Dosage Advice

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Louise & "Abby"

Louise & "Abby"

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For the 1st time this morning, Abby was in the blue range, AMPS 9.3 (167). For the past week I have been giving her 2.5 units of Prozinc twice a day. I'm not sure how much to give her for her AM shot. Unfortunately, I rarely do PM mid range BS tests as we are in bed, to see how low she went last night.
Do I shoot at the same time but reduce the dosage or wait & test again in an hour?
Thanks in advance for your help.
Louise
 
Waited & tested Abby again an hour later. She was 16.8 (302). Just to be on the safe side, I gave her 2 units rather than 2.5.
Strange that Abby's BG's would be that low 12 hours after her evening shot, then jump as much as she did in an hour.
 
Hi there and you did good to stall and retest and see that she came up. For a new diabetic cat, the no shot number is 200. Whenever you test preshot and get a number under 200, stall 20 minutes without food (as the food will give an increase in BG) then retest and if she is up to 200 or over go ahead and feed and then shoot your dose. If would be helpful if you could get a mid-cycle test during the night so you can see how low the dose is taking her. Many of us set our alarms and get a test in. That information is helpful to know in case she were to need a dose reduction. You played it safe and that is okay. The more numbers and data you can get the better to help see what her patterns and trends are.
 
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@Bobbie And Bubba - Thanks for your reply. I will make a point in trying to test Abby mid range during the night to see where she is at.
Rachel said:
Did you feed her during that hour you were waiting to retest?
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Yes Rachel, I did feed her a little between testing as she was hungry. In the past week & a half since she has been feeling better, she is becoming more & more feisty & uncooperative when it comes time for BG testing. My husband has to literally hold her down. She generally eats about every 2 hours, so we try testing before her next feeding. Sometimes we get lucky, other times we have to give her a little munch, then try again.
 
I've now had an entire cup of coffee, so I'm able to speak more than one sentence. Sorry, I'm not at my best before coffee :coffee:

The food might have influenced the BG test. That is probably the reason her number shot up. In the future, try just stalling 15-20 minutes without food and retesting to see if the number goes up. You want to try to make sure she doesn't eat for 2 hours before her test and shot so the number you get isn't food influenced.

Hmmm...do you give a bribe...er...treat each time? Even if you can't get a number? Do you have a specific place you test? Gypsy and I had a towel on the floor by the fridge (towel because it was cold!). I'd go in the kitchen and she'd hear me rattle the box of testing supplies and come running. She knew to lay down on the towel and wait for her test...and knew that if she put up with it there, she'd get a treat after. Sometimes always having that place helps since they know what is waiting at the end!
 
@Rachel
I generally try to wait to test Abby 2 hours after the last time she eaten. But since she is still always hungry, it's a fine line getting that test in 2 hours after her last feeding without her being rowdy because she isn't interested in cooperating with her test but wants foodz.

Yes, yes & yes. We test/shoot Abby on the kitchen counter with a towel every time. Whether we are successful or not, she gets a piece of cooked chicken as a reward, sometimes in between if I have trouble getting a drop of blood. A few weeks ago, she objected so much to getting her shot (she literally growled, grabbed the syringe out of my hand with her teeth & tossed it away), I started feeding her while she was getting her shot. Even with foodz in front of her, she tenses up sooo much, getting the needle into her is like trying to inject a tough rubber hose. Some days are better than others but even after 7+ weeks of getting insulin shots, she still doesn't like it! :nailbiting:
 
Welcome Louise and Abby! It looks like you posted when most of us were asleep. Are you in Europe? We are a small, friendly group. If you ever have an emergency, please post here and on Health to get more eyes.


If you give us some more info, maybe we can help. What gauge needle are you using? A 30-31 gauge is the thinnest and hurts the least. Where are you giving her the shot? Most cats have their favorite spot - usually in the scruff of the neck or in the flank. How do you shoot? We pulled up a flap of loose skin at the scruff and shot into that. We always shot while his face was deep in the food dish and he barely noticed.
 
