Nico— 1/5: New Thread link in comments

Emily Tuomey

Emily Tuomey

Member Since 2020
Historically Nico is a pretty bouncy, little boy with a tendency to run high as a default. We have now been holding steady at 2.75u for 9 days, and as his numbers become more steadily in the normal range we are looking at reducing his dose to 2.5u once again— hopefully this time with better results. Now the question would be when do we make that leap...? Hmm..
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(yes, those are Nico’s real paws, crossed :joyful:)

Previous thread link: https://www.felinediabetes.com/FDMB...4-5-5-79-10-151-pmps-307.240240/#post-2706584
@Deb & Wink @Shelley & Jess @JanetNJ
 

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I'm a bit on the fence, about saying to go ahead with a dose reduction or not.
I think, not yet, but soon, soon.

You could always try the 2.5U dose now. If it doesn't keep Nico down low enough after several cycles, you can bump the dose up again.
 
Deb & Wink said:
I'm a bit on the fence, about saying to go ahead with a dose reduction or not.
I think, not yet, but soon, soon.

You could always try the 2.5U dose now. If it doesn't keep Nico down low enough after several cycles, you can bump the dose up again.
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I agree. Though I’m not an expert by any stretch of the imagination. I’d like to keep him where he’s at for the moment, and continue to communicate and assess, if that’s okay? I want to try to spare him some more major bounces back and forth if I can, he’s just spent so much time all over the place/too high already. I’ll be back with a PMPS in 30 mins.

@Deb & Wink update: PMPS, 293. 2.75u given. Will see what happens overnight.
 
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@Shelley & Jess @Deb & Wink @JanetNJ just a few more numbers from overnight, and into this morning. (:coffee::coffee::coffee:)
Last night: +6, 235, +9 197
AMPS: 335
I’m gonna keep him on 2.75u for the moment. He’s got a curve day tomorrow (official, for the vet) that will be tested using both the Alphatrak and ReliOn simultaneously— mostly because the vet needs AT numbers to compare with his office visit numbers. I think once we are through that we should revisit reducing his dose. Sound okay? Wish us luck! :cat:
 
CURVE DAY. Will update throughout..
AMPS, 173. (AT2 238.)
+3, 205. (AT2 286.)
+6, 123. (AT2 173.)
+9, 178. (AT2 225.)
PMPS, 297. (AT2 311.)

@Shelley & Jess @Deb & Wink @JanetNJ out of curiosity, because it’s our first go-round with the AT2, I’ve read anything below 68 is considered hypo but at what number should I consider stalling and/or not shooting??
 
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Emily Tuomey said:
out of curiosity, because it’s our first go-round with the AT2, I’ve read anything below 68 is considered hypo but at what number should I consider stalling and/or not shooting??
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@Emily Tuomey Specific for you:
Since you're using a human meter for everyday use, the simple answer, next time you stall or get a number on your human meter that you wouldn't shoot on, grab a test with both meters to see how great the difference is and make a note of it on your spreadsheet that you can refer back to if you ever need it. (Unless we get a couple 'good' numbers we can refer to from todays curve)
1. There's no conversion chart between a pet meter and human meter.
2. You've lowered your thresholds using a human meter, we have no data indicating that these same threshold numbers are safe using your specific pet meter.
3. We can see there is going to be a difference between the human meter and pet meter you are using by the numbers recorded above.
Personally, I would take in to consideration the general difference between your two meters (once you get a little more data from your pet meter from todays curve) to make those stall/no shoot decisions using your pet meter.

Emily Tuomey said:
AT2, I’ve read anything below 68 is considered hypo but at what number should I consider stalling and/or not shooting??
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To answer this as a general question:
If someone starts out with an Alphatrak (or other pet meter), gathers all data using the pet meter/AT2 and makes all dosing decisions based on the pet meter/AT2 data:
This thread: https://www.felinediabetes.com/FDMB...-question-on-pz-using-at.235290/#post-2635834
discusses that the Prozinc dosing methods use the same BG level decision points for both human and pet meters on giving insulin, stalling, or skipping the shot and that the protocol only differentiates at the lows - 68 on a pet meter and 50 on a human meter.

