Wynken, continued dosing help

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Cara and Wynken (GA)

Cara and Wynken (GA)

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Well, I figured it was time for a new Thread. Great help from Sue, Robin and Rachel! Grateful for any and all continued help.

So, a 415 PMPS. ((((((Sigh))))))))
 
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Sue, I don't even know what I'm talking about, probably, but it seems to me he couldn't be bouncing from going too low on 2 u. It seems more likely he is just "staying high", like he was awhile back (November) on 2u... When I did get mid cycle checks.

Unless I feed 100 percent Tiki, I'm not sure how to get much lower in carbs. Right now I am considering the 1/3 Wellness Grain Free portion of his meal HIGH carb, and it's only at 4 percent.

I'm going to come home at lunch tomorrow. Will catch a +6.
 
Woke up early this morning thinking about his high PMPS last night and high +3.... So I got a + 10 this morning of 253. I'm inclined to give him a higher dose this morning... Maybe 2.2 if the AMPS is well into the 300s like I think it will be. I will come home at lunchtime +6 to check him today. This feels safe to me but I need a reality check - anyone disagree? I have to get his sugar down!
 
Are you definitely coming home for a nadir? I think I'd be inclined to stick with 2, get a nadir, and go from there. That way, we have data to see what he is doing for sure at mid cycle and can determine if this is a bounce or just needing more insulin.
 
Hi Rachel. Yes, I am. Very frustrated.... Gave him just slightly more than 2 just now (not even close to the 5.5 mark on the U100). Just barely over 5.
 
I understand. Let's see what this dose does for him! The nadir should help us out and we can figure out from there if the dose needs to come up or not. :)
 
I am glad you just gave a little more. I know it is frustrating and you want him lower. We are always cautious because 1) it's not our cat and we don't want to cause harm to anyone else's kitty and 2) things change slowly but also fast and we are worried I f no one will be home.

If a bean is going to be home and knows how to bring up low numbers, I am much more likely to say "yes, go for it". I think besides today, I think that you were going to be home another day for nadir? If today looks higher and flatter, then I think it would be safer to up the dose a bit for that cycle.

The other option (which is hard but safe) is to up the dose overnight. Get a before bed test so you can see if he drops early, set the alarm for a nadir and be willing to stay up if needed. For people who work, sometimes that is the only option. And the weekends when you can be more daring and test more.

Cara, I have read a number of heart breaking threads when the bean comes home after work and the kitty has suffered through a hypo and can't be revived. It doesn't happen often, but once is too much. We are always going to give you cautious advice. You hold the syringe; you decide.
 
I agree with you completely Sue. And that's why I gave the 2.4u on Sunday when I knew I wasn't even leaving the house. I also gave what I considered a really low carb meal that morning. And the curve with a nice low spot was the result.

For a long time now, it seems 2u was leaving him too consistently high... And now that I have made a shift from VERY low carb (4-6 percent) to very very low carb (hopefully under 3 percent) I know I have to be cautious and see how the 2u affects him, with the lower carb meals.

It's just that those high 300 readings and over 400 readings on 2u WITH lower carb meals is starting to scare me!!! Will his numbers EVER come down? I feel like crying. He has been MOSTLY high sugar for MONTHS.
 
Hi Cara...I tend to be cautious like Sue says. Especially since it's unlikely I can be around during the day if anything happens. Once we have more data like the nadir today we can have a better idea what to do. I know it's tough but we will continue to work towards lower numbers!!!
 
I know he has been on insulin for several years. But don't forget how far you have come since you joined the forum again 9 days ago. You've figured out the protocol, are consistently testing, monitoring his diet and lowering his carb levels. You are being fantastically proactive in his care.

You will get him where you want him to be.
 
I definitely think you can increase the dose, maybe tonight? But I am interested in his unusual cycles. The yellow at +10 last night was interesting.....especially after he jumped up into the reds. His unusual nadirs are one of the things that make me worry a little about his dose.
 
Yes, sometimes he nadir's late... But I think that is recent, given the occasional curves I have always done.

On Sunday, the curve was typical of his previous history with lower BG at 5-7 hours in.

So what could cause this? I want him lower sugar, but predictably and safely.
 
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I'm not sure. Sometimes if the nadir is late and or higher than the preshots, it means the dose is too high. I don't think this is the case for Wynken, but I still wonder why he sometimes has odd cycles.
 
Sue, I have wondered if needle length could factor into this. I have used 8mm forever on him. But I can get 12.7 mm. Maybe the insulin isn't getting where it should sometimes? I always rub and then smell my hand after the shot, so I know it's not fur shots. Plus he holds absolutely still for shots (except chewing ). I inject along the L side of his body in the am and R side for pm. I try to vary location. And having been a pharmacy tech (years ago) I feel like I'm accurate with pulling up the dose and rolling the vial gently before that. Is there such a thing as occasional (intermittent) resistance? I mean, look how well he did Sunday, and today was crap at only slightly lower dose. I'm just stymied and don't know what else to think about. Any of this remind you of something you've seen before? We got bloodwork at the end of Sept and I posted it on the Labs tab. We may need to go again?!
 
