TOMORROW'S DOSE? 5/20 Sushi: PMPS~105|+2~186|+3~198

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Sushi (GA 5/05-3/14)

Sushi (GA 5/05-3/14)

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Thanks for all of your replies Yesterday! I'll write more later, but right now I'm concerned.
Sushi's numbers are unusually low today. Again, I'm wondering if we're headed for trouble. He hasn't eaten too much (maybe 3oz so far), and I'm trying to get him to eat more...
His appetite seems to have taken a step in the right direction since I was gone the past 2 days. He woke me up with all sorts of obnoxiousness before 5am this morning because he was hungry. He used to do that all the time; I don't miss it!! :?
I'm just afraid he's going to drop too low by the time +6 comes along; should I do something now to be proactive? Just keep feeding and testing?
 
Re: LOW #s! 8/20 Sushi: AMPS~150 | +3~65

I would be testing him every 15min-30min to make sure he doesn't get lower. If he gets below 50, then I might give him some HC fuds, and keep testing. It may be that Sushi has an early NADIR like Mr. Howell, as early as +3 or +4, so he might just hit this low number and keep going up, but the only way to know for sure is to be testing.
 
Re: LOW #s! 8/20 Sushi: AMPS~150 | +3~65

Okay he ate a bit more, but I can't get him to finish off the can. So he's eaten about 4.5oz so far today.
His #s are still dropping.
Should I go ahead and feed some HC food?

AMPS 150
Dose @ 7am
10:19 - 65
11:02 - 53
 
Re: LOW #s! 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53

I would give Sushi a little more LC and test again in 30 minutes. If below 50, then feed a little HC food. You are really looking for numbers in the 50 to 100 range.

John
 
Re: LOW #s! 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53

...still dropping: 47
I was able to get him to eat a bit more, so we're at about 6oz of LC, and I just cracked open a can of high carb. How much HC do I give?

You guys will be here for me if he goes hypo, right?? nailbite_smile

AMPS 150
Dose @ 7am
10:19 - 65
11:02 - 53
11:36 - 47
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

Hi Ashley and Sushi,

You can start with a teaspoon of HC food and test in 15-20 minutes, you don't want to feed to much as Sushi BG numbers can drop again and he might be too full to want to eat again.
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

N worries.

At this point I would feed 1tsp HC and retest in 15-20 mins. I'll be here a while.
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

Thank you so much for your answers and advice.
Sushi probably ate about 1 TBS of the HC before I got your answers. I'm concerned about him being too full as Tracy mentioned because I've been chasing him around the house all morning forcing him to eat. But he LOVED the HC, so I hope it won't be a problem!
Thanks again!
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

:lol: Yeah that doesn't seem to be a problem with Leo either, they really do love that HC food!

Good luck ;-)
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

Yeah, If you read the sticky Sienne linked you to, one of the important things to remember at a time like this is to try and keep the cat a bit hungry.
 
Re: #s DROPPING 8/20 Sushi: AMPS~150 | +3.5~65 | +4~53 | +4.

Well Sushi just earned himself a dose reduction of 0.25 units, keep testing and feeding HC as needed, otherwise if he's not too low just feed LC.
 
Re: #s DROPPING 8/20 Sushi: AMPS~150|+3.5~65|+4~53|+4.5~47|+

You may not be out of the woods yet...
Feed another tsp of hc and test in another 20-30 mins. The numbers could bobble. You want to get to a couple safe numbers in a row.
 
Re: #s DROPPING 8/20 Sushi: AMPS~150|+3.5~65|+4~53|+4.5~47|+

...20 mins later...we're at 59. Should I keep feeding 1tsp of HC and testing? Or just keep testing?

AMPS 150
Dose @ 7am
10:19 - 65
11:02 - 53
11:36 - 47
11:55 - 50
12:12 - 59
 
Re: #s DROPPING 8/20 Sushi: +3.5~65|+4~53|+4.5~47|+5~50|+5.2

Ashley --

You're doing great!! With the HC, usually what you want to do is to spoon (or drain) off the gravy. The gravy is far less filling than the solids and it's where the carbs are.

If you take a look at Gabby's SS, you can see how I enter the tests that are not exactly on the hour. You need to change the colors manually if you have more than just one test in the cell.
 
Re: #s DROPPING 8/20 Sushi: +3.5~65|+4~53|+4.5~47|+5~50|+5.2

Okay...we're at 89 now. Is that right??

AMPS 150
Dose @ 7am
10:19 - 65
11:02 - 53
11:36 - 47
11:55 - 50
12:12 - 59
12:45 - 89

Sienne and Gabby said:
Ashley --

You're doing great!! With the HC, usually what you want to do is to spoon (or drain) off the gravy. The gravy is far less filling than the solids and it's where the carbs are.
Click to expand...
Thanks Sienne!!! So you feed the gravy then, right?

