Wynk - shoot a 90?

Discussion in 'Prozinc / PZI' started by Cara and Wynken (GA), Dec 30, 2015.

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  1. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    OK, I'm sorry I don't have my spreadsheet up-to-date because I left my iPad at work tonight. When I got home tonight I tested Wynk at 166. So I waited 15 minutes and just tested him at 90!

    Help! I don't know what to do.

    I fed him his 3.2 ounces of extremely low carb wet food. And am waiting to hear from someone for a dose.
     
  2. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    I would not give any insulin at 90, Cara. It looks to me like you will have to skip tonight and reduce tomorrow. Maybe his pancreas is helping out? What nice numbers!
     
  3. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Yeah - Mr pancreas is flexing his muscles!!
     
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  4. Robin&BB

    Robin&BB Well-Known Member

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    You're definitely in the no-shot zone tonight, Cara - and that's GREAT news!:D Sure looks like he's got a pancreas that's waking up...
     
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  5. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    It was SO WEIRD, Sue! When I got the 166 I just knew that the reading after 15 minutes would be 200 or 210, because he's always rising when I stall and check him in the evening. When the 2nd number was 90 I literally (mentally) froze and panicked and fed him immediately!

    I feel like I'm in new territory… I'm going to definitely check him at +3. I won't be too surprised if he's at 398! LOL

    Thanks for the advice. I think that my gut was telling me I should've gone ahead and shot one unit or something, since I suppose his blood sugar will go up with the food? That's why I am VERY grateful for this board, and for YOU! :bighug:
     
  6. Rachel

    Rachel Well-Known Member

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    Wow, Cara! I'm impressed with that number! Yep, as everyone has soon, definitely no shot. You can take a break too and get some sleep without worrying he might drop this way.

    You're doing great! The first time I got a 2 digit preshot, I panicked too! I immediately got on here and begged for help. I think we all do the first few times because it's so strange!
     
  7. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Thanks Robin and Carol!!
    I had no idea that was it! :eek: I just figured that maybe I had gotten him extremely low carb food and that the dose was high enough this morning ....

    ?

    I really hope what you guys are saying is true, although this will also mean that I have to watch his sugar even more closely than I'm already watching it, right?
     
  8. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Rachel - So strange is right. To not give a shot... I feel a little giddy and drunk! :p
     
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  9. Robin&BB

    Robin&BB Well-Known Member

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    Yes, but what a good feeling!;)
    Well, this is a perfect example of why we all keep on testing. You're already doing a super job of watching Wynk's levels: Consistently testing before every dose and accumulating good mid-cycle data, too. (And that's what's so great about our spreadsheets - you get to see what's really happening.)

    I agree with Sue about lowering that dose some tomorrow, Cara - as what you'll be trying to do now is keep him from bouncing. You might want to try him at around 1.8U in the morning - if he gives you a shootable AMPS #, that is. If he were mine, I don't know that I'd want to go any higher than a 2.0, tops - even if you do see a fairly high AMPS tomorrow - as it appears to me that his body may be telling you it would prefer a lower dose.:)
     
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  10. Carol & Murphy

    Carol & Murphy Well-Known Member

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    I read a very interesting thread on the Lantus forum today about keeping the curve rather flat, thus avoiding lows and therefore bounces, with timing of feedings depending upon the nadir - I think it is under a Paula (Woodsywife) thread - it may be peculiar to Lantus though
     
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  11. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Robin, thanks for the morning tips. I can't imagine him being anything other than high 300's. But I get what you're saying. :)

    So I think it's really ironic that halfway home I remembered my iPad was at my desk. I was berating myself for forgetting because it has become part of my routine to enter everything about him in real time... Then THIS happens :joyful:

    All of you have made me feel so good tonight!! Thanks for the support and info but also for the cheering! :D:bighug:
     
  12. Robin&BB

    Robin&BB Well-Known Member

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    Rah, cat! Rah, cat!:cat: GO, WKYKEN!!!:D
     
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  13. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Interesting. Seems like a good idea to avoid the extremes if you can ... It would be very difficult for me to adjust or change his mealtimes. I wonder if it is a Lantus thing?
     
  14. Robin&BB

    Robin&BB Well-Known Member

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    I believe that is more of a Lantus thing; used primarily by folks who are following the tight regulation protocol for that insulin.
     
