3/30 Max...pmps 108, +4 55, amps 86

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Mindy & Max

Mindy & Max

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Yesterday: viewtopic.php?f=9&t=10526

Right, so I'm trying to talk to the vet today. She only works on Tuesdays and Fridays (total pain in the rear, I know).

Last night despite having a higher ps number, Max was heading towards crash land, and for the second time in 2 days, I had to give HC food so that I could actually go to sleep (and I still stayed up too late...today is going to be a rough one). It really makes me wonder how low he dipped during the day yesterday, and whether the "higher" (but still good) ps number was a rebound.

This morning I only gave .5U (half the dose we've been going at) to try to use up some of the shed. I do plan to return to 1U tonight, and hopefully we won't be dropping into the 50s again at +4. Really, I do want him OTJ, but not this fast!
 
So I just talked with the vet (first time I've not had to wait for her to call back)...

She said it does sound like he's going into remission, but also doesn't want him to come off the insulin too fast. Any number in the 50s makes her panic, and she said she didn't want him dropping that low too often--especially since we can't be home during the day to watch him. She wants me to hold the .5U dose for the rest of the week and do a curve on Saturday to see how low he's really going, and then we'll go from there. She also said that if his ps number is in the 50s, not to give him a shot, but if his ps numbers stick around the 80s/90s like they have been, to keep up with the .5U dose.
 
Mindy, we do the decreases when a newbie cat hits the 50's, and according to the protocol, we just decrease by 0.25U at a time..His numbers are terrific and it seems like he is headed in the right direction, bu some cats, who get taken off insulin too quickly, return with higher numbers as it may have been too fast.
Asking our dosing helpers may be of advantage to you...I think your vet would agree that slowly decreasing dose brings better results, after all look how many cats here have gone into remission!! Our people are here 24/7..and have more knowledge than many of the vets we encounter with FD..No disrespect intended.
Also, when your cat hits low numbers like 50's You Are in Control, as you have your low carb, medium carb, and high carb foods available to bring Max up, right? I use med. carb, as it brings her up quickly with little rebound. Dose Hopping is not recommended, as it screws up their numbers,
but to give a reduced dose occassionally is fine, need to keep the shed filled--You're doing great!
 
Roni--
Mindy, we do the decreases when a newbie cat hits the 50's, and according to the protocol, we just decrease by 0.25U at a time.
Click to expand...

That is a piece of information I did not have. The dosing protocol says they have to hit 50s on 3 separate days to decrease...so I've had people telling me he hasn't earned any of the decreases I've given him (yet his numbers aren't rising in response, and are barely rebounding with giving HC with the low numbers)...but if he only has to hit it once, then he "should" be at about a .75U dose, right? I haven't been getting a whole lot of help when it comes to dosing--I don't know who the "experts" are. I've just been going with my gut at each decrease, trying to make sure I don't make him go hypo. And I totally agree that I think my vet knows about as much as I do (okay, probably a bit more, but still she doesn't have much actual experience with it) when it comes to getting a cat into diabetic remission--but she's the only other person who actually knows my cat in real life.

Yes, I do have MC and HC food available...the problem is that I don't know what's happening to him during the day because I'm at work. I have a 40min commute, so I can't run home at lunch to check on him. During the week all I have to go by is the evening/night numbers, which in the last 5 days have all been saying his dose is (suddenly) too high.

D--
Thanks for that link with all the kitties' spreadsheets! That will be invaluable as soon as I have enough brain function to look through them (I can't even begin to tell you how tired I am today!). I did read through last night's posts on the condo, and looked at George's ss this morning.

You know, at the beginning of last week, I was just getting "comfortable" with testing, shots, his dose, etc. It looked like things were evening out and he was doing well. Now I kinda feel like I'm flailing my arms all over again. It's all happening too fast! :-D
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

I think this dose will be much more comfortable for you to hold. Once I went from 1u to .5 I didn't worry as much and I could comfortable shoot 80s and even some high 70s and leave for work or go to bed without worrying. My girl also flattened out quite a bit at .5 where at 1u she would drop fast so I was skipping a lot of shots.

If you look at our spread you'll see once at 0.5 we quit seeing any 50s and almost no 60s and starting hitting blues for the first time since the early vet tests. Here's where slowing down and letting the body get used to it is really important, we almost moved back up from .1 to 0.25 because we were getting many more blues than I was used to. They were still low, but higher than I thought would help get her to permanent OTJ. You are almost there.
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Mindy - I was looking at your SS and all comments you have in there. Good job. Your numbers are coming down so nicely. Yes it seems fast and furious right now but IF max is able to be one of the ones that can OTJ in a relatively short time it will be so worth it. I personally have not experience the mad rush down when a cat decides it it time - I heard it can be a crazy ride - I do see many a comments about trying to find a dose that will stick and slow the cat's ride down. Hopefully your .5 units will do that and give Max a little more healing time. I think you have a good plan set up right now for the rest of the week (if Max adheres to it). Take a deep breath, sleep between the pm checks (I got good about snoozing on the couch with the timer set, I was always afraid to actually get into bed that I wouldn't get up - or if I did go to bed I'd keep my clothes on so I'd get too hot and wake up :) --- OH - have you remembered the important part? The part where you get chocolate if Max gets MC or HC????
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Hi Mindy,

I'm not sure where the 3 days in a row bit comes from.
If you get a 50 or lower in a newly diagnosed cat-it's a .25u decrease as Ronnie said.
What isn't then recommended is if the next shot (reduced by .25u) also takes kitty under 50 that you reduce again.

