Dosing question

Discussion in 'Prozinc / PZI' started by AliceL, Jun 15, 2023.

  1. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    I am newish to this and following SLGS protocol.
    A week ago kitty earned 0.2 dose reduction because her nadir dropped under 90.

    On SLGS I would usually hold dose for a week and make adjustments where necessary. But I'm not sure what to do with our dose now because her daytime nadir is between 90-150 but her night time nadir is generally higher. I feed a similar schedule day & night so not sure why that is happening.

    Just a side note, she had an overnight stay at the pet hospital on Sunday (for babysitting only, no medical reason) so I have been waiting to see how she adjusts after that whole ordeal, seems to have bounced back fast.

    Previous thread for reference: https://www.felinediabetes.com/FDMB/threads/evies-updates-cont.278280/
     
    Shelley & Jess likes this.
  2. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    I think that you have some room to increase back up to 1.2 to see if you can get nadirs down a little bit. You may want to choose a custom reduction point that’s a little lower than 90 (and just write Reductions at ## in your signature.) She was just borderline with the reduction and I do think she would be safe on the 1.2 units- with the amount of testing that you do. I am so impressed with your care of Evie. And I am really impressed, too, with the Pet Hospital that you found! I have never seen such careful monitoring! I hope your trip was successful. What a relief for you to know that you have a place that will take care of her according to your instructions if you need it again in the future.
     
  3. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Honestly I think the hospital staff were just terrified of disappointing this crazy cat mom foreigner because I arrived armed with a folder full of pictures and strict instructions hahaha.

    Do you think a custom reduction point of 70 is too low?
     
    Last edited: Jun 15, 2023
    Shelley & Jess likes this.
  4. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Agree with Suzanne!

    (Hi Alice!)
     
    AliceL likes this.
  5. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Second cycle of increased dose and our AMPS is 175! Never had that happen before. I’m holding food and will test again shortly but what to do if it is still under 200? Reduced dose or just go for it at the increased dose? I can watch her today. She was quite high last night so wonder if this is just a bit of bouncing.
     
    Last edited: Jun 17, 2023
  6. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    188 20mins later. I am going to feed because she is really unhappy with me not giving her breakfast immediately

    I think I should shoot the current dose, what do you think?
     
  7. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Update: On the advice of the FDMB Facebook group admins I gave her the current dose.
    But now that I have had time to wake up properly and think straight I am very worried that I did.
    Last lowest preshot number was 201 but that was on 0.8U dose.
    The lowest nadir I've had on 1.2U dose was 88 @+6 with a preshot number of 251.

    I can watch her most of the day but I have a short doc appointment at +5, do you think I should maybe take her along or is that just a crazy idea? I don't want to stress the cat out unnecessarily. Hubby is home to watch her but he is not so knowledgable yet on this whole process. He can test her though and of course will contact me with everything.

    I'm a little panicky about this today.

    I actually need to predetermine a new low no shoot number because I cannot fumble around trying to make important decisions at 5am :D
     
    Last edited: Jun 18, 2023
    Suzanne & Darcy likes this.
  8. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Shelley & Jess likes this.
  9. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Very safe number - feed a little LC and test again in 30 minutes to see how fast (or slow) she's moving.

    You're in control by testing. You've got this!!
     
    AliceL likes this.
  10. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    89 30mins later after food
     
    Shelley & Jess likes this.
  11. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Still very safe. Feed another tsp of LC and test again in 30 minutes or so.

    She dropped 13pts in 30 minutes, if she keeps up that pace she'll still be in safe numbers in another 30 minutes.
     
  12. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    67 @ +5
    That’s 22 points drop in 30mins.

    and that’s after a tbsp of mid carb food.
     
    Shelley & Jess likes this.
  13. AliceL

    AliceL Member

    Joined:
    May 11, 2023
  14. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Still safe a little faster and still an hour to go until expected nadir. Do another tsp of MC. Can your hubby test & feed?

    We don't want to slam on the brakes with HC just yet.
     
    AliceL likes this.
  15. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Only if someone can be there to test and feed. If not, I'd do a tsp of HC.
     
  16. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    My husband is feeding and testing

    68 +15 mins after last test, only up 1 point. He also gave her one more tbsp of MC food
     
    Shelley & Jess likes this.
  17. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    That's good! Looks like you stopped the drop.
     
