First time holding a dose

Ducote was switched from Vetsulin to Prozinc 2 days ago (6/16). The first day was horrible numbers (pre shots in 400's but all day in 500's). The second day was great (he even earned a .25 reduction) . I just did his AMPS and it is 142. I am holding the dose and will recheck in one hour. On Vetsulin he lived in the blacks so I am in new territory.
If he is still under 200 in one hour, do I just continue waiting another hour or do I skip the morning dose all together?

 

At +1 he went to 196. It still was not at 200 so I was scared to give the full dose of 3.5u but I didn't want to skip all together with it being so close. I went with a dose of 2.5u to be safe. Does this sound alright?

 

I would say without dosing advice its perfectly fine. Keep checking back for more replies ok?

 

Great job stalling! 196 and 200 are basically the same number (remember 20% meter variance) so you could have technically given full dose, but always do what you're most comfortable with.

If I remember right the recommended "chicken shot" token dose is something like 10-25% less, so 3u would have been a better chicken shot number than 2.5u. He'll probably rise up a good bit on that dose today.

 

I will definitely remember that for next time! My 2.5u was the truest definition of a chicken shot lol Knowing that when he starts at yellows it makes him dip down into greens I was being a big chicken thinking about how low he might go when starting in the blues. But, if I would have remembered the the meter variance I probably would have felt more confident. It is hard to think logically when you are in new territory. I can not wait until this is normal for us!

 

Oh for sure! It's definitely something you have to get used to (my first time shooting a green was TERRIFYING) but it's what kitty needs! Pancreas doesn't start healing until they hit green, so remember to not let your fear keep him from getting better (easier said than done!).

 

I remember shooting a full dose when Trouble hit 145! I had people here screaming at me saying I probably hypoed him. But that never happened. In fact it put him into normal rage (cant remember what they called it) until the day we declared he was OTJ.
((Heather...I wasnt sacred when I shot the 2 units of NPH but I was DEFINITELY scared when I told everyone I did that. They like to tear me apart lol and for good reason, AND I almost left the board because of it. Yet here I am ))

To be clear, I now, would never recommend ANYONE do this. It was a VERY stressful day.

 

You gave full dose of NPH at 145?
Well you must have known what you were doing if that ended up putting him OTJ

 

I can only imagine the nerves that day! I would have been checking levels every hour . But I am sure that when you gave that dose you were at the point of knowing how Trouble reacted and what to do if things went south. You went with your gut but only after you had the confidence and knowledge to do so and that is a very important part of the process!

 

LOL this was before the days of spread sheets so I was going by my little record book. I just kept seeing the same numbers with no budging. I think I couldnt get any help at the time.No one was around. So? I just did it. Troubles lowest test was 83 after that shot. Then it just stayed in the 90's range after that. I think they said he broke the glycemic window?or something like that.

 

The ONLY confidence I had was that if I didnt shoot nothing would change. COMPLETELY WRONG THINKING! Troubles angels kept him safe. I was very grateful

 

Aww you and Trouble contributed to science then! Scary science. Perhaps that was a rare example of when it was needed!

But uh do not do this at home, kids.

 

EXACTLY!!! I'm thinking I should delete that post

 

Haha! Panic took the words out of my fingertips

196 might as well be 200 so now you know for next time. I got a 199 with Minnie yesterday am so she got the full dose

 

His +6 is a beautiful blue (152) If he gives good numbers on the chicken dose of 2.5u from this morning, should I give this dose at night as well or go back up to the 3.25u?

 

Initially I would say no. But you increased your Vetsulin doses very quickly - part of me wonders if you've been giving too much and missed your perfect dose.
I am tagging @Deb & Wink and @JanetNJ , they are very good with Prozinc dosing advice and are better at reading spreadsheets than me.

 

I tend to agree with Panic again. That would be a big decrease of .75 so 3x what we recommend which is going by .25 increments, but let’s see what Deb and Janet say

 

I wouldn't stay with 2.5 unless you have a very low preshot. if you don't wanna go back to 3.25 maybe try 3. Lets see what the preshot is though. Looks like you are getting a better duration with the prozinc.

 

Yes! I am really happy with the switch to Prozinc and I think that it is working well for him (fingers crossed!)
Do you think it would it be safe to plan 3 units if the PMPS is >200 and 2.5 if it is <200?

 

I have a feeling it will be over 200 but I think Janet's referring to closer to 100-120 being low.

 

His PMPS was 333 so I took that as a sign to go with 3 units

 

Sometimes, you go with your gut feeling Heather, when you don't have much test data to go on.
You do not have to wait 1 hour to retest. Stalling is not feeding, waiting 20 minutes and retesting to see if the number has risen (remember the 15-20% meter variance). That 196 was close enough to 200 that you could have gone ahead and shot. Something to remember for next time.

