? need dosing advice for tonight

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Murphy, Murphy. Well, we can't complain about his high numbers any more. I am guessing the all wet diet is really doing wonders.

I assume you plan to monitor (and I am sorry in advance). Cindi had him at 1.5 for 180+. I would be nervous suggesting more than 0.5. I know it is only 30 points below that 150 line, but if the food is working too, it makes things more unpredictable and 50% gets you into hypo territory. And truthfully, he will probably surprise us regardless.

What are you thinking?
 
Let's see what Cindi and Robin think. The food is the unpredictable part that makes me nervous, and I am always cautious under 150 on AlphaTrak. I am rethinking the 0.5. Maybe less than that.....
 
I had to feed him - when his stomach is totally empty he starts to vomit, and he was starting to do that
He just ate 1/2 a 5.5 oz can - I have about 15 minutes before I get totally off schedule (of course, if I give him nothing it doesn't matter)
 
What's considered normal BG on an AT meter?
 
I think, if he was mine, I would skip. I'm just nervous to suggest anything more since it is night time and he is so low. If you wanted to give a token dose of like...I don't know, maybe .25 you could. I'd make sure I was carefully monitoring...what are you thinking?
 
Rachel said:
I think, if he was mine, I would skip. I'm just nervous to suggest anything more since it is night time and he is so low. If you wanted to give a token dose of like...I don't know, maybe .25 you could. I'd make sure I was carefully monitoring...what are you thinking?
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I decided to skip - although I will probably wake up to a black number, it will be interesting to see what it is
 
If your gut said "skip" then you did the right thing.
 
actually I was leaning towards giving something, but since I really don't know how he will react - its' probably better not to give anything - although I do hate the thought of not giving anything
To answer your question, from what I have been reading (post from @BJM) AT meters are calibrated to mirror what a cat's sugar would be if measured in a laboratory - therefore it would be ~ 60- 120 I would imagine
 
I feel more comfortable with out your skipping and imagine you do, Carol. Yes, you'll lose a little ground but you've gained so much in just the past week. He is looking great - and you get to sleep tonight.

Remember, if it works, you can shoot early tomorrow morning.
 
Carol & Murphy said:
actually I was leaning towards giving something, but since I really don't know how he will react - its' probably better not to give anything - although I do hate the thought of not giving anything
To answer your question, from what I have been reading (post from @BJM) AT meters are calibrated to mirror what a cat's sugar would be if measured in a laboratory - therefore it would be ~ 60- 120 I would imagine
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I'm not sure what normal is on an AT, which is why I asked. BJM posted this yesterday on the health forum-
http://www.felinediabetes.com/FDMB/threads/abbot-alpha-track-2-readings.147609/#post-1537251

The point I was getting at is that you were shooting a "normal" BG if you shot. Not saying that's wrong because I did it a couple times. Just wanted to point it out.

I think what today's cycle looks like is a longer than normal duration. So overlap or carryover could have come into play. It would have been an interesting night most likely. ;-)
 
I was thinking of it more along these lines: -- his nadir's have all been pretty late (+6.5 and +7) in the past few days so any insulin from this am should be long gone by then. This is the situation where I feel most uncomfortable about what to do - when the pmps is relatively (or is this case absolutely) low
 
Hey, any night where I can go to bed early is a good night in my book! Sometimes you'll have to skip and lose a little ground...but it's definitely worth it since it gives you peace of mind. :)
 
Rachel said:
Hey, any night where I can go to bed early is a good night in my book! Sometimes you'll have to skip and lose a little ground...but it's definitely worth it since it gives you peace of mind. :)
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I'm glad I posted because I was ready to give 1 unit until I heard from Sue - I truly don't feel like I know what I am doing in these situations
 
Carol & Murphy said:
I was thinking of it more along these lines: -- his nadir's have all been pretty late (+6.5 and +7) in the past few days so any insulin from this am should be long gone by then. This is the situation where I feel most uncomfortable about what to do - when the pmps is relatively (or is this case absolutely) low
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"should be" is the key. Yes, it should be, but in this case, the numbers (to me) tell a different story. They look like they have been going down since AMPS, so his "nadir" in this case was late. It may have happened between +7 and +12, but you can't know for sure. The only other cycles I see like this one on his spreadsheet was the AM cycle on 10/6, and AM on 10/11.

Carryover and/or overlap don't happen often, perhaps, but they do happen. Cycles can and do last longer than 12 hours with PZI/Prozinc.
ETA - and while some might think that a cycle that lasts longer than 12 hours indicates that a dose is too high, I don't agree with that. I think sometimes a cycle just lasts longer than 12 hours. And rather than avoiding them, it is better to take advantage of them when they do happen.

