Dosing Advise for Maggie

Maggie 7 yrs old. Diabetic since January 2021. He’s currently on Prozinc 3 units twice a day. I have a hard time to find a right dose for Maggie. I can not keep him on the same dose for 7-10 days since he either get too low or too high within 3-4 days. I also reset his insulin to a lower dose but still can not regulate him. Can Admin help to look at Maggie spreadsheet and see if i missed something here ?

https://docs.google.com/spreadsheet...x2JlX9RTOw/pubhtml?gid=1923986863&single=true

Thanks

 

What food does he eat? Any other health issues or medications? Checked ketones lately?

Couple of things:

1. I would hold the 2.75U. You want to give each dose a minimum of 3-4 days, depending on diet and BG numbers. Often you may need to hold closer to 5-7 days.
2. Give the same dose AM and PM, we adjust dose based on nadir not the preshot (except in very special cases, but Maggie doesn't quite qualify yet).
3. Dose changes are typically done in 0.25U increments - I'll expand on this once I have the answers to the questions above.

 

Maggie food: Weruva Truluxe Glam N Punk with Lamb & Duck and Weruva Cats in the Kitchen La Isla Bonita Mackerel & Shrimp plus lots of water in food
7 am - 1 can 3 oz of Glam N Punk
11 am - 1 can 3 oz of La Isla Bonita
4 pm - 1/2 can 3 oz of Glam N Punk
7 pm - 1 can 3 oz of Glam N Punk

No other health issue and this point, no keytones, no teeth issue. no change in food or any activity.

 

Ok thanks.

You'll want to read our dosing methods, explained here - https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

The main differences are:
Start Low Go Slow - you would reduce by 0.25U any time he goes under 90 (or you can reasonably infer he went below 90 - we can help with that). You would hold each dose for one week, then determine whether to hold the dose or increase by 0.25U. Continue to test the way you're testing.

The benefit to SLGS is it typically is the better/safer option for those who can't test often. The downside is that it lets them stay in higher BG numbers longer.

Modified ProZinc Method - you would reduce by 0.25U any time he goes below 68 on an AlphaTrak. Now because we let the BG get into a lower range, more testing is often required - but you're already testing very well, especially when he goes into the lower numbers. You would increase the dose by 0.25-0.5U every 3-7 days, depending on his BG (the guidelines for how much to increase and when are in the link above).

The benefit to MPM is you can adjust the dose more quickly and get them into better ranges more quickly. It does have a higher chance at remission, but that is never guaranteed for any cat. The downside to MPM is the lower range requires more active/frequent testing and sometimes food intervention. .

Now some other housekeeping -
A hypo kit if you don't already have one. Ideally you want some wet foods in the 10-15% carbs range, and some in the 16-20% range. I also like to keep just a few in the 20%+ range. If you let me know what country you're in, I can find the appropriate food list for you. - https://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

Getting a signature set up - https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

Thank you FrostD. I do have everything needed. I am trying to hold the dose at least 3 days but everytime Maggie’s number jump across several band of colours make me worry Maggie will end up with keytone if i don’t increase insulin. Is there a way you can help to look at Maggie existing data and be able to tell what her dose should be? I need a second eyes to view and see if i need to do something else different to help her curve more steady in a lower number range ?

 

In my first post I advised to hold the 2.75U for a few days, regardless of the preshot number. You would reduce if she earns a reduction.

Since you're already on a few days of 3U just continue with that dose for 2 more days.

Jumping the dose around inconsistently and/or too quickly tends to "shoot you in the foot" more often than not. His body needs time to adjust to a dose, and have to make sure he's not swinging too low then causing a spike (I don't think this is the case).

Insulin needs can and do change over time. I suspect your reset was too drastic, so now you're fighting some glucose toxicity. At some point you'll hit a breakthrough dose and BG and dose should come down.

Just check ketones 2-3 times a week. If you get a trace or higher result let us know; trace we can usually be proactive at home, but higher than that is emergency.