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Hi @Sue and Oliver (GA)
No, I'm not in Europe, I live in Ontario, Canada. We are early risers & Abby's test & shot time is 5 - 5:15 am & pm.

I introduced us in early Oct. You can read the thread & a bit of Abby's history here:
http://www.felinediabetes.com/FDMB/threads/abby-newly-diagnosed.145522/

I am using U-40 syringes, 29 gauge. The vet gave me a whole box of them when we started giving her insulin. When these are used up, I will see if I can buy some finer needles.
If you look at Abby's spreadsheet, you will see that during late Sept & Oct, there were times after her shot, that her BG's either stayed the same or got higher. Her worst day was Mon Oct 2nd, when she remained in the BLACK range & her BG's were very high, even after giving her another 1/2 unit a few hours after the 1st! I suspect I was giving her a lot more fur shots than I realized. On the afternoon of Oct 2nd, I went out & bought dog clippers to shave some of Abby's fur, so I could see better what I was doing. I shaved a stripe down each side of Abby's back, on either side of her spine. I shoot as you described, pull up a tent & shoot into the base. Since Oct 2nd, you will see that Abby's BG results are much better, as I can see that the needle is going in & not coming out the other side into the fur. Even though I always checked for liquid in her fur, I never found any. But the progress that she has made in her recent results proves that I was missing the mark more than I care to admit.

Abby's face in her food bowl doesn't help. As soon as I pinch & tent her skin, she tenses up & sometimes growls. But at least with the food distraction, I can get the shot into her.
 
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In general, her spreadsheet looks pretty good. (Let's disregard that day of blacks - who knows about that). If you look at it as a whole, her pre shots and nadirs are generally coming down.

One thing you might look at is a sliding scale. The idea is to give less insulin on a yellow preshot than you do on a red or pink. Sometimes this helps with the bump you sometimes get shooting a lower preshot. If you'd like to try that, Cindi is our resident expert ( @Merlin Cindi, I hope you don't mind me volunteering for this)
 
@Sue and Oliver (GA)
Thanks for your reply & suggestions. I was trying to follow advice on Insulin Dosage Adjustments that I found somewhere else on this website.

Lowest point of the curve is above 8.3 mmol/L, increase the dose by 0.5 unit.
Lowest point of the curve is between 5.0 and 8.2 mmol/L), keep the dose the same.
Lowest point of the curve is below 5.0 mmol/L, decrease the dose by 0.5 unit.
Desired range [lowest point of the curve approaching (5.5 mmol/L) and pre-shot value around or below (16.6 mmol/L)
(Living in Canada & using the metric system, I'm more used to the above #'s, not US #'s.)

The above gave me the impression that if Abby's preshot levels were in the yellow, it was just right & dosage should be kept the same.

@Merlin If you would like to have a look at Abby's spreadsheet & give suggestions, it would be much appreciated.

Thanks!
 
Louise & "Abby" said:
even after giving her another 1/2 unit a few hours after the 1st!
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Louise to give more insulin a few hours after giving it, is not advisable. It will make finding the nadir that cycle impossible and it could be dangerous when you suspect a fur shot to give more because you don't have any idea how much you actually got into her and then to give more could be an overdose. Just rack up the alleged fur shot as "oh well" and let the cycle ride out. One time I gave a fur shot , I could feel some wet on his fur and it turned out that the next Pre shot was lower than the one I thought I blew. If I'd given more, I could have taken him too low.
 
@Bobbie And Bubba
Normally, I wouldn't have done that but with her BG's being so high, I didn't think it would hurt. As it was, must have been another furshot as her #'s stayed in the black for the duration of the cycle.
The other reason I gave her an extra .5 unit was because just the previous Thurs Oct 29th, she was admitted at the vet's office due to high ketones, dehydration, a bladder infection & refusing to eat. She was put on IV fluids & I was told they gave her another .5 unit of insulin. If they gave her extra, I thought it would be okay for me to do the same. She was discharged late that afternoon & we had to bring her back in the next morning to be shown how to give her Sub-Q injections. While there, they did more blood work to see if she had Pancreatitis & Renal failure. Luckily both her pancreas & kidneys were fine. For the next 3 days, we had to give her Sub-Q injections twice a day. That was nasty & I hated doing it to her!!! I also had to force feed her for 4 days. Gave her another appetite stimulant Sunday morning & a few hours later she started eating on her own again with a ravenous appetite. Thank god for that!
 