This is another good thread: https://www.felinediabetes.com/FDMB/threads/10-14-lola-pmps-164-at2-hold-dose-1-163-2-227.236893/ (scroll to the bottom) that explains why the Prozinc sticky requires human meters and pet meters to use the same reference numbers.
ETA - except for the lows, as noted above.
 
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@Deb & Wink @Shelley & Jess @JanetNJ not super impressed with that PMPS tonight, but the rest of the day went okay— mister ball of unstoppable energy!! Sigh. And so it goes. Will be sending his AT2 numbers off to his vet in the morning, but she is off Wed/Thurs each week, then Friday is a holiday, so I’d expect I won’t hear anything back until at least Monday afternoon/evening. Will keep you all posted!
 
@Shelley & Jess @Deb & Wink @JanetNJ I made a poor call last night, in the wee hours this morning we are sitting in a hypo a +6, 47. I’ve given him higher carb (Temptations) treats and will retest in a half hour to make sure he’s come up a bit before I start his AMPS fast. Thoughts on reducing to 2.5u, given he’s over 150, in a couple hours? I feel like a bad mom at the moment.. he’s acting fine though!

+7, 61. A handful more of the higher carb treats given.
 
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Emily Tuomey said:
@Shelley & Jess @Deb & Wink @JanetNJ I made a poor call last night, in the wee hours this morning we are sitting in a hypo a +6, 47. I’ve given him higher carb (Temptations) treats and will retest in a half hour to make sure he’s come up a bit before I start his AMPS fast. Thoughts on reducing to 2.5u, given he’s over 150, in a couple hours? I feel like a bad mom at the moment.. he’s acting fine though!

+7, 61. A handful more of the higher carb treats given.
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Temptations work for me. I always do gravy food with crunches because the crunches stay in the system a longer time. Glad you were able to handle it
 
Emily Tuomey said:
@Shelley & Jess @Deb & Wink @JanetNJ I made a poor call last night, in the wee hours this morning we are sitting in a hypo a +6, 47. I’ve given him higher carb (Temptations) treats and will retest in a half hour to make sure he’s come up a bit before I start his AMPS fast. Thoughts on reducing to 2.5u, given he’s over 150, in a couple hours? I feel like a bad mom at the moment.. he’s acting fine though!

+7, 61. A handful more of the higher carb treats given.
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47 is not dangerously low, esp since he was at or close to nadir. It might bounce this morning but yes, he earned a reduction back to 2.5.
 
Emily Tuomey said:
I made a poor call last night
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Whatcha talking about kiddo? You stalled, seen a good 47 point/40% rise and shot a higher/faster rising number compared to a couple of others you've shot recently.
Emily Tuomey said:
I feel like a bad mom at the moment.
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I see a GREAT mom - You got that test, caught the low, handled it well and now we know :)
 
Shelley & Jess said:
Whatcha talking about kiddo? You stalled, seen a good 47 point/40% rise and shot a higher/faster rising number compared to a couple of others you've shot recently.

I see a GREAT mom - You got that test, caught the low, handled it well and now we know :)
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YES EMILY YOU ARE A GREAT MOM. PLEASE DONT BE SO HARD ON YOURSELF!! YOU HANDLED IT WELL. now give yourself some TLC ok? Good job!!!
 
After that low of 47, it's no wonder that Nico bounced soooooooooooo HIGH! He'll get better. Nico EARNED his dose reduction. No doubt about that.

Catch up on your sleep, wait out the bounce, and hopefully Nico will settle back down to lower BG numbers in a couple of cycles.

p.s. Happy New Year!
 
@Deb & Wink @Shelley & Jess @JanetNJ absolutely zero change between +6 (234) & +8 (237) which seems kinda weird.. does that happen on occasion with kitties?? Just curious.. I anticipate a high PMPS, and still giving him 2.5u until it’s indicative that he either needs another dose decrease or to bump him back up, depending.
HAPPY NEW YEAR!!!
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Emily Tuomey said:
absolutely zero change between +6 (234) & +8 (237) which seems kinda weird.. does that happen on occasion with kitties??
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Yes.
Emily Tuomey said:
I anticipate a high PMPS, and still giving him 2.5u until it’s indicative that he either needs another dose decrease or to bump him back up, depending.
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I would hold the dose for a couple of cycles.