If you see a cycle where PMPS is lower than AMPS, but you see definite lower numbers in between, you can safely assume nadir has come and gone, and the numbers are rising, the insulin is wearing off or has worn off, and it's a rising number you are shooting at. But when you see a sliding number from AMPS to PMPS, you can't assume even that "nadir" has happened yet.

All that said, I would have supported a small dose tonight, .5u was as high as I was willing to suggest. And it might have been a long night, but I would have been happy to stay up and help if you needed help. I'm off work tomorrow, so I wasn't worried about a curfew ;)

I would have first asked if Murphy is a kitty who will pretty much eat on demand, because it is likely you would have had to feed him "off schedule". If so, I think you could have shot, and planned on monitoring for at least 5-6 hours after shooting.

I learned when I used to "hang-out" in the TR forum that a person never advises a shot on a cycle where the caregiver is likely to have to lose sleep unless that person is willing to stay up all night with the caregiver. And I did so quite a few times. So while I might give what is seen as "aggressive" advice at times, I don't do so lightly.
 
You're absolutely right, Carl But in this case, I am glad I didn't shoot, because it's just one night, and would have not been worth losing so much sleep. He won't eat on demand (he's a cat, he doesn't do anything on command, come to think of it ) I guess if I am faced with the same amps tomorrow ( which I don't anticipate) should I give the same dose?
 
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That depends on the rest of the cycle before the shot. :). What time will that be? I will make sure and be around. I don't have to work until Sunday, lol.

I was lucky. Bob was a "hoover" and would eat whenever he couldn't see the bottom of his bowl. I think it came from feeding several cats at the same time in the same area. If they didn't eat their share, somebody else would! Polly is a much more dainty eater, but she's an "only" so there's no competition at meal times.
 
Oh, edit that! I just realized you said AMPS and not PMPS!!! The likelihood of my being awake for AMPS are pretty much nil.

Yes, I think the dose on this morning's AMPS was fine. I would expect at least that high as it will have been without insulin tonight. But at least you'll know it wasn't a bounce.

If you are faced with a "shoot or not" dilemma at PMPS, I will be around.
 
Hey Carol - Sorry that I am late for Murphy's party. My chores start around 5:45pm so just got done. Oh Murphy - you are keeping us on our toes. Just because we noticed that your AMPS have been lower that your PMPS, you had to prove us very, very wrong. Anyway, great numbers at least.

So was the numbers that you tested were 123, 126 & 122, correct? I guess I would have skipped too but would have loved to have checked him about 60 minutes to see if he could shoot then. A token dose would have been nice like a .25 if he would have been just a little bit higher.

I like the idea of possibly shooting earlier tomorrow. Maybe he will go long on you again tomorrow but who knows. Murphy does not quite do what we think he will do.

As Sue pointed out, since you are on an all wet, low carb food, we may want to rethink the lower part of the scale. An example would be just yesterday (AMPS) you got a 276 and shot 1.75u and your nadir was 82. Perfect. You also got a 276 (AMPS) and shot 1.75u which got you in the high blue but Murphy was not feeling well that day so that may be the reason why he didn't go lower.

We currently have the lower range of the 1.75u dose as 241 (241-300 1.75u). That might be a little low now. We may want it to be more like 260 or 270. You can wait to see if you get a similar number or a lower number like 260 or 270 and shoot 1.75, so you can see if you need to change that range. By changing that range and the fact that you are on all wet, low carb food (no dry), then we probably should rethink the 180-241 range. Maybe it could be something like 180-199 .5u; 200-220 1u; 221-239 1.25u; 240-269 1.50u; 270-301 1.75u. Up to you if you want to go ahead and change or test out the current range. Since I am typically on the conservative side, I suggest to make that change to your sliding scale.
 
Hi Cindi - He does get some dry - Young Again Zero Carb - does that make a difference? I like your being conservative because I am too (well, let me clarify - for Murphy's handling of insulin doses, I am conservative) :)
 
Merlin said:
Hey Carol - Sorry that I am late for Murphy's party. My chores start around 5:45pm so just got done. Oh Murphy - you are keeping us on our toes. Just because we noticed that your AMPS have been lower that your PMPS, you had to prove us very, very wrong. Anyway, great numbers at least.

So was the numbers that you tested were 123, 126 & 122, correct? I guess I would have skipped too but would have loved to have checked him about 60 minutes to see if he could shoot then. A token dose would have been nice like a .25 if he would have been just a little bit higher.

I like the idea of possibly shooting earlier tomorrow. Maybe he will go long on you again tomorrow but who knows. Murphy does not quite do what we think he will do.

As Sue pointed out, since you are on an all wet, low carb food, we may want to rethink the lower part of the scale. An example would be just yesterday (AMPS) you got a 276 and shot 1.75u and your nadir was 82. Perfect. You also got a 276 (AMPS) and shot 1.75u which got you in the high blue but Murphy was not feeling well that day so that may be the reason why he didn't go lower.