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  15. Rachel

    Rachel Well-Known Member

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    Good morning! Just wanted to let you know I'm around this morning if you need anything. :)
     
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  16. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Thank you, Rachel! I was out of my routine due to my missing iPad and didn't even check my email until I got to work. So I just updated his SS... I followed Sue and Robin's guidance to not shoot above 2u regardless of AMPS (to avoid bounce?). So he was 502. :blackeye: Without their advice, I would have given 2.4u... But instead shot 1.9.

    I checked him 4 hours after feeding last night and he was 464.... Which makes me curious now why we didn't give at least a little dose, so he wouldn't go so high (then or overnight). I'm sure there's a reason. o_O
     
  17. Rachel

    Rachel Well-Known Member

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    Hi Cara! With such low number last night, any dose would have been unsafe. There are different no shoot numbers....newbies start at 200 and as more data is collected it goes down since we KNOW how the cat will react and the bean knows how to steer with food if needed. However on ProZinc, no one I know would shoot below 100. I think the lowest no shoot number I've seen is 150...and that only if the bean has tons of experience and data and will be home to monitor. 90 is a normal number....so adding insulin could and probably would cause a hypo. Remember that Lantus (which Bobbie is on) works differently so their no shoot numbers can be much different.

    I know today's high number is a disappointment but it's really to be expected. We'll get Wynk back on track!

    Does all this make sense? If not let me know. Basically this is all to say better too high for a day than too low for a moment!
     
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  18. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Lantus is just dosed differently. It has a later nadir (in Bubba's case, a very late one) and a flatter cycle. ProZinc is less predictable and the cat is more likely to ave a shorter, smile shaped cycle. Our guess is that Wynken is s unpredictable because his pancreas is helping out. This makes dosing him more difficult as we don't know when it will join the party and start dropping the levels. So we think conservatively. The only way you could have given him insulin last night is to wait, without feeding, until he was higher, then dose, and plan to dose 12 hours later.
     
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  19. Are you using an AT meter?

    If so, I would never consider shooting a number as low as a 90 with Prozinc. Not even a tiny dose.

    ETA - I would have suggested you retest when you saw the 90. A drop from 166 to 90 in 15 minutes at that point in the cycle defies logic looking at your spreadsheet/history.
     
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  20. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Hi Cara - I have definitely been where you are (take a look at Murphy's spread sheet from a few months ago)
    just one thing I want to add -not uncommonly, I get a reading that is totally unexpected (usually something very low) from the meter - the amount of blood is too little (or too much) when that happens, I always get another immediate reading - just this morning's amps, the 1st reading I got was 141 - I knew that wasn't right and the blood was a small amount so I rechecked it and it was 460 I have no doubt that some of the early low readings I got were due to meter error
     


  21. I don't understand the logic of lowering the dose to avoid bouncing? Why is a bounce a bad thing? A cat that never bounces is a cat who will remain on insulin forever.
     
  22. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Well, speaking for myself and my advice - the 2.4 gave Cara a long cycle, still dropping at +12 and unshootable. So, it makes little sense to me to repeat that same pattern the next cycle. My thinking is to reduce the dose a little and see where that gets her in terms of two shootable pre shots. As we have been noticing, it looks like Wynken's pancreas may be waking up and helping out with the longer cycles. To me, that suggests advice that is conservative, as Cara is not home during the day always and he has been pretty unpredictable.
     
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  23. If the bounce is caused by a hypoglycemic number, a reduction is warranted. If it is caused by a number that is just lower than a cat is "used to" a reduction is counterproductive.

    As for the "still dropping at shot time"... I dont know that it was. Either the 166 or the 90, IMO, was a meter error. Cats don't drop that far in 15 minutes when their last dose was nearly 12 hours ago.

    If the 166 was accurate, it was shootable. If the 90 was accurate, on an AT meter, I'd say a reduction was warrented. Not because of a bounce, but because a 90 indicates a reduction (see SLGS protocol).

    In either case, the bounce took place during the PM cycle last night, and caused the high AMPS this morning. The high this morning was NOT due to skipping last night. So it was already too late to avoid a bounce.

