7/24 Mottyl's +4 47 +5 67 - dealing with low numbers

Good mroing. We made it through Mottyl's first day on Lantus - I shot her 0.5 at 70 last night, had a friend check on her around +3 while I was at work and give her a little snack, I fretted and paced until he texted me to let me know she seemed totally normal. When I got home at 4AM I noticed she had thrown up a bit. I slept 3 hours, got up to get her AMPS, which was 196, gave her 0.5, went back to sleep. She threw up a little bit again around +3. I'm not too concerned about the vomiting because it was after the insulin and her appetite is otherwise normal.

So far so good, I think? Will post back with her +5 and +7. I don't work today so want to get a +10 too.

 

Re: 7/24 Mottyl AMPS 196

good morning! nice to see you here for day 2!

here's your condo from 7/23 Mottyl.

great job shooting low last night! most people would've skipped that - just know that it's ok to skip when you're not going to be able to monitor. Shooting low can really flatten out the cycles and is great overall, but you do want to be able to monitor when you're beginning to do that so you know how Mottyl's going to respond.

Usually when you give a reduced dose because you're not going to be home and the preshot is low, you'd want to return to the regular dose with the next shot. I actually think i'd return to the 1.0u tonight and then stick with it for 5-7 days, starting from tonight. The guidelines suggest holding the dose for the first 5-7 days on Lantus to let the depot adjust. It takes that long to see what the initial dose can actually do with the blood sugar.

We do a lot of counting cycles - when you change the dose for any reason, you start your cycle count over.

Tight Regulation Protocol

If you can get a +2 this morning, that will help tell us what Mottyl has in mind for the blood sugar curve today. We compare the +2 to the preshot. If the number is about the same, we can expect a "typical active" lantus cycle. That's described in the New to the Group yellow starred sticky. If it's significantly higher than the preshot, then it might be that Mottyl is headed off into higher numbers with New Dose Wonkiness or a Bounce.

If the +2 is significantly lower than the preshot, that often signals that you've gotta pay extra attention in that cycle because Mottyl is going to have a very active cycle.

Because of those factors, the +2 is a great test to get in, if you can.

 

Re: 7/24 Mottyl AMPS 196 +5 106

I missed the +2, oh well. I'll get one tonight after her PMPS.

It was suggested to me by both my vet and a member here that if her PS number is under 90ish on the first day I should change her baseline dose to 0.5 and hold steady on that for a week. So that's what I did/am doing.

 

Re: 7/24 Mottyl AMPS 196 +5 106

ok, that's a reasonable strategy.

nice +5 today!

 

Re: 7/24 Mottyl AMPS 196 +5 106

Anna, I was just reading back through your earlier posts and wanted to suggest that you put your work schedule, or something that says you work long shifts, in your signature line. that will prevent all of us saying "can you test more in the day/night cycle?" to you on an endless basis. :lol: just catch mid-cycle tests here and there when you can, a before bed test, a walk-in/out-the-door-from-work test, etc.

does she have a history of vomiting like she did this morning? any chance it's a hairball?

Mottyl's doing well for the first couple of days on lantus. woot!

 

Re: 7/24 Mottyl AMPS 196 +5 106 +7 55.8

Re vomiting: Like all cats she has been known to hurl on occasion, for no perceptible reason. It didn't look like a hairball though. Anyway she's been steady for the last five hours and seems a-ok so I'm not going to get too bent out of shape about it. If it doesn't continue tomorrow I'll write it off as new insulin jitters.

I edited my signature as you suggested so hopefully readers will understand my situation. It really varies - there are times when I work from home three days in a row, and others when I'm out for 9+ hours.

 

Re: 7/24 Mottyl AMPS 196 +5 106 +7 55.8 +10 76

The Divine Miss M is doing really nicely today. Be sure to get some PM readings while you have the opportunity!

When you brought her in to the vet, were you able to get bloodwork done? I'm asking because it's important to see if Mottyl has any secondary things going on that could complicate dealing with her diabetes. Did the vet do a Spec fPL, for pancreatitis? My cat, it turns out, had panc, but my previous vet never tested for it. Mottyl is recently diagnosed, so you have a very good chance of getting her to remission. That's why I'm kind of Mother Henning you, to make sure you have the best chances for both of you being FD-free. The rest of it is up to the Sugar Dance, as anyone here will tell you...

