Afternoon nadir is 64... time for an insulin reduction?

Please take a look at Lewie's spreadsheet... I'm a little uncomfortable with a nadir of 64 and this means I'll have to stall again tonight. His AM preshot was a little high (pink) so I moved his shot up 45 minutes... because because his numbers were already going up and also because I need to get him back to 8:30am shots.

Yesterday
PM Tested at +12 (8:35pm)=145 STALLED for 45 minutes, gave food and pills.
Tested at +12:45 (9:15pm)=203 so gave shot.

What do you recommend?

 

It'll really depend on where he is at preshot. You may have to stall again to get him to a good number for a shot. But he could go back up enough...he's done it before. As long as he hits 200 I'd be inclined to give him his shot.

 

Is the low afternoon nadir and the need to stall in the evenings and indication that 3 units is too much? Although his morning preshot number is in the pink and yellow. Or does it mean that he just swings that high and low and 3 units is still correct?

 

I just tested at +12 and his number is 154. That's too low for him. I'm using 200 as his safe to shoot number.

Do I go ahead and feed him and give the shot in 30 minutes? Since he will have eaten his number will be higher.

 

Kathy is there any way you can set an alarm on nights like that? Or get a before bed test around +3 or +4 (or is that after bedtime for your schedule?). Many cats run lower at night than they do during the day, and since it looks like Lewie is getting lower during the day, it would be a good idea to verify that he's staying in safe numbers overnight.

I think you did the right thing last night to feed and stall instead of stalling without food. You might try giving a skinny 3u this morning if he's showing a normal-ish AMPS. So somewhere between 2.75u and 3u. If he gives you a low AMPS, then you might need to adjust more.

 

ADVICE NEEDED
Something strange is going on this morning!
I'm trying to get him back to 8:30am/8:30pm Central time shots.
I tested at +11.15 (that's + 11 plus 15 minutes) and he was at 143... too low to shoot so I gave him his pills and breakfast.
I tested at +12 and he is even lower at 131 and this is 45 minutes AFTER eating.

What is going on? Is something wrong? I did NOT shoot yet this morning.
.

 

UPDATE: I just tested again... 45 minutes later... and he is at 145 so he is rising... I will wait till he is above 200 to give his shot...

...and then give only 2.75 units I guess?

The only thing I did differently yesterday is that I did not feed him his 6pm dinner until 8:30pm. Do you think that messed him up?

 

UPDATE with NO Shot:
+11.15=143 gave pills and fed Fancy Feast Kitten 0 carb
+12=131 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+13=145 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+14=110 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+15=72 GAVE 1 TABLESPOON NULO WET FOOD WITH 3g CARBS
+16=81 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+17=76 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)

Any advice? I'm not sure what's going on.
...
NOTE: I incorrectly thought Fancy Feast Kitten was 0 carb, but it's 3 carbs! So feeding him the Nulo with 3 carbs didn't make any difference!

 

I think you can take a testing break until PMPS. Let's see where he is then. These are great numbers after a "no shot".

 

Ok, I'll take a break. (whew)
Shot time isn't until 9:15pm Central Time.
His nadir is typically at +8 so that will be 5pm Central.

 

Hi Kathy! Sorry I've been offline all day. Work has been...an adventure today. So Lewie never got a shot today, right? My gut feeling is that his pancreas might be kicking in some...you never got a food spike, and he has had a really LOVELY cycle today! Now the thing to remember IF that is true is that it doesn't mean he'll suddenly be in remission. Usually the pancreas sputter and sometimes show up for the party and sometimes don't.

Also remember if you don't give a shot, that means he is safe from hypos. Can't hypo with no insulin on board.

Very interested to see where this cycle ends up!

 

Hi Rachel. No, he never got a shot today! Thank you for telling me he won't go hypo without a shot. I didn't know that! That's why I was testing him so much. Poor guy!

I'm so glad to hear that his pancreas might be kicking in... but confused on what I do though... If his PMPS is above 200... just give the regular does of 3 units? What if he is 150 and it's time for bed? Just trust that he will be ok through the night... or set the alarm for a certain time in the wee hours and give a shot? With a sputtering pancreas... how does one know what to do regarding dosing? (I'm asking now because everybody will be asleep when this all starts to unfold! ) Is there a guide?

 

I figured you must not know that he can't hypo without the shot. I don't think we've ever had cause to tell you that before, so how would you know?