    Lastly, if I had a diabetic cat and was using PZI or Prozinc, I would hop up and down with joy every time my cat had a "long cycle". I'd want one twice per day actually.
     
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  24. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    And we disagree. 90 is a watershed number - even on the SLGS approach, one approach is used above it and one below. I prefer to be conservative. Cara has been testing awhile; she got 2 numbers, both dropping 15 minutes apart. I see no reason to jump to the conclusion that the meter was in error and make a dosing decision based on that presumption.

    We don't have the same approach. That's why it is a peer reviewed board and the bean holds the syringe.
     
  25. "And we disagree. 90 is a watershed number - even on the SLGS approach, one approach is used above it and one below."

    I don't understand what you mean?
     
  26. "Cara has been testing awhile; she got 2 numbers, both dropping 15 minutes apart. I see no reason to jump to the conclusion that the meter was in error and make a dosing decision based on that presumption."

    So it's more logical to base decisions on the illogical conclusion that he dropped 80 points in 15 minutes after +11? Do you see that anywhere else on his speadsheet? I didn't.
     
  27. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    From the SLGS info:

    If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit. If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same. If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.

    . I'll base my dose advice on what the meters says and be conservative. If I'm wrong, it is fixable on the next cycle.

    Carl, I don't want to clutter up Cara's thread with our disagreements. You gave your opinion; I gave mine; Cara decides.
     
  28. Ok. Then based on both SLGS and on the prozinc protocol that you wrote, your advice is counter to both. SLGS says she should hold the dose if 90 or above. Your protocol says nothing about AT numbers.

    I was actually incorrect sugessting a reduction at 90 as well.

    As far as cluttering up threads? Where exactly am I supposed to post if I agree or disagee with you or anyone else for that matter? My posts are not only intended for the original poster. They will hopefully be read by lots of others, even years from now.

    I don't really understand. You want me to post more often, even daily. Except, I guess, when I actually do post. Then I'm supposed to state my thoughts, have you disagee with them, and then shut my mouth?

    You don't get to set the terms on where, when, or what I post.
     
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  29. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    I don't see any reason for me to continue cluttering up Cara's thread. Carl, you, as always and for everyone, can post wherever, whenever you like.

    Cara, the info I posted from SLGS assumes that 90 is the nadir and that, with ProZinc, I think it is is assuming that it occurs somewhere in the 5-7 range, not at +12. For me, a nadir of 90 at +12 needs a cautious approach as does a nadir of 80 (AT meter) in the 5-7 range. I don't use the SLGS approach - I don't know when it was written or who wrote it. I think it is a version of the approach Lantus uses. I think on the forum, the 90 has been revised to be 80, for an AT meter, so it seems to be outdated.

    As I said, Cara, it is a peer reviewed board and you hold the syringe. For my part, I am sorry I cluttered up your thread with a discussion that probably hasn't helped you much.
     
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  30. "I don't use the SLGS approach - I don't know when it was written or who wrote it. I think it is a version of the approach Lantus uses. I think on the forum, the 90 has been revised to be 80, for an AT meter, so it seems to be outdated."

    SLGS predates the Lantus protocol and the popularity of Lantus. When it was written, very few people comparatively used the L's, and the insulin of choice for TR people was PZI.
    There is no "conversion for AT users of 80", and the only conversion I am aware of is for TR users on lantus/lev using a 68 on an AT as a reduction cutoff.

    SLGS is not meter specific or insulin specific.
     
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  31. Bernie

    Bernie Member

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    90 is a beautiful BG number, so no do not give insulin with a reading like that. The drop was 76 points, never shoot into a falling number, always be sure BG is rising.
     
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  32. Ar these numbers, I'd agree with Bernie. But I don't agree with a blanket statement saying "never shoot into a falling number". Depends on the number, and how much data one has collected. And the insulin type, though I don't know what type of insulin Bernie has experience with.
     