The only other thing I would do is keep out for other signs of illness or dental problems, those are the usual culprits for increased BG.

If you want to post every few days asking for advice, I can certainly take a look and see if dose needs adjusted.

 

Thank you FrostD. Will continue Maggie on 3 units for now and see how it goes after that

 

Hi FrostD, Maggie number start going down. He was 148 before shot. I still give 3 units and i gave him extra can of food he asked for the safe side. Should the pm number go down to 2.75 or just keep going and wait for him to get below 100 to go down on insulin?. Thanks

 

Can you get your signature set up when you get a chance? It will just make it easier for me (and others) to find what I need.

You would hold the 3U unless he goes below 90 (or you think he might have gone below 90).

 

Do you have a link to where i can set up the signature ? I don't see the setting or place that i can edit my information from my profile below. it's read only

 

Signature setup done.

 

Hi FrostD, it’s been the same 3 units for Maggie but do you know why sometime the number high and sometime it low? Should i go to 3.25 tomorrow? Thanks

 

Maggie got diarrhea last night and this morning. Maggie did not finish the 1 can breakfast. Usually when Maggie is in hypo or about to go hypo then diarrhea/loose stool will occurred but not to the point of not finish food. Then why bg number higher than other day ? Why bg number keep fluctuate up and down on different days even with same dose?

I still give Maggie 3 unit this morning and will treat diarrhea if it continues during the day. Nothing change in daily activity and foods/water intake

 

Hold the 3U at least 3 more days. You want a nadir (the lowest BG) between 90-120, and he did that the other day.

Numbers bounce all over the place when they are unregulated and getting used to the insulin. He hit a lower number than he's used to, so now his BG is fluctuating a lot. I would expect it to come back down a little in the next 24-36 hours.

Unfortunately I'm not sure what the diarrhea issue might be.

 

thank you FrostD. Will continue with 3 units for Maggie. I will update if i see any change on him.

 

Maggie seem to eat less than before. Maggie eat 3/4 can for breakfast at 7 am on 6/7 and just a spoon for lunch at 11 am then ate again 3/4 can at 4 pm. Did not bother to eat dinner as usually at 7 pm. I still give 3 unit insulin at PM shot. Nadir for pm shot at 1 am is 142 then at 3 am 115. Worry his sugar continue to go down so i get him up to eat 3/4 can of food at 3 am in the morning 6/8. I guess he still full so does not want breakfast at 7 am as usually. continue to give 3 units insulin at AM shot. At lunch he does not want his usual food so i gave him tiki cat and he eat some of them. He very alert and playful even in the morning with no food. I check his sugar and 200 + and 300 +

Was your cat change in the food consume as well. Maggie is now start eating like 2 cans total per day instead of 3.5 cans as before. Is this sign of him getting regulate ?

 

Yep! As numbers come down you'll see him eat less food.

 

he went to 142 at +9 and want to eat so i give him couple spoon on his normal food. I hope to hold him of so he can eat at 7 am and 7 pm (insulin shot). Is it ok if he does not want to eat at his shot time ? as long as i monitor him closely then it should be ok to continue to give shot when he's not eat at his shot time right? do i need to adjust him so he can eat at shot time or let he eat whenever he want ?

 

You could try to adjust your schedule so he's more hungry at shot time. You want him to eat at least 2 tablespoons of food usually before giving the shot. If he doesn't eat or eat much, you have the option to do a one-time reduced shot (10-50% of your normal dose) or potentially skip depending what his BG is.

 

For this last 2 days, If he eat about 1 can (3oz) then he won't eat another can until 10 hours or so after. Will try to give him small amount of food for now when he ask so he can adjust him back to eat at shot time but

What is the rule for "one-time reduced shot (10-50% of your normal dose) or potentially skip depending what his BG is"
For example:
If pre shot is in 100-150 range and he still full and does not want to eat at shot time then i can skip or give 2 units ?
If pre shot is in 150-250 range and he still full and does not want to eat at shot time then i can give 2.5 unit?
If pre shot is in 250-350 range and he still full and does not want to eat at shot time then i can still give 3 units ?