There is no guide to what to do. You kind of have to wing it. If he's above 200, I'd be tempted to give a shot and get a +2 if you can. That should help tell you if you're in for an active cycle or not. If he's under it...I'd suggest stalling for 15 min without food and see if he rises. If he's not rising, you definitely don't want to give a shot.

 

Thank you Rachel! I'll follow your suggestions and hope that it won't be sleepless night! I have a meeting tomorrow that I need to be awake in!

 

Lewie's PMPS was 243 so I gave 2.9 units.
I then tested at +2.30 and his value is 173 so I guess that number is "significantly" lower than PMPS? Meaning that the cycle will be more active and I will need to test to make sure he doesn't get too low. His typical nadir will be at +8 so I will test then.

 

I rarely jump on dosing threads but I'm not sure anyone else is around ... so with the way the day went, I would NOT wait until +8 for the next test. If he's dropping like a rock, you'll want to intervene sooner rather than later.

 

Thank you for jumping in JL and Chip.

1. How often should I test?
2. What do I do to halt the drop if he is dropping like a rock? Can I give him food with higher carbs?

 

I'd check a +4 because I'm pretty risk averse and would want to see where this cycle was going and how quickly.

If he's dropping rapidly, I'd try to slow it down with a little higher carb food. And then keep monitoring.

Given he dropped on his own with low-carb food earlier (which can be a sign that his own pancreas was kicking in), it's possible that low-carb could actually drive his BG lower, not higher.

 

I agree that I’d check at +4; I wouldn’t wait until +5 as he’s dropping pretty fast. While the BG likely doesn’t drop at the same rate every hour, he could speed up as he moves toward mid cycle.

 

I didn’t hear the email come in so I woke up and tested at +5 and he is at 70. I feel this is too low based on his history so I gave him 3 Tablespoons of Wellness Chicken and Herring which has 6 grams of carbs.

I didn’t think to ask how much food and how many carbs were recommended. His normal food is 3g carbs. I’ll check again in 2 hours unless I hear from somebody to test earlier.
...

 

Thank you for telling me this! I didn’t realize this could happen!

 

I'd test again in an hour. Better safe than sorry. If he typically nadirs at +8, you want to be vigilant as you still have a few hours to go.

6 percent is still relatively low carb. If you need higher-carb food and don't have any on hand, you can make your own by adding a touch of syrup or honey to your current low-carb food.

 

Well dang...I was wrong! I'm so sorry Kathy.

 

I don't know about that... he was at 243 when I gave the shot which meant he needed insulin right? Maybe I shouldn't have given so much? What do you think?

Giving the Wellness 6g carb food did affect his BG as it went from 70 to 103, which I'm please about.
I'll check in another hour. He is probably going to want to eat breakfast by then.

 

Thank you. I just looked through the cabinet and I have some Royal Canin Babycat Instinctive that is 11g carb.
I also have Purina ProPlan EN that is 17g carbs.
So I'm prepared to go in steps if I need to!

 

Could you please add an explanation for this? I've never seen that happen. Curious. We've often used low carb food to steer a cat up and avoid an influx of unnecessary carbs.

Kathy, I'm sorry you had such a sleepless night! I would suggest lowering the dose a bit more because of the concerns with Lewie and lower numbers with his other health issues. Maybe try 2.75 or if you're using u100's, something around there.

 

Thank you! I'm a little foggy headed today but will survive!
I stalled this morning 2 hours and then gave 2.75 units. I'm using U-40 syringes and they only have the full increments marked (1,2,3,4 etc) so I have to really study the syringe and take pictures of the syringe to be consistent with the dosage. The syringes came as a pack... "UltiGuard Safe Pack". It holds the syringes and is a sharps container, too. Next appointment I will ask for different syringes. Recommendations are welcomed!

 

i’ll toss in my thoughts.

When the pancreas is working and you feed, then 3-4 hours later, you should expect the BG to be lower. That is how endogenous insulin works.

What I can’t tell you is if you’d see any difference in a diabetic cat if you are feeding high carb food vs low carb food if the pancreas is working. That’s because the pancreas, if working, should release the appropriate amount of endogenous insulin to counteract the carbs being eaten and lower the BG 3-4 hours later.

For example, if a nondiabetic cat (or human) eats a high carb meal, the pancreas can handle it and release the insulin to keep the BG at a normal number although you might see a slight and very temporary spike in BG shortly after (postprandial) it’s eaten but by 3-4 hours later, the BG should be in normal numbers.