Cara, I don't know about the needle length. I would assume that wasn't the issue, but I could be wrong.
 
This morning he was (relatively) low at 250, so I waited, because I wanted to know if he was rising or falling. When I retested in 20 minutes he was at about the same point... 255. I was going to give 2u but then decided to give slightly less. Not sure why… Not sure what I'm doing at all. :(
 
:p Hey, Cara, take a minute to celebrate that nice amps! Looks like it was one of his long cycles; I like your dose.

I'd suggest you plan to get some data this weekend and then we take a look at the whole spreadsheet.
 
Rachel said:
Cara, I don't know about the needle length. I would assume that wasn't the issue, but I could be wrong.
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Yeah, I don't think that has anything to do with it, Cara - just look at the nice drop you had on the day cycle on 12/13. And the trouble with the longer needle length is that you could inadvertently end up shooting into a muscle instead of sub-q.
Sue and Oliver (GA) said:
I'd suggest you plan to get some data this weekend and then we take a look at the whole spreadsheet.
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I'm with Sue on this; gather some more data over the weekend - both day and night cycles if at all possible. (And can you get a weight on him before you feed tonight?)
 
Thanks for all the input, fellow beans :bighug:

I will get more data this weekend and will continue thru Friday nite just giving right around 2u, based on PS values. Sound ok? I will try to get us weight, Robin, some evening between now and Fri eve. I do think his pee balls are getting slightly bigger, recently. He and Blynken share a drink well fountain, so no way to assess his PU/PD other than the daily scooping impressions I have.

Question: Do I plan on a more aggressive dose for Saturday morning ? (or Sunday- not sure yet which day I can do the curve, and his poor ears aren't up to doing it both days). Kinda like last weekend?

Or do I just leave him right about 2u that morning... and see how he does? Thanks!
 
Hi Carol- thanks! Looking at your sig I can tell you have several issues with Murphy. So I am OK - he just isn't having predictable responses to the insulin. I am sure that all the wonderful people here will help me figure it out! :D
 
Have not been able to test much lately, but still getting pinks and reds when I do... And it's been quite a few days on the low low carb diet. Will do a curve this weekend for sure. I read something today that made me think Wynk should eat every 6 hours, not every 12 hours... His meals have been every 12 hours for years now. This advice was in the FB group for hyperthyroid cats (my civvie Andrea has HT and just had radio-iodine). Would it help Wynken's BG if I fed the same amount each day but put some food in an auto feeder that opened at +6? I feel like only an insulin increase is going to get these HIGH numbers down, but want to try anything else that might help.
 
I don't know, Cara - I'm thinking you may want to try feeding Wynken & his sister (I know they like to eat together) out of two separate dishes (just to be 100% certain he's eating only his portion @ every meal) - and possibly you might also reduce his rations some? (As I thought you'd said something a while back about perhaps getting his weight down a little?) Unless he gets lots of exercise, I'm just guessing here that he may need a little redux on his daily chow; that might actually help the insulin work more effectively. (Just tossing some random ideas out here...)

I fed my cat only 2 low-carb meals per day for a long time (back in 2013 on Lantus, and again this year when she lost remission & started ProZinc) ... and she did just fine that way; got her well-regulated pretty quickly, too.
 
Thanks, Robin. It's good to know that you were successful with twice a day meals, and that you don't recommend more frequent feeding. That's actually a relief.

I believe I have reduced the calorie consumption, by giving approximately the same amount of what are mostly lower calorie per ounce foods (the ultra low carb, like Tiki).

I feel like a bit of a failure that I can't comply with watching them while making sure they eat only their own portion off of an individual plate. In this, I have to admit that I have too many cats. Several of them need much more of my attention than Wynk does right now. I spent most of November bringing one kitty back from what I thought was deaths door (we were lucky). I predict that four of my cats will not be with me six months from now, and that kills me.

I don't have children and I no longer have a husband. I have a great job that allows me to pay for good cat care and excellent cat food. What I don't have is time. There are many evenings when I get into bed without having eaten dinner myself. I am not complaining to you, because this is the life that I have chosen. And I love these cats more than anything! I do spend time with them, but at mealtime there are many other cats to feed and medicate. Honestly, I have to admit that I've become overcommitted, but I will continue to do the best I can.
 
Gee, I'm sorry, Cara - you do have a lot on your plate! Please know that when I make suggestions/ideas, they are only just that: suggestions and/or ideas ... and some may work for you; some may not. I know you're trying to do your best in the midst of having other kitties with health problems, too. :bighug:(P.S. Please try to at least make time to feed yourself, too - ok?;))
 
I do have too much... But it's ok, honestly it is what I chose.... and I would choose it again, to rescue them all over. I am slowly bringing down his calories, because weight could impede progress... and I just can't stand him being high sugar like this.

