Time for a Dosage Change? Hank's 3rd NS

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Kimmied

Kimmied

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Hank had another no shot at PM tonight.

I re read the Prozinc protocol and it says if only one pre shot is shootable that it's time to lower the dose to get 2 shootable pre shots.

Soooooooo, what does everyone think?

I have only had Hank on the .5u just 2 shots.

Both times his numbers are going low at +3.

I'm feeding Hank a half a can of wet food at time of shot. Then I'm feeding a 1/4 of a can after I test at +3.
But last night and this mornings +3's I've been giving kitty candy, his usual snack of wet food to try and keep his numbers from dropping any lower.

Is it the lower than low carb food not helping to keep his numbers up or do I need to hang tight on .5u?

Or should I lower his dose to .25u?

Any help would be appreciated. Thank you.

Kimmie
 
i think I'd stick with .5 as long as you can monitor, watching for that early drop if it comes and feeding it. His numbers are safe. This is the second scariest part of the sugar dance; the first is the the week he is diagnosed. :-D But, the easiest way to get him OTJ is to get him and keep him in blues and greens.


I would look at those 186s like tonight and stall, then shoot when he comes up a little, even if you skinny up the dose a bit. It would be better not to skip.
 
I might...

1 - test him in about two hours after he ate and see if the number is still at 186 or lower. If lower, his pancreas might be trying to work like it's supposed to.

2 - Maybe draw a line in the sand? Like .5u if he's over 200 at shot time and .25u if he is lower than that?
 
Too late Sue. :sad:

Hank was due for PM shot at 6:30pm tonight.

I was planning on testing around 9ish.

The last time I skipped a shot the next morning his BG was 252. Not bad.

Ok, I'll stay on the .5u a little longer.

Yep, it's scary going lower that soon after shot.

Ok, I'm going to go test and then I'll post it.

Kimmie
 
If being more agressive is too scary, then don't do it. You can take the process slower and he will get there eventually. You need to do what feels good to you.

I would try shooting those under 200 numbers after you stall and make sure they are rising. Even if you decide to go down to .25 (which is fine)
 
You do need to have a line in the sand. Will 180 be too scary? Are you more comfortable with 190? 195? There is no right answer. It's what you are comfortable with. You hold the syringe; he's your baby.
 
I don't know which one.

I was in the mind set of "skip shot if under 200".

I see what you're saying, that he needs to stay in the blues and greens. :YMSIGH:

So what you're saying is...go ahead and shoot under 200 IF I've checked again and number is rising as low as what I feel comfortable with?

nailbite_smile

Kimmie
 
We generally say skip under 200 for the newly diagnosed. They don't have data yet to say how their kitties will do. Once you've been testing and have data you can shoot lower. I hear you that you get in that mindset and it's hard to do something else. Remember 200 is not really a low number...it's basically a line in the sand that we draw. You're just looking at taking the line a bit further back.
 
Skip if under 200 is for new diabetics who have no data. You have data but he is changing fast and it is hard to predict what he might do, so it's understandable that you would be nervous.



. So what you're saying is...go ahead and shoot under 200 IF I've checked again and number is rising as low as what I feel comfortable with?
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Yes, that is the plan IF you feel okay with it and IF you can monitor what happens. I wouldn't try less than 180 until you see what he does. Once you try it, you'll know how it works and it MAY be easier going forward. :mrgreen:

It may help if you go to the remission thread on the top of this page and check out those spreadsheets to see what other people did. There are definitely different approaches.
 
Kimmie,
That's the key - "comfortable with."
Three things are important:
Data to show you what a dose has done.
The ability to test after giving an "aggressive" dose.
And knowing how and when to slow or stop a dropping number.

I WOULD NEVER ADVISE ANYONE ELSE TO DO THIS, BUT....
When Bob got close to OTJ, I shot as much as 1u into a number in the low 100s. I shot .25u at a number in the 90s. My confidence was due to knowing what different doses did on different ranges of BGs. He got as much as 4u at times during his time on insulin. And his vet was extremely aggressive when it came to dosage. It worked for Bob, because ECID.

carl
 
Wow...I guess I don't know what to think.

Oh, I know I can do this.

How to play with the numbers is what I'm not so sure about.

Over 200, I'll give .5u and under 200, .25u...

Wow...

Kimmie

Oh, and I will check out at the top about remission SS.
 