For a diabetic cat with a working pancreas, feeding high carb food in the situation @JL and Chip referenced, might cause the BG to just be steady and not drop as low 3-4 hours later. But I have no evidence of that and I would imagine it’s ECID depending on how many beta cells are working. Even considering that, I would hesitate to feed high carb food to a cat on insulin as the insulin is waning even if the pancreas might be working unless the cat’s BG is below 40. (If the cat’s BG is in the 40s, I’d try LC first and if that didn’t work, I’d try MC).

When I’m looking at Lewie’s Spreadsheet, at 2.75u, I doubt very seriously that what you are seeing in BG is from a working pancreas. Cats with a working pancreas are usually at a much lower dose and you don’t see bouncing.

 

Hey Kathy, yeah I'd stick with the 2.75. Since you're using the u-40s, have you tried the colored water trick? You can draw some colored water in a syringe to 2.75 and then compare your syringes to that when you draw insulin. That way, even if it's not exactly 2.75, it's consistent...which is most important.

 

Sure. I didn't want to get too far into the weeds and confuse things earlier while we were focusing on the numbers.

The key factors kicking around in my head when I made that comment:
- relatively newly diagnosed cat (1 month or so)
- started at 2U Prozinc and quickly moved to 3U without clear data to support it
- Prozinc is an "in and out" insulin (no depot)
- there are multiple instances on the spreadsheet of having to stall a shot and feed just to get to a "shootable" number
- yesterday's AMPS was, yet again, not shootable, despite being fed an hour earlier. There were then multiple (hourly?) feedings from +12 to +17.
- the multiple feedings didn't spike the BG ... rather between +11 and +17, the BG went from 143 to 76 ... this at a point when the last Prozinc shot should have been well out of his system.

Last night's recap from one of Kathy's posts:
UPDATE with NO Shot:
+11.25=143 gave pills and fed Fancy Feast Kitten 0 carb
+12=131 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+13=145 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+14=110 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+15=72 GAVE 1 TABLESPOON NULO WET FOOD WITH 3g CARBS
+16=81 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)
+17=76 Fed Fancy Feast Kitten 0 carb (actually 3 carbs)

My thought at first glance is that it looks like Lewie could be contributing some of his own (endogenous) insulin to explain the drop. It seems like too much of a delta to be explained by meter variance alone. Could the Prozinc still be working at +17? You sometimes see late nadirs when the cat is being overdosed so I guess it's possible ... I'm just not sure it's probable.

If this were Lantus or Lev, I would NOT have gone down that logic path. Rather, I would have suspected the depot was still working at +11-17 to handle the influx of food and postprandial needs. But the "L" insulins are very different from an in-and-out insulin such as Prozinc. When Prozinc is gone from the system, typically before the next shot, it's gone. Hence the typical "U" type curve of Prozinc rather than the flatter "averaging" you see with the L's.

So to finally answer your question...
In a cat whose pancreas might be "sputtering" and is therefore potentially contributing endogenous insulin in addition to what has been shot exogenously, food can (at least theoretically) encourage the pancreas to try to kick insulin in an effort to offset the meal. When this happens when the cat is already at lowish numbers early in the cycle, you can actually exacerbate the low numbers...a "double whammy" so to speak of endogenous and exogenous insulins. A higher carb food ensures that you're overcoming the combination of insulins to stay safe.

I agree that normally the "rules of the road" are to feed low carb to gently nudge up lower numbers. That is generally the case in cats where the exogenous insulin is doing most of the work. But when you throw in the variable of endogenous insulin, and it appears that the cat has at least some capability to handle some of the load on it's own, it might be wise to consider the carb load when making food decisions. I learned this from the great Jojo and Bunny back in the day when my cat was going on and off insulin and I saw first hand how his body's efforts and my food choices sometimes seemed to be at odds when trying to bring up his numbers.

