? 7/23 Max - First time PMPS at 107; AMPS 371, +2.5 306, +7.5 134; PMPS 107. Token dose?

Last post 7/20

Since dropping to 43 on 7/20, Max was reduced to 1.75U (from 2U). AM shot would have been the third cycle at 1.75, but I didn't need to hold him...but also wasn't ready to move him back to 2U, so gave him a fat 1.75U at 12:30 PM (that is our AMPS time due to a stall). Nothing major today - been dropping to the mid 100s near nadir for last couple of days. I was not expecting the PMPS at 12:30 AM to be 107. I know I cannot stay awake all night - I'm going on 4 hrs of sleep a night as it is. I set an alarm for +3 unless Max wakes me at +2 for food. Can I give a token dose for his PM shot? I do not want to do a NS because I am afraid of losing the progress we have made, but I'm also not ready to shoot him at 107.

He was fed by my daughter, so I couldn't stall, but going to retest him now to see if the LC food did anything. Suggestions? He has NOT been dosed as yet.

 

+0.5 after PMPS with food 139.

 

It looks like tonight will be a bounce clearing cycle and he may keep going down. I know you don't want to skip, but you may need to if you can't stay up and monitor. If you do skip, I'd still try and check at +3 just to be safe. The depot will still affect the numbers, even with a skipped shot or a reduced shot.

 

Is it worth testing once more? It's been +1 since his PMPS read and +0.5 since his last read. If he's still climbing would that be food-related, or moe of the insulin wearing off?

 

I don't mind skipping, but my fear is him bouncing really high, which we haven't seen in awhile.

 

He may go high if you skip, but it's a trade off to keep him safe and he will come back down and get back on track. You can try another test, but I'm not sure how long the numbers will be food influenced.

 

Okay, thank you! I think I will skip tonight, and hope for the best. I will set an alarm for 2 hours, to check him at +3, as you suggested.
The idea of a token dose is still new to me, and I’m not even sure if there’s a hard/fast rule on how much to shoot. I remembered reading something at a 1/4 of the dose to 1/2, but I could not find that here or on the FB page archives. That could have also been for the SLGS, and not TR. I reread the protocols and only saw I could do a token dose but it was best to shoot low to stay low. Okay, then, off to bed for me. Max is already sound asleep!

 

That was the problem. He told you 2.0 units was too much 3 days ago so you should have held the dose this morning. We dose based on how low the dose takes the cat, not in reaction to preshots. Sometimes cats will signal they are about to clear a bounce by going higher before they come down. That might have been what Max did this morning. If a cat is doing the "high before the low", it's really important not to increase. Always wait for the bounce to clear after a reduction, then see where the nadirs land, before deciding if you need to increase again.

As for token dose, there isn't any guidance, cause it's not really a thing for TR. You might want to take a look at the Sticky Note on TR: Becoming Data Ready to Shoot/Handle Lower Preshot Numbers. If you can get a few more +1's, it'll give you a better idea how much or if he spikes with his usual dinner, and that might have helped you figure out where he was before your daughter fed him. 107 is perfectly safe to shoot, if you could have monitored.