? Updates and Below 200 Dosage Question

Kay&Kiara

Kay&Kiara

Member
Hey y'all.

Kay & Kiara here; long time no questions (yay?)

But now we're back.

Its been 3 monthes now since Kiara's diagnosis, and let me tell you, she has made sure every month was something different. lol

October: Diagnosis; Started out with 3units Vetsulin with PS ranging anywhere from ~223-380 (Not including the vet's test), which led to a crash early on in the month that brought me here. (Thanks to everyone who helped!) Dosages mellowed out into the 2u-2.5u.

Thought I had it all figured out, but Kiara decided to mix things up.

November: Started noticing some low numbers on normal dosages, though the PSs stayed the same. I had 2u crashing her from high 200s to below 70s; and even 1.5u crashed her from low 300s. Purchased 100ml (with half marks) syringes and converted into smaller doses. Dosages dropped to anywhere between 1u-2u.

Okay, I got this. (Kiara: "I'm about to ruin this woman's whole career.")

December: BLUE NUMBERS! I never thought I could ever be so happy to see the color blue and yellow on a spreadsheet. And as you will notice from the (!) on the sheet, it was a little amazing to see as more than a rare occurrence. And they didn't stop. Exactly 2 months to the date from her diagnosis, and Kiara is no longer getting 300s level PSs, (she gets close, but never crosses that line.) PS ranging from ~160-290. Dosages staying around 1.2u-1.4u until *drum roll, please* Christmas Morning, Blues and more blue every morning after.

But now it's a new year and of course, there is a new question that comes with it.
Its now January and Kiara's starting off the year with another change (again). New numbers, new scales, and hopefully some lower doses (and maybe even some green PSs)! *fingers crossed*
(~120s-250s PSs; 0-1.2u doses)

So here is my question: I know about stalling when the PS are close to 200 and have added that to my new sliding scale adjusts. But is there recommended starting dose for PSs under 200 if the stalling doesn't push her above 200? And where would the lowest limit be?
Should I just see where 0.2u takes us and go from there?
Or frankly, leave things as they are?

Blues are amazing but like I read on a post on another thread "...well staying in the blues may be less stressful for the caregiver - but it's like your doctor saying to you - I'll only give you enough medicine to make you feel a little better, but not enough to cure you of your problem."

Starting on the 10th, we'll be testing out below 1u doses and to see if we can get more accurate drops.
I just don't want to mess anything up with the way things are going now. I like blue, blue is good, even low yellow makes me happy.

Thanks for reading.

Kay & Kiara
 
She sure does keep you hopping! Don't know the answer to your question, so looked at your old posts to see who was responding before. Tagging @JanetNJ and @MrWorfMen's Mom for you.

Middle of the work day so might take a while for an answer. MrWorfMen's Mom seems to be the go to person for Vetsulin questions with that fine detail you are looking for. I'm ok with the basics, but not to the detail you need.

Looking at Kiara's SS, I see a lot of skipped doses. Looks like you need to learn how to shoot those smaller doses. How much, I couldn't say. Part of that is being data ready. Kiara looks like she drops early, around +2 to +4. No idea what your life and work responsibilities are, but is there any way you can get some PM tests in that +2 to +4 range?

Do you wait 30 minutes after feeding before you give the insulin? That can slow down the drop with Vetsulin.
 
To verify for me, because you are using U100 syringes to give this U40 insulin, I just want to make sure I have this right.

When you record the Units of insulin given, you are recording the U40 amount (left side of conversion chart), not the amount of insulin drawn up in the syringe. Correct?

Hey, you've got four more dosing levels to drop by using the U100 syringes. Gets trickier to get the air bubbles out when the dose gets that small. Tap, tap, tap to get those air bubbles to the top of the syringe.
 
I'm a bit confused. What does N/A* in the PMPS column mean?

As I mentioned before, sliding scales based only on pre-shot readings are not usually successful with the exception of a very well regulated kitty with lot of data and can be very unsafe when employed without an adequate history and ongoing evaluation. You need to know how low a dose is dropping BG to keep Kiara safe. While Kiara's BG is improving, it's really difficult to see what any dose is doing for her when it's constantly changing or shots are being skipped. While I understand the skipped shots are due to low pre-shot tests, the lows when you have shot are a bit too low for Vetsulin which can and often does cause steep quick drops in BG which you have noted.