As an aside... I've had three feline diabetics and still don't consider myself an expert. There has been a lot of cumulative knowledge gained here since I first joined this site nearly 14 years ago, and I'm probably a little "old school" when it comes to dosing and speed of moving up the scale. Thus I rarely giving dosing advice. That said, if I were holding the syringe and Lewie were my cat, I would NOT be dosing 2.75U at this point. I believe it's very possible that Lewie was started at too high of a dose, did some bouncing, and that he probably nadirs far sooner than +8 so some of the low numbers might have been missed. To me, it makes no sense to stay at a dose where you regularly have to stall shots and feed just to get to a shootable number. I'd personally drop to a lower dose and prove the need for more insulin by collecting data, then slowly moving back up the dosing scale as warranted. As I said, I'm more conservative in dosing. We're all colored by our experiences, and I've seen a hypoglycemic cat seize, so I'm probably biased toward underdosing, at least in the early days. As has been said here numerous times, in a cat who doesn't have a history of DKA, "better to high for a day than too low for a minute."

And that's my two cents (probably not worth a penny).

 

Wow. Thank you everyone for all of this information. It's over my head of course so just a few questions:

1. When you say Lewie should NOT be on 2.75 units.... does that mean that my next step is 2.5 units?
2. Should I get a 0 carb food to feed him all the time? Or is 3g ok.
3. When I have to stall, it's ok to feed him to force his number up?
4. I thought I was to feed him most of the food in the first 1/2 of the cycle. Is this still true?

Thank you. Also thank you for the tip to fill the syringe with colored water to help me be consistent.

Lewie's next shot is scheduled for 11pm Central. I'm so tired from being up a lot last night so I hope he's at shooting range at 11pm.
UPDATE:
Tested at +11.45 (10:45pm Central) and he's at 176. I fed him.
Tested at +12.26 (11:26pm) = 190. Still a bit too low.
I'll give him 2.5 units at +13 (midnight Central)... or maybe +13.30... so I can sleep for an hour... OR... I WONDER IF I SHOULD SKIP TONIGHT AND GET UP AT 6am??? (if anyone is awake?)
...

 

I respectfully disagree that Prozinc is an in-and-out insulin. I've long read that on the board, but from research and experience, Prozinc is most often referred to in research articles as a long-acting insulin though with a shorter duration than the L's. A dose from one cycle does impact subsequent cycles. Not for as long as the L insulins, but you cannot dose it well looking just at one cycle at a time. If a cat has received too much insulin it takes a few cycles to work out and stabilize again. if a cat receives a BCS or a skipped dose, it takes a few cycles to get back to normal responses. It's duration is shorter than the L's, but the carryover is a factor that has to be considered. When I see cats on a sliding scale with Prozinc it is nearly always a very bad idea, yet it works fine on Vetsulin which truly is an in-and-out insulin. Though perhaps this discussion would be better in Think Tank instead of on Kathy and Lewie's thread.

Marge and JL thank you both for the explanations of the LC food comment. The way I read

it sounded like you were saying the LC food would cause the BG to go lower, not that the pancreas would respond thus lowering the BG. Clearly the way it read was not the intended meaning, so I appreciate the clarification.


Kathy, I'm glad you went down to 2.5u tonight given your past few cycles, and given that you and Lewie definitely need some sleep. I do not believe that he's been getting too much insulin, but I do think he's heading down the dosing scale now, so take the reductions as you need to, keeping in mind that you don't want him to run as low as many cats do. You might want to take reductions whenever he hits a green at all in order to keep him away from the low greens, particularly when you need to be at work.

As far as syringes, there are a variety of options from adwdiabetes.com. Do you want to stick with u40's, or do you want to try the u100's with the conversion chart? Either option is fine and we can give suggestions for whichever you prefer.

 

Hi Kathy, just saw your update. I'll try to respond to the other questions as well, but as far as tonight's dose....I do think you and Lewie need some sleep given how much you've been up lately. Taking care of yourself is so important in all of this. I think he would be safe at 2.5u given his other cycles, but I wonder if it might be better to go ahead and drop down to 2 or 2.25 so you can rest. When a kitty is moving down the dosing scale they can sometimes surprise us and you don't need that right now. Then we can see where he's at tomorrow and go from there. Do you have a sense of what amount might be best?

 

1. see post #32
2. 3% carbs is fine. Anything below 10% is fine. Some cats do better on the lower part of the range. Other cats to do better in the middle or higher parts of the range. It's just one more area where ECID. If Lewie likes his current food and is happy and healthy, it's fine to continue with that.
3. You don't want to do that on a regular basis - it's better to adjust the dosing. But when it needs to happen it's a workable strategy
4. Yes, that is generally agreed to be a good practice. However, as with everything ECID. When my guy was healthier I needed to feed him late in the cycle or his numbers would skyrocket. Now he does better with less calories late in the cycle.

