What dose for what #'s?

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Meridith and Zeke said:
Zeke is 185 tonight, so not giving his dose. How could he be at 390 this morning, then that low tonight? He has even been getting treats of chicken today, and he had a can of FF. Hopefully we can have him stressing less soon so we can get his curve going. Would hate to have seen what tonight would have been if we had still been doing 3u.
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Wow great preshot! Good call not shooting. In the future when you get a lower than expected preshot you can stall for 30 min without feeding and retest to see if the number is risin. If it is you can give a partial dose.
 
Wow! Was just checking in to see what Zeke was up to and so happy to see that 185 pre-shot. I agree with Janet about stalling and giving a partial dose if BG is rising. It will be interesting to see what his BG is this AM.
 
@Yong
I was so tired when we got back that after we got kitties and hotdog settled, my booty was in bed lol.

We are going to give him a couple more days to settle into the tests then gonna go for a curve. I think I am also going to need one through the night too since the amps and pmps seem to stay so different most the time.
 
Have done a +4 and +6 and going to go ahead and do a +8. With only 1u this morning, he is almost below 100 at +6! o_O wondering if tonight is going to be another NS or maybe 1u. I do like that his numbers aren't way up and down, more steady with slow transitions. That is the goal right? Did get a wonky reading so went ahead and grabbed another strip to do another without having to reprick. The wonky one was 336 so didn't make sense with his +4.
 
Meridith and Zeke said:
Have done a +4 and +6 and going to go ahead and do a +8. With only 1u this morning, he is almost below 100 at +6! o_O wondering if tonight is going to be another NS or maybe 1u. I do like that his numbers aren't way up and down, more steady with slow transitions. That is the goal right? Did get a wonky reading so went ahead and grabbed another strip to do another without having to reprick. The wonky one was 336 so didn't make sense with his +4.
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Perfect!
 
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Getting more impressed by the hour! This cycle is a thing of beauty at this point. What he'll do for pre-shot tonight is anybody's guess. He may bounce a bit given the 108 at +6 or he may not. I think it's safe to say he doesn't need more than 1u and may need even less in the coming days. Go Zeke! :cat:
 
And thank you both! Yall have been a big help. Don't know where we would be if I never found this site, but have a feeling that it wouldn't have been pretty. I love that it looks like we might get to stick with much lower doses then the vet last said! Home testing has made this possible. :)
 
Meridith, vets get very little training about feline diabetes, usually have few diabetic feline patients and obviously aren't dealing with them 24/7. We see all too many cats arrive here, on the wrong diet and getting too much rather than too little insulin thanks to ill informed vets. There is nothing like hands on experience and home testing to make this sugar dance a lot easier and you have proven that with your decision making last night and this morning. A lot of this dance can be mastered by knowing your own cat and having ongoing data on which to base decisions. Unfortunately many vets have yet to appreciate the value of regular home testing vs. clinic visits.
 
MrWorfMen's Mom said:
Meridith, vets get very little training about feline diabetes, usually have few diabetic feline patients and obviously aren't dealing with them 24/7. We see all too many cats arrive here, on the wrong diet and getting too much rather than too little insulin thanks to ill informed vets. There is nothing like hands on experience and home testing to make this sugar dance a lot easier and you have proven that with your decision making last night and this morning. A lot of this dance can be mastered by knowing your own cat and having ongoing data on which to base decisions. Unfortunately many vets have yet to appreciate the value of regular home testing vs. clinic visits.
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Sadly, the vet who diagnosed him said they had their own diabetic kitties, yet with what I have learned, it really is hard to believe that now.

His +8 was 265. I think he was stressing a bit though since we have tested him so frequently today. Tomorrow will only do a +8 other then the normal PS's as long as the normals are similar to today.
 
Well that's an interesting tidbit about the vet. How old is the vet? In days gone by, no one home tested and people just blindly shot every day. Some cats obviously did fine but I can't help but wonder how many suffered through hypoglycemic events or worse.