I'd love to take a shower and go pick up some lunch! Are we in the clear? Is it safe for me to go about my day now?
 
Re: #s DROPPING 8/20 Sushi +4~53|+4.5~47|+5~50|+5.25~59|~5.7

Guidelines from the sticky:

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
Click to expand...
 
Re: #s DROPPING 8/20 Sushi +4~53|+4.5~47|+5~50|+5.25~59|~5.7

good job this morning - you've basically learned the process.

it's a "lather, rinse and repeat" til he's past the nadir and you've seen 2 rising numbers.

make notes on his spreadsheet so next time you can look back and see what you did. if he zooms up high now, make a note of that and next time feed him less high carb. your goal is to have sushi spending as much time as possible between 50 and 120 - great healing numbers for his body.

you caught the "drop his dose by .25 tonight" part, right? sometimes when you drop the dose they go back up the next day, so you keep checking and if he doesn't stay in these nice numbers then go back to this morning's dose fairly quickly - i don't think we have an exact guideline on it - but maybe 2-4 doses at the new reduced dose tonight, and if he hasn't settled down to some green numbers go ahead and take it back up to the same dose as this morning. if he zooms up later today it's probably from the high carb food - you want to wait til that clears before you decide if the dose reduction "works."

does that make any sense?
 
Re: #s DROPPING 8/20 Sushi +4~53|+4.5~47|+5~50|+5.25~59|~5.7

julie1220 said:
good job this morning - you've basically learned the process.
...
between 50 and 120 - great healing numbers for his body.
Click to expand...
Thank you!!! Whew I'm glad we made it! Thanks also for this range--this is a question I've had for a while now!

Soooo, now that we're on our way out of trouble, this has given me a myriad of new questions: (imagine that! ;-) )
> His AMPS was 150, which is very low for Sushi. Was it a bad move that I dosed him as usual?
> Because his numbers are typically so high, I've had trouble applying the "dealing with low preshots" guidelines to our situation. (I've read it a million times; I have it printed and in a page protector for quick reference):
----> What is a "too low to shoot" PS for Sushi?
----> It is so essential that our schedule stays the same that I can't really afford to test and wait.
----> Also, we've skipped so so much this week, and may have to a few times in the coming week, that I can't stand skipping another shot!
> What caused these low #s? I didn't give an increase or anything!
> He's not eating well to begin with, but the initial response to low #s is to feed him LC food. So I tried stuffing him with LC food, but when that wasn't enough to do the trick and I needed to try HC food, he was too full. How do you balance that?
 
Re: #s are safe - now a LOT of ?s 8/20 Sushi: +5.75~89|+7~72

ok, good you've got lots of questions. the trouble is that a lot of the answers vary depending on this or that.

first of all, think of it this way. insulin is a hormone. remember yourself at 13? one minute sunny and happy the next you want to cry? yeah - that's hormones. so it's not just a cut and dried thing about why their bodies change in their reactions to the same dose of insulin. i know i thought that it would be a math equation. take one 14.3lb punkin, add x units of insulin, feed x oz of food at the same time every day, and VOILA! i'd have a cat with a nadir of 51 and a high point of 120.

:lol: :lol: :lol: :lol:

no.

that's why people call this a dance - you just keep tweaking to try to keep it in the healing range. under 50? add a little high carb food. decrease a little insulin. too high? add a little insulin. wait out the bouncing and new dose wonkiness - see what it does. after 3 days-ish, tweak more.

same unhelpful answer with the "what is too low of a preshot number to shoot?" the answer is it depends. it depends on if you're home to check. depends on if you have strips and high carb food. depends on if your cat is a zoomer or a flat cat. every day you are building data about how sushi reacts on a given dose. you have to look at sushi's ss and learn to interpret what he's telling you.

for a newbie, usually the answer is "don't shoot under 200 or maybe 150." people who have a lot of data regularly shoot under 100. the wide swings in numbers at the beginning of the process flatten out as your cat gets regulated. so just because a new kitty drops 150 points in a day doesn't mean a kitty later in the process will drop 150 points. the closer the kitty gets to OTJ the flatter the curve is - they might only move 30 or 50 points in a cycle with just a drop or two of insulin.

what makes you think he's not eating well? is he losing weight? often as a cat's BG stabilizes they are metabolizing the food better and they will eat less. tracking his weight is what will tell you if he needs more/less food.

when people are telling you to feed for low numbers, they're talking about a teaspoon of food - either high or low carb.

does that help? ask away on whatever is muddy.
 