 

I hope I didn't mess up... I gave 2.5. I think I'm too tired to make a good decision. What I was thinking is that the 2.75 dose this morning was new... so go with 2.5 so it's not too big of a reduction. ug.

 

I think 2.5 was just fine, Kathy. I believe Djamila was suggesting a lower dose so you could rest without being worried. We sometimes reduce a bit more than probably necessary when we've had a tough few days. Taking care of YOURSELF is just as important as taking care of Lewie...you can't care for Lewie if you're frazzled and exhausted. Sometimes you gotta do what you gotta do, but you also have to work and live.

I agree that I believe he is on his way down the dosing scale. That can often happen rather suddenly and the reductions sometimes have to be taken quickly until you find whatever dose the kitty now needs.

 

This thread has provoked some very interesting discussion.

 

Yes, Kathy, my suggestion to lower the dose more was for peace of mind and rest. Not for safety. I expected Lewie could handle the 2.5u just fine. I just wanted you to sleep through the night! As Rachel said, reductions may come fairly quickly for a little while now. This morning if he's blue or low 200's, you might drop the dose again. We also want to be extra cautious with him since he's a bit fragile so it would be better to lower a little too much and then have to raise it again, instead of risking him going too low and not having the resources to keep himself safe.

 

Thank you everyone. I did get about 5 hours of straight sleep so that's good! You are so right Rachel that I need to really take care of myself, otherwise I might make a mistake.

I tested at +6 and he was 88 so he did handle the 2.5 dose ok... although a little low for my comfort. Is 88 too low?

Thank you Djamila for mentioning to drop the dose again if he's blue or low 200's. His shot schedule is very difficult now being at 12:30am/12:30pm.

 

Tested at +11.45 hoping to get a little jump ahead on shot time, however his number is 102. So... I will need to stall again.

Interesting that +8 = 121, at which time I gave pills and breakfast.
+11.45 = 102
+14 = 106
NO SHOT YET

Any thoughts?

 

I'd skip the shot, then post again before the PM shot to see where you're at. He handled a skipped shot two days ago with no apparent adverse or next cycle consequences. It also lets you return to your preferred shot schedule.

You also fed him small amounts throughout the day during that cycle without spiking his BG, so if he's hungry and you're around, you could try that again today. Sometimes small frequent meals work better than one large meal.

As Rachel mentioned previously, Lewie shouldn't be at risk of hypo since you didn't give the AM shot. If you do decide to officially skip today's AM shot, you can take a testing break until PM shot (though I might be tempted to get a test in just for the data point).

The others have been giving you good advice. I particularly agree with the following:

But that's a discussion for later. It's just something for you to chew on for now.

 

Fantastic! I love the skip and then getting back on my preferred schedule!
Thank you for seeing that I fed small meals throughout the day on the other day that I skipped. I have fed him several times today, so I will offer more food every few hours.
I will get another data point around 6pm Central, and also post tonight pre-shot... hopefully around 8pm Central.
Thank you!

 

Lewie's doing really well! I'm glad you're able to just pop back to your preferred shot time with that skip...it makes it a lot easier when you can do that! I'm very interested to see where he goes today!

 

Thanks Rachel! I tested at 6:30pm Central and his number was 151 so I'll test at 2 hours (at 8:30) Central to see where he is.
If he is just barely over 200, I think I'll give only 2.25 units... or 2.0

 

I don't trust myself with a conversion chart with all these sleepless nights!
If possible, I would like a syringe that has quarter marks... 1/4... 1/2... 3/4... 1...
Triple bevel, no silicone, latex free... is there such a syringe?

 

I tested Lewie at 8:40pm Central and he is just at 205. I think I'll wait till 9:00pm Central and give 2 units without retesting... or should I test again in case he drops? He is getting a wee bit tired of my many tests. I went ahead and fed him again with a food with 1 carb because I just realized I'm out of his regular food that has 3 carbs.
Thoughts?

 

Are you planning to test mid cycle overnight?

Since he's barely above 200, I'd probably shoot a token dose and call it a night. Maybe 1U. He might be higher by morning but at least it would mean you could get some sleep. I'd rather undedose and work my way back up if needed.

The other option is to shoot 2U, but I'd probably do a mid-cycle check just to be safe. It'll probably be fine based on what you've seen in the pm cycles lately, but I like to err in the side of caution myself.

Just tossing out my thoughts since you asked ... and since I'm not sure anyone else is around. What do your instincts say?

