? 05/11 Eddie AMPS 205 +2.5 207 +7 176 (Dose question, please)

Good morning,
Here's yesterday's story

https://felinediabetes.com/FDMB/thr...-pmps-245-2-5-122-3-5-76-4-25-77-5-99.263123/

@Wendy&Neko @FrostD
Has Eddie earned a reduction today? His baseline for reduction is 2x76. (Or 1x68). The day before he hit 72 and overnight @ PMPS +3 he hit 76.
Should I go back to 9.5 this morning or 9.75? What seems the most reasonable?

 

Gah sorry replied on yesterday's thread -

Sorry we have a heat wave and Ive had the kids outside as much as possible!

I'm inclined to hold. He technically didn't go under 76 last night. I like this time in green, though if you're worried about him getting ahead of you you could try 9.75 as a fine-tune

 

A heat wave!!?? Wow, we're still seeing snow in some areas in British Columbia. Don't get me started on climate change...

Ok, I reposted that question because I didn't see a response to last night's (same) question. I ended up giving him 9.75u not only because of the 76 last night but the 72 the day before. It's true he didn't go below 76 last night but he would have had I not kept up the food (including some gravy). Earlier, after the 72, Wendy said wait and see if he reaches his reduction point and I thought, well, 76, here we are.

I'm not sure, though, where to go from here. Do I go back to 10u tonight or keep at 9.75u?

Things are getting tight for me: I have the conference at the end of May (25th-28t) and I start teaching in summer session for the next six weeks (May 16-June 22nd): Mondays/Tuesdays/Thursday 11:30-:200pm! I've got to get him settled so that I can leave him during the day while teaching and then for the 4 days at the end of the month!!!

 

Ok, we're @ +7 176 (I had to be out for the last few hours).

@FrostD @Wendy&Neko Do you think I should a) return to 10u? b) stay @ 9.75u?
I'm sorry to keep asking but I'm getting closer to not being able to be at home all day (for the next six weeks).

 

That's a long time from now. Worry about dosing a couple days before that starts.

Any chance you could move your shot time up an hour before then? Then instead of +3.5, you'd be leaving later in the cycle and have a better idea what he's doing. By +4.5 any action seems to be winding up for Eddie.

If you are uncomfortable with the nadirs on 10 units, see how he does on 9.75 units. You have time to play with this and see what's your comfort zone.

 

How are his stools these days? Any change after giving gravy or higher carb foods?

Just curious. With Eddie’s history of “random” diarrhea, it’s good to try to rule out an association with food. Charlie couldn’t handle gravy foods so I had to make my own MC/HC by adding corn syrup to LC food. That’s always an option if needed.

Also, it seems that some cats can have “hang time” after HC foods, meaning it affects their BG in the next cycle or two. That’s why it’s so important to “know thy cat” and keep those nuances in mind when choosing foods, evaluating a cycle, and making dosing decisions.

 

Neko also couldn't handle gravy made with wheat. So I went to products where the carbs were from potatoes. And to JL's point, Know Thy Cat is even more important with an acro, doubly so with one after treatment.

 

Here's the question. It's not that I'm uncomfortable with the nadirs at all. it's just that I thought the point is give the dose until a reduction is earned. Is that not right? I've always wondered because we give food at low numbers and bring the numbers up but then when the numbers are low, we're happy because the dose is reduced. I understand that giving food to raise BG is necessary but then we keep the BG high enough to not necessarily warrant a reduction. Maybe I'm missing something.

I'm not uncomfortable with the low nadirs. I'm just tired, on the one hand and, on the other wonder why we have certain numbers listed in our profiles that are the line drawn to earn a reduction.

I hope this makes sense. I am tired.

Also at PMPS he's high again: 315. I've gone back to 10u. I hope that's ok.

 

Eddie's diet is pretty consistent. The only time he gets HC is when his BG is down there: like 32-70 something.

 

Eddie being an acrocat, your goal doesn't need to be to earn reductions. My goal for Neko was regulation, with as much times as possible below renal threshold. Yes you can give a dose until either a reduction is earned, or an increase is needed. But sometimes you have to consider life and how you as a caregiver are doing. There were many times I did a temporary reduction so I could get some sleep, then go back up when refreshed. It's a balance. You also want to have him spend as much time as possible to help reduce the bouncing, and not give the antibodies of glucose toxicity a change to grab on. If you can keep him at a slightly higher dose where you feed to make sure he's not bottoming out, you can get him to level out and get used to normal numbers.

You also don't need to have numbers in your profile to describe when you want to reduce. You could stick with TR and use 68 as your reduction point. Then change again if you find a phase of SRT is kicking in and reductions are coming fast and furious.

 

Somehow I didn't realize that things could be so flexible. I've been so cautious about insulin itself and tied that caution to the numbers. I really appreciate your thoughts, especially since tonight I am so tired I can hardly see straight. So, at PMPS +2 292, I've given a few hefty TBSP of LC and I'm going to get horizontal. Thanks, Wendy, goodnight.