Help Please, testing advice and dosing questions

Thank you so much for the advice on the testing increments and a better way to deal with monitoring him. Since it is p.m. where I am, I will test at +2 and see where he is. And I don't want him going below 90 with the Vetsulin. It will be so much better to get all this down and get him regulated. We will all feel better. My poor little dog is feeling neglected lately. And I don't want my Kitty hating me with all this testing. I'm really hoping for a better night tonight.
 
While one wouldn't expect BG to go up it happens sometimes. I see Clarence came down nicely after that higher readings so it was a pretty normal cycle and for now the 2u dose seems to be working reasonably well. Give it a few cycles to see the full effect of 2u, then re-evaluate and if a dose increase is needed, I'd increase by 0.25u to ensure you don't jump over the ideal dose.

When you get a reading of 114 in the middle of the night, you can give Clarence some food to slow down his drop and if need be, a little higher carb can be used to keep him from dropping too low so you can grab some sleep.
 
P.S. I did give him food after that +5 114 reading, I put it in the remarks section of his ss.
 
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I think I can monitor. Should I maybe run a quick test to see where he is -- it is about 15-20 minutes after finished eating right NOW.
 
In the rush of the moment, I get forgetful, so I want to take this opportunity to thank you for the tremendous help you have been. I'm sure it isn't easy for anyone out here to take care of their own cat(s) and household, let alone take the time and have the courage and compassion to help others care for their cat(s) as well as their sanity. Just so you know, I am always appreciative and thankful you are all are here.
 
No problem. My pleasure. I know all too well what it's like but I am one of the lucky one's. Thanks to this board, my girl is in remission so the least I can do is pay it forward! :D
Check Clarence around +3 to see what he's up to. He tends to hit his nadir (lowest point in cycle) later than some on Vetsulin so depending on what he's up to at +3, will dictate when you should test him again. I'll check back in later.
 
Just did the +3 test: 316

Since I gave him only 1u of insulin, he might be on the rise. On the other hand, I noticed that his numbers at +5 have been lower than I was expecting last night, like he drops quickly from the Vetsulin. Should I wait and test at +5 or maybe try for a +4 and see if he increases slightly?
 
I think you can safely wait till +5 and test then to see if he is starting to come down at all. The lower dose may mean a flatter cycle but he's gone up over 100 points since AMPS before food so I expect he should start coming down soon.
 
Sounds like a good plan. I'll test him at +5 and hope that he comes down instead of going up more or sticking around the same thing. When I gave him the 1.5u dose yesterday morning, he mostly stayed stayed in the 300s all day with only slight fluctuations -- I guess that is what you mean by a flat cycle. But then when I gave him the 2u dose in the evening, he dropped to the 100s. Would you consider that to be normal given the AMPS/PMPS and dose amounts? I'm so new to this, but if 1.5 doesn't do much for him, and 2 puts him down to where I have to monitor so close, why is that and is that usual?
 
Dee Dee C said:
he mostly stayed stayed in the 300s all day with only slight fluctuations -- I guess that is what you mean by a flat cycle.
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Exactly. The 1u dose will likely be too low BUT with his AMPS being so much lower, better to try it out and see what happens than to dose too high and be chasing numbers. You need to look at where Clarence starts the cycle and how much he drops on a given dose from that pre-shot BG. So yesterday he started off at 367 and dropped down to 114......a drop of over 250 points. Today when he started off at 190 and you definitely don't want him dropping 200 points so the dose needs to be lowered for safety reasons or skipped altogether. Rather than skip, since he was so close to 200/225, I suggested trying 1u to hopefully keep his BG down a bit but not take him too low.

We don't usually change doses by 0.5u.....we usually only do 0.25u because even a quarter unit can make a big difference for some cats. Some even need finer dosing with skinny or fat doses to keep them in optimal numbers.

