? trying to decide - increase, decrease, keep same dose? soliciting opinions

see Catcat's spreadsheet (not the metric one, that's a WIP)

already determined, 2u is too much -- nadir in hypo range (52 on pet meter)

things appeared to be going well on 1u until nadir appeared to be edging too low daytime

coordinated with vet, reduced to .75 u -- and values appeared to increase

Real Life got in the way, had to skip shot one evening -- got nice blues for 3 days
then nothing but pinks and yellows --
thought it was a bounce, returned to 1 u dose to see -- still yellows and pinks

advised by FD experienced user to try small increase -- blue at night, yellow and pink daytime

increase dose = values go up -- decrease dose = values go up --- I could use some input to come to a decision where to go from here

Catcat due for dental -- vet advises to accomplish that before transitioning to a longer lasting insulin
(have access to Lantus)

will be tagging several people, would like to hear soon
@Tanya and Ducia
@BBelshan
@Yong
@MrWorfMen's Mom
@Elizabeth and Bertie

ETA -- I am not asking for dosing advice, am asking for opinions which might weigh in, but I am making the dosing decision myself

 

First of all can you confirm you are using a human meter. It would be a good idea to add that info into your signature. If you do add it, I think you are going to have to remove something to make space. You don't need to put the insulin dose in your signature since that is on the spreadsheet and will no doubt change periodically or even frequently at times.

I'm also not clear on how you are drawing up 0.9u? Are you using calipers?

Looks to me like you were getting better numbers on a full 1u dose and I'd be inclined to go back to that dose and hold it for few cycles to see what Catcat does. The cycle on the 12th of May was good. While the lowest point in each cycle is not necessarily the same day to day, Catcat appears to be hitting nadir sometime around +4 or +5 in the cycle so I would concentrate on tests between +4 and +6 randomly to see if in fact his BG is going even lower than you are currently aware of. Some of those pink pre-shots may be due to bouncing from large drops in BG or lower numbers you are not seeing and that Catcat has become unaccustomed to. Bouncing is a normal phenomenon whereby the body's defence system spills out hormones to release glucagon to raise BG when the cat's body perceives BG dropping a lot, quickly, too low or lower than they are now used to. Some cats are bouncier than others and it takes time to get them re-accustomed to lower more normal BG.

I'd also grab the odd test in the +7 to +9 timeframe as Vetsulin sometimes causes a secondary drop of BG in that part of the cycle albeit a smaller drop than the first. This will give you an idea of duration which can sometimes be a problem with Vetsulin.

 

signature has always shown ReliOn Confirm (human meter), used to show my backup too (ReliOn Prime) but I haven't used it, so removed for other info
.9 -- this is an approximation -- using the plunger orientation relative to unit markings -- top of plunger is just touching but not aligned with 1u mark, bottom of plunger is just past 1u mark with a tiny space showing (this is using my 3.25 power reading glasses) -- I do have calipers but haven't practiced with them enough to calibrate dosage yet -- several postings show that plunger itself is .25 unit or close to it

Catcat is definitely bouncy -- and at least once, either pancreas chimed in, or it was a late nadir -- I wound up with a no-shoot AMPS which I later recorded as a +11 on the night cycle, then recorded the two subsequent AMPS'es in the AMPS slot -- both of course show food influence because I found I have to supply food to get an ear prick to test (I posted about this, got advice on the board)

AMPS today was 243 so I elected to give the full 1u dose and commit to monitoring Catcat this morning -- he gets quite upset and fights me if I try to get test every hour; I've tried to space these out so I at least get one or two tests in bracketing nadir --

he's happy, grooming himself, loves the bonito flakes he gets as a treat post-test, alert, chittering at birds he sees through skylight, keeping a stable weight though still perhaps a pound too skinny (flanks still caved in) despite eating 400 calories a day or thereabouts, still always hungry (of course, he's not regulated yet), supplementing with turmeric/blackpepper/e v olive oil (anti-inflammatory to heal cat acne from inside), dry sardines for treats (and Omegas), and sharing PB8 probiotic capsule with me occasionally, normal size urine spot in litter box (we use pine pellets) which is amazing because I add water to pate, he has a tongue issue, cannot curl it, so he licks food with flat tongue, mashes it against sides of bowl, easier to turn it into sloppy gravy

 

pink preshots most likely due to vetsulin not lasting 12 hours, perhaps not lasting even 10 -- REALLY difficult to get test without supplying food so I haven't been testing past +6 in the cycle except a couple of times -- claw and bite marks on hands and arms do heal fairly fast under Neosporin treatment, but as a cancer survivor, I try to limit the insults to my immune system

leaving food out overnight created a problem several times, since Catcat left it all night then ate within 2 hours of AMPS (dawn) -- he usually sleeps with adult son and dog, sleeps much or all of the night, does his crepuscular walkabout then comes in and curls up

 

DAHHH! Apparently I had not yet had enough coffee this morning when I mentioned the meter. Or maybe I hadn't cleaned my glasses yet! So sorry for missing that.

