Question on dosing-

I went up today on copper to 2.25u and he responded fairly well. Now his pmps is lower in the 200's. Do i just stay on the same dose of 2.25 no matter the amps or pmps shot number is? My instinct is yes, but just want to make sure.

Lori

 

I don't know what to tell you. What would Dr. Lisa do?

 

I think I would normally say 2 units, to be safe. But I think Dr. P is a little more aggressive than I tend to be. She might say 2.5 and monitor.

Go with your gut Lori and get some tests in.

 

I emailed her and she said to stay on the 2.25u. I will stay up tonight as late as i can and test him. I'm going for it!

My other question is: If he is in the 100's @ amps or pmps do i stay on the same dosage or reduce?

THANKS!

lori

 

Lori,
What time was the PMPS shot?

 

It was shot @ 8:20pm. I have to stay up and clean anyway, company coming in tomorrow.

lori

 

OK, no problem. Can you check BG at about 10:30? And post it here? I'll be up as long as you need help. Just keep this thread updated......I think you and Copper are okay.
Question - if you need something to bring his BG up (do NOT get all panicked about this), do you have some higher carb gravy type canned food available. If you need to make him come up, again, not saying you will, that it better than karo or dry food. Don't feed without asking here first, okay? There's a "way" to do it when needed, and you don't feed a lot at once.

I've been here, done that. Don't stress. Just do what you need to do with the house and get a test around 10:30.

Carl

 

Yes, have the food ready. Thanks!

lori

 

His +3 shot is 354. NOW WHAT IS GOING ON! I just don't get it at all! It's not supposed to go higher. Is this a bounce or what?

 

OK, any time you get a number that seems to make no sense logically, test again. So can you get another try?
Carl

 

I will try. He is not cooperating very well tonight. I'll be back.

lori

 

Had to stick him 3times. UGH! It's @ 361. Way too high. What is going on. He did eat something about 45min ago. But it was on 1 oz and one of the FF cans that is less than 10% carbs. Maybe a food spike?

 

Could be from food. No chance any of the inuslin was a "fur shot"? It all went "in"?
It's just a number. Put it on your SS, plan on another test in 1 hour. And, I dunno, find something to dust? He's fine! :lol:
One test, one number, one cycle....that's all it is. One. When you get lots of them together, they start to make sense. Just one won't tell you anything except about that exact moment in time.

Carl

 

No fur shot. Can't imagine the food making it go that high. Doesn't an invert cycle mean too high of insulin dose? Now he was starting to respond and do well and now i've messed him up again. His poor ears are so sore and he jumps like crazy when i try to stick him. He hates it. It must hurt him something terrible. I am using the 30guage lancets. It's just so hard to find a spot that is not sore. I'm about to call it a night on testing since he is so high now. He definelty won't drop, just keep going sky high. I hate this dance!!!! Makes no sense at all.

lori

 

Lori,

Have we looked for someone who might live you and give you some tips on home testing? Do you hold his ear for a few seconds to help with bruising? Have you used Neosporin with pain relief on his ears? If you can get more comfortable with poking, everything seems easier.

I would say you could chill for the evening.

 

Lori. Take a couple deep breaths. Reread what I said last post. It's one number. You didn't mess him up. He didn't get diabetes in one day, right? He's still going to get insulin tomorrow. 12 hours at a time, Lori. That's all we worry about. 12 hours at a time.

His ears. How much of the ear edge do you use? You can get blood all the way around it, not just that place we call the "sweet spot". Do you warm it? I used to rub Bob's ears for a minute or so, and he liked having his ears rubbed. I never had to warm with a sock or anything, but lots of people do. Do you use the device, or use the lancet free hand? It's ok. Just step away from it for a few minutes.
Quitting testing probably isn't a great idea. The insulin is still in there. Maybe it took a little longer to kick in this time. Another test in about 45-60 minutes at least? One step at a time...
No meltdowns here, hon.
Carl

 

I'll go with Carl. Another test in an hour. Better safe than sorry?

 

I am using all around his ear edges on both ears and try to alternate. He just doesn't cooperate very well anymore so hard to get him to sit still. I've tried the freeze dried snack trick, but he doesn't seem to care. He likes the treat after, but still hates getting pricked. Yea, i rub his ears for about a minute and then poke. Sometimes it works great and others he just doesn't bleed and have to stick again.