Kimmie,
Over time, you just get a "feel for it". Many people don't adjust the dose based on the numbers at shot time, most don't actually. But that was my vet's technique from day one, so it is something I did for the 10 weeks Bob was on insulin.
Some cats respond well to it, some might not. And every care giver thinks differently too. It is just one way to use this type of insulin, and I just happen to believe it is the " best" way. It can be pretty stressful, but feline diabetes is stressful no matter what you do. ;-)
I think the most important thing is to "follow your gut instincts" and if you are going to err, always err on the side of caution.
 
I just looked at Buzz's SS of Sarah and Buzz in remission thread.

A couple of things that I noticed;

1) She had some low numbers sometimes! (35, 44) In her notes, she didn't seem panicked! Just said fed LC at +3 and +4.
2) If the number is under 100, you do or don't shoot? If that's the case, How will I know when Hank is in remission?
3) At what point is it going to be easier for me to use the U-100 syringes for dosing with the conversion chart?
4) What happens on a morning that I have to be at work at 5AM and he has a low AMPS? Cause I won't be home for at least 4 hours. Skip then or reduce even more and worry? I don't know...

I think that's it. I'm trying to figure this out so bear with me.

Kimmie
 
. 1) She had some low numbers sometimes! (35, 44) In her notes, she didn't seem panicked! Just said fed LC at +3 and +4.
2) If the number is under 100, you do or don't shoot? If that's the case, How will I know when Hank is in remission?
3) At what point is it going to be easier for me to use the U-100 syringes for dosing with the conversion chart?
4) What happens on a morning that I have to be at work at 5AM and he has a low AMPS? Cause I won't be home for at least 4 hours. Skip then or reduce even more and worry? I don't know...
Click to expand...

1. He'd been at those numbers before and she'd been able to bring him up with food. It's that ECID thing. Some cats can dip low, have no symptoms and stay safe. Others not as much. You have to learn Hank's patterns and be confident you can handle them.

2. I wouldn't be able to advise shooting under 150 for anyone else's cat, and then only a tiny token dose. The remission range is 40-120 without insulin. If he is at 100 at preshot, it would be nice to be able to "chase" the numbers and shoot once he reaches your target number. Some of the remission spreadsheets show that people shot off 12/12, often much longer than that, by chasing the number.

3. Soon.

4. Anytime you are worried that he won't be safe, I'd skip. You can catch back up.
 
1) . That's where "know your cat" comes into play. She must have felt confident that LC food would be enough to bump up the number.

2). Under 100? I don't think anyone here, including . me, will advise you to shoot under 100. You will know he is OTJ if his numbers remain under 100 with no insulin for two weeks.

3). I think you'd be OK with the U100s at anytime. When his doses are under 1u, I think the U100 syringes will allow you to dose more accurately.

4). That's all about "level of comfort". If you aren't sure, don't shoot. Or reduce. You can always shoot four hours later when you get home.
 
I can shoot 4 hrs later when I get home? Doesn't that throw everything off?

Yeah I did notice that Sarah sometimes waited before shooting. She was saying +13.

What about the wait 3 cycles before changing dose? How does that work now? Do I try to keep same dose till something different (off) happens.

Don't worry I'm not going to be up much longer. :smile:
I just want to understand what to do. Thank you so much Sue and Carl for all your help.

I'm kind of excited about being able to shoot under 200. :smile:

Kimmie
 
. I can shoot 4 hrs later when I get home? Doesn't that throw everything off?

What about the wait 3 cycles before changing dose? How does that work now? Do I try to keep same dose till something different (off) happens.
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I think the assumption is that, at that point, you'd likely to be off a 12/12 schedule, often going longer than that to reach a shootable number. So, maybe shoot 4 hours later, knowing you'd be around the next day and be able to shoot later, when the number is in your shootable range.

No, the 3 cycle rule is probably out. You're trying to keep him in a good range and it may mean a sliding scale.
 
I can shoot 4 hrs later when I get home? Doesn't that throw everything off?
Click to expand...

Some people refer to this as "chasing the numbers". Sometimes, when a cat is on low doses and it looks like it might be almost time to go into remission, people will shoot on an " as needed" basis. You determine what BG you are considering as "shootable" and you wait until the number is high enough to shoot. Could be 16 hours, 24 hours, whatever.
What about the wait 3 cycles before changing dose?
Click to expand...
In my mind, there is no such rule (although I am probably in the minority). I shot a sliding scale, and it was extremely rare that Bob ever got two shots in a row that were the same dose. The protocol, and ANY protocol for that matter, is a set of guidelines that are compiled based on the experiences of lots of people. They aren't rules. And cats can't read, so they don't care? :lol:
 
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