We currently have the lower range of the 1.75u dose as 241 (241-300 1.75u). That might be a little low now. We may want it to be more like 260 or 270. You can wait to see if you get a similar number or a lower number like 260 or 270 and shoot 1.75, so you can see if you need to change that range. By changing that range and the fact that you are on all wet, low carb food (no dry), then we probably should rethink the 180-241 range. Maybe it could be something like 180-199 .5u; 200-220 1u; 221-239 1.25u; 240-269 1.50u; 270-301 1.75u. Up to you if you want to go ahead and change or test out the current range. Since I am typically on the conservative side, I suggest to make that change to your sliding scale.
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So I could have tested him an hour after eating and if he was high, given him something then? Should I test him now (not to give him insulin just to see what it is?) What would his # have to be to give him .25 or even .5? I think I will change the lower end of the sliding scale as you suggest - thanks -
 
If he ate, the ideal situation would be then to wait two hours so you won't get the food influencing the numbers. Otherwise, you would have to withhold food for an additional 60 minutes in order to give that token dose.
 
Carol & Murphy said:
Hi Cindi - He does get some dry - Young Again Zero Carb - does that make a difference? I like your being conservative because I am too (well, let me clarify - for Murphy's handling of insulin doses, I am conservative) :)
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Oh ok - still good. I just thought I read in one of these posts that you are feeding more of the wet and less of the dry.
 
Merlin said:
Oh ok - still good. I just thought I read in one of these posts that you are feeding more of the wet and less of the dry.
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I am feeding more of the wet and less of the dry but still some Young Again Zero carb - guess what? I just checked him and his BG is 435 now (less than 2 hrs after some canned food but nevertheless) I'm afraid now of what tomorrow will bring - anything to do now?
 
I would just chalk it up to a skipped cycle or fur shot. I guess we will see how quickly we can get Murphy turned around from a skipped shot. Just more data! Get a good night sleep tonight.
 
It could also be a bounce, if he went lower than your PMPS shortly before that.

And no, I don't think the YAZC would have an adverse effect on his numbers. I've read that it might not quite be "zero" carbs, but it is very low if not zero. Probably takes a bit longer to digest than wet food.
 
Carl & Polly & Bob (GA) said:
It could also be a bounce, if he went lower than your PMPS shortly before that.

And no, I don't think the YAZC would have an adverse effect on his numbers. I've read that it might not quite be "zero" carbs, but it is very low if not zero. Probably takes a bit longer to digest than wet food.
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So that's why Murphy seems hungrier sooner after he eats wet food -
 
Carl & Polly & Bob (GA) said:
It could also be a bounce, if he went lower than your PMPS shortly before that.

And no, I don't think the YAZC would have an adverse effect on his numbers. I've read that it might not quite be "zero" carbs, but it is very low if not zero. Probably takes a bit longer to digest than wet food.
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I was around and wish now I would have gotten another reading between +7 and +12, but judging by previous days, it didn't seem necessary :(
 
Think of it like if you leave fruit loops in milk to long, lol. As it gets wet, it swells. It probably makes his tummy feel more full too. But yes, it takes longer to digest dry. And with regular dry food, that would be expected to cause the "carbs" to hang around longer.
 
Carol & Murphy said:
I was around and wish now I would have gotten another reading between +7 and +12, but judging by previous days, it didn't seem necessary :(
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Try not to "Monday morning quarterback" yourself. At +7, I think I would have assumed he'd hit nadir and was most likely on his way back up, like he would normally do. Pretty sure the PMPS would have surprised any of us like it did you.
 
If he'd be in that range today, I think it might be worth looking at lowering the range for the amps, or trying 11/13 for a few cycles. Hanging on to ProZinc for longer than the 12 hours can mean: too high a dose or the pancreas is helping - in my experience. It would be lovely if it were the second, it is worth exploring if it is the first.
 
Sue and Oliver (GA) said:
Not bad at all, he surfed a long in that range for awhile. No worries; you'll get him back on track.
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do you mean a different sliding scale for am and pm?
I gave him insulin at 6 am today so I can check him later and see where he is If still lowish at +9 or +10, I will postpone until 7 pm Thanks so much Sue - don't know what I'd do without you
 
I don't agree, as I posted above. I don't believe that dose adjustments should be made just because something happens once in a blue moon. Often it causes you to lose any momentum you have achieved. The only exception being if a cat goes below normal BG, which would indicate an immediate (although not necessarily, permanent) reduction.

"Carryover and/or overlap don't happen often, perhaps, but they do happen. Cycles can and do last longer than 12 hours with PZI/Prozinc.
ETA - and while some might think that a cycle that lasts longer than 12 hours indicates that a dose is too high, I don't agree with that. I think sometimes a cycle just lasts longer than 12 hours. And rather than avoiding them, it is better to take advantage of them when they do happen."
 
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