+5 of 48 for Clarence, please help for tonight/tomorrow

@MrWorfMen's Mom

Hi Linda, I hope all is well with you and your kitties.

Hi to anyone else that might be reading this as well, it takes a village and all input is welcome and appreciated.

Sorry this is a bit long, but I haven't posted in a while, so please forgive.

When you have a bit of time, would you mind to take a look at Clarence's spreadsheet? I think I need to increase him to 1.5 units and see how that goes for him. He has been on the 1.25 dose for a little over a week. I won't be doing the increase for a few days because I have other things going on and I'd like to have time to monitor him closer during the first few cycles once I do 'up' his dose, so I'm thinking of doing it this week-end. I'd love to get your thoughts on the increase and also weather waiting until the week-end is too long.

I don't want to increase too fast and it seems to me that he is just so quick to bounce whenever he gets down to those good numbers.​

To me (and I'm no where near as good as you at interpreting the numbers and spotting the patterns), but to me it looks like he was doing some small bounces -- some of the pink AMPS and PMPS. But a lot of the AMPS/PMPS have been in the yellow, so that's good, right? On August 19 when I did his PMPS test, he was at 187 and I had to stall for it to get above 200. That low of a PMPS or AMPS has been rare since I've been testing him and hasn't happened at all since I started using the Human Meter now.

I've been working on my technique and getting better (I think and I hope ) at drawing up the insulin and giving the injections. I got myself a pair of stronger reading glasses and a head lamp and that really helps, too. Clarence hasn't been complaining much lately, either, so I feel like I've been improving from his perspective also. I got him some toys and have been spending time playing with him to try and get him some exercise. I can tell by lifting him that he has gained back a little of his weight, but he doesn't do much but lay around and until I can fence in a larger area for him to go wander and hunt (which he loves), the squeaking toy mouse, feather wand, and tunnel will have to entertain him. I feel like he is somewhat depressed because he can't be out just wandering wherever.

I would really appreciate your thoughts and views on all this. Let me know if you have any questions. Have a great day! I'm gonna tag again incase the first one didn't work... @MrWorfMen's Mom
Hope to hear from you soon, Linda, I really value your input.
Thanks!
Deedee

 

Clarence isn't looking too bad but he definitely has room for improvement. I agree a dose increase is needed. It's Ok to wait till the weekend but I don't think he'll do anything too dramatic with a 0.25u increase. Going forward, I would only hold a dose for a max of 1 week if numbers are not improving or getting to the levels you desire. Letting them sit in higher numbers can cause glucose toxicity and that can mean a dose increase or a few increases to get kitty moving again and BG starts improving.

 

Hi Linda,
Thank you for checking in.

Thanks for that info. I appreciate it. I'll have to look up glucose toxicity again to refresh me of what it is. I have so many sticky notes on my desk, I need to organize all this diabetes stuff so I don't get (more?) confused!

I wouldn't wait 'til the week-end but wanted to be around for monitoring and will be in and out on Thursday and Friday so won't be able to collect testing data at regular times--I'm sure you are right that he won't be doing anything dramatic, but I get uncomfortable doing an increase and then just leaving.

I will make a note not to hold a dose for more than a week if it looks like an increase is needed.
Questions:
In your opinion, what is a good amount of time to wait before making an increase?

Can I expect to be making changes/adjustments to his dose regularly or I guess what I'm asking is will there be a dose that I will likely be able to hold him at for any period of time? I'm only asking because I was under the impression from the vet that he would mostly have a dose that he would stay at, since the vet only did his initial dose and 2 adjustments and last time said he wouldn't be seeing him for another adjustment for about 6 months. I'm not really asking for a prediction from you, just maybe some clarification about what I might expect?

P.S. After his injection this morning, Clarence was playing with a new mouse toy I got him -- it squeaks when he bats at it -- anyway, somehow he managed to uncover the a/c floor register and bat the mouse down into the ducting, he was so funny trying to get the darn thing outta there!

Thanks again, enjoy the rest of your day!
DD

 

Until you get Clarence regulated the dose will likely change more frequently. It may go up and down numerous times before he becomes more stabilized. Ideally you'd find a dose that gets kitty into good numbers and that dose might work for a long period of time but BG is not static and insulin needs can change so there is always the possibility of doses going up and down a bit albeit probably not as often.

How long to hold a dose really depends on the cat. I would recommend holding doses for at least 3 days (6 cycles) before making changes but some cats need a dose held for 5 or 7 days. Rule of thumb would be not to increase when you know kitty is bouncing because if the bounce breaks the higher dose may prove to be too high. And definitely make changes when you can monitor....you just never know what these guys might do!