 

I waited another hour and he is now at 276. I don't want to test mid cycle overnight, I want to sleep.
I think I'll give 1.5U.

 

Sounds good. Lewie might be higher in morning than you've seen recently but who knows, maybe not. It will be a good experiment. And you can sleep.

Ideally you can find a dose that lets you quit skipping and stalling shots while staying in relatively decent BG range. It might be 0.5U BID, 2u BID, or whatever. It seems clear that he needs at least some exogenous insulin for now, it's just a matter of honing in on the ideal dose. You've been doing a great job collecting data; kudos for being so diligent!

 

Thank you so much for checking in with me tonight!
I'll give the 1.5 now (10pm) and then test him in the morning!

 

Lewie did great with only 1.5U last night and at +11.30 he is at 310.
I'm going to give 1.5U this morning and see how he does.
Note: I'm giving his shot 15 minutes early so I can inch back to a better schedule.

 

Ouch. Was hoping he wouldn't be quite that high.

I'm really really glad that you got a solid night's sleep. Also glad that you're able to get back on schedule again.

 

Yeah, I was truly hoping for a blue or yellow score but I guess relieved that it wasn't higher. Funny, I woke up at 4am but made myself go back to sleep.
I'm thinking 1.5U was too low for this morning... I'll check at +5 and +8 and then decide if I need to go higher.
I can't tell if he needs more overnight and less during the day.

 

I just tested Lewie at +5 and he is at 75... much lower than I anticipated so... 1.5U *was* correct... unless he needs more at night and less during the day? Is that possible? I typically feed him twice in the morning but he was sleeping so soundly that I didn't wake him for his 2nd breakfast. I don't know if only 1 breakfast attributed to this low number or not. I will feed him now since he woke up hungry and then test at +8.

 

Good catch on the 75. And that's why we test. Data really is your friend and will help guide you.

Lewie was just barely in the pink this AM so although higher than we were hoping, at least going with a lower dose last night wasn't a total train wreck. I'm glad you got some sleep.

I'll be curious how the rest of the cycle pans out.

 

Sorry, didn't mean to ignore your question...

It's possible, but more typically if there's variability, we tend to see them go lower at night. Try not to write too much into it just yet.

When you were checking throughout the night the past few days, were you feeding at all?

 

On 9/26 I did give 3 Tablespoons at PM+5 when he was at 70 because I thought it was so low.
Question: when you look at Lewie's spreadsheet on your desktop/laptop, if you hover over the individual cells... can you see the comments that I add the cells? Not the comments in column AB, but in the individual cells? I've been adding those mainly for my benefit but I see now that they can help you, too.

 

Hmm, I can't see any comments in the cells. I know there is a way to do it...I've seen the comments in some people's SS, but I can't recall how to do it offhand. When is the last comment you added? Maybe I'm just missing it.

 

I've tried to Google it... maybe right click on the "Sheet 1" tab at the bottom left and then click "View Comments"...

 

Ok... I just tested Lewie at +12 and he is at 141... so we are stalling again tonight.
In reviewing JL and Chip's reply when I thought I didn't give enough last night I read "we tend to see them go lower at night" so I'm currently thinking 1.5U will be still good even though he was a little high this morning
To recap, I skipped yesterday's AM shot, PM shot was given at 10pm Central.
This morning AMPS = 310, AM shot was give at 9:45am Central, 9:45pm +12=141
Thanks!

 

Did you already shoot? I'm just seeing this but it looks like you posted an hour ago....?

 

I'm about to fall asleep, so I'll just try to give a few options in case you haven't yet.
1) it would probably be okay if you skip. I know you're trying to get back on schedule, and stalling doesn't exactly help with that. He may be high in the morning, but as you saw today, he seems to handle that pretty well.
2) you could give 1.25u, but I'm afraid you'll end up with a long night unless he has risen a fair amount while you've been stalling. 1.5u was okay during the day, but it still left you with a low PMPS, so it ws a little too much at this point.
3) you could give a much smaller dose like 50% of normal, and go down to 0.75u. Again, could be a bit high in the morning, but I don't think you need to worry too much about that at this point.

Honestly if it was me and he hasn't risen, I might just skip and go to sleep.

 

No, I haven’t shot yet.

I need to feed him and give him his pills so I’ll probably need to give him some kind of dose. I’ll go test him now.

 

Kathy, I'll be around if you want to bounce your thoughts off someone, but Djamila laid out the options pretty well.