I know it is one number and one cycle. But from the past experience of not haivng the right dose, it took a while for him to come around in numbers again. Now i have no idea what to do tomorrow amps. I guess i will go back to my orig sliding conservative scale. This looks like a bounce to me. Too much insulin. I just feel so frustrated and wish i had someone to advise me every step of the way. I'm exhausted and just can't live like this everyday. I need to find the right dosage and get him regulated. I don't know how to do it and it's causing so much stress to me and copper.

I think i will wait until +6 to see if he went down. That is if i'm still awake. Getting so tired and frustrated. Just want to call it all a wash for the night. Can't imagine his BG dropping way down to cause any trouble.

Thanks for letting me vent....

lori

 

Oh, yes i do hold the ear to prevent bruising and use neosporin with pain killer in it.

I wish there was someone in my area. I live in a very rural area of NC. I can't even find a vet that is decent in this area.

Lori

 

Lori.
Venting is allowed here. We all do it. Lots of ears here, along with lots of eyes.

I will be on till +6. that's 2:20? If you can get a test at midnight and 2, that's enough. After the midnight one, we can think about tomorrow morning. That's like forever from now. ;-)

Rural NC.
What's the closest city we'd recognize the name of?

 

I'm going to test now +4 and see where he is at. He doesn't act normal right now. But what is normal? He just seems like he doesn't feel very good. I guess the ups and downs so much is hard on him.

Thanks for the support. You all are the best!

Here it goes.....

lori

 

Wow! That was a struggle to get any blood out of his ear. I guess i'm too tired and so is he. He ran away and hid after testing him. Here is his +4 260. What a swing up and down for him. It must of been the food? Maybe just onset didn't work until late. Shot absorbtion? Who knows. Now i need to test +6? I wish i could just leave him alone, but know i need to check it. I will be alright if you want to go on to bed. I'm sure he will not be going into the low green's tonight. He usually is in nadir @ +5 or +6. So he is close now. Will be interesting to see what his amps will be.
Thanks for the wonderful support.

Lori

 

Lori, I'm up anyway. I am working noon to eight this week, so this is my "normal" routine! I'm actually "working" my other job, so you aren't keeping me up. If you can stay up, a +5 would be great. After that, you can give him a little snack and hit the hay.
I know this is hard. But unless I'm reading you wrong right now, it wasn't as bad as you feared, right? Like you, I thought he'd go pretty low on that dose.
Ok tomorrow morning.... first off, you said you had company coming tomorrow right?
What's that mean in terms of you being around the house after the AMPS?
Let me know that, and I'll help with figure the dose for the morning. I know I won't be awake for that! But someone else may be on the board. It tends to be busy in the AM and PM but not much during the middle of the day.

Carl

 

I will be up until around 2am. My youngest daughter still has some intestinal bug with fever, so having to give her motrin every six hours. So i will be up until at least then.

I think i will test him @2am and that will be @+5.5. Don't think he will go any lower. But i'm not good at predicting any of this stuff. It is one CRAZY disease. It is always a dance like this for every kitty? Wish it was a little more simple to understand. For a high "A" personality and science background, I just want to find the answer of right dosage or formula and follow it and he gets better. Done deal. Huh! Not happening! God really knows how to stir up the pot for me.

If i start him earlier in the morning and get amps @ +10 or +11hrs then I can be here until +5. Otherwise, only +4 and then gone for several hours to pick up company @ airport. Then it will be very busy hectic couple of days after that.

Lori

 

OK,
This only applies if the 2am number is logical. If he shows you a 100 or something, besides us pulling out our hair, I'll have to do a quick rethink....

In then morning, I would test him at what would be his +11. Get the number. Then do his AMPS at the regular time.

