Wynken and dosing help (sliding scale/not?)

OK - new thread! Thanks to anyone and everyone who wants to help me get Wynk's BG down. I have already received SO MUCH help!

After quite a long time (3+ years) of MOSTLY blind shooting (even though I knew how to take BG, and did occasional curves, per the vet) I joined this group and had an epiphany that I should take readings right before the shot. Duh! On board now, and tracking with all of you on your beautiful spreadsheet format.

I learned yesterday that I should "stall" and see if he is rising or falling if the PS value is low (Thanks, Sue!). The problem is his readings are inconsistent recently. Today, he was terribly high AMPS, and his 6+ was also high . I am conisdering leaving work early today just to see the +10 (would normally miss this) and maybe +11 and the PMPS. Searching for the nadir.... IS there one? Maybe I will miss it at +8 (sigh)

The big question in my mind right now is should I be adjusting his dose (like I have the last few doses - is this a "sliding scale"?) based ont he pre-shot value?

Or should I continue what I have done for years, and keep it the same for a long while (what his body is used to), before making an adjustment? The PZ protocol talks about both, but how can you TELL what is best for your kitty?
Thanks!

 

Still falling at +11. If the PMPS is lower, do I stall? Do I give 2u like normal? Or do I base it on the PMPS?

 

As long as it isn't under 200, I wouldn't stall. He is still pretty high, so unless it's a giant drop, I think we can still go with a shot.

 

Thanks, Rachel. Yes, now I recall that Sue's recommendation to stall was because he was low last nite. If this were your kitty would you adjust dose based on BG, or just give the 2u like he's accustomed to?

 

i think 2 units should be okay. It is always wise to get a before bed test, just to see where things are headed.

Some cats do well with sliding scales; some respond well to the same dose for several cycles before a change. The only way you know which is best for your cat is to try one and then the other.

 

Yep, I'm with Sue. If he was mine, I'd go with the 2 units.

 

Thanks. Will do that now and should be able to get a +3....

 

Just LOVE seeing that mellow-yellow AMPS this morning from Wynken! (Will it be possible for you to get a mid-cycle test?)

 

Thank you, Robin... Me too. I cannot get away from work today, but plan on curves this weekend. Thanks for looking

 

Ok ok ok... PMPS of 147.... So, stalling. What now? Retest in 30 min or do I have to wait an hour? He is wondering where dinner is... Lol. Also, I do not want a repeat of 2 nights ago where I
His morning value the next day was so high, so maybe a reduced dose, and regular meal, not slightly higher carb? Or really low carb (all tiki?) and no dose? Help!

 

Yes, I'd stall without feeding. If he gets up near the 177 you shot the other night, you might try 1.4 again (I wasn't sure about that dose, as we didn't really know if it was rising. Sometimes the next cycle is wonky if you shoot a falling number.) If you can monitor and are feeling brave, you might try 1.6 ( if we are thinking the 1.4 could have been too little but not sure.....)

My thinking is : yesterday, your amps looked like a bounce but we can't be sure. It could have been too little insulin. Either way, it is good data but I'd plan to test and see how the cycle goes and be ready to bring him up if he drops low.

 

Ok going to retest in a few minutes to see if he is rising or falling. My guess is that the 1.4 was too little, given the (for him) higher carb meal I decided to feed that night. BUT, as you say without checking we don't know. Since it's Friday night and I can nap tomorrow I may get up and check him in the middle of the night regardless of what dose I decide to give. Stay tuned!!!

 

OK! I am leaving for the evening. So if you need help, post here and on Health so you will have more eyes. Remember if he'd drop to the 50s, regular carb and retest in 20 minutes. If he drops more, the gravy off high carb food. (I figure if I give you the info, you won't need it - hope!) Or honey rubbed on his gums. Three rising tests before you are safe.

 

I'm keeping my eyes open for your next test, Cara!

 

176. Feed normal meal with 1.6u and check at +3 and +7?

 

Sounds like a plan. The +3 test will let us know if the cycle is likely to be active or not and whether more testing will be necessary.

 

Hi, Cara (& Rachel) - I'll be around tonight, too; will look forward to seeing that +3#.

 

Sue, you are a DOLL for arming me with all that info for a possible hypo tonight. Like you, I imagine that because you did that, it won't happen. LOL Seriously though, I will be surprised if it does... Thats just not like my boy! I mean, if I was still blind shooting like I've done for years, I wouldn't have even known about the low PMPS and I would have given him 2u with the meal I just fed him (scary thought - I have been a lucky girl!).

Robin and Rachel- I LOVE having your company on this ride... I live alone, and while I never mind that at all, it's nice to have friends! Will check in with the +3 reading at about 10pm (Eastern).