 

Thank you! I just tested at +13.45 (11:30pm Central) and he is at 254. That's safe shooting range AND I just fed him his 2nd dinner and he was VERY hungry so I'm sure he will eat everything.
I'm kinda thinking to give him 1.25U.
What do you think at this point?

 

What are your thoughts about getting a mid-cycle test tonight?

 

I can do it. What time is mid-cycle?What are your dosing thoughts?

 

Mid-cycle will be +5 or +6 for Lewie?

 

Lewie's BG has gone up noticeably during the two-hour stall so he's definitely shootable. I think I would go with 1.25u as you suggested and see where he's at around +5 for good measure (it's probably not critical to get in a test but I'd want to know what happened rather than speculate).

 

I just gave him the 1.25U and will test at +5.
Thank you so much for being around tonight!

 

You're welcome. I'll try to pop back in around +5 to check in on you.

 

Wow! Thank you so much.

 

Good Morning! I tested Lewie at +5 and his BG number is 83. This is with the dose of 1.25U.

 

Great number! Hopefully he'll hang around that zone for the rest of the cycle. I'll be curious what he has for an AMPS.

 

I'm not sure if I'm misreading this Kathy, but remember that if you ever DO skip a shot, you go ahead and feed them normally then.

 

lol... I replied to your message this morning but was doing it from my phone half asleep and I forgot to hit post. Thank you for your reply so early this morning because it gave me confidence to go back to sleep!

 

Thank you Rachel. I ended up giving his shot at midnight so I didn't have to skip. Yay. I was unsure how feeding him so late and giving his shot so late would affect his overnight BG levels... he did good!

 

I fed Lewie his 2nd breakfast and gave him his pills in 1/2 pill pocket at +10 (10am Central).
I just tested him at +11.45 (11:45 Central) and he is at 363. (not the full 2 hours after feeding rule; short by 15 minutes)
I don't know if the food still has him high.
Since I keep having to stall at night, I wonder what dose you think I should give now. The 1.25U dose last night was the first of this dose.
Should I give 1.25 again or go down to 1.0? I'm kinda thinking 1.0U looking at his low value yesterday of 75 at +5.
Thoughts?

 

I think if it was me, I'd go with 1.25 again today. It gave you a shootable preshot this morning and while he went down to green on it last night, it was a nice, safe green. And since he's higher this morning than last night, it should be more than safe to give it.

 

I just tested again... 20 minutes later and he is 306. Thoughts?

 

I'd still be tempted to give 1.25. It's still much higher than last night and the second breakfast probably hasn't hit him yet. HOWEVER...as we say here, you hold the syringe. You have to be comfortable with the dose. If you think 1 is better, go with that. Remember that I'm not there and I can't know Lewie like you do. I don't want you to feel uncomfortable with what I suggest. It doesn't offend me if you choose to do something different, because Lewie is your cat and I really believe in mama sense...sometimes we just know things about our cats without knowing why. If you think 1 is best, go with 1 and we'll see what happens.

 

Ok. I'm going to try mama sense and give him 1U just so his shot doesn't turn into 1am shot time. I'll test him early at +11 tonight. I have the 1 hour window with ProZinc so if his number is getting too high I can shot early? I hope my understanding is correct... without causing the small overlap as was discussed earlier in this thread.

 

Yes, if he's at a typical PMPS number, you can shoot early. You've got the earlier number which will serve to verify that he's high enough and rising. Changing the dosing times around isn't ideal, but when the kitty is dancing to his own music, you just have to do the best you can do.

 

Lewie has always been a very unique fella. I've never met a cat which so much charisma. I had a thrift store years ago and people would stop in just to visit him. Once a group of young girls from ages 6 to about 9 were all sitting in a circle on the floor. I was wondering if they were reading... or playing a game... neither... Lewie was in the middle and they were talking to him!

 

So my mama sense was off and at +10 he is already at 277. Can I shoot a whole hour early at +11? Or should I wait until +11.30 so there isn't any overlap?
Also, I'm thinking 1.25U will be his dose?
Thoughts?

 

Alas, mine too tonight. I reduced my guy a drop and shouldn't have. Sigh. Yes, you can shoot an hour early if he's high enough. 1.25u sounds good

 

I don't think your mama sense was off at all. It was good to see what 1u would do.