If the AMPS is higher than the +11 (rising BG) AND if it is 300 or higher, then shoot the same 2.25 dose.
If the AMPS is lower than 300, but higher than 200 then shoot 2u. That will be safer since you won't be home after +4.
If his number is not rising, then post here. What time would that be? like 9AM? Somebody should be on line to advise.
If his number is less than 200, then post here. You've shot that low before but only .5u. Shooting .5 on a number between 150 and 200 would be better than skipping completely in my opinion. He's beginning to react better to the insulin. Tonight's numbers aren't really that bad, and if you reread what Dr. P. posted in your other thread the other day, he hasn't given you any number that would qualify as "warranted bounce". Nothing that made him go so low that he would bounce way up.
I think I understand Dr. P's thinking (wish I was THAT smart, but I think I'm at least catching on). My cat was dosed this way. My vet was aggressive with increasing Bob's dose. He started at 1u, bid and went to 4u bid before I started reducing. His numbers were sort of like Copper's too, only his preshots were even higher. He lived in the 300+ range too long. Copper is actually doing better at this point than Bob was. There's this concept we call "momentum", not sure if she uses that term or not. When his numbers are doing okay, and you suddenly reduce the dose, you lose that momentum. I think that is what we are trying to avoid here. I know that the curves look a little inverse at times. But if they aren't inverse for several cycles in a row, then it isn't a real trend. Just something that happens.
If I'm way off on this, hopefully she'll let us know. I'd rather be told I'm wrong and learn something from it than to be wrong and nobody say anything.
If anyone else disagrees, please say so. That's what "peer review" is all about. I'm not an expert. I'm a work in progress!

TO recap
AMPS > 300 then 2.25
AMPS > 200 but < 300, 2.0u
AMPS between 150 - 200 .5u
AMPS less than 150, skip it. Again, safer if you aren't going to be around for nadir

Does that make sense, or have I confused you? :lol:

 

Oh, one last thing. Tomorrow, about 1/2 hour before you plan on leaving for the airport, test him. It'll put your mind at ease is what I'm hoping. Need you focused on the road, not the kitty, ok?

 

Here is his +5.5 270. So stick with the plan you stated?

Just had a scary moment with my 11yr old dog just 10 min ago. She had a sezuire. Don't know what is wrong with her. She is ok now. weird.

Ive got to go to bed....

Thanks for everything...Really

lori

 

Lori,
Hope doggie is ok?

Yes, stick with that plan unless you see something different posted here before then.
Have a nice peaceful rest of the night!
You done good.
Carl

 

Amps was @283. So shot the 2u. We shall see what happens today. I'm ready for another rollar coaster

Lori

 

Good number.
Carl

 

hang in there Lori
It will get easier

 

Went back up to his 2.25 dose tonight. will test @ +3 or +4 and go to bed.

THanks for all the support.

Lori

 

Lori,
The PMPS looks like a little bounce, that's all. The curve is still shaped right. I'd stick with the 2.25. This wasn't the roller coaster you expected, right?

Carl

 

Food for thought...

What is often called a "bounce" may just be simply lack of duration....or other factors,

I honestly think that rebound and bounces are often overemphasized/WAY overdiagnosed when it is no more than BIPO....or the cat just metabolized the insulin faster that day.

We have nothing in our data to denote that the higher PMPS is due to any 'bounce' (warranted or unwarranted) which, on this board, is used to denote a rebound-type situation.

Ok...even I had to ask what BIPO meant.

Big Insulin Poop Out

 

Also keep in mind that for many cats, a higher dose means longer duration.

If we use the term "bounce", that often scares the caregiver - especially dear Lori - into thinking that the dosage is too high...scaring them back into lowering it again.

Carl - you are so good about wanting to bat these things around and learning from dialog so thanks for hanging in there with Lori!

 

I had not considered that a higer dose means longer duration.... yet another variable in the equation!
Is there a better term to use than bounce? I guess we can borrow "BIPO"? ;-) I understand about the warranted/unwarrented bounce that you detailed a few days ago, and it has gone into my logic when I'm trying to figure things out.

Thank you for the encouragement. I want to get this. The "glucose toxicity" thing, and the reading I've done on it since then, has been gnawing on my brain since that night. There are too many kitties in the high numbers for too long, and I want to help get them down..... just not quite sure how sound convincing I guess.... :smile:

Thank you,
Carl

 

Keep it simple: "short duration"..."the insulin was dead and gone...fizzled..."

I am not a fan of using abbreviations which leaves lurkers/newbies stumped.

We need to start differentiating this just a bit more. I know that you do, very often, discuss this in detail and, thank you for that, but I like to use a one word description to keep from having to type so much after I have explained what it means.

I think "warranted" and "unwarranted" do that pretty well.

Exactly. I take a much more 'sledgehammer' approach to this disease and, knock on wood, I have never hypo'd a cat yet. Never needed sugar...rarely have even needed any HC food.