And tonight, Robin, I DID stand there for most of the meal (from just before they were halfway through, until the end) and watched them eat. After they had each eaten a little more than half their "part", she wandered off while he ate from both sides of the plate... Then she came back, while there was still food on both sides, and like it was a signal, he looked at her like "ok" and he walked off and washed his face. She finished the rest. So, it was very cool to get insight into what may be a little routine of theirs... He ate about half (really, maybe slightly more...)
Now, maybe there are times when that doesn't happen the same way, but boy was that plate clean when she finished! This is all they get, ever... And they don't act hungry between meals, they are so used to food coming every 12 hours, they act VERY hungry right before the meals. I love them having an appetite!

 

Yes, that certainly beats the alternative - you know, when they're not eating or are not able to eat (that can be so scary). Although I have to say ... when Bat-Bat was totally ravenous from the effects of uncontrolled diabetes, there were times that she yowled so much (& so loudly) for food that I thought I'd lose my mind! Is so much better now - she just does this cheery little "chatty" thing at mealtimes now; almost like she's ... chirping!
She looks happy at feeding time; no longer does she have that desperate, half-crazed look in her eye, where I'd half wonder if she might try to wrestle me to the floor as I opened a can of kitty food.

 

P.S. Good job!!!!!!

 

Robin since you are here for her +3 I will leave her in your capable hands and get some sleep!

 

@Rachel - Sounds good - sweet dreams, Rachel!

 

Thanks guys! 365. Guess I can sleep thru the night, and skip the + 6 or 7, Robin, do you agree?

 

Yep, Cara - I think he'll be fine overnight.

 

Depending on what you see for an AMPS tomorrow, might want to shoot somewhere in the middle: I'm thinking perhaps 1.8? AsWynken has held onto the 2.0 dose a little too long (@ PMPS) twice now in the past couple of days. (So maybe 1.8 could turn out to be his "sweet spot...")
Enjoy a good night's rest, Cara!

 

Thanks Robin, will think about that more when my brain isn't fried!! Hope you rest well, too!

 

Will do! And yes, we'll just see what he's doing at AMPS time ... Sweet dreams!

 

Hi, Cara - Just peeked @ Wynken's SS; nice PMPS we're seeing there! (Every time I think of his name, I see one of these in my mind: )
Will you be getting a +3 or +4 tonight?

 

Robin, thank you! Yes, it was higher than I thought I might see. Also, this late nadir thing is new. He used to peak at about+6 or 7. When I kept the results in excel his curve was smile shaped. Now (since Last weekend) during the day I think he's rising after breakfast and staying flat with a late shallow nadir. Not at all sure what that indicated. And not getting the drop we used to. At some point I ought to make a historical tab with his earlier data.

I will get a reading before bed. Thanks for checking on us. At some point I will want to do something to get him out of these pinks and reds! I have been eliminating some foods from his lineup and trying to get even lower carb meals. I also plan to make the carb content very consistent (so each breakfast will have about the same carbs as any other breakfast and each dinner will also have the same carb content as other dinners). This would have to help, right?

 

Yes, that's a good plan, Cara.

Some cats are really carb-sensitive, and reducing carbs as much as possible can make a significant difference. My cat is one of those who - if I feed her anything more than 3% to 4% carbs - will spike much higher BG#s (found that out by trial and error).

 

Robin, I am so grateful for your help and attention. Going to bed now and will start again tomorrow. I really need to get him below 300, consistently, but how? Meanwhile, I looked at your Bat-Bat's lovely green and blue sheet. . Great job! How do I get there from here? . I want to share a picture with you of my BatGirl(GA). She was named because of her Bat Mask! I had her 16 years, and think she was 17 or 18. This was taken at Medvet oncology the day she was diagnosed with cancer (mid July this year). She was gone on the 25th, and I am glad it came swiftly... She felt really good until the night before she had to be helped to the Bridge. I miss her very much and so does her sister (littermate) Gracie.

 

Aww ... BatGirl was a darling! Thank you for sharing this photo. I'm so sorry you lost her, but must have been wonderful to have had her for so many years. (That certainly doesn't make it any easier to bear, though, does it?)

When our Little Dog left us at age 13, it was a similar situation: We didn't even know she had liver cancer - seemed as bouncy and healthy as ever - until the last week of her life when she suddenly started coughing. We thought she had a cold, so took her to the vet; discovered via chest x-ray that the cancer had already spread to her lungs. (Vet found the primary site - her liver - by doing an ultrasound of her abdomen after the chest film. She was as shocked as we were!) So we, too, were very grateful that it was a swift and gentle exit for our dear girl. She let me know, the very last night, that it was time for us to help her cross the Bridge. She just locked eyes with me, and she did not break her gaze, not until I stood up and said aloud, "Alright, sweetheart," and reached for the phone to call the vet to come. It was the most incredible thing. I know this sounds crazy, but it really seemed as though I could hear Little Dog telling me, "Please ... it's time. We both know it's time." That was in September 2004, yet there's not a day that goes by that we don't miss her ...