As for the 277 at +10, when did Lewie last eat? I'm curious whether that's a food influenced number (I haven't found a way to see your cell notes so have only the notes from the far right col as well as whatever you note in the individual hourly cells). Is it correct that he last ate at +7?

If you're considering shooting an hour early, I'd test again at +11 and see where his BG is at that point. If it's higher than 277 with no additional food on board, and if you're wanting to accelerate getting back to your preferred shot schedule, then I'd certainly consider doing it. Just keep in mind that an early shot can act like a slight dose increase. I might go with 1u tonight under those circumstances to err on the side of caution. If his BG is notably higher at +11, maybe 1.25u, but you caught him in the 80s overnight last night on 1.25u so that combined with shooting early is a judgement call.

As for the higher numbers at AMPS ... I wonder if that might be partly due to feeding him breakfast late in his previous cycle (PM +10) when the last insulin shot was waning. I would be very interested in what his BG was just before you fed him compared to where he was at AMPS. As he's honing in on an ideal dose, this late-cycle feedings might have more impact.

I just saw that Djamila posted while I was typing, which is great. Follow your instincts ... I'll try to be around later if you need anything.

 

I see what you mean about feeding him breakfast late in the previous cycle so tomorrow I will get a reading before I feed him breakfast.
Tonight... for the 277 at +10, he ate at +7.30 (7:30pm Central) so I waited 2.5 hours before I tested.
When I tested at +10 I fed him again. I fed Fancy Feast 1g carb food.
I tested at +11 and he has dropped to 225. I expected the food to raise his BG but as previously discussed in this thread, it CAN cause a drop.
So it sounds like I need to wait until closer to +12 to determine dose. I was wanting to give him his subq fluids tonight and I think that will lower his BG down a little, too? Maybe I should wait on the fluids until tomorrow? He's a bit dehydrated.

 

If he needs fluids, then I'd certainly give them tonight. Yes fluids can lower BG a bit, but hydration status trumps minor concerns about BG impact.

Truthfully, I'd shoot 1u and call it a night. If you wake up or are concerned, I'd grab a midcycle check because he did drop rather than go up between +10 and +11. I'm all about collecting data but you do need to sleep! If you're more comfortable with 0.75, by all means that's reasonable too. I'll poke my head back in later to check on you guys...

 

I tested at +12=252
He just drank/ate a wet sloppy bowl of food so I'm going to wait to give fluids until the morning.
I will give him 1U tonight and call it a night.

 

Yeah it looks like 1 unit definitely wasn't enough yesterday. If he's at all comparable to where he's been the last few days I would give 1.25 today.

 

Yes, with meter variance those three yellows are all basically the same number.

Also in regard to the note on your spreadsheet, remember that JL and Marje clarified that JL didn't mean to say that the food drops the number. It's that the pancreas, if it is kicking out insulin, may lower the BG after eating.

And as another point for clarification:

This is true for the depot insulins, but we only see this effect with Prozinc when a cat is on higher doses. While Prozinc does have some overlap when dosed well, it does not have a depot, so you can, if the numbers allow it, shoot up to an hour early without acting like a dose increase.

 

Thank you so much for clarifying this information for me.
I messed up and fed him at +10 when I am wanting to shoot at +11. If I test at +11 and he is at a shootable range, can I give the shot? This does NOT follow the 2 hour rule.

At this point in time, I'm expecting to give a dose of 1.25U based on the last 24 hours.

 

Did you get a test at +10? Sorry I’m on my phone and it’s hard to see!

 

I tested at +8 because that was his real breakfast with pills. +8=319
When I started giving the fluids, I gave him more food to distract him... wasn't thinking. So no, I didn't get a number at +10.
I just tested at 45 prior to +12 and he is 339 so I think I'll give 1.25U.

 

I think you’d be fine to shoot if he’s high enough. Just keep an eye on him to make sure he doesn’t start dropping fast.

 

At what point when shooting early would you expect the BG to start dropping fast? Like at +5? At typical nadir time... or before nadir? Thx.

 

I’d check at +2 (from when you shoot). That’s usually a good indicator of an active cycle.

 

Ok. Perfect. Thank you!

 

Oh boy... I tested Lewie at +2.5 and he is at 190... down from AMPS of 339. I'm guessing the 190 is considered "significantly" lower than the AMPS of 339, so that means he will have an active cycle with the risk of going too low. I'll test him at +4 to see where he is.
So just moving his shot up 40 minutes throws him into an active cycle?