No need to hold the champagne!;)
 
@Deb & Wink @Shelley & Jess @JanetNJ Some surprise numbers today (and an awful health day in general here... a virus has hit the house. Big time. It was all I could do to get Nico what he needed as well as myself today. I’ll keep everyone posted as I am able). AMPS 224, +10 77, PMPS (+12) 108/(+12.5) 149. I did hold tight at 2.5u, well just a hair under, but am nervous he might have a low low overnight. We should talk AM cycle dose, maybe.. thoughts? Hope y’all had a better New Year’s Day than we did!
 
Emily Tuomey said:
@Deb & Wink @Shelley & Jess @JanetNJ Some surprise numbers today (and an awful health day in general here... a virus has hit the house. Big time. It was all I could do to get Nico what he needed as well as myself today. I’ll keep everyone posted as I am able). AMPS 224, +10 77, PMPS (+12) 108/(+12.5) 149. I did hold tight at 2.5u, well just a hair under, but am nervous he might have a low low overnight. We should talk AM cycle dose, maybe.. thoughts? Hope y’all had a better New Year’s Day than we did!
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You can bring it down a bit and do 2.25. Stomach virus is awful. Feel better.
 
JanetNJ said:
You can bring it down a bit and do 2.25. Stomach virus is awful. Feel better.
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Stomach viruses are terrible!!! At least I sorta am more mobile today, and know where my head is at.. yesterday was rough! I pretty much crawled out of bed 3x, just getting Nico tested/fed/injected was all I could do. But, we made it. Just hoping it isn’t covid... I’m monitoring for fever (which has only been 99s so far) and will be quarantined until I’m certain it’s not, or be tested before I can leave home officially. Sucks! Anywho. Nico is all over the place. Should I attempt to keep him at 2.5u? I have no idea.. he’s ranged from just 51 all the way to nearly 500 (AMPS, 496) in less than 24 hours. Thoughts? @Deb & Wink @Shelley & Jess?
 
Emily Tuomey said:
Stomach viruses are terrible!!! At least I sorta am more mobile today, and know where my head is at.. yesterday was rough! I pretty much crawled out of bed 3x, just getting Nico tested/fed/injected was all I could do. But, we made it. Just hoping it isn’t covid... I’m monitoring for fever (which has only been 99s so far) and will be quarantined until I’m certain it’s not, or be tested before I can leave home officially. Sucks! Anywho. Nico is all over the place. Should I attempt to keep him at 2.5u? I have no idea.. he’s ranged from just 51 all the way to nearly 500 (AMPS, 496) in less than 24 hours. Thoughts? @Deb & Wink @Shelley & Jess?
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I know you feel crumby... Could you fill out whatever numbers you have from yesterday and today into the ss?
 
JanetNJ said:
I see. If you slide that tab to the left that will be the one that opens. He earned the reduction. Go down to 2.25 at the next shot. This morning was a high bounce from going too low.
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Done. Thank you! His +7 was 225, so again with oddly coincidental (for two mid day) numbers to be so similar only two hours apart, second day in a row. Weird.
 
Deb & Wink said:
Hope you got some sleep last night after all those tests.

Nico may be tumbling down the dosing scale pretty fast now. Keep alert to that possibility please.
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Good timing, I was just coming to update. We have had higher numbers today, assuming from the low overnight/early morning.. +4, 317, +7, 227. What do you guys advise for this evening, assuming he’s over 150? And, I guess a contingency plan if not..? @Shelley & Jess @JanetNJ will you guys weigh in too? Hope y’all are having a relaxing Sunday!
 