Love hearing that Clarence is enjoying and losing his new toys! I call the furniture in my house, toy traps! Haven't had a toy go down a register but some just disappear for what seems like ages and then magically reappear. I guess I need to hone my toy hunting skills!

 

Lol, do check your registers!

FYI, just tested him and his +3 was 174, down from his AMPS of 333 (I think the 333 was a bit of a bounce from the night, perhaps?)

DD

 

Thanks, this is good to know.

 

Ok, Thank you again. I will keep this in mind. Appreciate all your time helping me get educated on all of this! Clarence appreciates it as well!

 

Yep probably a bounce!

Only have one floor register (most are on the bottom of the walls.....old house) so they aren't the problem here. There are however lots of toy traps!

 

@MrWorfMen's Mom

Hi Linda,

Well, I tested Clarence around +5.5 and he was at 48 - I tested again right after that incase there was some mistake and it was 49. I fed him and gave him some honey on his gums. I even tested him again while he was eating, poor guy - I couldn't believe it was that low. So, after he ate a good amount, I tested him about 15 minutes after that: 60. I know I should probably have waited a half hour after he ate, but I was scared! I will test him again pretty soon to make sure he is not going back down.

All that said, my question is, given this incident, should I still give him the 1.25 tonight or reduce it, and if reduce it, how much of a reduction? Also, I suppose he will probably have a huge bounce from this, or at least I expect it.

I have an appointment tomorrow morning and will have to leave shortly after giving his insulin, so I'm not sure what I should be doing about that!?!

Can you please help me figure this out? I can't believe he went that low! Is that just a result of his bounce from last night/this morning?

@MrWorfMen's Mom

 

What a little scamp! It's funny how often a threat of a dosecrease seems to bring on some lower readings.

Yes Clarence earned a reduction with that drama today so back him off to 1u to keep him safe tonight. He will no doubt bounce from the low today and should be fine tomorrow. You can always leave food out for him when you leave so that he has something to eat should he want or need it.

Test again and if he is still high enough, don't feed anymore and retest in about an hour to make sure he is holding. He's probably at or past nadir now so should be fine but you just never know with these guys as you found out today.

ETA I just realized you posted about 2 hours ago. I see he got up to 81 so just test him again to make sure he's holding.

 

Thank you, Linda, and yes, he is a little scamp! I tested him just a few minutes ago and he was at 149, so he's fine.

So that I don't have to be a PIA and bug you when you are trying to get some sleep or watch some tv or get a night out or something, I want to be sure I have my plan:

• Give him 1u tonight (even if he comes way up high by his PMPS time)

• Give him the 1.25 tomorrow morning as long as he is 200 or more, right?

If he is under 200, I can maybe stall a bit but not long because I will have to leave, so if he is under 200 tomorrow AMPS do you think I could get away with 1 or even .75 so he wouldn't be without? I realize there is a chance he will be super high from this 'drama' as you rightly called it, but want to not be all freaked out in the morning if he decides he wants to keep me guessing!

I'll plan to put the dog outside in the morning and leave Clarence inside with some food so he can eat if he's hungry.

Oh yeah, he hasn't been as hungry the last couple cycles, and didn't pig-out at breakfast like he had been, so that might have factored in to why he went so low - but he did eat a full can, just not more than that.

And does this mean I should post-pone the increase until maybe Sunday or Monday, or for sure just re-think it and see what he's doing these next couple days?

Thanks again, Linda, you -- and everyone out here-- are so kind to help out all these kitties and caregivers.

 

Yes as long as PMPS is high enough which I imagine it will be but again you never know. I don't know that I'd chance a shot if BG is not 200 or more. He dropped almost 300 points today and it looks like that AMPS could have been a bounce Clarence cleared very quickly.

Nope. Stick to 1u for tomorrow and the next few days following. Today's low was too low for Vetsulin so stick with 1u for at least 3 days. Lows can also make them a little more sensitive to the insulin so no increase right now. Sometimes too much insulin looks just like not enough and only time will tell if the lower dose works better or those lows today were just a fluke for some unknown reason.

The fact that he wasn't as hungry today may have played into the lower BG but it could also be that his pancreas is sputtering into a bit more action.

 

Ok, got it: 1 unit for at least the next 3 days. If his BG is below 200, or if he doesn't eat (which isn't likely but he did eat after the 48 BG, so who knows), then I won't give him anything. Have nice night and thanks again!

DD