 

Re: 7/24 Mottyl AMPS 196 +5 106 +7 55.8 +10 76

55.8 - lovely! woo-hoo! she may go below 50 on this dose before long. let's keep this dose for the moment and see what happens.

by the way, just to get you ready for when you see numbers under 50, I suggest you read Shooting and Handling Low Numbers now while you have time. She's going to get there and it's good to have an idea of what you're going to do so you don't panic. Read the link above, especially the 3rd section about handling low numbers.

The basic process is if you get a number under 50, you pop open a can of gravy high carb canned cat food, put the lid back on the food and squeeze mightily to try to get the gravy out. take a teaspoon of that gravy and feed it to her. it's ok if she gets some food, but most of the carbs are in the gravy, which is why you're trying to get to that. Some brands have more gravy than others, so it's worth having a generous gravy food for this purpose.

post here and ask for help - edit the subject line of your first post in that day's thread and put in something like "help with low numbers" or whatever you choose that gets that message across. you're going to wait 20ish minutes and retest. In some cats (mine) it takes 30 minutes to get into the bloodstream, so don't panic if it's still under 50 in 20 minutes. You just give another tsp of gravy and wait another 20 minutes and retest again.

you don't have to panic - you'll have time to bring her up. This is part of the dance of Tight Regulation, but it's safe. If you get scared, it's ok to hit the 911 to get more help.

If you don't have gravy cat food, you can use a drop or two of Karo (corn) syrup, honey or maple syrup. they'll all work.

It's a good idea to print out that particular yellow-starred sticky on low numbers so if the site goes down or your electricity goes out, or it's 4am and no one is online to help you, you've got the information you need.

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 47 HELP?!

Mottyl's PMPS was 124 so I shot 0.5, and now her +4 seems really low (47) and she's still three hours from her nadir. Eep! What do I do? Why is she dropping so fast?

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

I am a newbie myself, but when Skooter went that low, the pros on here had me give a couple teaspoons of high carb food and then tested every 30 mins or so.....

I am sure one of the more experienced people will jump in shortly!

You might want to adjust your original post to have the 911 icon to make sure it is seen quickly

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

Oops I just saw Julie's post from above about how to handle low numbers. Will go for this.

And to answer Picknickchick - yes when she was diagnosed with diabetes she had a full course of bloodwork done - I didn't know what was wrong with her, so the vet checked everything. She doesn't have any complications.

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

Molly is right!

If you have some "Gravy Lovers" food, pop it open, push the lid back down and squeeze hard to get the "gravy" part out into a separate bowl....Give Mottyl a teaspoon or 2 and retest in 20 minutes


If still below 50, repeat the gravy and retest again in another 20

47 is a safe number, but we want to get it back up above 50

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

Hi there

"feed the 40s" is the rule of thumb.

Easy does it - as stated in the info Julie provided.
You got enough test strips?

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

I need some general information too. All in all, I don't feel cut out for tight regulation. I guess I'll be up for another three hours tonight testing, will be a wreck at work tomorrow and will be worried all day wondering if she's going hypo, will come home and stay up another night testing, be destroyed the next day, etc. Frankly I don't understand how you all do it. Surely people here have jobs they need to go to, events to attend, etc. How do you handle it? Does it get better and you have to do it less? I really feel overwhelmed and don't know if I can go on like this.

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

Hello again

I see Mottyl just started Lantus yesterday AM.. .It seems to be agreeing with her.

Take a deep breath. One shot at a time. We have all been there.

Regarding this present cycle -
Do you have enough test strips for tonight?
Did you feed Mottyl a small bit of high carb food/gravy? If so are you coming up on 30 mins since?

 

Re: 7/24 Mottyl's +4 47, feeling like I can't handle TR

Yep I have enough test strips. I fed her some hi-carb 20 mins ago and she's up to 66.6 (no coincidence?).

Will keep testing but seriously don't know if I can stay awake.

 

Re: 7/24 Mottyl PMPS 124 +2 99 +4 7 HELP?!