Wouldn't worry about that 265. He's bouncing again but it will take his body some time to get used to those lower readings so just hold the dose for now barring any pre-shot surprises. Tomorrow, I'd check around +5 or +6 instead of waiting until later if you can. From your current data, he seems to get peak action (nadir) around +6 and that's the number you need to focus on along with having a safe pre-shot of course. :)
 
@MrWorfMen's Mom
The vet is about mid to late 40's and his wife who is also a vet there is a few years younger. So young enough to know better. I understand on the older Dr's, same with people ones too. My son can't take amoxicillan thanks to one, because of over prescribing.

I will do a +5 tomorrow and see how that one is looking then.
 
Meridith, I'd keep an eye on Zeke tonight. Not sure why you opted to give 2u instead of 1u but I am assuming it was because of the pre-shot number. It would be better to hold a dose for at least 2 if not 3 days rather than shooting more insulin when it appears Zeke is likely bouncing. When I said "barring any pre-shot surprises, I meant if he had a low unshootable pre-shot. If the bounce breaks and you've given more insulin than he needs, you simply start the bouncing all over again or you could find yourself having to monitor more intensely and steer him to keep low numbers up. I'd check his BG around +3 to see what he's up to tonight. Slow and steady wins this race. :)
 
MrWorfMen's Mom said:
Meridith, I'd keep an eye on Zeke tonight. Not sure why you opted to give 2u instead of 1u but I am assuming it was because of the pre-shot number. It would be better to hold a dose for at least 2 if not 3 days rather than shooting more insulin when it appears Zeke is likely bouncing. When I said "barring any pre-shot surprises, I meant if he had a low unshootable pre-shot. If the bounce breaks and you've given more insulin than he needs, you simply start the bouncing all over again or you could find yourself having to monitor more intensely and steer him to keep low numbers up. I'd check his BG around +3 to see what he's up to tonight. Slow and steady wins this race. :)
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Just seen this. So I need to stay at 1u? I was thinking 1u for 2-300 and 2u for >300. How can u tell when they are bouncing or u need to shot for the number? Confused on that. :(
 
You don't want to double the dose if he's >300, would just be a slight increase like 0.2U on U-100 syringe or 0.25U on U-40 syringe.
This was written by Kris&Teasel, maybe it can help you too :)

Here's how bouncing works:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
  7. Many vets have little/no understanding of the bouncing phenomenon.

So for your most recent example, yesterday, AMPS was 266. Since his BG went below 133 (which is half of AMPS) it caused a bounce. Usually don't want to increase the dose based on a bounce number but hold it like Linda said, unless it's a no shoot number, like she also said :smuggrin:
 
Unfortunately, this sugar dance can be totally counter intuitive and we've all been through this period of confusion at some point or other. Once you have a somewhat regulated cat, and lots of data so you understand how kitty reacts to different doses, you can dose based on pre-shot numbers. The first step however is to find a dose that gives Zeke a smoother cycle to keep bouncing to a minimum and yesterday at a dose of 1u, Zeke sailed through the cycle beautifully even if he did bounce a bit at the end. That beautiful cycle followed a skipped shot which suggests that Zeke needs less insulin than he was getting and that he has been bouncing.

Throwing more insulin into a bounce can just muddy the waters more by raising rather than lowering pre-shots. The bounce yesterday was expected given the 108 he had mid cycle. His body is not used to those lower numbers and he is working against the insulin to keep his numbers up. If you throw more insulin at the higher number, you just set up a circular pattern of more insulin higher numbers. If you can get the cycle a bit flatter then the pre-shot numbers should come down on their own. I looks to me like Zeke needs a dose in the neighbourhood of 1u but whether it's a little less or a little more remains to be determined.

We generally only change doses by 0.25u at a time because tiny changes can make considerable differences in BG in most cats. Holding a dose for a few cycles to ensure any previous bouncing has passed before increasing is the way to go. It may mean you don't get as low a mid cycle reading but it will keep Zeke in more optimal numbers for longer through each cycle and allow his body to get used to being in lower numbers which will help to eliminate a lot of the bouncing. That can take time. The hardest part of this dance can be having the patience to follow Zeke's lead rather than trying to lead Zeke. Zeke is in charge and you have to use ALL of his moves to make decisions which means basing doses on pre-shot and mid cycle numbers in combination rather than just on pre-shots.
 