    AliceL likes this.
  18. Charlie (Evie's Dad)

    Charlie (Evie's Dad) New Member

    Joined:
    Jun 17, 2023
    Hi. I'm Evie's dad. Alice needs to go in for her doctor's appointment shortly soon, so I'll keep updating.
     
    Shelley & Jess and AliceL like this.
  19. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    It takes about 30 mins after feeding to see a change to the BG.

    Once you stop a drop and she flattens, stick with LC and see if you can get her to “surf” green numbers
     
    AliceL likes this.
  20. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    You guys are doing great!!
     
    AliceL and Charlie (Evie's Dad) like this.
  21. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    63 now 15mins later

    MC or HC now?
     
  22. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Give the last MC time to work. She's still safe.
     
    AliceL and Charlie (Evie's Dad) like this.
  23. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    She's coming up on expected nadir. It takes about 30 mins after feeding to see a change to the BG so unless she’s in the 30s, I’d be careful about testing and feeding every 15 minutes or you will overdo the carbs and send her skyrocketing.

    Often, mid to late cycle green numbers require less carbs than early in the cycle
     
    Charlie (Evie's Dad) and AliceL like this.
  24. Charlie (Evie's Dad)

    Charlie (Evie's Dad) New Member

    Joined:
    Jun 17, 2023
    Here's her timeline
     

    Attached Files:

    Shelley & Jess likes this.
  25. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Ok, so we won’t test at +5.75 and just check at +6. And no more food for now. Panic stations here :smuggrin:
     
  26. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    I was running around the house in an absolute tizzy with our first 'low' numbers - they weren't even that low, still in the blues!!
     
    AliceL likes this.
  27. Charlie (Evie's Dad)

    Charlie (Evie's Dad) New Member

    Joined:
    Jun 17, 2023
    75 @ +6 so it's climbing a bit.
     
    Shelley & Jess likes this.
  28. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Yep, the drop has stopped. No more food for now & fingers crossed she surfs the greens for a bit. :)
     
    Charlie (Evie's Dad) likes this.
  29. Charlie (Evie's Dad)

    Charlie (Evie's Dad) New Member

    Joined:
    Jun 17, 2023
    Thank you and let's hope so!
     
  30. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    What % of carbs is your MC?
     
  31. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Of course, we haven't talked about this yet, but under the terms of SLGS, she's earned a reduction. So if you plan to continue to follow SLGS then drop her back down to 1 unit. She will probably start having nadirs similar to the ones she had before (that you weren't that happy about.) It depends what you are comfortable with. I was also wondering a few days ago when we talked about taking her back up to 1.2 if you might want to try a "fat" 1 unit. I thought that first we could try the standard increase. A lot of this is going to depend on what you are comfortable with and what your goals for Evie are. She was in safe numbers during this cycle, but I totally understand (and remember) what is was like to see those kind of greens for the first time!
     
    AliceL and Shelley & Jess like this.
  32. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    I gotta laugh because I was silently screaming inside but acting very composed sitting in the doctor's reception room. We've only ever had one single green before so it's going to take a few days before greens feel normal. And what a time to introduce Charlie to the world of FD hahahahaha. That was quite intense for us but Evie is super unfazed having a good ol' snooze after that nice carb-y food. I'll test her now again at +9 to see how her numbers are doing.
     
  33. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    I was thinking about that. I was thinking how I'd be texting my husband constantly asking what was going on and trying to tell him what to do. The doctor would think I was nuts.
     
    Shelley & Jess likes this.
  34. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Oh, we were on the phone the whole time until I went into the office and then I still told the doctor - sorry I have to answer messages when they came through - he was easy-going about it though.

    It is Nature's Variety and it worked out to around 12% carb on some cat food carb calculators but I actually just double checked it now on the Balance It calculator and it says it's 8.9%. So perhaps doesn't qualify as medium carb after all.

    Evie's day-to-day food is around 2-4% but I sometimes give her another food that's 7% and I can see the effect immediately in her glucose reading, so perhaps she is quite sensitive to carb content.

    Our hypo can is Gourmet Gold and works out 18.4%, would that be high enough for a hypo?