Is there a rule of what his BG is to determine how much insulin he needs without food at shot time ? Of course i'm monitoring him closely and BG test every 2-3 hours anyway but just want to understand how this thing work

Also how do we make a decision how to increase or decrease insulin ? Do we base on Nadir as well for Prozinc ? since sometime his Nadir is not his lowest number. Sometime his lowest is before Nadir or after Nadir

 

It might take him a little while to get used to a different food schedule. You could try smaller meals - half can in the morning, half can midday, etc.

Dose is always based on nadir. By definition nadir is the lowest BG in the cycle, so what I think you mean is that his nadir moves around a bit - very normal! He's in the +6 to +8 range which is fairly common for ProZinc. If he goes below 90, that's a 0.25U reduction. As long as his nadir is consistently between 90-120 on cycles he isn't bouncing, you'll hold the dose. So he's looking pretty good right now. We'll watch him another few days for the next bounce break and decide if he needs an increase.

Unfortunately I can't give you solid guidance until you actually end up in the situation and try a dose lol so for now, I would err on the side of caution. Here's what I suggest -

If he's below 150, skip insulin.

If he's 150-175 and you can monitor, I'd try close to 25% of your normal dose. If you can't monitor, I'd go 10%.

If he's 175-225 I would try 25-50% of your normal dose based on whether you can monitor or not.

225-300, 50-75% of your normal dose.

Above 300, full dose.

Ultimately you hold the syringe, it's what you're comfortable with trying.

 

Thank you FrostD for the explanation. I always thought the nadir is the mid cycle (+6) where it will show the lowest point but it seem to be the lowest BG number in the cycle of the day. so it can be +4, +6, +8. Usually i see him got into hypo before was most of the time is +4 or +8

He's bounce again today . He was at 225@+10 and 231@+11 but then certainly bounce to 569@+12 before shot this morning and very hungry started at 6 but i hold him of until 6:45 so he get food at the shot time. He eat 1/2 of 3oz can his normal food. Insulin still 3 units for AM shot. should i give 2 spoon or so of food so he won't bounce this hard next time and still can eat a gain at his normal shoot time ?

So if the nadir consistently everyday between 90-120 without the bounce then will hold the dose. Does this mean his right dose ?
If the nadir some day between 90-120 like (6/3, 6/4, 6/8) and someday not (6/9) because of the bounce as his situation right now then what i need to do ? When he bounce, it goes really high across several bands color within an hr.

He's in the 9 days holding at 3 units and still bouncing. I wonder when he keep bouncing like this because his body not get use to the lower number or is it too much insulin ? What should i do if he continue bouncing like this ? Also i noticed whenever he bounce he got loose stool and if he's steady then he does not get loose stool

 

He will bounce no matter what you do with the food, since it is his liver causing the bounce. It will take some time for him to get used to lower numbers, so he will probably continue to bounce for at least another month (or two). But what you'll see is he'll start to spend more time in lower numbers before bouncing, and not bounce as long/high. Nothing to do during a bounce unfortunately! Just continue to shoot your normal dose.

Yes, for now, this is his right dose. Insulin needs can and do change over time, so you'll see the "right dose" fluctuate. The hope is that over time, insulin needs continue to decrease.

 

Thank you FrostD. I will continue to keep him on 3 units for now and see if he stay around for more yellow and blue number before he bounce again.

 

Hi FrostD, Maggie is low all day, just wonder if it’s safe to give him 3 units tonight?

 

That is a PERFECT cycle, oh my gosh I am so happy to see that. If you can monitor and have a hypo kit handy, yes give the full dose. I suspect he'll get a reduction to ight or very soon.