Re: LOTS of ?s now that #s are down! 8/20 Sushi: +5.75~89|+7

Thanks for this info, Julie!! It's GREAT!! :-D

I think one problem I'm having is interpreting Sushi's spreadsheet. We should have enough data to make some inferences, right? But I still don't see any patterns. I went through and bolded his lowest # for each cycle, but they don't seem to occur at the same time.
"if he zooms up high now, make a note of that and next time feed him less high carb."--what do you think? Did he zoom up too high? Or do you think I gave him about the right amount of high carb?

What I mean by he's not eating well is that he's not eating enough IMO. I got him to eat 6oz this morning, which is what I would like to see him eat every meal. But getting him to eat that much literally involves chasing him around the entire time, sprucing up the food, putting it back in front of him, feeding him from my hand, etc. He'd only eaten 3oz when his numbers started scaring me this morning. I'm wondering if things wouldn't be so dramatic all the time if he ate quicker and had more food in his system around +3 or +4. He is still adjusting to eating canned and not grazing, and if he wasn't diabetic, I would just let it ride until he got used to it. But since it's such a determining factor, with his weight (he can't lose or gain or we're in trouble) and his BG, it feels like we can't afford to let him adjust. So I literally spend 2+ hours every day chasing him around forcing him to eat.
when people are telling you to feed for low numbers, they're talking about a teaspoon of food - either high or low carb. Aha! GOOD TO KNOW!!
But at the same time, it all happened when I was trying to get him to eat more of his LC breakfast anyway. I was already feeding him, regardless of his #s.
 
Re: LOTS of ?s now that #s are down! 8/20 Sushi: +5.75~89|+7

That looks like a great cycle! The best cycles are definately stressful the first time.

In the spreadsheets I've seen, the cycle is often all over the place when the numbers are still >200. The clean cycles I've seen are generally when the numbers are <200.

Today's cycle was a little low, but you just touched down to 50, after shooting a 150, so in general, I would say that proved to be a good decision since you were around to deal with the aftermath. You have "officially" earned a dose reduction to 4.75, but if you are not going to be able to track as closely tonight, you may want to reduce a bit further to be safe.
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Okay, our PMPS is 105. That's another unusually low # for Sushi. I know we already earned a decrease of .25u, but should I drop even lower due to the pre-shot #?
I need to go run some errands for an hour or two, but other than that I'll be around to monitor and STRESS!!
 
Re: LOTS of ?s now that #s are down! 8/20 Sushi: +5.75~89|+7

Congratulations on your first official reduction. :-D

As Sushi's FD becomes more regulated he will need less food as his body will make better use of it.

You Are still very early in the game. Remember, Every time the dose or time is changed it will be refleted in Sushi's BG numbers. So it will be difficult to interpret his SS until things settle down.

Sorry I'm out of town and trying to type on my iPod. You are doing great!
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Hey Ashley,

I don't see many of the experts arround, and you know I don't have much experience to help you, but I'd be happy to talk through it with you if you want.

If your numbers were on S'mores, I would drop further. Maybe 4? We don't know much about how Sushi responds to these low numbers.
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Sam and S'mores said:
We'll find out soon enough ;-)

You might need some ~O) ~O) ~O) ~O)
Click to expand...
:-| I was just nervous to drop any more than a 1/2u. Seems like a change of anything more than a 1/2u is a big no-no.
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Yeah, I have not found any good "rules of thumb" for when the numbers drop like a rock for the first time. The Sticky basically says either full dose if you have data, or no dose. That doesn't help when you have a lot of data (like you do), but don't know what it means yet!

I think it's going to be purrfect!
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Well, if it were me, I would have only taken the 0.25u decrease but you sound pretty nervous about it. Given your schedule, stalling doesn't sound like it would have worked so shooting a reduced dose was a good option.
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

Hi Ashlely,

Lost my internet in the house - postinig from my office at BK central.

When presented with a PS too low for your comfort, the 3 basic choices are:
stall
skip
give a token dose.

A 4th option, used from time to time by high dose kittie beans, is the BCS (big chicken sh!t) dose. I would say what you did tonight falls into that category. A reduced dose rather than a token.

You should keep an eye on Sushi tonight, he very well may be operating on this mornings dose still.

Regarding his eating, 6 oz at shot time seems like a lot.

I use a 5 compartment programmable timed feeder and it was/is a lifesaver. BK eats 2 3oz cans of LC FF per 24hrs. I feed him 1/2 can at AMBG and 1/2 can at PBMG. In between those main meals the feeder feeds him. 1/4 can at +4, 1/4can at +8 and a freeze dried chicken breast chunk at +10. Around the clock. It works for us. It's controlled grazing.
 
Re: DOSE ADVICE? 5/20 Sushi: PMPS~105

PM +2 at 186?

Looks like it may not be such a late night after all. He is probably bouncing off of the low greens and HC. If +3 is also rising, I would think that is enough to sleep well.

