? Need HELP and advice. PS#s falling, do I give shot or reduce? stalling..

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katiesmom

katiesmom

Member Since 2013
Help! Katie's PS was 120. Checked her hr later and now at 106 & 113 ( always try to do 2 tests).
Her numbers have been high for 5-6 weeks, rarely falling below 200. We saw a 99 on Sunday. Back up Mon & Tues, figure she was bouncing.

Numbers this AM are low for her, especially for a preshot.

Dont know what to do, am stalling. She's hungry ready to eat and getting super grumpy.
Here by myself, so testing is super difficult by myself (usually DH holds her), sometimes she will let me by myself, sometimes not. I cant guarantee I how much more I can test her, I know I cant do it every 20 minutes or something, she will never let me do that. I got lucky to do tests 1 hr apart this AM.

Was suppose to have vet appt. for my another kitty this AM, but can cancel if I have to.

Dont know whether to give reduced shot, what to do... hate to skip when we are finally seeing better #s, but I want to keep her safe. She is not predictable in this situation, this is unusual for us.

Please look at her sheet and give me your opinion.
Thanks!
 
I use the Alpha trak meter so am used to a little higher numbers. But after looking at your spreadsheet if it were my cat I would lower to 1.75. Remember that lantus is a depot insulin. Her numbers are in a safe range. I would feed her. I usually wait for the more experienced members to pipe in but I noticed no one had answered yet. My cat has been controlled on lantus for the past 5 months.
 
I have to log off to leave for work and can not log on from there. My opinion is to do what you feel comfortable with. I am from the old school, been around a long time, and we used to shoot, skip, or do a BCS (one time lowered dose). I would not advise skipping if you are going to be around to test, she will eat, and you have lots of supplies. You want the lower pre shot tests. It shows the 2 units is working. Even if you give a BCS dose, she still has the depot from the 2 units, so will probably go lower if she's headed that way, whether you shoot the full dose or a one time lowered dose.
Good luck. Gotta go.
 
Thanks for your reply. I just managed tested again and it was the same basically, 109 & 115. It's been about 45 minutes since last test. It would be a + 13.25. So they are not rising yet.
I know her numbers are in the safe range, I am just concerned what more insulin will do to her right now. I have to feed her, I just dont know whether to shoot now or wait.
 
As Diana said, this very much depends on what you are comfortable with. From a quick gander at the SS it looks to me like you were getting better numbers at 0.75u than you are at the higher doses. If you want to do a big Chicken shot, I'd reduce at least 50% or even to 0.75u since you are not sure about being able to monitor well without another pair of hands.
 
Yes, she did good for quite a while @ .75 but her numbers rose and rose so I have been slowly increasing without much change or luck. I know I have to make a decision here, its just so hard to know what to do....
 
If you are uncomfortable giving insulin, then skip the shot. Nothing wrong with erring on the cautious side. Many of us have had to do that at times based on schedules/other factors like testing ability etc. Katie may run a little high for a day but better too high for a day than too low for a moment.
 
I just gave .5 just so I didnt feel like I skipped it altogether. Her evening dose, assuming she is back up to her "normal" 200.....keep it at 2 units or reduce?
I have been meaning to post for advice on her dosage anyway.
She did very well at .75 for quite a while and then her numbers rose and I slowly increased dosage. It seemed like every time I would get a decent number it would only last one cycle than back up to 200+. I wasnt sure if she was bouncing or what.
Sometimes I wondered if she was getting too much insulin and bouncing...or just not enough...confused.
Can any expert eyes out there take a close gander at her SS and give opinions?
 
Let's see how this cycle plays out and around +11 post for dosing help ( change your title to say Need PM Dosing Help)

Katie could still be under the influence of the higher dose so please get a +2 to see if this cycle is going to be active.
 
Coming a bit late to the Party.
You mention HC makes her vomit, have you tried just adding honey or syrup to her regular raw food to make that HC? Would that make her sick? There have been a number of folk whose cats can't tolerate the comercial HC and they have successfully resorted to using honey/syrup added to their regular food to make it HC and then used that to steer numbers.

With the benefit of hindsight , and assuming that you would have been able to use honey/syrup to steer numbers, had enough strips and were going to be around to monitor, and your sig block says you are following TR, I think you would have been OK to shoot the full dose. She wasn't really dropping, but more or less staying flat, with meter variance all those tests you got while you were stalling were basically the same.
You shot a 147 5 cycles ago, that's not much different to today's numbers (looks like he was flat at pmps that day too), that cycle as you can see panned out quite nicely, she did quite nicely and dipped her toe into the lagoon, that drop into green was enough to trigger a bounce as that's not a place her body is used to being, and that bounce seemed to be clearing this morning, 5 cycles later. The low blues she has got into and the BCS may well result in some high numbers, don't worry about them at the moment, if she does go backup into higher numbers look for her clearing in 4 to 5 cycles time.
Lantus does much better at holding numbers flat we have a saying 'shoot low to stay low'. Meaning that when you shoot a lower than usual number often it will result in a nice flat cycle that Lantus is famous for, having said that, it would perhaps be wise to post up for advice before you shoot a lower PS, like you did today.

katiesmom said:
Her evening dose, assuming she is back up to her "normal" 200.....keep it at 2 units or reduce?
Click to expand...
Suzanne Kostenko said:
But after looking at your spreadsheet if it were my cat I would lower to 1.75
Click to expand...