 

Thank you FrostD for you quick reply. Let me give him his shot and continue to monitor him. Yes i do have hypo kits and know how to handle him

 

He just bounce again . 139 after 6:30 pm He ate 1 can at 7 pm and i just curious check him before i give ínulin. He already 329. At least he does not bounce in red or black zone this time

 

I thought that might happen, but he did so well today

 

Yes he díd well today. First time he has a flatter curve in a lower range. Hope was part of food contribution since he just ate 30 mins ago

 

Maggie got hypo - 33 at 2:15 and back up to 58 at 2;40. He’s earn a dose deduction. I will give him 2.75 at his am shot then ?

 

Since he went so low I would actually go down to 2.25U now staring with your PM dose.

 

Thanks FrostD. So it’ll be 2.25 starting tonight and monitor for another 10 days ?

 

I'm sorry I meant 2.5U, so a total of a 0.5U reduction from the dose that brought him so low.

Hold it for at least 5 days. If he doesn't go below 120 we'll think about increasing. If he goes below 90 it's a 0.25U reduction. If he goes really low, it's a larger reduction.

He's definitely on a mission so vigilance is key!

 

Got it. Thanks for reply

 

Hi FrostD, Maggie drop again to 65@+11 after pm shot. Do i still need to keep give him 2.5 units or
Should I reduce to 2.25 ?

 

Reduce again to 2.25U

 

Thank you FrostD. Will give 2.25 for pm shot

 

Maggie dropping again to 99 @+6 after morning shot of 2.5 units

 

That's perfect! That's right where you want him. Very happy to see today's cycle.

 

Hi FrostD, Do you think 2.25 is too low for him ? Should i start 2.5 for him tonight instead ?

 

He is bouncing. Let's see what happens when he clears the bounce, so for now keep giving 2.25U

 

Thanks. Will do

 

Maggie numbers doesnt look like it’s bouncing ?

 

It looks like she might have cleared the bounce with the 187 the other night then bounced again, but it could have also been a "partial clear". Let's see where she goes tonight and tomorrow, and increase by 0.25U if she doesn't see anything below 120

 

So will keep 2.25 tonight PM dose and 2.25 tomorrow AM dose and if no number below 120 today and tomorrow then tomorrow night start with 2.5 PM dose ?

 

Looked at spreadsheet - go ahead up to 2.5U at your next shot.

 

Thank you FrostD. Will up to 2.5 for PM shot

 

Hi FrostD, Maggie's number did not seem to improve with 2.5. Do you think we should go to 2.75 ? Thanks

 

Yes go ahead and increase by 0.25U

 

Thank you

 

Hi FrostD,
I know it’s too early to discuss Maggie situation when he’s on 2.75 since it’s not enough data to determine the situation yet and i know it’s not recommended to give different dose for AM and PM. I noticed if Maggie on 2 or 2.5 then his number is high but if 2.75 or 3 then his number will go low. This is what i have a hard time to regulate and find the right dose for him. Have you seen other cats in the same situation and what is your recommendation for his situation ?

 

He's currently sitting in a perfect range at this dose, we'll see how the next few cycles go.

Did you give the full 2.75U this morning? We recommend not shooting if preshot is under 200, or at least stalking without feeding and waiting to see if they come up to a number that's safer to shoot. Please do check him often today to avoid very low numbers.

What you'll want to do is give full dose if he's above 200. You've sometimes shot lower and been ok, but that was luck because he was bouncing. But other times, like that night he had the 33, it wasn't ok. So under 200 you'll do a sort of "sliding scale" as we call it. So you'll do preshot, get a lower number, stall for 20 minutes without feeding, retest to make sure his BG is rising. As long as it is rising -
150-199 I would do 0.75-1U.
125-149 I would do 0.25U.
I would skip anything under 125 for now.

This sliding scale will likely change over time, I'll let you know my thoughts as I watch his spreadsheet.