Do you have half unit markings on your syringes? If so then it's easier to eyeball quarter unit dose adjustments consistently. If not, then depending on where you are located, you can either order syringes with half unit markings online or go to Walmart and pick up some U100 syringes with half unit markings for even finer dosing options. If you use the U100 syringes you also would have to use our conversion table to ensure correct dosing.

I think that pink cycle yesterday may have been some bouncing (elevated BG) from beautiful blue readings of the previous cycles. It's normal and sometimes can take several (up to 6) cycles to clear. He went to blue again last night and was still in blue this morning telling us 2u is likely too much insulin. So I'm guessing right now that the ideal dose for Clarence will be 1.25u to 1.75u. That said, it's still early in the game so only time and data will tell.
 
+5 reading is 185
so, you were right on -- he started going down, that is 131 points lower than his +3 reading and 5 points lower than his AMPS. So should I do a 6 hr to see if he is on his way down or on his way up?
 
Thanks, I will do a +6
And yes, I do have syringes with half unit markings on them. I wasn't happy with the ones I was using from the vet (no half unit marks), so I ordered a couple different brands to try, so now I have a lot of syringes!

With a 3 hour time difference between you and me, I appreciate your time so much!
 
Oh, one other thing, I usually feed Clarence the chicken and beef feast or the just the beef feast (both of those are supposed to be 5%). This morning I gave him the fish and shrimp (flaked) which is supposed to be 0% because I was hoping his BG wouldn't be affected by his food since it was 190 and I didn't really know what I was gonna do about insulin (time difference and I hadn't seen your post yet). That would probably make a difference in his ideal dose, wouldn't it?
 
Yes carbs can effect how much insulin Clarence needs BUT if you are staying below 10%, which you are, the difference between 5% and 0% probably won't make any instantaneous or major difference of consequence. Now that said, it's a good idea to mark your SS with what you fed so you can look back on it in the future. As much as we stress low carb foods, some kitties do better on 5% than on a 0% carb food for whatever reason. It's good to note if certain foods seem to elevate BG a bit or keep BG down. Knowing how carb sensitive your cat is comes in very handy when and if you are ever dealing with low BG that needs a boost. Some kitties need high carbs to get their BG to move while others will spike on food with 8 or 10% carbs. It's really a matter of getting to know your own cat.
 
+6 is 169
so he is actually in the process of lowering.
Since his lows are happening so late in his cycle right now that it causes his next PS test to be low, how can an ideal dose be achieved (I was looking at his ss and just seeing how his PS numbers have gotten a lot lower than they were when I first started testing him.
 
Love it! He won't necessarily stay that low by PMPS. There are 2 parts to Vetsulin. We usually see the first part of the Vetsulin's action starting almost immediately and evident and sometime it's lowest as early as +3 while other kitties seem to get better mileage (Clarence) and don't start dropping until about +3 or +4. There is a second little dip with Vetsulin and it usually happens around +7/+8 timeframe but in some cats it's so small it's not noticeable. Looks like Clarence is late enough with his initial drop that the second drop looks like an extension of the first. Vetsulin for some cats doesn't last long enough through the cycle. Clarence seems to be getting good duration and that's a good thing. Once you know what your cat's pattern looks like you simply dose accordingly.
 