 

Oh Robin, thanks for sharing your story about Little Dog! She was really connected with you, obviously! They weave themselves into the very fabric of our hearts...❤️

This morning, I let my frustration with weeks of high values get the better of me and adjusted Wynk's dose up. I would never have done this on a work day but I'll be home all day to check him. His +2 was yellow! So I will be watching him all day.... Please let me know if you think Wynk needs more insulin based on his SS ? (EDIT- not more than the 2.4 I just gave! What I'm really asking is do the numbers before this morning show he needs more than 2u? I guess I am starting to think he does... Which is why I gave 2.4.... Am I out of my depth here?)

I am not knowledgable enough to "see" everything that might be going on, and I have no knowledge of other protocols or insulin so we might try... I am just really upset with all the high numbers! This cat hasn't had kibble or high carb wet food for YEARS! My ultimate goal is to see if I could get him OTJ, of course... But if I let go of that dream for the short term, I JUST want him lower! (Safely of course)....

 

Since you'll be home all day, do you think you could gt some more tests in? A nadir would be helpful to see how low this dose takes him today.

I know it's frustrating, but give it some time. It's rare for a cat to get on insulin and get off in a week or two. We can help you figure out a good dose based on the numbers you get. You're not alone in this...we want to help.

 

Hi Rachel! Yes, I planned on getting readings every 2-3 hours today. I want to find his nadir, too. ☺️ I know it will take awhile, and like I said, I am actually setting aside the OTJ goal, with the immediate goal of just getting him yellow and blue most the time rather than red and pink.

I guess my angst right now is over the fact that I had an epiphany a few weeks ago that the "feeding 100 percent low-carb wet and blind shooting" was NOT in any sense good diabetes treatment. . I suddenly feel bad about not doing better for him (although I am juggling concern for several older kitties with multiple ailments). After today's curve, hopefully one of you can recommend an approach. His vet thinks he's fine because he feels good and is eating.

 

Hi, Cara! Yes, today might be a very good day to get in a little mini-curve (i.e., testing every 2 hours, mostly around mid-cycle) & I see that +2 on your SS already ...

Totally understand your frustration. Sometimes you just go, "Arrrgh! When are we going to see a breakthrough???!!!" But take heart: The numbers you accumulate today on this cycle may help provide you with a better idea of how he's processing both his food & the insulin. While a single cycle is only one "snapshot," this can help you plot your next move.

Speaking of frustration ... I woke up totally freaked because I overslept by more than an hour (!) AND I was completely out of it when I awoke, too. (My vertigo came back with a vengeance last night & took meclizine for the nausea, which knocked me out - forgot to set my a.m. alarms in all the hubbub.) In fact, the only reason I woke up at all was that the Bat had one of her claws stuck in the kitchen window screen & was whining about it. (She must have seen a bird fly by.) So Bat-Bat's AMPS test was waaaaaay late: Imagine a dizzy, disoriented, half-blind person with no coffee in her yet trying to get an ear-prick out of a feisty cat whose breakfast is more than an hour late in coming. NOT good! Anyway, in spite of Bat already being super-agitatated, she only popped a 180 on the AT2 meter, so I said to myself, "Oh, to h*ll with it!" - and just fed her 1/8th can less this morning & followed my gut & didn't shoot a dose. We will see later whether or not that was an error in judgment on my part ...

Anyway, that's where feeling frustrated took me this morning ... So now you know that you're definitely not alone in that sort of thing, Cara!
(On 2nd cup of right now ... Thank you, thank you to whoever it was who first invented coffee-drinking.)

 

Remember, Cara, that Wynken is more than just a number. I know it's hard...we tend to get overly focused on numbers for our diabetic kitties. Part of the reason is we are trying to figure out doses and how to get our kitties either regulated or OTJ here. But as you look at Wynken, focus on other things too. Is he acting happy? Does he seem to enjoy life? Remember that you are doing what you need to take care of him and if he is happy, that means something.

Oh Robin..it's so clear you and I have a lot in common! I don't function without coffee!

 

Robin and Rachel - you guys are the best! I was LOL at your description, Robin. I could so imagine that being me! I slept in 30 min, but it was on purpose -- I tend to start with Wynk at 7 on the weekend, rather than my normal 6:20 (workaday hellish morning routine, stomp, stomp, grumble). When I saw the format of the SS, that was one of the first things I noticed: that the + X would work, no matter when you started that day... and I was glad for that.