 

Yes. i did give him a full 2.75 PM dose last night when he was 164 and a full 2.75 AM dose this morning when he was 126. so i've been doing this incorrect then since i thought we don't look at the preshot to determine the dose and have to keep holding the dose consistently for at least 6 cycles

so for today PM dose, if the pre-shot is under 200 then don't feed at his dinner time and wait for 20 mins to check the BG again. If he's continues to be under 200 then do as below but if he's above 200 then give 2.75 after food ?
- 150-199 I would do 0.75-1U.
- 125-149 I would do 0.25U.
- skip anything under 125 for now.

If we do this then how do we know if the dose is right for him since we will change the dose up and down dramatically from 0.25/0.75/1 to 2.75 ? I checked his BG @+3 was 242 and i did give him 1 can of food for lunch. Will check again @+5 or +6

 

Just dropping a link to the dosing sticky again, it's discussed here (and I did mention the lower BGs on June 8th as well) - https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

His normal dose is determined by nadir. Eventually, when he's (hopefully) regulated, you will give the same dose 99% of the time, even at lower numbers. The trouble is while they are still getting regulated, they don't always have a set pattern. He's bouncing today so it worked out, but the other part of the trouble is we don't always know if they're going to bounce from those low numbers (like that night you got a 33).

The sliding scale is just for now until he settles down more. It will take some adjustment trying to get the optimal scale, so for now I've given you something a little more conservative to be safe.

 

thanks again FrostD. I guess with the date I highlighted in tan (4/29, 5/2, 5/6, 5/14, 5/16, 5/17, 5/20, 6/5, 6/10, 6/11, 6/22, 6/23) were the one that I supposed to do the sliding scale but did not which caused him went into hypo and bouncing around ?

What's about 6/12 (night) and 6/13 (morning) ?, he was over 200 with full 2.5 dose and he still went into 65 (6/12) and 99 (6/13). would it save to give him full dose when he's in 200-250 ?

Sorry for flooding you with questions

 

I would actually ignore everything before 6/12 since we know the dose was too high for awhile, then there was the reset, etc. But I'll explain a few anyway --

6/5 - Yes the recommendation would have been a lower than usual dose, but he did not hypo because I believe he was bouncing - so the higher dose cut through the bounce.

6/10 - AM - I think this was just luck. Doesn't look like a bounce, could have been, I wonder about possible furshot. 6/10 - PM - this one in particular highlights the dose being too high - if those tests are right, he bounced, and the dose still cut through that bounce and had him go hypo.

6/11 - same thing, fortunate that he was bouncing anyway, the full dose cut through.

6/22 - in this case the full dose at 164 worked out. He didn't bounce (at least I don't think) and he didn't go too low. This day in particular is why I'm saying I expect the sliding scale will need adjustment, but better to start a little more conservative.

Today - he bounced, and the full dose kept him flat yellow.

One other option you have, if you have the schedule flexibility, is delaying shots (without feeding) for up to an hour or so. If it's clear hes bouncing - very rapid rise - can probably give the full dose to help stop the bounce. The trick there is you'll probably need guidance to learn to see the pattern of a bounce beginning.

 

thank you for your explanation. Yes, i would love to learn more about the pattern and want to help him into remission if possible. I do have a flexible schedule and i'm able to monitor him closely during the day.

 

Please remind me to check his spreadsheet tomorrow to watch the bounce...caught up with a few complicated kitties and I'm worried I'll forget to check in

 

hi ForstD, can you please check Maggie number for me ? i increased Maggie to 3 units this morning. i don't think it's a bounce since it does not look like he's going any lower. he's keep dancing around 2.5-3 units

 

Yes I think an increase was good. He is bouncing from the blue yesterday - that was a rapid rise to PMPS and he's so high this morning.

Very normal for them to float between doses! Remember insulin is a hormone and is affected by a lot of things, so needs change.