Louise & "Abby" said:
@Bobbie And Bubba
Normally, I wouldn't have done that but with her BG's being so high, I didn't think it would hurt. As it was, must have been another furshot as her #'s stayed in the black for the duration of the cycle.
The other reason I gave her an extra .5 unit was because just the previous Thurs Oct 29th, she was admitted at the vet's office due to high ketones, dehydration, a bladder infection & refusing to eat. She was put on IV fluids & I was told they gave her another .5 unit of insulin. If they gave her extra, I thought it would be okay for me to do the same. She was discharged late that afternoon & we had to bring her back in the next morning to be shown how to give her Sub-Q injections. While there, they did more blood work to see if she had Pancreatitis & Renal failure. Luckily both her pancreas & kidneys were fine. For the next 3 days, we had to give her Sub-Q injections twice a day. That was nasty & I hated doing it to her!!! I also had to force feed her for 4 days. Gave her another appetite stimulant Sunday morning & a few hours later she started eating on her own again with a ravenous appetite. Thank god for that!
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Oh Louise, you have really been through the ringer with her lately. Hopefully, some others will weigh in about the extra 1/2 unit you gave a few hours after the initial injection. Once, when I was first here and did that, I was told it was a big no-no but, of course we didn't have all that you had going on health wise either. I am glad she is eating for you again Whew! There is a probiotic called Florti Flora made by Purina. It is helpful when they have diarrhea but it is also handy to have to sprinkle on their food when they aren't eating and it will usually get them going again. It has the same animal enzymes that the dry food company coat the kibble in to make our kitties get addicted to it.
 
Hello. I have been out all morning and just got back to the house just to test Merlin. I should be back later tonight and will gladly take a look at Abby's spreadsheet. Stay tuned.
 
Bobbie And Bubba said:
There is a probiotic called Florti Flora made by Purina.
Click to expand...
If we have another episode Abby refusing to eat, I will inquire about Florti Flora. Hopefully it won't be necessary.
But yes, we have been through the ringer with Abby since she was diagnosed in Sept., including her going into hypoglycemia while in intensive care at the vet's, the 1st weekend she was on insulin on Sept. 28th. It has been a roller coaster of a ride since!

@Merlin Thanks Cindi. Looking forward to what you have to say.
BTW, in case you notice how low some of Abby's BG's were between Oct 30 & Nov 1 on a much lower dose of insulin, this is when we were force feeding her with a syringe. You know what that is like, more came oozing out of her mouth than I was able to get into her. She wasn't consuming many calories. On my digital scales at home, she had dropped from 6.2 lbs to 5.8. She is now 7.4 lbs.
 
Louise & "Abby" said:
If we have another episode Abby refusing to eat, I will inquire about Florti Flora. Hopefully it won't be necessary.
But yes, we have been through the ringer with Abby since she was diagnosed in Sept., including her going into hypoglycemia while in intensive care at the vet's, the 1st weekend she was on insulin on Sept. 28th. It has been a roller coaster of a ride since!

@Merlin Thanks Cindi. Looking forward to what you have to say.
BTW, in case you notice how low some of Abby's BG's were between Oct 30 & Nov 1 on a much lower dose of insulin, this is when we were force feeding her with a syringe. You know what that is like, more came oozing out of her mouth than I was able to get into her. She wasn't consuming many calories. On my digital scales at home, she had dropped from 6.2 lbs to 5.8. She is now 7.4 lbs.
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Wow, Louise, you are such a good bean! Abby is so lucky to have you. :bighug::bighug::bighug:
 
So much for reducing Abby's dosage this morning from 2.5 units to 2. units, due to a low AMPS. Just tested her & her PMPS is 25.7 (463). Back to 2.5 units for the next cycle.
 
You might check out the protocol we put together for ProZinc. Maybe it will give you some ideas.