Hello!! Billie and I are fairly new here - she started insulin in mid May. I just want to say that it does get easier! I was very overwhelmed and stressed at first, and I thought it was going to be a nightmare the whole time, but it's not at all. That is mostly thanks to how incredibly kind and helpful everyone here is. It's also because I have seen improvement in Billie, and it's encouraging. It looks like Mottyl (I LOVE that name!) is already responding really well to a low dose, and that's awesome.

The worst part for me was also the "going to work and being a nervous wreck all day" part. That is rough. I am lucky and was able to adjust my schedule so I can work from home a lot now, and that helps so much, but I still have to be gone for extended periods sometimes of course. I have dealt with that anxiety by leaving a lot of food out and having someone stop in to check on her in the middle of my shifts to make sure she's okay and encourage her to eat more (usually by adding parmesan cheese to her food). I know some people will leave higher carb food out, others use timed feeders to give new meals throughout the day...I'm sure more people will give you ideas!

If it's not for you, that's totally understandable, but you're doing great so far, and it really does get easier!!

 

Re: 7/24 Mottyl's +4 47, feeling like I can't handle TR

You will need to monitor this cycle for a few more hours.

Continue to test every 30 minutes and guide the numbers with food if needed. Just small bites -
Lather, rinse, repeat. . .

• When Mottyls BG is in the 80's, as long as it's past +6 once an hour testing is OK as long as she's not diving down.
• The general rule of thumb is we like to see 2 tests with rising numbers, without influence of food, before calling it a night.

Please add the test numbers to the ss as they become available. It makes it easier for folks here to assist quickly

edited to add - standing by for the next update

 

Re: 7/24 Mottyl's +4 47 +5 67

Okay I'm at +6ish and she's holding steady at 66.6. Get behind me, Satan!

 

Re: 7/24 Mottyl's +4 47 +5 67

Also, I need to know what to do tomorrow. I leave for work at 11:15, back at 9 PM. Calling in sick not an option. May be able to get a neighbour to check on her but no guaratees - they have jobs too. And they don't know how to test bg. Do I skip her morning shot? Give it to her, leave food out and hope for the best?

 

Re: 7/24 Mottyl's +4 47 +5 67

Well Done !
see you in 30 mins. . .

regarding the AM, what time do you shoot?

 

Re: 7/24 Mottyl's +4 47 +5 67

I try to shoot around 8.

 

She's now at 65, no food for the past hour and a half. She's at +6.5.

Advice?

 

Re: 7/24 Mottyl's +4 47 +5 67

From the information at hand it appears Mottyl falls into the 'newly diagnosed' (less than 1 year since diagnosis) category . Is that the case?

From the TR protocol;

So a reduction in dose is in order, making the new dose 0.25u, (whenever the next shot happens).

It's early in the game and you don't have enough data to see any patterns so you are flying by the seat of your pants right now. Let the numbers (and your instincts) be your guide. Safety first. If you have doubts skip it. you can get back on track the next cycle. Chalk it up to a 'fur shot' ;-)

Keep in mind that with Lantus, generally the best results are achieved when you use a dose you can safely shoot consistently every 12 hours.
Also, when it comes to a chance at remission, being newly diagnosed is an advantage. Although there are no guarantees, It worth the effort to go for it.

See you in 30.

 

if it's been 2 hours since you fed any food of any kind and her numbers are staying in the 60's, you're probably good to go to bed

We all truly understand how you feel and have been there before. You develop a plan that works for you regarding testing.

In the morning, if her AMPS number is 150 or above, go ahead and shoot the new .25 dose

If it's under 150, STALL, DON'T FEED, AND POST AND ASK FOR HELP! Say something that will catch people's eye like "Stalling, Need Help!"

Retest in 20 minutes...if the number goes up, it's probably safe to go ahead and shoot because the lantus is starting to wear off.

Good luck to you and Mottly!

 

Okay, it's now +7 and she's at 63 on no food. Hopefully we're out of the woods. I'm going to give her some LC food and go to bed.

For tomorrow: I'm not sure how to accurately dose a 0.25. 0.5 is hard enough. Any tips?

Will post again in the AM.

Thanks all.

 

You can find a pictorial guide here (scroll down a good bit)
Don't get hung up on whether it is exactly 0.25 - it is your 0.25.
The most important thing is you being able to replicate it consistently.

Oh. . . a magnifying glass helps