So I have to ask....do you have a science background? Not many folks know cats are crepuscular or even know that word or what it means. You seem very well versed on the ins and outs of the diabetes too. I'm a retired R.N. myself but worked in Orthopaedics so while I understood the what's and why's of diabetes it wasn't something I had to contend with much during my hospital days so I found myself on a steep learning curve when my girl was diagnosed.

A little food or a treat for bribery so you can test is fine. Takes a few minutes for food to hit the blood stream and bump up BG. You do what you have to do to keep both you and kitty safe. Hopefully with more time, Catcat will become a little more compliant and complacent. You are doing tremendously well for this early in the game.

Let's see what the little guy does on the 1u for a few cycles.

If this is a duration issue, would you/have you considered trying a longer lasting insulin? I know the costs seems horribly exhorbitant but if you order from Canada which many folks do, it's not nearly so bad and in fact despite an initially larger price tag, the overall cost is almost comparable, depending on dose of course.

 

I now have access to Lantus, and plan to switch -- among other reasons because it LASTS -- but vet would like to do dental cleaning before we switch, as that probably has an effect on the BG , get that over with and BG re-stabilized, before going to another protocol

science background, yes -- my degree is in audiology, BS not BA (started out in pharmacy, 3 years in, involved in organic chem lab fire on bench, 3rd degree burns), mother was RN (graduated 1928)/research librarian (her other love), always tended towards hypoglycemia myself, now officially prediabetic, hubby is type 2 on oral medication and diet, read voraciously whatever I can get hands on (other than war stories or horror) -- never practiced as audiologist, ASHA decided, my senior year at UW, that henceforth a Masters was required for the CCC (now they want PhD), and UW said they accept only one of their own undergrads per year into that grad program, want "crossfertilization" -- sounded to me like School-of-Agriculture=BS -- nearest programs too far away to commute (husband working for Boeing, two kids) -- so went to work as an inventory clerk, many companies, Seattle area employment volatile due to Boeing layoffs, worked up to CFO then got caught in corporate fight; retired in 2000 (long story)

 

I'd try to get the dental done sooner rather than later but if you can't do it soon or his numbers don't come down a bit more and it looks like a duration issue, I'd suggest switching anyway. I don't quite see the point of waiting to switch if duration is a problem. It might get him into better numbers before having the dental done.

I figured there had to be some science background on the other side of this screen! Interesting career path you've had. I went from nursing to insurance to banking technology positions so a bit of a diverse career path for me too. I retired in 2003 but I did so to look after aging parents and a SIL with Down Syndrome.

 

will remind the vet that she hasn't set the appointment yet -- normally that practice isn't all that busy but there may be things I don't know about causing the delay; I have saved up enough for at least the cleaning, and she offered to set up a payment plan for further expenses, extractions, etc -- more of a country practice though they work exclusively with small animals, why the clinic is called Horse Cart,. I don't know (not yet anyway)

 

okay, will stick with the 1 unit dose for a few cycles, see if we can recapitulate that history and get into a green once in awhile

have a promise of a loan to pay for whatever dental work he needs done

 

could not get a midday test -- Catcat fought me -- four e-7 errors in a row (not enough blood) -- I swear it was coagulating instantly -- and by the time all that was done, his BG would have been sky high due to stress -- his and mine both

 

Don't sweat it. I'd poke maybe 3 times and then give up. No point continuing when both you and kitty are stressed to the max.

 

fortunately, all had calmed down for PMPS = 263

he looks happy, had a good sized dinner at shot time, now is telling me he wants a snack (not due til 8, 25 minutes to wait)
had an active romp with catnip and a BeanieBaby (one stuffed with cotton not polyester beads)

wiped chin with cosmetic pad, Clindamycin smeared on it, this time there was no blood nor pus nor serum on pad afterwards, skin more pink than red now, still has pustules but bumps are much smaller, black debris gone -- may treat with Bag Balm before bedtime