MrWorfMen's Mom said:
Yes carbs can effect how much insulin Clarence needs BUT if you are staying below 10%, which you are, the difference between 5% and 0% probably won't make any instantaneous or major difference of consequence. Now that said, it's a good idea to mark your SS with what you fed so you can look back on it in the future. As much as we stress low carb foods, some kitties do better on 5% than on a 0% carb food for whatever reason. It's good to note if certain foods seem to elevate BG a bit or keep BG down. Knowing how carb sensitive your cat is comes in very handy when and if you are ever dealing with low BG that needs a boost. Some kitties need high carbs to get their BG to move while others will spike on food with 8 or 10% carbs. It's really a matter of getting to know your own cat.
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So in the beginning of our journey, the vet tech told me to feed him twice a day, which I did for the first week. Clarence likes to eat often, and almost always begs for more food. when I asked the vet about feeding him in-between his regular meals, the vet said I could do that. I started doing that (around the time I got the meter) but only would allow him to eat FF Fish and Shrimp in-between meals. That was his regular routine: 1 can of Tender Beef Feast for breakfast and 1 can for dinner. In between he would eat about 1 1/2 cans of the Fish and Shrimp. Around 7/23, I began feeding him 1 can of the Tender Chicken and Beef Feast for breakfast and dinner. And, Because I was going to be testing him on the increase to 3u, I fed him his 'snack' Fish and Shrimp either as soon as he finished breakfast/dinner or otherwise sparingly because I heard from the vet that he shouldn't eat a couple hours before a test. Maybe my food changes have caused some of these swings I'm seeing--specifically not feeding him much thru the day? Also, it has been pretty hot here and he hasn't wanted so many between meal snacks. I don't want to do anything to harm him.
 
It used to be routine to tell kitty parents to feed twice daily before shots. That leads to a ravenous cat whose BG doesn't necessarily regulate very well because it's not as easy on their pancreas and also the stress of being hungry all the time can elevate BG. What you are doing currently seems to be working fairly well. Every cat is different so feeding times are something you have to experiment with a bit. The only general rule would be to keep the majority of food if not all in the earlier part of the cycle so as not to lessen the duration of the insulin's action. With Clarence, he doesn't seem to be having any problem with duration now and that may be thanks to your feeding schedule or it may just be Clarence.

Dee Dee C said:
Do you mean I should maybe be altering his dose based on his AMPS and PMPS?
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Not exactly. Ideally you would find a dose that works well and allows you to shoot twice daily on a routine basis. In some cats, it's possible to set up sliding scale dosing depending on pre-shot tests. I am not a big fan of sliding scales as a rule but they do work for some cats but only after you have plenty of data.

You've only got about 15 days worth of data right now and it's only been the last couple of days that Clarence has been getting a good run in the blue range and starting to see lower AMPS/PMPS readings. Right now it's still not clear exactly what dose works best for him but I think we can safely say 3u was too much insulin, 2u might be too much and 1u isn't quite enough. You're narrowing down the best dose right now and numbers are a bit erratic but slowly increasing as needed by 0.25u will help figure him out.

The dose increases your vet recommended were too much all at once. It's harder to back up the dose than to just increase slowly by a quarter unit at a time and that I think is why BG seems a bit erratic right now. Looks to me like Clarence is settling a bit now so let's see what he does in the next few days. This is a marathon not a sprint so just take each day at a time and remember each reading is just a moment in time. It's the big picture that matters and Clarence's picture is definitely improving!
 
Thank you for all that info. It helps me to understand more and also not to feel so overwhelmed and SCARED. It feels good to have a better understanding of this. Got it, marathon, not a sprint... Big Picture...
Thanks!
 
Clarence's +9 was high at 382. He was begging for food, so I fed him a small snack of fish and shrimp a couple hrs ago, it didn't stop his begging, tho, so maybe that has something to do with the high BG? And he seems hungry and agitated.
I'm thinking about trying the 1.75u and see what that brings -- dependent upon what his PMPS is. But, he was high last night and 2u seemed a little too much.
 
MrWorfMen's Mom said:
You're narrowing down the best dose right now and numbers are a bit erratic but slowly increasing as needed by 0.25u will help figure him out.
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Do you suppose it would be better for him and better to try to figure out what an ideal dose would be if I just increase to 1.25 tonight and go the route of increasing in .25 increments rather than a jump from the 1u he got this morning to 1.75u? Sort of ease him up in hopes of keeping him from any type of rebound type of activity?
 
I'd give him 1.75u tonight. He's bouncing from the long run of lower numbers earlier. It's normal.....frustrating but normal.
 
Ok, 1.75 it is! thanks for the quick response. Whew! that made me panic. then I noticed that he had some fairly high 400s, and didn't feel so icky! I think it was the black on the spreadsheet that did it! He just finished eating, so Ill give the shot in about 20 minutes.
 