Actually, a token dose or BCS (Big Chicken Shot) is 10 to 25% of the normal dose. So if a cat is getting 1U, a BCS or token dose of 10% would be 0.1U. A BCS of 3 at 25% of the normal dose is 0.75U.

So you reduced Heather, but only by a little bit. No where near a BCS. Where's that chicken suit? NOT earned yet, but here it is anyway.



Bouncing off that low blue from AMPS. Prozinc seems to agree with Ducote much better than Vetsulin.

 

Of, not less? Interesting. I've either been told wrong or misunderstood! Pretty sure I was told to decrease by 10-25%. Time to do some reading.

 

LOL! Thanks for the laugh!
And yes, I think the Prozinc does agree with him much better than the Vetsulin did. I hope that this trend continues! I can only imagine how much better he feels over the last two days without all of the steep drops and big bounces!

 

Yes, OF, not less. The italics and bold highlighting are mine.

From the Prozinc Dosing Methods sticky, where it talks about shooting a lower than normal pre-shot.
How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)

 

In the famous words of AC/DC we are "back in black"

I guess with two good days I should have seen this bounce coming but I was so hoping that we were getting on a path to regulation

 

This doesnt mean you arent Heather. Its just not happening right now. Hang in there for advice. @Deb & Wink

 

Panic didn't stop bouncing regularly until she was 8 months on insulin, and only after I switched to Lantus. It's a marathon, not a sprint. You've got a while to go yet until he gets used to blues!

 

Baby steps, Heather, Baby steps.

He's bouncing off those blues from the other day.
Patience little one. You'll get there.

 

Patience? What is that? I seem to be looking for a magic potion and in turn I am overlooking the process

I like to look over all of the different spreadsheets on here to try and look for patterns and familiarize myself what normal diabetic days look like. I find myself getting a little discouraged with each spreadsheet because I haven't seen any with as much black as Ducote (even those who are newly diagnosed like him). I feel like I am on a time crunch. I know that there is a window for regulation if there is any hope for remission and I feel like I am failing him. I keep trying to figure out what I am doing wrong or what I might be missing but I guess what I am missing is patience

 

@Heather & Ducote Your kitty and mine seem to be doing similar things. I’m trying to not be a chicken, but it’s hard not to when you see lower numbers that you’re not used to. Looks like we’re getting some great advice from the experts though.

 

Any Type-2 can achieve remission. Some reach it within a couple months, other after several years. Off the top of my head I can think of at least one kitty that was on insulin for 11 years before going into remission. Of course the more dilligent we are (plus with a bit of luck) the faster we can help our kitties reach it but there's no cut-off date. You're not doing anything wrong, it just takes some kitties longer to have pretty spreadsheets.

And if it helps, take a look at Panic's 2019 spreadsheet. Look at all those blacks! I never thought we'd hit a blue, much less a green.

 

It's a marathon. BUT, look at it this way. The four days PRIOR to starting prozinc your AM preshots averaged 459, and PM averaged 422 for a total average of 440.5. In the past four days your am preshot has averaged 307.5 and your PM preshot average 409.25 for a total average of 358.4 I'd say that's an improvement. don't look at individual numbers, look at trends.

 

I forgot to look for the silver linings

 

Oh! and a nice preshot this morning too! So your morning preshot average for the past 5 days is now 299.

 

Heather its ok to miss the silver linings as long as you remember any marathon has set backs. It WILL all come together as it will fo NoahFL.
j.

 

Yay! Today's number was great but, as usual, I am nervous about it when I should be excited . Last time he had a AMPS in the 200's he dipped down into the greens and I am not sure how low he went because I didn't test as much as I would have liked that day. I am expecting him to drop today and I am leaving from 11:00 - 2:00 (he got his dose at 8) for Father's Day lunch at my dads (an hour away). I have a tendency to sabotage him when things like this happen by giving him higher carb food before I leave but I am going to try to keep a level head and give him his normal mid-day Fancy Feast before I leave (he normally gets it at 2 but I will give it to him early since I won't be here). Pretty numbers scare me when I am not here to be the testing police

 

Sounds like a good plan.

 

was he fine? yep, so don't worry about it.

I hear ya. Test before you go and make your best guess.

 

When we look at the SS (spreadsheets) we look for trends.

 

Trying to keep a level head His PMPS is 158 and I don't know what to do about his dose. I am holding it for now but what do I do from here?