I wonder if the scale you saw was for the depot insulins, Lantus and Levemir. They adjust the dose based only on the nadir. We adjust the dose based on the pre shot and the nadir. It is based on the cat's previous history of doses and levels, not on a prescribed scale. So, if 2 units on a 300 pre shot gave you a nadir of 100, you might figure a smidge more insulin would get you both a lower nadir and a lower preshot without a big bounce.

If you want to post daily and give your numbers, we might have some ideas for adjusting the dose. It might also be helpful to look at other people's spreadsheets.
 
Sue and Oliver (GA) said:
I wonder if the scale you saw was for the depot insulins, Lantus and Levemir.
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I just tried locating the page where I copied & pasted the dose adjustments from. Sorry, couldn't find it. But, it might have been the scale from the insulins you mentioned above. I wasn't aware that with Prozinc you adjust the dose based on pre-shot & nadir. I assumed those guidelines were for all types of insulin. :confused:

I did read the ProZinc protocol. I guess I should read it again.

I update Abby's spreadsheet each time I test & shoot. Will post again if I have any questions or concerns.
Thanks to all who posted help & suggestions! :kiss:
 
Thanks, I was looking and couldn't find it!

The protocol you linked is not insulin specific.

It states: " Step 1. Start at a low dose of PZI, Lantus, or Levemir insulin, as recommended by your vet."

There are protocols that are specific to insulin type. There is an SLGS posted in the Lantus/Levemir forum specific to those depot insulins, a "Tight Regulation" for Lantus and Levemir, also in that forum. And the Prozinc one mentioned by Sue above.
 
That link (and protocol) predates the insulin specific protocols I mentioned. It is just one way to use pzi, Lantus or Levemir.

The primary reason that Sue spent so much time and effort putting together the "Prozinc" document is because there wasn't a set of guidelines specific to Prozinc and "today's" version of compounded PZI.
 
Hey Louise. I am studying your spreadsheet. I don't have anything to share with you yet and may want to see a few more cycles. Since 11/1, you have increased your doses (nice job!) and I think that time frame is where we are going to be able to draw our information in order put something together. The data prior to 11/1, really didn't get you close enough to a good nadir so it is a little more difficult using that data. I have a few questions.
* What time do you shoot?
* Could you get some bedtime tests in? If you could test just before you go to bed, it would be very helpful. It would also give you a piece of mind that Abby will be safe for the night.
* What did the comments mean on the dates 10/31 - 11/2?
* What do you think happened on 11/2? Fur shot?
* The next time you get a 400 number and you can monitor, can you shoot 3 units? You shot 2.50 from 11/6-11/9 (AM) and it gave you yellows. I would like to see if 3 units will get you some blues.
 
Merlin said:
I have a few questions.
* What time do you shoot?
* Could you get some bedtime tests in? If you could test just before you go to bed, it would be very helpful. It would also give you a piece of mind that Abby will be safe for the night.
* What did the comments mean on the dates 10/31 - 11/2?
* What do you think happened on 11/2? Fur shot?
* The next time you get a 400 number and you can monitor, can you shoot 3 units? You shot 2.50 from 11/6-11/9 (AM) and it gave you yellows. I would like to see if 3 units will get you some blues.
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Cindi,

I will answer your questions.

* We aim to shoot around 5:15 am/pm. Reason being, my husband is semi-retired & works on the weekend. He has to leave no later that 5:30 am to get to work. Due to the fact that Abby does not like getting her shot, we do it before my husband leaves, so he can hold her still for me. We feed her at the same time but even the distraction of her food often doesn't help. I don't want to be stressed out for the duration of her am cycle every weekend because I either couldn't get her shot into her or only part of it. She's had enough problems since she was diagnosed in Sept, with me giving her fur shots more often than not & her not getting the insulin she needed.

* We have on occasion tested Abby in the evening after her pm shot, if we stay up that late. My husband & I are in our 60's & bedtime for us is often 8 - 9 pm. To get a mid-range reading would mean setting the alarm for around 11 pm. Not impossible to do but would make for a rough night for us, as I have the alarm set for 4:45 am, to start the cycle all over again. If I could drop back to sleep again quickly, it wouldn't be a problem but as often happens, broken sleep makes it harder to go back to sleep. When you finally do after laying in bed starring at the ceiling for a few hours, you no sooner drop off, then the alarm goes off to get up again.

