the lower the numbers, the higher the dose and the higher the numbers, the lower the dose. Now, how does eating affect her and should I leave out some dry food for her to snack on?
No, that's not correct. Dosing is more complicated than that. For now, follow this:
1. If the pre-shot is lower than 200 = no shot
2. If the pre-shot is between 201 and 600 = .6 or .8
Do NOT give anything higher than .8u, no matter how high the number is. I'll do my best to explain why. Let's imagine that it's morning. I think you said you were doing your tests and shots at 7:30, is that right? I'll use that time for now:
1. 7:30a.m. The first thing you do is test and get a pre-shot number. We usually call this AMPS (a.m. pre-shot)
2. Then you feed Chloe.
3. If her blood glucose number is higher than 200, you give her a shot of insulin.
4. The food she just ate will usually make her blood glucose (BG) go up for a couple of hours. This is normal in a diabetic cat.
5. After about 2 hours, the insulin will start to lower her BG.
6. After about 5-7 hours, Chloe's blood glucose will reach it's lowest point in the cycle. This is called the nadir. This number should never be below 50. If it's below 50, she's hypoglycemic, and it's very dangerous.
7. After the nadir, the BG will start to rise again, and will continue to rise until the PMPS (p.m. pre-shot).
8. At the pm pre-shot time (7:30pm for you), you test again, feed Chloe her dinner, and if her PMPS is higher than 200, give her some insulin.
Okay, so that's how the cycle goes. But now what about the dose? Here is what happens:
1. If you get the AMPS number, and give a dose that is too low, then a diabetic cat would have BG numbers that rise after eating, and then slowly over the day, the BG would stay more or less the same, or slowly go down until the PMPS. The numbers would be too high all day. If that goes on for weeks and months, it will make the cat sick.
2. If you get the AMPS number, and give a dose that is too high, then the BG will drop too much. Here's where it gets tricky though: the BG number will drop, and then the cat's body panics and dumps stored glucose into the blood stream. If you are testing during the day, you will see the number go down, and then you will see it rise quickly as the stored glucose floods the cat's body. If you are NOT testing during the day because you are at work, then you will see the AMPS, and you will see the high number at the end (the PMPS), but you won't see that low number in the middle because you couldn't test at that time. So you'll see the high number at the end, and
think that her BG is really high and she needs more insulin. But that is WRONG. She actually needs
less insulin because that whole thing happened because she had
too much insulin at the beginning of the cycle.
So here is an example with actual numbers from one of our cats. The +1, +2, etc. is how many hours after the AMPS. The numbers are the blood glucose numbers:
AMPS: 432
+1: 478 (it went up a little because the cat ate breakfast)
+2: 332
+4: 147
+5: 48 (at this point, the cat is hypoglycemic - the blood glucose is too low and it's dangerous - when this happens, it's important to give the cat high carb food and try to get the numbers to rise)
+6: 52 (this is still very low)
+7: 389 (see how high this number is now? that's a normal response when the BG has gone too low - we call it a 'bounce')
+10: 402
PMPS: 455
So if the owner had only tested at AMPS and PMPS, it would look like a test of 432, and a tests of 455. The owner would think that the insulin wasn't helping, but really, it had been too much insulin, not too little.
I know you're teaching all day, and can't do those mid-day tests. That's okay right now. But as we look at your spreadsheet, our best guess is that this is what's happening to Chloe: She's dropping low while you're gone. So giving her more insulin will keep making her drop too low, and if she runs out of stored glucose, she won't be able to bring her levels back up. That could be dangerous. So until you have a day off on the weekend and can get some mid-cycle tests, please give her
less insulin, not more insulin.
Please ask as many questions as you have. This whole process is complicated, and we really want to help you and Chloe. And again, if there's any way you can get a test tonight before bed, it would help to get some idea of what's happening for Chloe.
And in answer to your last question: yes, please leave food out for Chloe tonight, and when you leave for work. It's best for diabetic cats to have access to food, especially when they aren't regulated yet.