I would stick to the 2u, she hasn't dropped low enough to earn a reduction (below 50 on a human meter for TR), dropping the dose will likely see her numbers rise, spending unnecesary time in higher numbers can lead to glucose toxicity and eventually you will more than likely have to take the dose up even higher.
As you did a BCS this morning the cycle count will start over with the 2u, so see if you can gold that for at least 6 cycles (maybe more, if she sees blue/green again before then you would hold for at least 10cycles)
Here is a great thread/reminder about earning reductions.

ETA just looking at the ss again there might even be an argument to take her up to 2.25, you had already held the 2u for 10 cycles and the lowest it got her was 99.

And here a link where glucose toxicity is explained

There's a great post by Libby on shooting a falling number
post number 6 on this thread http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/
Some other interesting points are discussed on that thread, one of the most useful threads I found in my early days, helped give me the confidence to shoot lower.
Additionally the TR sticky on shooting and handling low numbers

Lastly it's only natural to get spooked when we see a number that's lower than we are used to, so taking a BCS today is OK, I just wanted to give you some info to ponder so that when it happens again (and it will) you will feel better prepared. Believe me when I tell you that eventually you will be craving those lower PS as they will indicate that Katie is making progress and before long you will dissapointed if they are not green :)
 
d
Gill & George said:
Coming a bit late to the Party.
You mention HC makes her vomit, have you tried just adding honey or syrup to her regular raw food to make that HC? Would that make her sick? There have been a number of folk whose cats can't tolerate the comercial HC and they have successfully resorted to using honey/syrup added to their regular food to make it HC and then used that to steer numbers.

With the benefit of hindsight , and assuming that you would have been able to use honey/syrup to steer numbers, had enough strips and were going to be around to monitor, and your sig block says you are following TR, I think you would have been OK to shoot the full dose. She wasn't really dropping, but more or less staying flat, with meter variance all those tests you got while you were stalling were basically the same.
You shot a 147 5 cycles ago, that's not much different to today's numbers (looks like he was flat at pmps that day too), that cycle as you can see panned out quite nicely, she did quite nicely and dipped her toe into the lagoon, that drop into green was enough to trigger a bounce as that's not a place her body is used to being, and that bounce seemed to be clearing this morning, 5 cycles later. The low blues she has got into and the BCS may well result in some high numbers, don't worry about them at the moment, if she does go backup into higher numbers look for her clearing in 4 to 5 cycles time.
Lantus does much better at holding numbers flat we have a saying 'shoot low to stay low'. Meaning that when you shoot a lower than usual number often it will result in a nice flat cycle that Lantus is famous for, having said that, it would perhaps be wise to post up for advice before you shoot a lower PS, like you did today.




I would stick to the 2u, she hasn't dropped low enough to earn a reduction (below 50 on a human meter for TR), dropping the dose will likely see her numbers rise, spending unnecesary time in higher numbers can lead to glucose toxicity and eventually you will more than likely have to take the dose up even higher.
As you did a BCS this morning the cycle count will start over with the 2u, so see if you can gold that for at least 6 cycles (maybe more, if she sees blue/green again before then you would hold for at least 10cycles)
Here is a great thread/reminder about earning reductions.

ETA just looking at the ss again there might even be an argument to take her up to 2.25, you had already held the 2u for 10 cycles and the lowest it got her was 99.

And here a link where glucose toxicity is explained

There's a great post by Libby on shooting a falling number
post number 6 on this thread http://www.felinediabetes.com/FDMB/...combining-merging-protocols-good-idea.111088/
Some other interesting points are discussed on that thread, one of the most useful threads I found in my early days, helped give me the confidence to shoot lower.
Additionally the TR sticky on shooting and handling low numbers

Lastly it's only natural to get spooked when we see a number that's lower than we are used to, so taking a BCS today is OK, I just wanted to give you some info to ponder so that when it happens again (and it will) you will feel better prepared. Believe me when I tell you that eventually you will be craving those lower PS as they will indicate that Katie is making progress and before long you will dissapointed if they are not green :)
Click to expand...

There was two post going this morning, this one and one from Health which I linked above. The following is what was said by Katiemom on the other thread which is why she was guided to shot a lesser dose:

Dont know what to do, am stalling. She's hungry ready to eat and getting super grumpy.
Here by myself, so testing is super difficult by myself (usually DH holds her), sometimes she will let me by myself, sometimes not. I cant guarantee I how much more I can test her, I know I cant do it every 20 minutes or something, she will never let me do that. I got lucky to do tests 1 hr apart this AM.
 