* The comments of the dates 10/31 - 11/2 mean, I finally came to the realization that I must be giving Abby furshots, as her #'s either went up or remained the same. I gave her a little more insulin hoping to help bring it down.

* Yes, on 11/2, it had to most definitely have been a fur shot. Two of them because when her #'s started going up (even higher than her AMPS), I gave her another 1. unit a few hours later. That didn't help either. A couple of times I just entered 33 (500+) on her spreadsheet, as that is the limit my meter will read. The meter said it was too high for a readable number! I don't have any other explanation why her BG's would have been so high that day. They were good the day before.
That day was the day I bought some dog clippers & shaved a stripe down both sides of her spine, so I can see her skin when shooting. Based on her #'s since then, she is doing much better & confirms for me that many times she was getting furshots & not receiving the insulin she needed to keep her BG's down, prevent Ketones from developing, becoming dehydrated, getting bladder infections, low potassium, losing her appetite & losing more weight!

* I will play it by ear before increasing her dosage from 2.5 - 3.0 units. The past 4 days, she has gone down into the blue range with both 2. & 2.5 units. If I do decide to increase based on her preshot read being 400+, I may go to 2.75 units first. Increase it slowly to see what kind of results that amount gives us.

Thanks for taking the time to look at Abby's spreadsheet.
 
Thanks Louise for the info. This info will help. I hear you about going to bed early. I usually give shots around 6pm and am in bed around 9pm. I usually get a +3 test in just before bed so I know Merlin is not going low on me that night or when I am testing a new dose. So, I was just suggesting one before you go to bed whatever that time is but is totally up to you. Also no problem on the 2.75u for 400 numbers, that would work too.

I am out again all day today but plan to be at home for most of the day tomorrow. You are doing a great job testing while also adjusting the doses when needed. Abby is responding well to the insulin as she is getting some nice numbers.
 
@Merlin
Thanks so much for your feedback, suggestions & help. FINALLY, Abby is getting the insulin dosages she needs & is responding to treatment. I sincerely wish now that I had shaved some areas of her back weeks ago, so she wasn't getting those darn furshots so frequently!! :facepalm: It would have prevented those set-backs that made her so ill.
But she is doing soooo much better now. This past week - 10 days, she is grooming herself regularly, coming to us for cuddle time & PURRING (which she hasn't done much of since she was diagnosed) & putting some weight on. Her lowest weight just over 2 weeks ago was 5.6 lbs. Yesterday she weighed in a 7.4 lbs.!!!:cat:
 
Don't beat yourself up. We've all been there...wishing we had done more sooner. The point is that you are doing what you need to do now!
 
Hey Louise. First of all, great job in testing. Especially after 11/1 when you increased the dose, it was most helpful as you were getting closer to a more ideal nadir. Since 11/1, you primarily shot between 2u and 2.5u. For the most part, your nadir was in the nice mid- blue numbers and eventually the goal would be to go slightly lower. With the goal of getting into the mid to higher greens and low blues, you more than likely will need to make more adjustments to the sliding scale below.

So at first, we just want to start off with a safe sliding scale; a starting point. We want to make sure that we are still continuing to see the nice blue numbers and keeping in mind that we want to make adjustments to the scale to get you to little lower numbers. Therefore, this sliding scale is basically reflecting the doses that you have been giving in the last couple of weeks. With future tests, you will be changing this scale based on the results that you get at nadir. I have been using a sliding scale for almost two years and I usually update still every couple of weeks. You may also find that you may add extra numbers/doses to the scale as well. Instead of four different doses, you may have five or six.