Clarence's numbers are still high. I am going to go to bed and set an alarm to check in on him, maybe do another test in a few hours, but he has only dropped 86 points in the last two hours. If I test I will record on his sheet. Question: should I still give him 1.75 in the morning, or increase to 2 assuming he is still very high on his AMPS?
 
I would hold the 1.75u dose for a few cycles provided his pre-shots remain high enough to give insulin. I expect his readings will come down as he clears the bounce from those blues. You can always increase the dose if need be but you don't want to be fighting low readings when the bounce breaks.
 
Thank you. That's what I was thinking and what I was hoping would be the suggestion. Clever: 'when the bounce breaks'... reminds me of that nursery rhyme! I did a test in the wee hours at +9 and he was at 305. His AMPS was 370. I gave 1.75 and will do a test probably at +3 and go from there.
 
His +3 was 354 and his +6 was 134. I gave him a small snack in hopes of keeping from going a lot lower -- I hope that was the right thing to do. I will test again shortly...
 
Looks like Clarence is getting back to business.....YEAH! Loving that blue again! It's fine to give him a snack if he's hungry but his BG is fine and doesn't need any help at this point. :)
 
Even with the food, I just tested him again and it was 124, so still coming down. Should I test in another hour or wait -- I'm unsure at this point.
 
No give the little guy and you a break. You just fed him so check him at +9 at which time I think he'll be heading up again so you can wait till shot time to test again. It could be the second hit of Vetsulin kicking in right now.
 
Thank you. :) Ok, yes we could both use a break. I hope he goes up enough by his next pre-shot time. Which, I do have a question about -- it is a silly question, but here goes: Clarence normally takes about 15 - 30 minutes to eat his food and then with the 20 minute wait for giving his shot, it is almost an hour after his pre-shot test. So basically what I'm saying is that his pre-shot test is actually the +11 test so his shot can be 12 hours apart. I'm not supposed to be putting that number in both locations on the sheet am I?

By the way, I got the ReliOn Prime and have been using it at the same time with the AT2, just to get to know it a little. I guess I will have to convert the spreadsheet when I start using the ReliOn regularly. Do you know if there are instructions somewhere for what to do when I change meters?
 
Just want to clarify........are the readings on your spreadsheet right now all AT2 numbers? If not, that is going to muddy the picture a bit. Both meters are fine but the human meter will read lower so mixing the numbers will skew the picture of what Clarence's BG is doing.

As for the spreadsheet, you need to add a row to the sheet to indicate you have changed to the human meter. The last colour coding conditional formatting will need to be fixed to show the right ranges. We can get someone to help you with that when you decided to make the change.
 
MrWorfMen's Mom said:
Just want to clarify........are the readings on your spreadsheet right now all AT2 numbers? If not, that is going to muddy the picture a bit. Both meters are fine but the human meter will read lower so mixing the numbers will skew the picture of what Clarence's BG is doing.
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Yes they are all AT2 numbers. I should have stated that to eliminate any confusion, sorry.
 
Dee Dee C said:
I notice that when his BG is higher, the difference between the two is larger. Is that normal?
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Absolutely normal and what we expect. Either meter is fine but pet meters are expensive to use. The bonus is that the readings do look better with the human meter. :woot:
 
Haha! When I'm ready to switch (which will depend on when Clarence's readings stop fluctuating so much, I guess), where do I post for help in converting it over? I used to be expertly proficient in excel spreadsheets, so I'm pretty certain I won't have a lot of trouble with it, but I haven't used google sheets before this.
 
Ok, will do. Thank you so much!

Can you advise what is a safe number for me to give Clarence the 1.75 just in case he doesn't go back up high when do the PMPS?
 
It's hard to be specific due to the bouncing he's coming out of but I think for now, I'd stick with a PMPS of 225 or even 250 on the AT2. I'll be checking back in around 9pm my time so let's see where he's at.
 
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