 

A couple of questions for you.
Do you have your hypo toolkit ready with MC (medium carb) and HC (high carb) foods?
Do you have plenty of test strips?
Did you feed Ducote?
Will you retest in 20 minutes from you last test? Please.

 

Yes, I have my kit (super scared to think of having to use it though ).

Yes I have hundreds of strips.

I normally feed him with his shot (which would have been 10 minutes ago) so I haven't yet but can!

I will retest as much as I need to!

 

HOLD the food please.
But retest. In 20 minutes from your last test.

 

Ok, I gave him 9 Lives pate after I wrote but took it away as soon as I saw your follow up message. He maybe got 3 bites before I took it.

 

Just restested him (it's been 22 minutes since previous test) and he is 147 (he was 158) I have no clue what to do from here....

 

Test in another 20 minutes, without food. Please.

The 147 and the 158 are basically the same number, taking meter variance of 15% into consideration.

Your 3 options are:
Give the full dose and stay up to monitor.
Token dose. 10-25% of current dose?
Skip.

 

Thank you! I just checked him again (40 min from PMPS) and he was 156. I went ahead and gave him his food and I will give him 1 unit to be safe. I will check him again a few times tonight.

 

Got it.
You are there to observe, and know Ducote much better than we ever will.
So the ultimate decision in the dose needs to be yours.

So those 3 numbers you got are basically the same number. Stack them in the same cell for the PMPS and manually color code the cell to blue. One number, next number and a note that +20 min, next number and a note that +40 minutes.

You might have a test at +2, and would need that space for that test.

 

Ducote's AMPS was 186. I went with a dose of 3 instead of 3.25u. For future reference, when it is this close to 200 should I go with the full dose?

 

His +2 jumped to 403 so I guess that it would not have hurt to give the full 3.25 dose. I am guessing that what I am seeing is his jump from morning food and insulin not kicking in yet. Hopefully I will see better numbers throughout the day but on the other hand he has been having days where the insulin doesn't do much. Normally this is for a couple days after a really good day and he did have a good day two days ago. I guess I will see what is going on after more tests today.

 

That’s like giving him a reduction he didn’t earn. I’m not sure if that’s a good idea or not so I’ll let others comment. I personally for Minnie will shoot the regular dose for anything over 175. That’s what I’ve realized works for her

 

I always think earring on the side of caution is better then going too low... He's probably getting a good 12-13 hours out of the insulin ands that's why the jump. It wore off and he ate.

 

Yes.

 

I just did his AMPS about 5 minutes ago and he is 124. I always let him start eating while I test and dose him so right now he is finishing up his meal but I did not dose him. I hate getting a number that leaves me clueless on what to do next Does this procedure sound alright to go by today and in the future:

-Test again in 30 minutes to one hour. If he >175 give full dose
- If he is 150-175 give smaller dose (around 2.5 instead of 3.25)
- If he is under 150 give chicken shot (around 1 unit)
-If he is under 100 skip dose

 

I already went against my own advice After a 1 hr stall he was 165 and I gave 3u. I just figured that it was close to the 175 but not close enough for the full dose (I feel like I am going crazy over here ). And I knew that I kind of needed to factor in the feeding.

 

If you need advice about a preshot number and what to do you have to start a new thread and begin with “help” or you won’t get timely responses FYI

 

Thanks! I am just so confused by the numbers and what to do lately that I didn't want to aggravate anyone with posting a new dosing question every day

 

If you have a question, it’s a valid question. Ask away and don’t feel bad as you’re still learning and it’s a steep learning curve. I feel it’s also easier to see what others should do then to see what you should do. For me anyway. Different perspectives always help

 

Ducote earned a dose reduction of 0.25U with that 51 at +5 today, 6/23/20.
Please reduce the dose for the PM to 2.75U.
He may bounce and be high at PMPS, but that is to be expected. Don't worry if you see high BG levels.

When threads get longer than 50 posts, it's always recommended that you start a new thread.
You don't have to start a new thread for every day, but a new one now and then is appreciated.
Link your old post into the top of the new thread for some history and continuity.

You also have the option to change your thread title. Do you know how to do that Heather?

Deep breath, hold, release, deep breath, hold, release, deep breath, hold, release, deep breath, hold, release. Mindfulness breathing is as much for me and my stress as for yours.

BTW, You did fantastic getting him through that low today.

 

Thank you!

 

Answered you on your other post too, about the dose for this evening, and gave you my reasoning.

 

I saw it and went with the 2.5u. I figured that it would be better to be safe for an overnight dose when I can't check as much.

 

Ok.

 

Correction: I went with 2.75

 

I was going to increase Max this morning to 2.75, but he was 143 this morning. So stressful! I don’t want to overdose, but don’t want to underdose!