Emily Tuomey said:
Good timing, I was just coming to update. We have had higher numbers today, assuming from the low overnight/early morning.. +4, 317, +7, 227. What do you guys advise for this evening, assuming he’s over 150? And, I guess a contingency plan if not..? @Shelley & Jess @JanetNJ will you guys weigh in too? Hope y’all are having a relaxing Sunday!
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2.25 over 200, 2 150-199
 
JanetNJ said:
2.25 over 200, 2 150-199
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JanetNJ said:
2.25 over 200, 2 150-199
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Great, thank you! My thought is he will be up above 200 though. Just a guess/instinct!
Deb & Wink said:
If not >150, stall without food and retest in 20 minutes. Stalling for up to 1 hour works pretty well for Prozinc. Only stalling for 1 hour let's you keep to your normal shot schedule for the next cycle too.
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We are pretty old hat at stalling now, but if he remains under <150 after 1 hour (won’t happen, but we can hope!), then token dose? 1.0u? 1.5u? I plan on grabbing a +10 for him at 6pm, so about 1hr 35 mins from now, to see where we are at. I can post that when I have it, if it’s helpful?
 
Deb & Wink said:
I'd say a token dose of 1U, as long as you can monitor, but it depends on what the pre-shot test shows too.
If Nico is <100, you may want to consider even a smaller token dose, like 0.5U. Like you said, not likely, but surprises happen.
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I’ll keep my eye on him and dose as closely to your suggestions as possible. Every test is so very different/on its own agenda. Anything can happen!
 
I'd start with the recommended token dose for the first time this low. 0.5u. He's got a good rise going but this is awful low for Nico. Not worth taking a chance Emily. We can't stop all bounces, it's part of the process.
 
Shelley & Jess said:
I'd start with the recommended token dose for the first time this low. 0.5u. He's got a good rise going but this is awful low for Nico. Not worth taking a chance Emily. We can't stop all bounces, it's part of the process.
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I made a judgment call and gave him ~1.0u, a smidge under that because I wanted to err on the side of caution. I’m home the majority of the day (until 3pm— so will coincide with Nico’s +7/8/9– and can leave medium carb food down for him if I’m concerned about him being low at that point), so will monitor closely. I’ll be in and out to update here throughout the day, but maybe we should start thinking about this evening just in case? Please be in touch. Thank you!
 
Shelley & Jess said:
Had a feeling you were leaning that way ;) As long as you're comfortable with it, I'm fine with it too. You know Nico best.
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As he has a tendency to run REALLY high, I want to avoid him having recurrent episodes of that— while I’m not sure that’s necessarily how it works ;). He’s doing well so far, normal activity level, snuggly, happy, playful. He ate well. Will continue to keep a very watchful eye — though I’m 99% sure he will be just fine — and we are ready with his favorite carb-laden treats and food just in case he “needs” them! :cat:

EDIT: +3, 77.
 
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That's
Emily Tuomey said:
As he has a tendency to run REALLY high, I want to avoid him having recurrent episodes of that— while I’m not sure that’s necessarily how it works ;). He’s doing well so far, normal activity level, snuggly, happy, playful. He ate well. Will continue to keep a very watchful eye — though I’m 99% sure he will be just fine — and we are ready with his favorite carb-laden treats and food just in case he “needs” them! :cat:

EDIT: +3, 77.
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going low quick. Be careful and check often. Get that higher carb food ready to go.
 
JanetNJ said:
That's

going low quick. Be careful and check often. Get that higher carb food ready to go.
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Relatively the same number for +3 & +5 (77 & 78, respectively) so hopefully it’ll just sit right there and not go lower, BUT he has a tendency for a super late nadir, so who knows if that’ll actually be the case or not. We can hope! I’ll continue to keep a watchful eye and grab a +7 before I get ready to go to my appointment and leave food down, if necessary. Also, the vet just called regarding Nico’s curve numbers from just after Christmas. She advises NOT increasing his dose (she’s currently got him at 2.0u ;)), run another curve in 3 months, and wants to see him in clinic in April. At least I actually got a legitimate response this time— who knew a simple pet meter would do the trick! (Btw, she sounded AWFUL. So happy I’m not taking him in today— whatever virus she has... NOPE. Lol
 
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