So what do you need to know about updating and maintaining the sliding scale? This is what I do, however I am sure there are other ways to do this. With each number, I dose according to my sliding scale while also reviewing my spreadsheet for a previous, same number. If I change a dose, I try to catch a nadir or at least a +3 or +4. If the dose gives me a safe green or even low blue number (at nadir), I do not change anything. If the number is too high, I may adjust my sliding scale or may even wait to get a similar number one more time (I usually do the latter - wait). If I get the same results, two times (this is why I look at previous numbers and doses), then I change my sliding scale. I also will put something in my comment section indicating that I have a "pending" change as a reminder to change next time if a change is needed. If I get a low, unsafe number, I may change my sliding scale immediately or wait till I get another low number twice. It all just depends on whether I change the sliding scale the first time or the second time. Regardless, I am always, comparing my doses with previous numbers and my sliding scale and tweaking it constantly. Did I explain that correctly?

Here is an example: So with Merlin, before I would move the sliding scale, I would make a note indicating "this number is pending" and when he gets that same or close to the same number with the same result, then I would update the sliding scale and update the dose/number. If the mid-cycle number does not get me the same result (after the second time), then that is when I increase or decrease the dose. At least with Merlin, he had to prove it to me twice that that dose needed to be changed. Then the next time when I got the same or similar number, I would change the dose and make sure that I can get some extra tests in to make sure that the new dose is safe.

A few things that I would like to point out regarding the sliding scale.

1) Sorry, I didn't transpose to your measurements but it sounds like you are able to do it much better than me.
2) On 11/13, your number was 167 and shot 2u. According to Prozinc protocol, new users are advised not to shoot any number below 200. Since you did and the results were positive, then if you are comfortable with shooting 2u, then you may want to move your sliding scale or wait till you get a similar number to see if you get the same results. I am just a little more conservative at least at first when I shoot that low and was hesitant to put that number on your sliding scale.
3) Tonight you got an expected low number at PMPS. If you look at the sliding scale, the dose that you gave this morning was the dose that the sliding scale considered. I did not change that number because you need to "test" that number. One reason is that this dose has worked well for you in the past (11/6). So since you got this "wonky" PMPS number, I would test out this number prior to changing it. So the next time you get close to this number (360) either try this dose again and see if it gives you the same result or reduce the dose 2.25u (as Sue suggested) and see if it gives you better results.
4) I know that you work at nights so when you are not at home to test, I would suggest that you not try any new doses; try out new doses only if you can test sometime mid-cycle.
5) If you can indicate on your SS that you are starting this new sliding scale that would be most helpful. You could insert a line and color it before the date you start, that way we can easily see that a change has taken place. Also you might want to put this sliding scale in your comment section and move it down the page so you can readily see it. Check out Merlin's or Carol C or Likameow's SS as they just started a sliding scale too.
6) So overall, this sliding scale for some of the numbers may be a little conservative (unless Abby's pancreas is starting to work). This is where you come in to test, record and update your sliding scale. Anyway, this is going to seem like detective work for a while as you are trying to find the best scale with the best dose. We will be watching Abby's spreadsheet and of course, if you have any questions, just holler.

180 - 249 2.00u
250 - 349 2.25u
350 - 449 2.50u
450 plus 2.75u
 
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@Merlin
Thank you soooo much for all these details! Will have to read & absorb tomorrow. Too tired now.
Just tested Abby & she is 16.5 (297) without insulin since 5:15 AM this morning.
 
Merlin said:
Anyway, this is going to seem like detective work for a while as you are trying to find the best scale with the best dose.
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Wow, you are right, this is going to be like detective work! I'll have to really pay close attention to Abby's mid-range & pre-shot #'s. For the time being, I'm going to see if the waters will calm, before I make any changes (increasing doses) based on her PSBG's.

Last evening, I did give Abby 1. unit @ 9:30, about 4 hours after the usual time she was due for her shot. Her BG had risen to 297. I felt a little bit was better than nothing. Not knowing for sure what was going on in her body, I didn't want to give her the usual dose.

Good thing I did give her 1. unit. This morning she was 477. I was a little hesitant to increase her dose (based on your sliding scale) after her "wonky" PMPS last evening, so I stuck with 2.5 units. We'll see what that does for her today.

BTW, on 11/13, I gave Abby the 2 units almost an hour later than her usual shoot time, when her BG has risen to 302, not when it was 167. I wouldn't shoot if her BG was still that low.