 

There is no more issue with diarrhea and hope his condition stable now so we can figure if 3 is good for him

 

Maggie number start to come down this morning. I will see if I can do the sliding scale for him tonight if the number is still below 200 but he's very food motivate. he's screaming to ask for food even before 30 mins of his meal. will try to see if I can not hold him of for food then will do the dose reduction

 

Well there really was no indication he was going to break that bounce! Nice numbers today though. Hopefully he doesn't go too much lower

 

yeah, this is the problem for a while that i'm trying to figure out if something i did wrong or not but it seem 2.5 and 2.75 is not enough insullin and 3 is too much insullin. not sure what else to do if he go too low again

 

Based on today I think this dose is ok for now, just as you said will have to be careful because 3 seems to get to be too much for him sometimes. Sliding scale can help, just have to figure out what it is first lol

 

hi FrostD, do you know why Maggie jump across several band of color like today ? he went from 183 to 418 in couple hours. I'd seen him doing this a lot before

 

Bounce! Not used to the lower numbers and that was a fairly big drop

 

Is he still bouncing ?

 

Yes, but it's not as high which is good.

 

Maggie at 145 now before AM feed and shot. I am going to hold her food and shot for 1 hr now and will check again on her number. If he stay below 200 then will do the recommended dose. If go up high over 200 then will give full shot

 

Maggie is at 130, 2 hrs after his normal time without food and insulin. I am going to give him 1 can low carb and 0.25 now?

 

Sorry I wasn't around, holiday weekend here. He broke the bounce and had a nadir around shot time. So I'm glad you shot. Looks like he might be bouncing again but the shot is holding it down a little.

 

I did the sliding scale but instead of holding him off for 1 hr and i forgot to hold him for 2 hrs without food and insulin. His normal shot at 7 am central and i did not give him until 9 am

@7 am - 145
@9 am - 130. 1 can of food and 0.25 unit of insulin
@11 am - 270
@1 pm - 265

This mean i wont give him his pm shot until 9 pm central time correct ?but of course still follow the rule below or above 200?

 

You can move the shot back by 30 minutes once a day, so.you could do 830 tonight, then 8 tomorrow night, etc.

 

Thanks. How do you tell if he’s bouncing or not enough insulin? He’s jump to 416 now

 

Naidr tells you if your dose is good. Since we know he's seeing nadirs around 130-140 on his good (non bounce cycles), we know these higher numbers are bounces.

If nadir starts to trend up, that's how we know it's not enough insulin.

 

Maggie is below 200. I delay 30 mins and give him 1 unit
@8:00 - 162
@8:30 - 179 - give 1 unit and 1 can of food

 

He's coming off the bounces quickly which is great! I'll check in tonight hopefully to see how the partial shot did

 

It look like small dose is not enough for him to last 12 hrs? He’s always high in the afternoon. Also the low number in the morning because of his 3 units in pm ?

 

No, I think the 3U is good for him right now. He ended dup bouncing today so the 1U wasn't enough. But he bounces late in the cycle (and breaks them late in the cycle) so you had no way of knowing it was coming. For now keep doing what you're doing, because it's too risky to give full shot with a low preshot. If he doesn't bounce you'll be in trouble.

 

Since he needs more than 2.75 but less than 3, should i do skinny 3 instead then if he still below 200 then reduced. Do i still need to do sliding scale every time he below 200? If i keep doing sliding scale every other day then he wont get back to his normal 7 am and 7 pm ?

 

At this point I would not stall anymore (unless he's too low to shoot), because he bounces so late or breaks the bounce so late it won't help you. You can get back to your normal schedule by (1) moving one shot a day back 30 minutes or (2) moving each shot back 15 minutes.

125-149: I would try 0.25U if you can monitor. Otherwise, skip.

150-174: I would try 0.5U if you can monitor, otherwise potentially skip or 0.25U.

174-199: Try 0.75-1U if you can monitor, otherwise 0.5U.

You can shoot full dose or close to it if you want, but again my concern is if he doesn't bounce. You could easily get into hypo situation.

 

thanks FrostD. I will adjust him back to his normal time. So this mean I have to base on his pre-shot number to give him insulin which this is not the normal case for others ? I hope he will eventually break the fluctuate cycle of being up and down all the time or else it's impossible to get him anywhere near to be in remission

 

Eventually the goal is to shoot the same dose at any number above 90-ish, but it takes awhile to get there.