Ok, so then If I am understanding correctly, basically I need to just stick with the 1u dose for several days and see how he does? Only change his dose if he goes below 200 where I would want to skip a dose? Is that why his +5 we just did so high? He is still bouncing? He does get 1/2 a can of food at about +4 since he doesn't eat all he needs in just 2 meals.
 
I am so glad yall are patient lol. This will definitely take some time to get the full hang of it lol.

Now here is a big question that I have. On the 10th of June, my daughter and I will be going out of town and we will have to leave by 6am. With the first vet, he said everything was cool with being a couple hours early on his shot, so was thinking this would be a simple thing, just shoot before we leave. Now though I am seeing that isn't going to be the case. We can test before we leave, and even feed them, but how would it be best to do the shot? And would feeding that early really affect him? My hubby could probably run home from work and give him his shot at around 8am so that could be on normal time, but he will not be able to test him, unless between now and then Zeke finally lets us without one having to hold him still. My stepson will be here, but he is mentally disabled so unable to safely hold him without hurting him (can't control his strength very well). So we test and let him know on shooting or not, and then no shot at 8pm? We probably won't be home til at least 10pm that evening.
 
Meridith and Zeke said:
Ok, so then If I am understanding correctly, basically I need to just stick with the 1u dose for several days and see how he does? Only change his dose if he goes below 200 where I would want to skip a dose? Is that why his +5 we just did so high? He is still bouncing? He does get 1/2 a can of food at about +4 since he doesn't eat all he needs in just 2 meals.
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Exactly! That higher number now may be partially food influenced but is likely also a bit of bouncing. We don't know how low he went last night even though he wasn't that high this morning. I think the bounce mechanism can become more over reactive so stick with 1u for now barring any low pre-shot. If you get a pre-shot lower than 200, you can do a few different things.
1. you can stall for a half hour without feeding and get another reading to see if he is heading up and high enough for a shot
2 skip the shot
3. give a token dose AKA a big chicken shot (BCS). The amount would depend on how close he is to the 200.

As for your question about what to do on the 10th of June......by then you should have a better idea of how Zeke is reacting and what his ideal dose is. Vetsulin is flexible enough that you could shoot early that morning as long as the pre-shot is not too low or you could start backing up his shots gradually by 30 minutes to an hour a day to get to a 6am shot time for that day, give his night shot when you get home and then back him up the next couple of days to get back to your normal shot times. For example:
7th June - shoot 7:30am/pm
8th June - shoot 7am/pm
9th June - shoot 6:30am/pm
10th June - shoot 6am and 10pm
11th June - shoot 9am and 9pm
12th June - go back to your regular schedule
I am suggesting 30 minute differences before your day away to try to keep things as close to normal as possible and then a faster return to your normal times when you will be home to monitor.

The other option would be to skip the morning shot on the 10th and shoot when you get home and then adjust back to your normal times.

We all have times when our activities don't jive with kitty's schedule and we are firm believers here that caregivers need to make sure they look after themselves as well if not better than they look after the furkids. Zeke will be fine no matter what you decide to do.:)
 
Oops, sorry...my bad. Was just looking at someone else's condo who uses Vetsulin.:facepalm: Both Novolin and Vetsulin are "in and out" insulins and offer flexibility of dosing times that some others do not. So yes, they are similar in many ways. Difference tends to be when the expected peak of action occurs and in some cases duration of action.
 
Now that his #'s are starting to level out, how long do we need to sit at this dosing before we consider changing and how much would we adjust and which way?
 
I'd hold the dose for another couple of cycles before deciding what to do next. Looks to me like the bouncing from those lower blue numbers is now breaking so hold the course barring any low pre-shot readings and see what he does. :)
 
@MrWorfMen's Mom
Ok, he is definitely starting to stay pretty close on his numbers so I would think it is safe to say he is not bouncing anymore lol. Do I need to go up .25u or .5u?

I did jinx us when I said he was eating better. :D We had ran out of chicken, so opened up a can of tuna for his treat after testing and we unleashed a monster! He would just run through anything that was between him and the tuna, including us! He decided that was all he wanted to eat and we had to really fight to get him to eat his normal food lol. We aren't doing the tuna for treats anymore after that, but I do know now that I can mix a spoon of that into his food and he eats wonderfully!
 