This is because you can have carry over action from the first shot. Jojo (who I don't think posts very often now, I too have been away) used to say, after a reduction and you want sleepus 'HC the crappus out of it'.
That may seem extreme as some kitty's go to the moon with HC, but effectively you would get number up with MC/HC (easier once you know how your cat responds to higher carb food) and hold the dose.

If then on the (3rd)next shot it went under 50 again, this would be a dose reduction. On occasion it won't hold and you'll see bg's start to rise. In this case you return to last good dose.

Some cats have gone off insulin within a week or two. Ronnie is right in what she says though, some cats come off too quick and remission doesn't last. To me this is more about the very latter stages where your giving .25u, .1u (yes a drop makes a difference :mrgreen: )
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

HI Mindy
Yes I do believe our 2 Max's have been chatting it up. :lol: :lol:
You have had great advice above so I have litle to add on that end.
I know you have many concerns, moving too quickly, being afraid he gets too low and
sleep and your little kids.
All totally understandable.
Your vet also does sem to understand the importance of going slow as well
so at least youhave some backup then.
You have to be comfortable in everything you do and you can
always control with food.
I was also told that once they get into the smaller doses they
don't plunge as badly as before.
The best is for Max to keep his numbers 60 and above for as long as possible.
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Sorry, disagree with Randi.
If your aiming for remission, numbers are your guide.You wouldn't artificially keep him in the 60's.


What you don't want to do is only have 3-4 days at .1u. You want quite a few. Look at the ss's D posted for you.
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Thank you all soooooo much! I feel a lot better now. We'll definitely stick with the .5 dose, and hopefully (keeping all fingers crossed here!) have a much quieter finish to our week...with lots of sleepus! :-D

Just so I know for future reference when he starts showing some more blues...what number is "high"? I know the goal is to keep them under 200 for kidney function, but what is actually the "ideal" BG range? I've thought about testing my civvie just to see where he is at the same time as Max since they're eating the same food and nearly the same size, but he's a biter and I'm afraid of getting chewed on. :cool:
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Mindy & Max said:
Roni--

Mindy, we do the decreases when a newbie cat hits the 50's, and according to the protocol, we just decrease by 0.25U at a time.



That is a piece of information I did not have. The dosing protocol says they have to hit 50s on 3 separate days to decrease...so I've had people telling me he hasn't earned any of the decreases I've given him (yet his numbers aren't rising in response, and are barely rebounding with giving HC with the low numbers)...but if he only has to hit it once, then he "should" be at about a .75U dose, right? I haven't been getting a whole lot of help when it comes to dosing--I don't know who the "experts" are. I've just been going with my gut at each decrease, trying to make sure I don't make him go hypo
Click to expand...

I guess I was confused. When I posted in your condo yesterday about these kind of dose-related issues, you indicated you were familiar with the Queensland/Rand protocol and referred to the section on what to do in response to a low pre-shot. I did ask if you thought this section was in reference to dose reductions. I Melanie/Smokey also provided much the same information that Roni did. I'm guessing you did not see any of our replies.

For the purpose of making sure we're all on the same page, this is the information about dose reductions from the Tight Regulation Dosing Protocol:
When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.
Click to expand...

Alternatively, we have used a modified version of the dosing protocol. This is the information that I linked from the sticky in your condo yesterday. In the modified protocol:
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
Click to expand...

Hopefully, you are not completely confused. No one here is a designated "expert." We do our best to help one another. I will say there are some individuals whose guidance is extremely clear and helpful and who make a point of being available. If you do feel like you are in need of help, do what you did today and put a note in your first subject line of the day.
 
Re: 3/30 Max...pmps 108, +4 55, amps 86--dosing advice?

Alright, so I am too tired lately and my eyes are skipping, which has led to my confusion. I have the sticky printed out at home as well, but the Queensland/Rand protocol is easier to read for answers, so that's what I've been going by. They both sounded the same, so I didn't notice that "newly diagnosed" bit on the sticky.

But I know it now, and hopefully the .5U dose will do the trick and slow things down. :mrgreen:
 
Normal range is around 60-140 (sometimes up to 160

This link gives you the low down (approximate allowing for ECID) on the various ranges
http://petdiabetes.wikia.com/wiki/Blood_glucose_level.

Rather than looking for a particular number, your keeping an eye out for a trend that is starting to show numbers are going up gradually (depends how many tests you get in a day, 3 should be enough over 2 days for you to realise a dose isn't holding)

The Rand protocol is much tighter than the modified version. You do want to check the differences.

Would be really good if you can get a +6 today so you can se what impact that .5u is having.
 
Kate--Thank you so much for that information. I have printed it out and will put it with my ever-growing pile of feline diabetes info. :-D I will make an effort to get a +6 tonight, but no guarantees. Sleepus is becoming very hard to fight off at my desk this afternoon, so if I don't have to worry about Max dropping low, I may just sleep tonight and try to get it tomorrow night. He tends, however, to hit nadir around +8. If one of my kids wakes me up tonight (which is likely, they usually almost always do), I'll get a test whenever that may be. @-)
 
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