Pre shot numbers getting higher

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Stephanie91215, Oct 27, 2018.

  1. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    I get so frustrated with this dance. One day she has a lower pre shot number so I reduce her dose and then a day or two later her pre shot number increases. She is acting better than she has in a long time and she is getting into blues most days and sometimes I have to intervene to prevent her going hypo because I know where she is going to go with her numbers and maybe that's a mistake I just don't know if I am doing something wrong. Any advise would be appreciated.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    In my opinion, you might be adding to her volatility by attempting to set the dose in response to the PS number. That technique can work sometimes, generally with a kitty who's further along in treatment, is moderate in his/her responses and the dose differences between AM and PM are quite small. You have given AM and PM doses that are 0.5 u or more different on many days. That can set up a vicious circle of high/low PSs that you can't escape. The strong action of Vetsulin (fast onset, ability to pull BG down low) only adds to this problem.

    Here's what I would try for now:
    • choose a moderate dose that, based on your data, doesn't drop her too low. I'd try 1.0 u or 1.25 u for now.
    • give that dose consistently AM and PM for several days as long as PS is high enough. I'd go with yellows and above.
    • give her enough time to settle on that dose before making any dose changes - unless she surprises you with a low blue or dark green at PS. If that happens, post here for dose advice.
    • try scattering your mid cycle tests a bit more to widen the dose response picture - eg. +2, +4 on one day then +3, +5 another day, etc.
    The keys to settling a bouncy kitty are small, infrequent dose changes and day to day consistency in dosing as you build up more data on your SS.
     
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  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Another important point: it's best to assess a dose based on how low it drops the BG in the middle of the cycle versus what the PS is. The PS is useful to tell you if a planned dose is safe to give because the BG is high enough to support it. The ideal range for nadir with Vetsulin is in the 90 to 110 range.
     
  4. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    That makes alot of sense. I will try that for sure and see where it takes her. I'll start with 1 unit starting tonight. I guess once I started getting the lower pre shot numbers I was afraid to shoot her with a higher dose so I started basing my dose on her pre shot number. I'm so afraid of her going hypo and I think I am being overly cautious.
     
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  5. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Nothing about this is easy, especially at the beginning. You'll get there! :)
     
  6. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    I really hope your right. Thanks for info once again. I really appreciate you taking the time to help me
     
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  7. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Hi ya again. So her morning pre shot was 383. I gave her 1 unit like I have been and at 4.5 hours she is 85. I'm going to test her again at +6 to make sure she is okay for the rest of the cycle. My question is yesterday after I gave her PM shot she must have eaten too quick and threw up could that cause this drop?
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's a big drop but it's near the most likely nadir for Vetsulin. I suggest you get a +7 test to see what happens. This might be a one off drop or not - we don't know yet. Depending on a the +7 and PMPS it might be best to stay at 1 u. She's a very responsive kitty and that makes it harder to assess a dose. All the more reason not too change too much. Vetsulin + reactive kitty = lots of ups and downs. :)
     
  9. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Goodness her +6 was 134 and her +7 was 303. I do free feed her so she has eaten a few times since the +4 check.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Interesting. Looks like an early nadir. If her food is all low carb wet food it shouldn’t have a drastic effect.
     
  11. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Yeah-the only food she has access to is Fancy feast the pate style and friskies. I do change the flavors but I always make sure that the carb content is low from the food list.
     
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  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Those higher numbers after the dark green are a rebound from going lower than she normally does. I suggest you stick to 1 u AM and PM tomorrow again. The goal right now is to get her more settled without having her drop too low. That 85 is as low as you want. Try to overlook the red PMPS and avoid the temptation to up her dose in response. :)
     
  13. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    I'm glad I second guessed myself. I was trying to decide if I should give her 1 unit or 1.25. Glad I chose right. I will keep to the 1 unit tomorrow as well. Thank you do much for helping me through this
     
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  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Glad to help! :)
     
  15. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Hi ya. So I increased her morning dosebtoday to 1.25 unit. I don't think she has been this high and I am not seeing much blue on 1 unit minus that one day where she dropped to green for a short time. I hope I didn't make a mistake but I want to keep ketones at bay and get her back into the healthy numbers. Do you think I made the right decision?
     