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  33. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Wow! I had an extra long workday today, meeting an unexpected deadline... So I got home just in time to test, feed & shoot Wynken. He was high like I expected... What's weird is that I got no emails today informing me of activity on this thread. So I figured everyone was busy and I would post a question if I had one, which I didn't. He was high tonight and I shot the max dose I've been using for that range of 2.4 u. :)

    I am going to take care of my other kitties now... But later I am going to come back and read and RE-read this all several times. What I want to say now is PLEASE everyone keep posting!!! Post often and copiously... It will be wonderful to hear all approaches. I could not be MORE grateful for this group and all the cumulative experience and knowledge here... And I'd like to hear it all. I wish I could hug you ALL! :bighug:

    I'll be checking Wynk lots over the next 3 days... God know what he'll do, sugar wise, but he's better off than he was a month ago, I'm sure of that. HAPPY NEW YEAR!!!
     
  34. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Happy New Year to you, Cara
     
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  35. Robin&BB

    Robin&BB Well-Known Member

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    Will you be able to get in a mid-cycle test or two tonight, Cara? Would be some good info to have.
     
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  36. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Robin - Yes, I am planning on it. :D
     
  37. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Thanks Carl, for your input. I am learning a lot, and there are so many different approaches, it seems, based on insulin type, comfort level, whether you will be around to test... Which I have been able to do more of at the holidays, but am gone in the day, usually... AND the whole ECID thing.

    Yes, using an AT2 meter. Although the 90 was VERY surprising to me, it never occurred to me to double check it, so that is EXCELLENT advice. But when I saw the 90, I had already prepared his (now carefully measured) plate of food and so I just plunked it down in front of him after getting that (for him) low reading. He is very antsy at pre-shot time and it's all I can do to go back 15-20 min later to try & poke him again. He can't believe I have to do that again... He's like "you did that, woman! Where's my food?!?" Ever since limiting his portion size on the 20th, he is a HUNGRY boy at meal time. Next time with odd readings though I will try to test again. :facepalm:
     
  38. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Robin,

    Well, I got a couple readings before I had to sleep at +5... Wanted to set an alarm for his nadir (?) but I "think" that would have been 3-4 a.m. And just couldn't! :rolleyes: Of course I would have set an alarm if I were concerned he was gonna go low.

    We'll see what his cycle looks like today. :D
     
  39. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Cara - I think FDMB wants 2016 spreadsheets (new tab on old spreadsheet) please see the info message by Squeaky on the Prozinc forum ( a few threads down from yours) It's pretty easy
     
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  40. Robin&BB

    Robin&BB Well-Known Member

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    Yep, should be interesting to see what kinds of #s you get today. Will he drop? Or will he stay higher & flatter? We'll see ...

    Before I forget (looking back at 12/24 on SS), just so you know: You really don't need to steer with food when you see a drop down to a 98 on an AT2 meter. That # is just fine.;) Next time (unless it's earlier in the cycle and you have a situation where you have to leave for several hours, so would not be able to monitor him), just let him go without giving additional food. I know that seeing greens when you're not used to that can seem a little scary, but you don't need to be too concerned - at least not until you're seeing him drop down around 69-70 range on the AT2 meter.:)
     
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  41. Cara and Wynken (GA)

    Cara and Wynken (GA) Member

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    Ok, good to know those levels, Robin. I have a paper printout of @Sue and Oliver (GA) 's PZI protocol and I have written the BG ranges and doses for said ranges that Sue gave me a couple weeks ago. I have also written "don't shoot below 150 without advice/monitoring" and just added: "no need to steer with food until ~70 or lower on AT2". :D Thanks!

    This bring up a point... My SS doesn't go back real far, and it seems of value to keep everything visually available for at least a few more months in 2016 - or should I do as @Carol & Murphy suggests and start a new 2016 tab today? I want to do whatever is easiest for those folks that go out and look at his patterns. :bookworm:
     
  42. Robin&BB

    Robin&BB Well-Known Member

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    Gee, I've been pondering that one myself ... maybe reproduce the previous month's #s on the 2016 sheet & go from there??? (As anyone can easily click on the previous year's sheet for prior history ...)
     
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  43. I like Robin's idea of leaving recent history on top if you create a new sheet. Although since you have only about 60 rows of data, in your case I don't think it would be a problem to not worry about creating a new sheet and just continue on.

    I think the two tests you got last night show a rise from eating, and then a drop as the insulin tried to knock the numbers back down. I think all the numbers since the 166/90 are a bounce because Wynk is still not used to what normal numbers feel like. At some point he'll remember though. I'm hoping you get numbers that make you smile in the next cycle or two :)
     
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