    Yeah, I'm not happy with her nadir at 1U.
    I do want her to have more greens of course....in the hopes of kickstarting her pancreas....and yes it is scary at first but I'm sure we'll grow accustomed to it.
    I'm willing to try a fat 1U or even halfway between 1U and 1.2U, while we get used to reading those greens.
    Seeing her drop 22 points in 30 minutes was a little too scary for me...especially when we are that close to 50. I don't think I could cope with TR or PMP yet.
     
  35. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    It is possible that 1.2u for a couple cycles was enough to actually kickstart the pancreas a bit. Sometimes that's all it takes to get things moving again, an increase for a cycle or two.

    I used to do this with Jess when she'd get stuck (especially while on prednisolone), an increase for a cycle or two got things moving again and I could drop the dose back down.
     
    AliceL likes this.
  36. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    So depending on your p.m. preshot, you can consider the fat 1 or the lesser 1.2. How much difference would it be to be between the 1 and 1.2? I am trying to visualize this on the syringe.
     
  37. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Like this maybe? Between the 2.5 and 3.
    How would I do a fat 1U?
     

    Attached Files:

  38. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Making sure I set the 3 line squarely in the middle of the plunger width. If that makes sense.
     
  39. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    @Shelley & Jess Forgot to say earlier, but thanks so much for guiding us through that drop. Very much appreciated.
     
  40. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Well, I think the two doses are probably pretty much the same ... a skinny 1.2 or a fat 1. If to draw one unit of insulin you pull the plunger to the 2.5 mark, you'd go just a hair beyond the 2.5 mark. If, to draw 1.2 units of insulin you draw to the 3 mark (which you currently are doing), you'd go in between the 2.5 and the 3 mark to skinny that dose up a bit... so those two doses are both between the 2.5 mark and the 3 mark on the U-100 syringes, right? So those seem pretty much the same to me! What about you? Only if we had calipers could we perhaps adjust things more finely than the "good old eyeball" can do? :)
     
    AliceL likes this.
  41. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    So today I did a fat dose by aligning the plunger at the bottom of the 2.5 line, usually I align at the top, so it might have not been enough.

    The problem with this evenings cycle is she wasn't as hungry as she usually is but it's probably because she had such a low sugar day. She ate only half her portion at dinner and when I tried to give her more at +2 she vomited it up.
    I just gave her another small portion LC now at +4, she ate it all with some coaxing by mixing it with a little of the 'medium' carb food from this afternoon.
    +4 reading now is lower than +4 this morning so we might be in for a busy evening.
    I hope she will eat some more tonight because she is really not interested.
     
  42. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Hopefully the mix with a little bit of the medium carb food will help things. Sorry she vomited. And it only takes a few bites for these “steering” snacks. A teaspoon is fine.
     
    Shelley & Jess and AliceL like this.
  43. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    102 & 97 are virtually the same numbers. We're here, but you know what to do.

    Should be, anything considered HC starts at around 18%.

    What other food do you have carb wise?

    What's the name/flavour of the MC you used today that may be LC?
     
    Suzanne & Darcy and AliceL like this.
  44. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    It's this one: https://www.naturesvariety.com/en/c...-grain-adult-free-range-beef-chicken-767.html

    Besides her usual low carb food we do have an assortment of other snacks, treats and food from pre diagnosis days as per the picture.
    Are you thinking to try find something that is between the Natures Valley and the hypo can in terms of carb content?
    I will quickly calculate the carbs on these other items.
     

    Attached Files:

    Shelley & Jess likes this.
  45. AliceL

    AliceL Member

    Joined:
    May 11, 2023

    Attached Files:

    Shelley & Jess likes this.
  46. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    So Natures Valley or the Whiskas would be the highest before 20%+ carb food.
    Those liquid snacks are quite useful maybe, do you think I could mix a few drops with the lower carb food to bring down the overall carb content some?
     
    Shelley & Jess likes this.
  47. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Yes. You can mix some HC with LC to get MC if/when needed.
     
    Suzanne & Darcy and AliceL like this.
  48. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Yes & good for you to know what you have on hand carb wise for if and when you need it.
     
    AliceL likes this.
  49. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    67 @ + 6.5, but we are staying calm this time.
    She ate a little an hour ago, all LC.
    Will only start panicking if she doesn't start coming up at the next test.