The curve will be Sunday, I think. Too many holiday errands Saturday.
 
Amps really low at 166 then 15 min later 176. I WILL come home at lunch to check him... He's eating with his usual clean the plate gusto.

Should I give 1.8? I'm afraid if I don't he'll be sky high at noon.
 
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1.8 would probably be fine if that's what you did, Cara. Especially since you'll be home at noon. Interesting (and lovely) amps. Will be glad when you get the curve so we can see some explanation for his numbers.
 
Hi Sue! Well, this morning was weird.

Although both he and his sister started eating very well when I first put the plate down, they both stopped eating pretty soon and left three fourths of their meal on the plate. That never happens!!!! I have another cat that basically shares the same mix of food from the same cans every morning in a different part of the house. He always has a tremendous appetite as well. This morning he also seemed uninterested in the food.

So, I concluded that there was something wrong with one of the cans that I must've mixed into their breakfast. I'm not sure which can it was… But I decided to replace all of their breakfasts.

Zoom immediately looked grateful when I set down the new food for him (Wellness GF) and started to eat. Wynken's sister (Blynken) liked the replacement meal as well (for her and Wynk it was 100 % Weruva Paw Licken Chicken).

Wynk ate it for a few bites and then walked away again. Since I know he ate some of the 1st plate and a few bites of the second offering, I gave 1u. I'm pretty comfortable that he will eat more later. He was very alert and going in and out to his enclosure so he seemed to feel good. But I am going home at noon to check on his BG, of course!

I can't remember anything like this ever happening. All three kitties are very hungry at every meal, because they don't free feed. So I always get clean plates. Odd.

I get the sense that my sugarbaby is upset with me for how often I seem to need to poke his ears, recently. This morning he tolerated the first poke, but when I didn't feed him right away and came back 15 min later to poke him again, he seemed frustrated. After I got the second reading when I put the plate down I get the feeling he probably was disgusted that it wasn't appetizing. He seemed more interested in going outside than anything else!
 
Wow, Cara! Quite the difference, that blue AMPS today. Will hope you have a hungry kitty at PMPS time (and another nice pre-shot #, too.)
;)
 
Excellent dose as he wasn't eating well. See, you are getting the hang of this! Yes, early this am. One of those tossing and turning, might as well get up mornings....

Glad they liked the second offering. Re the tests. One, you do have to get firm. You NEED the numbers, especially with his changing levels. Do you offer a treat he really likes after the poke - even if he is eating? Sometimes that helps. Neosporin with pain relief can help if his ears are getting sore; sometimes varying the place up and down the ear helps. If you are getting blood each time and using the 25-27 gauge needles, you might try a 29-30 gauge and see if he is more comfortable with that.

Sometimes if one flavor was off and you offer that again, they won't eat. Sometimes offering something completely different (like beef vs fish or vice versa) helps.
 
Well it may have seemed like a good dose this morning, but evidently he ate with a pink +5. And it was a low carb breakfast the second time!!! Now I have a 510 PMPS! Lord. If anyone sees this, please advise. I'm thinking 2.4 and check at +6?

God I'm so mad at myself. I wrote this 25 min ago and thought I hit "post". Came back to see if anyone had answered and had not posted it... SMH. I think I'll give 2.2. Probably not enough. Geez.
 
Do you need more info, Robin? I am (uncharcteristically) watching them eat. Side by side then one walks off, comes back, they take turns.... I have 2.2 u in the syringe but interested in your thoughts before I shoot.
 
Cara, I'd like to get Sue to weigh in on this ... One of my concerns about upping the dose too much (even though we don't like that PMPS #) is that it appears that Wynken may have held onto last night's dose too long, resulting in that lower AMPS today. While I realize you're wanting to see that PMPS come down, I'd hate to see you over-correct ... maybe just a 2.0 tonight? Again, I'd like to see what @Sue and Oliver (GA) thinks about this situation.
 
Regardless of what you end up shooting tonight, is there any way you can set an alarm to get in at least one mid-cycle test overnight? (Yes, I know that's a drag, but we could really use the additional data ...)
 
Ok. @Sue and Oliver (GA) ? Oh cool! I didn't know how that worked until I used the at sign.... A little more info, too. I scooped their box and there was runny poop (just short of diarrhea ) in the box which seldom happens. May be related to the 1st meal I offered but no one wanted to eat much of.....this morning.

Yes I will test tonight, and ANY nite that I need to.
 
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Alright I was getting antsy because it is now about 45 min later than I usually feed and shoot and his dinner was late, and he was eating great but then STOPPED eating with about half the food left and then I went out and petted him and he got up and is eating more... So I went with your gut, Robin, and squirted some out and gave 2u.

He's eating well, again. Omg, minute to minute! Still eating...
 
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