Thanks for all your help & suggestions. I really appreciate the time you spent typing it all out for me! :bighug:
We'll see how things go & I'll continue to update Abby's spreadsheet with BG's & dosages. :joyful:
 
Oh let's change that on your ss so it is accurate. Plus I may want to change the lower end for you.

To show that you stall, folks here do it a number of ways but we need to show that you stalled and actually gave a 2u for a different number. I stack my numbers and then in the comment section, I state what time I shot. Check out the last time I did this - 9/19 and 9/28. If you do it this way, then you have to manually color code.

I agree with the 2.5u. It is good f you are giving a new dose, you want to try it in regular conditions. Since you waited for four hours to shoot, that will throw off your schedule a bit.
 
@Merlin
I did what you suggested & added info regarding stalls & times.

I tested & shot 1 hr, 15 mins later this morning than usual, because of the 1.u I gave her @ 9:30 last evening. I could have gone back to her usual 5:15 am/pm schedule but I didn't know then her BG would be in the red range. I probably could have shot at the usual time.

Here in Canada we use the metric system. So, any numbers you mention to me, I have to convert to metric so I know where in the ballpark you are talking. I found a website than converts mg/dl - mmol/L for the sliding scale you suggested. For convenience, I also added a row on the top of the spreadsheet, showing both metric & US ranges. Click on World spreadsheet. It looks a little different.
180 - 249 (10. - 13.8) 2.00u
250 - 349 (13.9 - 19.3) 2.25u
350 - 449 (19.4 - 24.9) 2.50u
450 plus (25+)

BTW, in your message about introducing the sliding scale, you said something about me working nights. You must have me confused with someone else. I don't work at all, now. Took an early retirement 6 months ago am enjoying my time at home. Good thing, I don't know how I would have dealt with Abby & all her problems if I was working! :nailbiting:
 
Sue and Oliver (GA) said:
If you want, you can use the World version of our spreadsheet. It's here under Option I past the US version
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Sue, I am using the World Spreadsheet. I just added the row with US #'s on the spreadsheet for my convenience. So I don't have to keep switching back & forth between the 2, to compare #'s & ranges.
 
I have re-worked your sliding scale and have adjusted the lower numbers/doses. Again, this scale should be pretty familiar to you as you have already been dosing as if you had a sliding scale. The unknown is any number under 218 and the new dose for anything over 450. Going forward, you will begin to adjust/change this scale based on your mid-cycle tests. If you have any questions in changing it, just holler as most of us use the sliding scale on this forum.

200 - 249 1.50u
250 - 300 2.00u
301 - 349 2.25u
350 - 449 2.50u
450 plus 2.75u

Yep, I am sorry that I thought you worked nights. I think I need more sleep!
 
Merlin said:
I have re-worked your sliding scale and have adjusted the lower numbers/doses.
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Thank you. Will update my notes.

Just tested Abby 10 mins ago. Mid-range today for her is 275. This is not influenced by food, she hadn't eaten in 3 hours. Not getting her usual dose last evening must have messed things up. :arghh:
 
Yes that is not unusual for the next couple of cycles to be a little weird after skipping or even stalling. Your nadir result is the same that you got on 11/5 so at least Abby is little consistent. Next time a 2.75u dose can be tried. Just hang in there...it is part of that sugar dance!
 
Merlin said:
this scale should be pretty familiar to you as you have already been dosing as if you had a sliding scale. The unknown is any number under 218 and the new dose for anything over 450. Going forward, you will begin to adjust/change this scale based on your mid-cycle tests. If you have any questions in changing it, just holler as most of us use the sliding scale on this forum.
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Hey Louise - Just checking in on your SS. How is Abby doing? We started on your new sliding scale on 11/17, correct? Ok, so I just wanted to give you some heads up to your most recent cycles and what you should watch out for in order to maintain your sliding scale.

First thing, you got a 380, shot a 2.5u and got a 194 for nadir. This number is one we may want to increase to 2.5u or at least put on the watch list.