Let's face it....you guys are in a tough spot. Lay folks on a message board are walking a fine line here and I know that you all take your jobs very seriously. It shows. I can't remember the last time I ever saw anyone give advice that would put a cat in danger of a life-threatening hypo.

That said, I sometimes cringe when I see things moving so slowly.

It's a balance that everyone has to deal with - even me since I can't be there for my long-distance clients if things go wrong so I also walk that tightrope as you all do. Believe me, I have given advice and then hung up the phone and worried that a cat may hypo. It has never happened but that does not mean I don't have sleepless nights worrying and wake up checking SSs on my iPad.

 

At least 2 cats on this board (I haven't searched for more) - Musette and Spitzer - get what appear to be huge food spikes of 200 points or more, after eating. In Spitzer's case, this can happen in 1 hour.

Perhaps Copper is a 3rd cat that does that.

 

Yes, this falls under the category of "other factors" that I mentioned above.

However, I don't think that Lori always feeds Copper close to his PSs. Maybe she does sometimes...but I don't think that it is always done. Don't know. Lori would have to answer that.

I just want to reiterate that I am in the generation that had Super Balls so the term "bounce" is, in my mind, synonymous with a rebound (warranted or unwarranted) situation...maybe...or maybe not...warranting a dose decrease.

I have seen many unwarranted suggestions stating to lower the dose with no clear indication of warranted rebound/bounce just because someone sees a high PS.

At the risk of repeating myself...we are all frustrated when we don't have enough data since data drives our suggestions. But that said, I also see cases where cats are driven nuts....along with their caregivers....with recommendations of too much testing.

Like last night - Lori should have just gone to bed after the +3. There was no need to stress her and Copper with more readings....given their already high stress level.

Here comes that darn "balance" word again!

 

I have thought lots about the food spike too. I try not to feed within 2hr before ps's. However, there are times when i do feed him right before i test. It makes it easier to ear prick him when copper is not so hungry. Then if i have to test within the next hour or two it does effect the BG test. I have seen his BG go up in an hour 60 pts(i.e., 11/23/11 between the +3 and +4 reading and then the +5 be 80pts lower). Sometimes i have to just leave food out in bowl and leave house for +6hrs and have no way to monitor food intake. So it's possible that some ps's could be higher.

Since i am a scientist, i did an experiment tonight. I just did a +4 reading and i know he hasn't eaten since 3hrs before. It was @ 141. He was very hungry, so i fed him right before testing, 2oz. He tolerated the ear prick so much better without fighting back when his stomach is full. Now, i'm a little nervous about this BG number being so low @ +4.5. So i will test him again in an hour. We shall see what his reading will be. Higher or lower? I think it will be higher because of the food spike. We shall see. I only give him FF<10% carbs and very careful not too feed him too much at a time when i can.

Lori

 

Hi Lori,
That number isn't "too" low. Sort of along the lines of the AMPS cycle yesterday, right? That's a good number really, and the food will bump him up a bit. Might be an hour, but you might see something at 4.5. Copper's looking good to me.

Carl

 

Carl,

How late are you up to tonight? I think i will wait to do his test @+6. That will be around 2am. Will you be up? He is looking ok right now and sleeping. I am trying not to have to test him too much and for me to feel ok to go to bed.

Lori

 

I'll be up past 2. I'm working noon till 8 this week, and that usually means night owl.....don't have to set the alarm to go off till 10am. My kind of hours!
Carl.

Test when you want, and I'll be around to look. Don't stay up all night though!

 

Too a little longer to get a BG. I guess i'm just too tired at this time at night. Here it is: +6 110.

That number is with feeding him @ +4.5. I wonder what it would of been without the food. I don't really want to test again. I'm tired and want to go to bed. Do you think he is safe?

Lori

 

Yes, I think he's safe. Maybe just put out a spoonful or two of low carb food, and get yourself to bed? I think he's had a good day, Lori, and so have you.

Carl

 

Thanks! I think i will feed him and leave out some extra for the next couple of hours so i can sleep.

Thanks for sitting with me again carl. Your the best!!! Didn't feel so alone in this.

Lori

p.s.
At least my doggie didn't have a seziure tonight @2am. Can't handle anymore stress.

 

Good news on doggie! And yes, get some sleep. Good job tonight, Lori. Make sure and tell copper he did good too.

Carl