You'll see the sticky does say until you collect more data under 200, it's best to try reduced doses until you figure out what is safe - that's where we're at, figuring out what is safe but also keeps him from going too high/too low.

Your full dose is still based on nadir, we still want that in the 90-120 range.

 

Hi Frost, i know every cat react different but do you have a case from someone else similar to Maggie and already have data so i can study the trend ? Maggie’s been in this situation of staying with the dose for 2-3 weeks then hypo since last year. His vet and I have a hard time to figure out how to stable him without going up and down the dose since last year and we switched him from vetsulin (gave by previous vet) to prozinc (current vet). We also do full blooded work and all the test for him monthly to make sure no underline condition contributes into his diabetic fluctuations but we still can not find his breaking point yet. How’s long do you suggest to keep what we do to know his trend? Anything else that you can suggest for him? Thanks

 

He is pretty normal for a cat on ProZinc. All those hypos we're from giving the full dose at lower numbers, hence my sliding scale recommendation. The hypos were causing bounces and changed doses, so sort of shooting yourself in the foot.

Our goal with the sliding scale is to keep his BG as flat as we can, and nadir 90-120. This dose is really good for him right now, just have to figure out the sliding scale.

If after 2-3 months he still isn't improving, that's usually when we recommend a switch to something like Lantus/semglee/it's generics.

 

Thank you FrostD. Will keep him on 3 unless below 200 otherwise. he's still keep bouncing for the last 2 days . Sometimes I just feel stuck and helpless when I don't see much improvement on him. I guess it's what it's and nothing else I can do at this point for him other than keep going forward

 

Exactly. It's very frustrating, you just do the best you can and the rest is up to his little body to sort out :/

 

Maggie is at 112 and below 125 rule this morning so i did not give him the shot

 

Ok that was a bounce break - again,.you can tell because his prior PS starts very high, then he slowly came down overnight. He nadirs pretty much at +11 when that happens.

What I would like to try next time - only if you're comfortable and can monitor - stall without feeding, retest in 20 mins just to make sure BG is flat or rising a bit. If it is, try shooting 0.25U if 100-149. What should happen is he will rise a bit before the shot kicks in, then once it does it will hopefully keep him on the flat side.

Right now looks like he's headed into a bounce, aided by a skip(not a criticism! You did the right thing).

 

Let me try to wait for him to break the bounce again and if I see him in a low range like this then I will do the stall. should I stall when the number anything below 200 ? or what should be the right number for me to stall him ?

After the stall for 20 mins, I will consider the rule as below ?

Below 100 - skip

100-149 range: will try 0.25U

150-174 range: will try 0.5U

174-199 range: will try 0.75-1U

Above 200: will try full dose

 

Correct. Skip under 100.

For now, stall only in the 100-149 range. You can stall 150-174 if it makes you more comfortable to make sure he's flat or rising before shooting.

 

thanks FrostD

 

Maggie drop from the bounce again . I am giving him more food to get him back and will keep a close watch on him now. i hope he wont bounce too high in the PM. If he's low in PM before shot then i will do the stall

 

You are still using an AlphaTrak, correct?

He may be headed for a reduction soon here. On an AlphaTrak, you reduce if he goes below 68. That 73 was pretty close.

Hes showing a lot of progress this past week!

 

Yes I am using Alpha Track. You mean if he low to 68 and does not matter how high his number after that then i need to reduce his dose to 2.75 on the next shot? Will 2.75 good for him, he seem get high number when he’s at 2.75 but low in 3

 

Correct. If he goes below 68 (or you can reasonably assume he did), it's a dose reduction of 0.25U. May or may not need to rework the sliding schedule, we will see.

It's very common for them to float between doses like this. Sometimes they need a little more, sometimes a little less.

 

He’s getting low again but let me see if he’ll go to 68 or not with extra food need. Will give him food went he get there

 

He’s bounce again