So yes, it helps that you describe your own "I'm not sure I did the right thing but I'm trusting my (hopefully educated and wise?) gut."

Rachel, I need the reminder you gave ALL. The. Time. So thanks! I am a scientist and spend my days looking at data. The cats DO provide balance in my life, but when they are not well, I bring out my "numbers-armor" ready to slice and dice data and make decisions... And then someone reminds me... Looook at the kittie.....

He's ok. Not the best, because I think the higher BG takes a toll. He's been gaining the last few months, probably I got to feeding a tiny bit more, with winter coming on, and of course the freeze dried meat treats, because he's a good boy! So Robin reminded me that his body shape is related to how well we will do, and he frankly needs to lose. He sleeps a good deal, and seems comfortable and happy. He went outside this morning and just enjoyed chilling on his chair looking around. He comes running back in when he sees "the sock". He loves the sock with warm rice! He does NOT like his ears handled much before pricking (which I do manually with the lancet) but he LOVES the sock rubbed all over his neck and face and ears. ☺️ I sometimes use it to form the ear around and poke. At this point he often lays down while I push the strip in, and then get the drop. He is content with petting for a reward, usually, the darling! If it's been a bad session or a struggle, I will give 3 freeze dried treats. He's sleeping again, now, but here's a photo I took a few minutes ago, showing his possessiveness with his sock!

 

Due to the very low carb breakfast and also this morning's bump up in insulin, Wynk's nadir was apparently right above 100 and also occurred at +7 which is more like it used to be, so I think that's all good. I woul never have done 2.4 on a day I couldn't monitor, but I did today and now I have data....so now what? I will continue to try and feed the very lowest carb I can, and try to keep the morning meals consistently lower carb than they have been, and leave the evening meals at about the carb content I had before (which was < or = to 5 percent). I welcome any advice on the dose!

Also, today I entered the blood work I got the vet to print out for me recently... On tab 2 where I saw a place for it with the conditional formatting...And I am trying not to panic, but some of the formatting turned his values black!! Neutrophils, amylase... Not sure what to make of it.... Other than his initial DKA event in April 2012... That looked bad, of course. I googled a few things, but still don't know what to make of the other things... I believe there are some 2013 and 2014 blood work that I don't have yet (alternate facility) but this is all I have right now. Can anybody look at it and tell me what they think? I would think his vet would have pointed things out if it indicated a serious problem...?

 

Just peeked @ Wynken's SS; I think that 2U you shot @ PMPS is fine -- as that was a hefty drop today @ +7 after the 2.4U this morning.
Good job!

 

Thank you, Robin! I won't go that high again in the near future. Wanted to see how he did all day with a very low carb meal and a larger dose. I was pleased with what I saw. What do you think about giving s "fat" 2u all week... along with consistent very low carb meals, as long as the PS is 175 or better?

 

Cara, are you going to be able to get in a +3 or +4 tonight?

Re: the "fat" 2.0U - If consistent very low-carb meals is something you haven't been doing 100% lately, I'd be more inclined to suggest - esp. if you're at work all day tomorrow and unable to monitor #s @ mid-cycle - that you might want to stick with a straight 2U tomorrow and see what happens from there. But if you can check him mid-cycle, I'd say you could go ahead with that.

I tend to err on the side of caution, esp. when there's a diet shift toward even lower carbs, as we just saw Wynken hang onto the 2.0 dose a little long on 2/11 from an AMPS of 298 (and we really didn't get to see what was happening @ mid-cycle on that day).

Does this make sense to you?

And what time is it again (your time zone) that you'll be checking his AMPS? (Sorry, my memory's shot tonight.)

 

Robin, thanks for all that advice! It is 10 PM here in the eastern time zone. I am just now getting my +3. Really it's about a 3.25. I will go with just a flat two units all week then, I want him to line out with the lower carb and the steady dosing ☺️ I may even be able to get home for a midday check on Monday or Tuesday.
I generally get his morning pre-shot value at 6:20 to 6:30 AM, Eastern

 

I'm 2 hours behind you, so will still be in the land of ZZZZs ... Rachel may be around, though, if you have any ?s then.

If you can manage it, that would be great info to have.

 

Hi Cara! I am around if you need anything. I like to joke that I take the early morning shift around here...though last week I was on vacation so I didn't. I'm in Central Time and am usually here around 5:20 or so weekday mornings.

 

I'm with Robin, Cara. That was a lovely cycle Sunday, with a perfect nadir at +7. If you could be around, I'd say that was a good dose. If not, a 2 is probably safer.

 

Rachel and Sue, Thanks! Will plan on 2u all week with this (slightly) lower carb food. Can't get home today at lunch to check but will try for tomorrow at +6 just to see where he nadir's at that dose. I am hoping for below 200.