The next number, you got a 263, shot a 2u and got probably a 200 or high blue number at nadir. This number should be on the watch list too and next time, you may want to try a 2.25u

The last number is a 205 and shot a 1.5u and it gave you a 232 nadir. Ugh on the nadir! So that was one of the "unknown" numbers and at least this time, you proved that this number may need to be increased next time. So let's put this number on the watch list as well.

So knowing that you had three numbers that are on the "watch" list or could possibly be changed. Let's review how you would update your sliding scale if you decide to change.

Current Sliding Scale
200-249 1.5u
250-300 2.00
301-349 2.25u
350-449 2.50u
450 plus 2.75u

Updated Sliding Scale
180-204 1.5u
205-262 2.00 I moved the number 205 up to the next dose of 2.00 and had to change the 1.5u dose numbers to 180-204 1.5u. I figured 180 may be your low number now (just guessing)
263-349 2.25u I took that 263 to the bottom number for the 2.25u dose. Then changed the last number on the 2.00 dose to 262.
350-379 2.50u
380 plus 2.75u I took the 380 number and made it the low number on the 2.75u dose and changed the high number to 379 for the 2.50u dose.

This exercise is dealing with three numbers (205, 263 & 380) that may need to be increased. If you had to decrease a dose with a certain number, you would do it the same way. Does that all make sense? What do you think you want to do?
 
Merlin said:
What do you think you want to do?
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Cindi, Abby is doing good.
I was thinking the same thing, that adjustments to her dosage could be made. Especially based on yesterdays AM BG's.

One thing I noticed when switching between my "World" spreadsheet & the US version you look at, for some reason it is not showing 11/18. (Click on World mmol/L & you will see what I mean). Abby had an excellent AM cycle that day. AMPS 16.5 (297 ), gave 2.u, nadir 5.4 (97 ), PMPS 15. (270 ), gave 2.u. Twelve hours later her AMPS was 11.4 (205 ). Based on your sliding scale, I only gave her 1.5u. Her BG's didn't come down during that cycle, so to me that dosage was too low.

This morning Abby's AMPS was 19.8 (356). I gave her 2.5u. If she was 21.2+ (380+), I wouldn't be comfortable increasing her dosage to 2.75u....yet. I'm using U-40 syringes & any dosage in between whole units, I'm just eye-balling it. Yes, I know I can use U-100 syringes & adjust the dosage with the converter but I still have several packages of syringes in the container that the vet provided me with when we first started giving Abby insulin. I'd rather use them up first before buying more.

I'll have to convert the new numbers & dosages you gave me before I update the sliding scale. It gets confusing sometimes switching back & forth between the 2 spreadsheets to be familiar with the #'s & ranges you are referring to.

Thanks for your help.
 
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Oh I see what you meant regarding the 11/18. Did you try and insert the row? Just click on the number (I can't view that number) that is the right of 11/19 and right click. Then click on "insert 1 above" then just fill in your day. That was a great day! We may want to test that range of numbers one more time then. Also you don't have to change anything on your scale at this time as you may want to test those numbers again with the same dose. However, I agree with you, there probably is a couple of places where we can test.

The other thing you can do is that if you know that you are testing a "range" and your number is at the top of a range, then you can test out that number. For example, let's take your range of 200-249 with a dose of 1.5u. We are currently watching your 205 number but am not ready to change that number on the scale yet. You get a number of 240 and this is a number that would be effective with you next change so you can test that number with 2.0 (because it is a higher number of the range). If you get a better result, then you can change that range as you creep down to the number that will work in that range. So itty bitty increments are sometimes better too. Oh, so many options.
 
Merlin said:
Oh I see what you meant regarding the 11/18. Did you try and insert the row?
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Cindi, I was going to try inserting a row on the US version of Abby's SS but I was worried it might mess up the World version that I use. I'll try it & see what happens.

I'm going to wait until the +6 hrs to test Abby this morning, as usual. We'll see what she is then.

Not that I am complaining or disagreeing with using a sliding scale for adjusting dosages but I wonder if, a certain dosage works really well for her one cycle, why you would just keep repeating it?
 
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