Love the description of Zeke running through anything to get the tuna! Good to know what to use if he gets fussy on you!

As for dosing, I'd suggest an increase to 1.25u. Doing tiny adjustments ensures you don't pass over the optimal dose and those little adjustments can make a big difference for some kitties. He's been pretty flat the last couple of days so up his dose tonight or tomorrow morning. I'd get a reading about 3 hours after the shot when you adjust. Personally I don't make dose increases at night because if the new dose does lead to a more active cycle needing more monitoring, I'd rather be bright eyed and bushy tailed. This Mama needs her beauty sleep.....even it doesn't do anything for my looks, it does improve my disposition! :woot:
 
Thanks, sounds like a plan then. I gotta have my sleep too lol. I am getting new syringes in today since the ones I am using now doesn't have half marks, will make it easier to eyeball 1.25u. Probably will even mark some to make it even easier if I have a pen that will mark those easily lol.

I had thought about ordering some of the animal digest stuff to put on his food, but now that we can just add the spoon of tuna to get him to dig in again, would much rather do that. Adds some protein without adding something that he probably don't really need anyways.
 
Since you will still be eyeballing the dose to a degree, you could use a trick some folks use when they are going away and have someone else giving shots in their absence. Make up some coloured water and draw up a dose as a sample syringe for comparison. That way your dose will be consistent even if not precisely at 1.25u. Those quarter doses drive me crazy and consistency is more important than being spot on. There is also a paper ruler I can send you but it is only good for BD syringes and you'll get a better price on the Relion brand from Walmart. If you do get BD syringes and want the ruler, just let me know.
 
With his number this morning, elected to stay at 1u a little longer. Starting to look like his numbers are slowly dropping on this dose. He was only 239 :)

Does this mean we might actually need to lower his dose instead? Given a few more days of course.

We are going back to Ren fest tomorrow (last day of the season so cant miss it lol), so probably a better idea also to not raise with his current number. We will do a test about +2, right before we leave since we won't be getting a peak.
 
That's a nice pre-shot number. I don't think you need to reduce and he may need a bit more. Enjoy your Ren Fest and see what he does in the meantime on the 1u. If he's staying in roughly the same range and pretty flat, through the weekend, then I'd take him up to 1.25u. I'll be watching to see how he's doing. :D
 
With the way his numbers have been going, if tonight is like his peak (192) would you recommend NS or maybe half his dose? I wouldn't think full since it would already be just below 200 so don't want to drop him too low. But with his numbers staying this way, I would think no dose might throw him off, correct?
 
When you skipped on the 185, he didn't do terrible on his own :). If he is around same number as nadir, and you skip, I would suggest a before bed test again to see how he's doing on his own. In contrast, you could try a small dose like 0.25U, and definitely get a before bed test. Both situations will give you extra data ;)

*This is just my thought*
 
192 is a much nicer number for his mid cycle but he's still got a few hours to go and will, I expect, be over 200 at pre-shot so I don't anticipate you are going to have to reduce tonight. If however his morning pre-shot is lower tomorrow, then by all means either a reduced dose or skipped shot might be in order since you will not be home to monitor. If you have to skip, you'll get him back on track in short order so no worries. I'll be around tomorrow morning so I'll keep an eye out to see what he's up to before you leave. The goal is to get those mid cycle numbers to within normal of 50 to 120 and while I'm not suggesting you aim for 50, it would be nice to get him down into the 90-120 range mid cycle.
 
He was a little higher then I expected tonight, but then, about 10 minutes before I tested, caught him sitting in a pan that my hubby had sat some partially grilled bacon wrapped chicken, so not sure how that affected it. Will be testing him again before bed so will see where he is sitting then.
 
Thank you! We had a blast as always. Today was the last day of the season so will be 10 months before we start all over again hehe. :)

Lol, yes that was a surprise with Zeke. I was at the stove and turned around cause I heard something! Luckily hubby had already got the meat outta the pan but he had so much grease that he was lapping up as fast as he could lol. I think he really enjoyed cleaning his feet after that too lol.
 
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