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you did the right thing. Hold that dose consistently for a few days to see what happens.
     
  17. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    She had a huge drop this morning at +4, over 400 pts. I just checked her +7 and she hasn't bounced back crazy. She is only 202. Depending on her pmps number would you reduce her dose?
     
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes - huge drop but the blue is in very safe territory. I'd try 1.25 u again tonight. Get a +2 to see what she might be planning. If it's 100+ points lower than PMPS, plan to test again at +3. Don't change dose yet unless she shows you some too low for comfort numbers.
     
  19. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Okay. I just get worried if she is in the yellows she will drop to an unsafe level quickly.
     
  20. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you get a yellow PMPS and giving 1.25 u worries you, you have the option of giving 1 u again. Varying the dose by more than 0.25 u can set the scene for more bouncing. That said, a low blue or green PS is another kettle of fish ...
     
  21. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    So I think I figured out why her numbers were all over the place. When I wasnt home or at night when I was sleeping she was getting into our pantry and chewing into rice, barley, quinoa, etc..and eating it. I thought I had mice until I saw her one day trying to get into a bag of dried cranberries. So I blocked the cabinet and have been watching her like crazy. Her numbers seem to be improving since.
     
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  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Son of a gun! Good idea to go back to 1 u AM and PM for a bit. Cats! :confused::)
     
  23. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Hi ya. So I am doing my first 12 hour curve on her because I need more insulin. Can you check out her numbers. It's very strange to see this steady of blue through out the day.
     
  24. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's actually a very nice, smooth curve! Nadir at +5 is typical of Vetsulin and the low of 115 is very close to the recommended nadir range for Vetsulin of 90 to 110 or so. The high PSs are fairly typical of Vetsulin's action in many kitties. You might have room for a teeny tiny increase if you want to try what we call a "fat" 1 u. Draw up insulin to just below the 1 u mark (with the needle pointing upward) and release drops until the plunger is *just* touching the bottom of the 1 u mark. That might shift the nadir down a little lower without going too low. If you're feeling a little braver you could try 1.25 u again.
     
  25. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Hi ya. Hoping you can shed a little insight on what might be happening with missy. Last night her pre shot was 320 I gave her one unit and at +3.5 she had dropped to 65. I gave hc food and she bounced back quickly. Tonight her pre shot was 348 and I reduced her dose to .75 to avoid another low number too early. I just tested her twice at a little past +3 I got 85 and 79. I am feeding her hc food as I write this but I don't know what's happening. She eats before and during her shot. Any ideas?
     
  26. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    The 65 last night was a sign that 1 u is now too much and the 79 tonight is also a bit low for comfort with Vetsulin. You could try another cycle or two at 0.75 u to see if she drops low-ish again or reduce to 0.5 u tomorrow AM. If you can't get a mid day test during the week, can you get a test the minute you get home from work? A couple of daytime numbers would be helpful to have.

    Variations in response like this are not unusual but they can be disconcerting. You can try using regular low carb or even medium carb food if she drops lower. Save the high carbs for numbers near 50.
     
  27. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    I usually do get one or two mid day numbers. After her curve yesterday I wanted to give her little ears a break. I watched her closely and she didn't seem to have any issues during the day but it's possible I missed something. But she was also 487 from having to feed her hc food the night before I believe. She is such a jumpy reactive kitty. Tomorrow I will try .75 for her morning dose no matter what her pre shot number and go from there.
     
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  28. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    What would be a medium carb food? Since her numbers have been improving she has gotten a little more picky with what food she eats if she just ate. I free feed and leave food out all the time so not sure if I could get her to eat regular food at that point.
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Medium carb is in the range of 11 to 13% carbs or so. You can mix some by combining your low carb and high carb food in a 50-50 ratio.
     
  30. Stephanie91215

    Stephanie91215 Member

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    Aug 19, 2018
    Okay. Great. I'll try that next time for sure. Hopefully later rather than sooner.
     
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