After 8 months, you are finally getting a lot of green! That's great news for Sushi. Now you just need to figure out how to keep him there.
 
Sam and S'mores said:
PM +2 at 186?

Looks like it may not be such a late night after all. He is probably bouncing off of the low greens and HC. If +3 is also rising, I would think that is enough to sleep well.

After 8 months, you are finally getting a lot of green! That's great news for Sushi. Now you just need to figure out how to keep him there.
Click to expand...
I know; I had the same thoughts! Yay for sleep!!! And yay for greens and blues!

:?: Okay, so what about tomorrow's dose? Should I keep him at 4.5 or go up to 4.75?

:?: Sushi ate well this evening; we're at about 5.25oz right now. That's 11.25oz total for the day. I think he would eat more; should I give him more?
It's still so fun to catch him grooming himself! He's always been SUPER soft, but his fur is like a cloud since we switched to canned food. And I can tell his senses are a bit sharper too. I'm amazed at how much he's improved in the 2+ weeks we've been a part of FDMB!! WOW!
 
...my major concern is that I am going to be gone most of next week, and the cat sitter will be testing/feeding/shooting him. She can't do all of this low #s stuff. I feel it's urgent to find a dose that won't cause any trouble, even if it keeps Sushi's numbers higher than ideal. Either that or we're going to be skipping a lot of shots.

Sandy and Black Kitty said:
Regarding his eating, 6 oz at shot time seems like a lot.

I use a 5 compartment programmable timed feeder and it was/is a lifesaver. BK eats 2 3oz cans of LC FF per 24hrs. I feed him 1/2 can at AMBG and 1/2 can at PBMG. In between those main meals the feeder feeds him. 1/4 can at +4, 1/4can at +8 and a freeze dried chicken breast chunk at +10. Around the clock. It works for us. It's controlled grazing.
Click to expand...
Thanks for all of your answers, Sandy! He ate 6oz from PS to +5 or so.
I have a programmable feeder that I tried a few years ago pre-diagnosis when we were still on dry food. Sushi broke into it. I can't remember if he broke it entirely or if he was just able to pop the top off. I suppose we can give it another try with the wet food, but I don't have much faith. ;-)
 
What you shoot tomorrow depends on his AMPS, but also how much you can monitor tomorrow. If you post a +11 tomorrow morning, you might get some good advice before you need to make the decision.

I have no idea what the guidelines on food quantity control are. I haven't had to deal with that.
 
How many cycles do you have until you need to rely on the cat sitter? He will probably be bouncing for a while with all these low numbers...
 
Okay. Are people usually around at 6am CT?

I have 3 more cycles; tomorrow and then Monday morning. But I can't play around Monday morning. I have to shoot and be out the door immediately.
 
Just a random note, I've noticed you seemed concerned that Sushi isn't eating enough. You said he has had 11.25oz today; that's close to an entire pound of cat food. I would NOT be concerned that this isn't 'eating enough' -- you might notice that a lot of sugarcats on this board get by on 5.5oz - 6 oz. a day. I'm not a food/calorie expert and ECID, it's just an observation.
 
Hi Emily!
Today is the first day I've felt okay about how much Sushi ate. I'm still unsure how much he should be eating exactly, but he is 16-17lbs, so I think anywhere between 11 and 16oz is right. He usually eats 6-8oz; that's when I get concerned. Getting him to eat that much today took a LOT of work on my part.
 
couple of things.

dosing is determined by the low point in the cycle - not the preshot. we don't change doses based upon the preshot unless we feel like it's too low to shoot. then you go with the options that sandy laid out for you - and you choose one and hope you chose right. it's all you can do.

if you drop a dose because the preshot number is too low, usually that's only for that cycle. what that's going to do is allow the shed (depot, storage deposit of lantus) to be used up a little more. unless the numbers for that cycle (tonight) were unusually low, you probably would continue with your same dose that you would've shot. so in this case, you shot 5.0 this morning, with the drop below 50 sushi would've been dropped to 4.75. but you decided because of a lower preshot to drop to 4.5. unless tonight's cycle went below 50 you would ordinarily return to the 4.75 dose.

however, because you're saying you want him to be a little high, you're going to have to decide what to shoot.

as far as the food goes, punkin is 14.3 lbs and eats 9-10oz of food per day. total. and he is a hoover with a tumor putting out growth hormones that makes him hungrier than normal - so for a non-acro cat, 16 oz of food is a HUGE amount of food. i know sushi is big, but . . . seriously, i'd stop chasing sushi around - the poor guy is probably stuffed!
 
i wanted to post a little from the general guidelines (from the sticky on the Tight Regulation Protocol) for you to help in your decision:

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

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.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
 
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