter how high she is so you can see which direction the cycle might be headed. If she's similar to or less than the preshot, she's probably going to come down and have an active cycle. If she's a lot less at +2 than the preshot, she's going to have a very active cycle with early drops.

 

Her +3 was 320. She dropped by about 60 in three hours. She has food out so I am going to go to bed now and just hope she doesn't do a crazy dive before +11. I don't know how any of you guys sleep without worrying you'll see a hypo when you wake up!

 

testing on the big pad?

 

Yeah, the big paw pad, the skin is tougher there and she seems to tolerate it far better than the ear. I feel more in control with it too. She is still a little stressed but definitely not half as bad as what she was!

It has obviously been a bit of an initiation by fire here, so I think she is doing really well. I am really proud of her for starting to get used to the testing so soon. I was expecting a struggle for months!

 

Oh yeah I am new to this also , I just started mine on insulin on Wednesday of last week

 

You have to remember, the insulin only lasts about 12 hours, so usually, by the time you're at about +6, it's starting to wear off and the numbers are going to start up again

That's one of the reason's we like to get tests sprinkled throughout the cycle....to try to find where Lily's nadir usually is so you have some idea of when she should naturally start going up on her own

 

isn't that what a glucose curve is? my vet said something about doing it a week from when I started

 

A glucose "curve" is doing tests every 2 hours for 12 hours to see how low the current dose is taking him

We generally don't do exact "curves" here because how our cats are doing can change from cycle to cycle.....what we recommend here is getting tests at all kinds of different points

Think of the spreadsheet we use like you would a puzzle....if you only had pieces filled in along the edges (just Pre-shot tests) or only had one row across filled in (doing a "curve") it would be really hard to see what the whole picture was

But if you have those "pieces" sprinkled in all over the "puzzle", the picture is a lot easier to see

 

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number.Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

Chris and China: some really excellent and clear posts here. They helped me understand some things I've been wondering about.
Lisa: Great questions and you are so right about feeling chained to your home and being tired. You are an incredible cat Mom! And what Marje said about how far you will come in a month is spot on. The learning curve is so big, but then you "get it" and your feline buddy is starting to also and the sugar dance becomes a lot more like a waltz instead of well, something wild and crazy and exhausting (not that knowledgeable about dance styles so couldn't finish the picture).
Hang in here, ask questions and take care of yourself too.

 

But also remember there are exceptions to this. When cats clear bounces, the BG is often higher at preshot and slowly decreases with the lowest number being at or near the next preshot. Also, some cats have early nadirs (Sienne's Gabby was one) and some (not many but a few here and there) have later nadirs....even as late as +12.

One of the things I like to encourage new members to do is study their cat's SS and see if you can determine their onset, nadir, and duration. It's very important in managing your cat's FD to be able to do this at some point after you collect data. It makes the dance easier and also allows you to better schedule your own time.

 

That's why I like to encourage new people to read other posts!! You learn all kinds of things you may not have even known you needed to learn!

 

Their ss? I gave her the shot at 7 it has been 2 hrs should I test her? Just to see before the bed, going to be tough on me at work if I have to stay up to 1 am tonight

 

Yes, getting the +2 in a lot of cats is kind of like a "crystal ball" and give us an early warning if they might be going too low later in the cycle

 

@Lisa and Gato it's a good practice to get a test right before bed. Many cats have their lowest numbers at night. You may want to change your shot time so that you can monitor later at night more easily. We shot at 7am/pm because we go to bed about 11:30, so it was very easy to make sure punkin was going to be safe at night before I went to bed. For him, we got a +3 most of the time. He didn't dive early in the cycle, and the +3 was a better indicator of where the cycle was going. This is one of those ECID (every cat is different) things - as people learn more and move along, they see patterns develop for their cat and learn when it's most important to test and when you can skip.

 

I

leave for work at 730, been getting up at 630 to test and then test again at 7 before I give her a shot, I do 7 /7, I go to bed around 10-11 every night depends how tired I am, I did a +3 this morning

 

Sorry...SS is spreadsheet.

You'll have to figure out what is best for you on timing. I'm not a morning person either but had to get up an hour earlier than I would have liked to. At night, if you can just try to grab a +2 or if you go to bed before then, then a test right before you hit the sack.