uh-oh... 4.6 at +2.5 Help!

This is what happens when I make bold decisions....
Decide to move onto MPM and be a bit more agressive to get those greens....
see dosing thread: https://www.felinediabetes.com/FDMB...-wrong-hercules-thread-3.235299/#post-2637789

We started with a lowish AMPS, but I tought that shouldn't affect the decision since it was above 11.
Well, he threw up immediatly after the dose. Could be coincidence... He had also scarfed his food pretty fast.
So his eating pattern is off. Gave him 25g 30 minutes later, 25 @ +1. Checked his blood at +2.5 and is 4.6

If it was at +6 it would be okish but at +2.5 is going to be a rough day.... I will keep monitoring, and we should be ok , but what do I do for his evening dose? Any suggestions?

I am torn because he seem to always "overreact" when I up the insulin dose. Also he is bound to bounce big time! Officially 4.6 does not warrant a dose reduction... but did I mentioned it happen at +2.5 ?!?!

 

oh, shoot! 30 minutes later and still going down
We are at 4 now, gave him a lick of honey and another tablespoon of gourmet gold in gravy

 

Oh my!

You're still in safe territory at the moment, though, so let's see where he goes from here.

If I understand you, he threw up his morning meal, but has since had a decent amount of food?

 

yes. he has been eating ok afterwords, and holding it down so far...

 

Thanks for holding my hand @Nan & Amber (GA)

 

You got this!

These are actually really nice numbers so far. The more time he spends in numbers like this, the more healing for the pancreas. Hercules' spreadsheet is quite the rainbow, though, he really doesn't like to stay in one place for long, does he?

 

so, did I overreact? should I have not pull out the honey and the gourmet gold?
It is so hard.... you want to see dark greens, but then the bright greens look so close.....
I guess I particulalry panicked because it was too early in the cycle. Should I stay steady for tonights dose, or reduce it?

 

That was a big drop from AMPS, so I definitely would have fed at least an LC snack then. I'm sure he didn't mind a little bonus gravy, though! And it's always better to overreact than underreact to low numbers, in my opinion.

Not sure about dosing, let's see what the Prozinc folks think first.

 

Well, I did pull the honey and the HC, and we are still at 4.3 at +4.5 He probably would have gone much lower if I hadn't right? So perhaps I do need to reduce the dose.....

 

What's this MPM you are trying out? Is it the same as TR?

Fingers crossed you don't get a huge bounce from his low numbers today.

Well done on what you're doing and how you reacted! How is it possible to be so pleased and so terrified at the same time at the sight of a number in a green coloured box!!

 

Modified Prozinc Method - an FDMB dosing method for Prozinc. Further info in the following sticky:

https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/


Mogs
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Jemma, I cannot deal with this everyday! I have used so many strips, and his poor ears! I cannot understand what has happened. I only increased from 1 to 1.2 units and it was complete madness! Mind you that this is the dose he is supposed to be on regularly according with the vet

He is 3.8 at +6.... More honey and gravy... my nerves are fried.... I should be happy he spent all this time on green... but we need to find a way for him to do that without all the food support. I am going back to work sometime soon, and won't be able to keep monitoring the whole day long.....

 

Mum

 

3.8 at +6? Can you take the rest of the cycle off work to stay home and monitor? That is a nice number but you really don’t want him going any lower.
You may not want or be able to dose at all later at this rate.
An increase from 1u to 1.2u doesn’t seem much but think of it in percentage terms. Could you give what’s called a fat 1u, ie just a smidge over?
Keep posting if you need help.

 

@Diana&Tom - Thanks! I am working from home today, thankfully! I agree the numbers today look like a dream....But these numbers have been "propped up" by High carb food 4X and honey 2X. I imagine the goal is to have something like this without all the help, just the normal food. Am I right?

 

Yes that’s right.
I’m very glad you’re working from home and can keep an eye, you’re verging on hypo territory there.
I’d be cautious about dosing tonight - see how the rest of the cycle goes. You may see a bounce.

 

@Diana&Tom - He is a bouncer, so I am expecting quite high values tonight. Which is what I am unsure about how much to reduce it.... Do you have any suggestions? I don't want to undo a hard's day work... but I don't want to spend the whole night testing every half an hour either...