On the 5th it appears you gave the PM shot late and Kiara dropped to 79 from 250 on a half dose of insulin (0.6u). It appears she bounced back up to yellow following that low of 79 and was high enough to receive a shot of insulin that night based solely on her pre-shot of 256 but you then gave her a full dose despite the fact that pre-shot was essentially the same as the pre-shot you had given half dose on the night before. There was no mid cycle testing at all following that full dose so we have no way to know how low Kiara might have dropped and come the morning of the 7th, she was in yellow again which I think we can safely assume is again a bounce. This time a dose of 1u dropped her down to 62. You gave a larger doses on what appear to be bounce numbers which is not safe. Bounces can last up to 6 cycles for some cats while others will clear bounces very quickly. Looks to me like Kiara is in the latter group which means shooting based on pre-shots is even more problematic for her because you need to be aware of when a bounce is being reflected in the pre-shot reading.

When shots have been skipped, Kiara's BG has not been that far above normal BG range. When you have dosed her, her BG has increased which indicates the dose is too high. I'd suggest you can lower your no shot limit to 150 and try a dose of 0.25u but do so only when you can monitor with mid cycle testing. And do not base dosing on pre-shot numbers. Hold the 0.25u dose for a period of 6 cycles (3 days) unless BG drops below 70 again. If BG drops below 70, then reduce the dose to 0.10u and repeat the process. It can be a bit difficult to get a cat to stay in low normal BGs with Vetsulin because dosing must be done carefully when dealing with lower pre-shots but with adequate monitoring, you may be able to get Kiara's BG down a little more.
 
MrWorfMen's Mom said:
I'm a bit confused. What does N/A* in the PMPS column mean?

As I mentioned before, sliding scales based only on pre-shot readings are not usually successful with the exception of a very well regulated kitty with lot of data and can be very unsafe when employed without an adequate history and ongoing evaluation. You need to know how low a dose is dropping BG to keep Kiara safe. While Kiara's BG is improving, it's really difficult to see what any dose is doing for her when it's constantly changing or shots are being skipped. While I understand the skipped shots are due to low pre-shot tests, the lows when you have shot are a bit too low for Vetsulin which can and often does cause steep quick drops in BG which you have noted.

On the 5th it appears you gave the PM shot late and Kiara dropped to 79 from 250 on a half dose of insulin (0.6u). It appears she bounced back up to yellow following that low of 79 and was high enough to receive a shot of insulin that night based solely on her pre-shot of 256 but you then gave her a full dose despite the fact that pre-shot was essentially the same as the pre-shot you had given half dose on the night before. There was no mid cycle testing at all following that full dose so we have no way to know how low Kiara might have dropped and come the morning of the 7th, she was in yellow again which I think we can safely assume is again a bounce. This time a dose of 1u dropped her down to 62. You gave a larger doses on what appear to be bounce numbers which is not safe. Bounces can last up to 6 cycles for some cats while others will clear bounces very quickly. Looks to me like Kiara is in the latter group which means shooting based on pre-shots is even more problematic for her because you need to be aware of when a bounce is being reflected in the pre-shot reading.

When shots have been skipped, Kiara's BG has not been that far above normal BG range. When you have dosed her, her BG has increased which indicates the dose is too high. I'd suggest you can lower your no shot limit to 150 and try a dose of 0.25u but do so only when you can monitor with mid cycle testing. And do not base dosing on pre-shot numbers. Hold the 0.25u dose for a period of 6 cycles (3 days) unless BG drops below 70 again. If BG drops below 70, then reduce the dose to 0.10u and repeat the process. It can be a bit difficult to get a cat to stay in low normal BGs with Vetsulin because dosing must be done carefully when dealing with lower pre-shots but with adequate monitoring, you may be able to get Kiara's BG down a little more.
Click to expand...
FYI not sure you saw this. Lot's of good information there. Linda is out for a while and can't respond.
 
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