Bobbie And Bubba said:
d

There was two post going this morning, this one and one from Health which I linked above. The following is what was said by Katiemom on the other thread which is why she was guided to shot a lesser dose:

Dont know what to do, am stalling. She's hungry ready to eat and getting super grumpy.
Here by myself, so testing is super difficult by myself (usually DH holds her), sometimes she will let me by myself, sometimes not. I cant guarantee I how much more I can test her, I know I cant do it every 20 minutes or something, she will never let me do that. I got lucky to do tests 1 hr apart this AM.
Click to expand...
Hi Bobbie, yes I read that.
I wasn't implying that it was the wrong decision today, and of course not being able to test is a huge issue and had to be taken into consideration. But rather that when katie next Throws a low PS, ( which we all know will happen) that as long as all is well, ie including being able to monitor, she should think about shooting rather than taking a BCS again as we all know shooting low is how we make progress with this sugar dance. I think today's PS was much the same as the 147 a few days ago, and that cycle panned out well, so she had data to support the decision to shoot if had she felt comfortable that she could monitor Katie (sorory I didn't make that clear in my previous post)

More my concern was addressing the suggestion of reducing the dose, I don't see any evidence on the SS to support that choice, but I will admit I have not been following Katie, so perhaps there is some other info that I am not aware of. But with the info I have ie following TR, and numbers on SS a reduction is not called for.
 
Gill & George said:
More my concern was addressing the suggestion of reducing the dose, I don't see any evidence on the SS to support that choice, but I will admit I have not been following Katie, so perhaps there is some other info that I am not aware of. But with the info I have ie following TR, and numbers on SS a reduction is not called for.
Click to expand...
You are right. Where I was coming from was just how low she might drop today at PMPS under the influence of the higher dose and still not having the help she would need to test tonight. That is why I said to ask for guidance closer to then.

It's great that you take the time to teach and reinforce. :bighug::bighug::bighug:
 
Thank you @Bobbie And Bubba and @Gill & George.
Thanks for the links, the first one I had not read before.

I just didnt feel brave enough to do the full shot this morning. When I shot the 147 a few days ago, my DH was here to help me monitor. Also, the 106 I got this morning @+ 12.5 after the 120 felt a lot lower and more risky than the 147...at least to me. Those numbers in mid cycle would have made me happy, but at shot time....yikes.

BTW, I just tested her @ +3.5 and as expected its up to 192. I know I screwed up. I just havent had enough experience with the lower numbers and how she reacts to feel confident in any decision because she has been surfing around 200 for so long now. I cannot even figure out what her usual nadir is. I do not see any pattern and that's why I asked for more experienced eyes.

And no I havent tried any honey/karo syrup with her because I havent had to try and get her numbers up before.

I know this will happen again, and I will try to be braver, I just wish she would do this when my husband is here to help me. The thought of her going too low, especially when I am here by myself scares the heck out of me because I know I cant just walk up to her and test whenever I want, I dont feel like I am in control of the situation. I am so utterly neurotic when it comes to these cats, it's pretty pathetic;)

One last question- since I only gave her .5 this morning and it was nearly 2 hours late, do I have to wait the full 12 hrs to do her PM shot, or can I perhaps do it at +11? I really screwed up our/her schedule.

Thank you again, I truly appreciate it.
 
To get back on schedule, the protocol is you can shoot 30 minutes earlier in a 24 hour cycle or can do it in increments of 15 minutes each cycle. With her going up higher all ready and if she continues to rise, you could probably safely shoot @ +11 since it was such a reduce dose this AM. And you didn't screw up, it's all a learning curve. You have to be comfortable with the lower numbers and the more you see them, the more comfy you will get. And the more you shoot them, it will help her to be in lower numbers more often.

She is most likely bouncing too from seeing that nice lower number this AM. That is another reason to shoot the whole dose too when they get a lower than usual number because chances are they are going to bounce.

Do you offer her poke treats when you test? My guy loves the freeze dried chicken from Stella and Chewy. There are also Pure Bites. It helps soften the poking process.
 
You didn't screw up, you made a choice, which given the particular set of circumstances was a reasonable choice.

The good news is that she seems like she may like to get into lower numbers on this dose, so once the depot builds you'll probably face a similar situation, hopefully she'll have better timing and DH will be around.
One thing I might suggest, is that if you are going to find yourself regularly on your own having to care for Katie, you could for a while at least, 'practice' at testing her on your own, even if DH is around, that way both Katie and you can get used to the idea of flying solo, and DH can step in and help if she's being a little too feisty, that way you may feel more comfortable at testing her when you really are on your own.

If she does climb high, I would say if she sees pink by +11 you could bring her shot forward by an hour (remember clocks go back in US at the weekend).
If she is still in yellow you could shoot at +11.5 moving the shot time by 30 min today at and 30 minutes tomorrow pm and so on.
(or 15 min per cycle)


Just a note on housekeeping with the ss.
If you can stack all the numbers you took in the amps block while you were stalling
and the +11.5 in the +11 of the pm cycle
so in the amps column you would have
106@+12
113 @+12.5
109@ +13
115 @+13.25
amps xyz @+13.75 (whatever number you shot)

Then your test at +3 and +3.5 would go in the +3 column where it's meant to go.

That will reflect the stall and the numbers you got. Hope that makes sense.
:)
(it really confused me when I stalled the first time, I had no idea what to do with the numbers:confused:)
 
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