 

I’m not a dosing expert I’m afraid - try asking on the ISG?

 

Hercules, whaddya doing to your mum today???

 

5.5 @ +9..... this is very unusual....

 

ENJOY

 

He's surfing! What a great run he's having today!

 

...and he bounced!!! 20.2 at +11.5

I couldn't prick his ears anymore, but now i do wonder how sharp of rise was it really....

I meassured a bit before the next dose so I could mutter about what to do for the next dose.....I could say he got a reduction and go back to 1U. I am terrified though of having to spend most of the night awake... but this makes the most sense. I don't think I have the nerves for 1.2U again....


@Deb & Wink Any suggestion? You missed all the fun today.....

 

What a day!! Well done you and Hercs for getting through it!!

 

Thanks Jemma! It is really, really wrong... but I am actually happy we are out of the greens.... I am seriously thinking about asking the vet for lantus, even though I have quite a lot of prozinc left... I am not sure I can handle these unpredicatble dives.
Kyra doing OK?

 

I know what you mean, Good luck with the request at the vets! Hopefully they are willing to make the switch for you.

He's well thank you we just can't get his am and pm out of the reds. Suppose that's caninsulin for you?!?...

 

Bouncing, yes he certainly did.
Sometimes, a cat can be more sensitive to the insulin after dropping into those lower green BG ranges.
But it does give his pancreas time to relax and heal.
Scary, when you first get that string of greens.

But Hercules was telling you his BG numbers were low, by his food seeking behavior. So that is why he was begging for some food. Good to know that he will do that, the food seeking antics.

Let's see if Hercs BG levels return to a more "normal" level for him, after he clears this bounce. That may take several cycles, 3-6 usually.

So the lower 1U dose for PMPS on 9/18/20 was a good judgement call on your part.
He was very close to earning a reduction on the MPM protocol with that BG of 3.8 mmol/L.
Using the SLGS protocol, he definitely earned a reduction.

So, a reduction it is.
Are you going back to using the SLGS dosing?

I have one suggestion. Invest in a set of calipers, to help you measure a consistent dose.

 

Hi @Deb & Wink thanks for your thoughts!

I would say the answer to this in my head is no.... but perhaps I just don't know what I am doing....
The protocols are very clear and at first sight pretty straightforwad to follow. But then protocol don't have enough details for everyday situations (and I understand why, is not a complaint). So, I could have stick to my food protocol, of only feeding him at PS, +2 and +4, but I suspect we wold have ended in A&E.... So how then to interpret the numbers, if I know that 3.8 was after 2 licks of honey and 4 tbs of gourmet gold? In my head, I think that the numbers given the dose were lower than 3.8, hence the reduction even if in MPM method? Have I got it all wrong?

Calipers - I'll definetely get one, but I suspect consistency requires some magic syringe that I have not found yet. The prozinc U40s had very nice marking and slide really well, so I could easily get where I wanted. But the needle and the price was too big. The u100 by BD, has Ok marking and I really like the size of the needle, but even though I go up and down before drawing the insulin, it is still quite jerky to get to the dose spot....

 

We got a totally yellow day! So am I right that the bounce passed, but he is back to not responding much to 1U?
So, if I am still following MPM, I give a few more cycles and try 1.2 again? Assuming things remain flat...

 

Try slowly twisting the plunger of the syringe when moving it into position, a bit like twisting a corkscrew.


Mogs
.

 

Have you tried drawing up a bit of excess insulin in the syringe, removing the syringe from the vial/pen, and then slowly twisting the syringe to push out the excess drop or 2 of insulin?

Never mind, Mogs already suggested that.

We wish there were "magic" syringes, but you do the best you can.
Try making a "reference syringe" with some colored water drawn up in it, to provide you a visual of what dose you are trying to get.
That can help with consistency.

Insulin syringes are not only lacking in "magic", sometimes the syringes don't even have the markings on the syringe barrel in the same place.
It's why calipers can help.

1.2U of Prozinc drawn up in a U100 syringe would be 1.2 times 2.5 = 3U.
Is that how much you are giving to Hercules?

The all yellow day at least means that Hercs is likely clearing the bounce. May not be totally clear yet.