    This is another reduction earned now isn't it?
     
    Shelley & Jess likes this.
  50. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Yes. Each time she goes below 90 she gets a reduction.
     
    Shelley & Jess likes this.
  51. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Remind me why your spreadsheet cuts off at +8 in the p.m. cycle? I can’t see anything after +8.
     
    Shelley & Jess likes this.
  52. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    So I guess really we should have given her the full reduction back down to 1 unit, at least with following SLGS.
     
    AliceL and Shelley & Jess like this.
  53. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    The columns were just hidden because I don't have any info there.

    We were doing a 70 reduction number but still that's a reduction. But what do I reduce to tomorrow morning? 0.8?
     
    Last edited: Jun 17, 2023
    Shelley & Jess likes this.
  54. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Should I try 1U or 0.8U tomorrow morning?
     
    Shelley & Jess likes this.
  55. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    Perfect cycle so far!!!

    Technically yes, following SLGS. But, you didn't technically take a full reduction tonight.
    I was thinking in this instance, and this instance only, specific for Evie, try 1.0u tomorrow because the full reduction wasn't taken.

    @AliceL How do you feel about the greens now?
     
    Suzanne & Darcy and AliceL like this.
  56. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Nervously optimistic? I wish I had a chance to get used to a few greens before having full on green curves. Today when I saw 63 @ +5.5 my soul just about left my body hehe, I am so not prepared for what this all means and of course very nervous about hypos.

    Honestly I'm not the expert and especially when it comes to managing the low numbers. I will follow what you or Suzanne think is best in this situation. Today has exhausted me.
     
    Shelley & Jess likes this.
  57. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    That being said I am willing to try 1U tomorrow and if that pushes her down below 70 then we reduce back to 0.8U.
    I'm quite tired now, it's past 1am.
    I'm going to get another test in shortly.
     
  58. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    I think that is a good idea to try. Can you write in your signature “SLGS: Reductions at 70”
     
    AliceL and Shelley & Jess like this.
  59. Shelley & Jess

    Shelley & Jess Member

    Joined:
    Jan 23, 2020
    This is what we need to know. Your comfort level is one of our main concerns.
    If you try 1.0u you'll more than likely still see green, just hopefully nudge it up a bit more.
    Thanks Suzanne!
    (I am such a slooooow writer :()
     
    Suzanne & Darcy and AliceL like this.
  60. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Signature updated.

    Last thing before bed, what do you think my new no shoot number should be?
    This morning I delayed her insulin so long while I tried to figure out what to do with 175/188 AMPS.

    Thanks to both of you for holding my hand through this!
     
  61. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Well I feel very confident in your ability to handle greens now. And yes, you have had a really exhausting day. You started early.
     
    Shelley & Jess and AliceL like this.
  62. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Well, should it really be a no shoot number — or should it be a “shoot a reduced dose number?” And then what, like a half dose or what? Because her dose is not really large already.
     
    Shelley & Jess likes this.
  63. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    The usual recommendation for SLGS in the beginning is to not shoot at below 150. But as you gather data that number can be reduced down. Also you can stall if you have time. This morning she really didn’t go up much though.
     
    Shelley & Jess and AliceL like this.
  64. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Shelley & Jess likes this.
  65. AliceL

    AliceL Member

    Joined:
    May 11, 2023
    Ok, thanks. I'll see what tomorrow brings, I'm off to bed. It's been 22 hrs awake and 17 glucose tests today.
    Evie is a little irked with me, just look at this annoyed face :smuggrin:
     

    Attached Files:

  66. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Anyway, at this point in our journey, I would hesitate to shoot the full dose below 150. We don’t have data to support this. That could change very quickly though as we see how she does with the reduced dose of 1 unit — and perhaps.8 if we find she needs it.
     
    Shelley & Jess and AliceL like this.
  67. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Good night!!! Sleep well! Beautiful baby girl, Evie!
     
    Shelley & Jess likes this.
  68. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Good morning. I see she had a similar AMPS to yesterday and you shot the straight 1 unit. She’s relatively flat so far. I hope she will have a nice cycle and that you all can have a peaceful day.
     
    Shelley & Jess and AliceL like this.

Share This Page