27 July Girlie AMPS 470; 178@+2:30; 121@+3; 79@+4; 83@+5; 74@+6: 64.8@+7: Help?

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Girlie's mom

Girlie's mom

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Condo: http://www.felinediabetes.com/FDMB/...-not-hungry-shoot-or-not.181248/#post-2008408

As I can't be home to monitor Girlie closely from 27 - pm of 29 July, I'm following Wendy's and Tricia's suggestion to give her just 0.5 am/pm to ensure she's safe when I'm away and that I don't worry.

Interestingly, even though her AMPS was 470, she dropped down to blues - 178 - @ +2:30. So that's interesting, although I don't know what that means, exactly... Is that enough of a drop that I should give her some LC wet or HC wet food? This looks like a steep dive to me, but I'm not sure...

I had a chat with my vet last night and it was not a pleasant experience. Her thoughts:
  1. Why are you testing so much? You don't need to test that much at all. She's never known anyone who has tested through the night. All cats probably go a bit hypo during the night and just sleep through it.
  2. Stick with the 1.0 U am/pm; if you just leave food out, her body will prompt her to eat and she'll PROBABLY be fine; you'll know if she's hypo because she'll be staggering, etc.
  3. You should have given her the full insulin dose (1.o U) even if she's close to or under 100 - even 88 would PROBABLY have been fine to give the 1.0 unit
  4. Her numbers have not been low enough so far to require any sort of additional attention like food, glucose, etc.
  5. If you switch her to 0.5, long-term you will end up with a cat who's not responding well and won't be possible to regulate and who's body will suffer for that lack of regulation
  6. Re: her lack of appetite even with Mirtazapine and my other cat (Max, currently in exile): let him back in; if he eats her food, he eats her food - maybe it'll make her hungrier

I know the vet has a sincere interest in helping my cat; she's with the specialist hospital here and clearly knowledgeable and has been supportive and encouraging. But I found that conversation last night rather challenging. Big sigh.
 
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Yikes! Guess that vet has never had a diabetic cat at home.:rolleyes: We see very few symptomatic hypos here, other than hunger, and I would rather keep it that way. At one point I was interviewing vet's with the thought of possibly switching. Thought I had found one who had a diabetic cat in the past, until I found out the cat had passed, probably from hypoing cause the vet didn't test. So I stuck with the vet who liked that I home tested, even if I was the first client to do so. We learned together.

Interesting that Girlie's high BG's so far are lower on 0.5 units than they were on the higher dose. I hope she slows down soon.
 
Wendy&Neko said:
Yikes! Guess that vet has never had a diabetic cat at home.:rolleyes: We see very few symptomatic hypos here, other than hunger, and I would rather keep it that way. At one point I was interviewing vet's with the thought of possibly switching. Thought I had found one who had a diabetic cat in the past, until I found out the cat had passed, probably from hypoing cause the vet didn't test. So I stuck with the vet who liked that I home tested, even if I was the first client to do so. We learned together.

Interesting that Girlie's high BG's so far are lower on 0.5 units than they were on the higher dose. I hope she slows down soon.
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She's still going down - 121 @ +3 (just a half hour after the 178): I assume I should try to get her to eat some low carb wet food, or should I go for high carb, or should I wait it out? I have to leave in about 3 hours to go to my physio...

Why is she dropping like this on the 0.5? Interesting, isn't it?
 
I would do low carb and test in an hour. This could still be the effect of the 1.0 unit depot. The higher depot can influence 4-6 cycles after a reduction.
 
Ok, now 79 @+4. LC food didn't seem to do much a half hour ago. Wait or feed HC food, do you think?
I've decided to reschedule physio appt for another day. Too tired to go anyway... :)

She's still drinking like a fish - I wonder why if she's low? No ketones or glucose in her urinalysis for the last two days; I haven't done today's yet. Puzzling... :confused:
 
I am in a ferry line up, so not able to answer quickly. Keep your subject line updated with the lastest BGs to get more eyes. Maybe even a summary of the question like "HC now or wait".
 
Wendy&Neko said:
I am in a ferry line up, so not able to answer quickly. Keep your subject line updated with the lastest BGs to get more eyes. Maybe even a summary of the question like "HC now or wait".
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Thanks so much, Wendy. She's proving too entertaining for words today... :-)

Hope it's a lovely night for your ferry!
 
74 @ AM +6:15. Three healing pancreas greens in a row and going down a little bit again. I might wait til +7 and test again and then give her a little more HC wet if she's going down. I'd like her to go up before her PMPS. :)

Anyone have any thoughts on this? I'm still new and still tremble a bit when I see greens....
 
Girlie's mom said:
74 @ AM +6:15. Three healing pancreas greens in a row and going down a little bit again. I might wait til +7 and test again and then give her a little more HC wet if she's going down. I'd like her to go up before her PMPS. :)

Anyone have any thoughts on this? I'm still new and still tremble a bit when I see greens....
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Hi! I saw your original reply, but not the edited reply. Sorry.
It's up to you if you want to feed or wait until +7, but either way do LC so you don't abort the cycle since cats start coming up around +7 to +8.
 
Mandy & Rex said:
Hi! I saw your original reply, but not the edited reply. Sorry.
It's up to you if you want to feed or wait until +7, but either way do LC so you don't abort the cycle since cats start coming up around +7 to +8.
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Thanks, Mandy. I'll be brave this time and wait til +7 just to see how she goes. Great tip: I'll make sure to use LC and not HC.

She came up yesterday to 270 by her PMPS, but that's (I think) in part because I gave her some HC dry at +4 when she was 79; this time I waited til +5 to give her some HC. I guess this is how I learn, eh?

I'm trying to get her on two consecutive insulin doses per day but that's proving an interesting challenge as I'm still new and I don't really want to shoot under 200 or so, especially since she's been going down the past two cycles in AM and PM. And I don't think I can stay up too late again tonight... What do you think?
 
Keep notes on your SS how Girlie responds to the food you feed. That will be handy in the future. Right now, you are learning by experimenting.

If you cannot stay up to monitor tonight if the PMPS isn't high enough for your comfort, you will need to skip. But eventually, you will learn to shoot a lower number. The popular saying here is "shoot low to stay low." I cannot stay up with you. If you need advice at PMPS, change your title to something like low PMPS, help.

How long until your +7?
 
Mandy & Rex said:
Hi! I saw your original reply, but not the edited reply. Sorry.
It's up to you if you want to feed or wait until +7, but either way do LC so you don't abort the cycle since cats start coming up around +7 to +8.
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Oh YIKES!!!!! 64.8 (3.6) @ +7 and looking for food, so she gets it.

Scary now...should I give glucose syrup, do you think? She's on AlphaTrak 2 readings
 
Mandy & Rex said:
And now you need to do 0.25u when you give insulin because she earned a reduction.
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Oh man - That will be interesting to try to do! Any tips on how to draw that fine a dose manually without going over or under the line? I inevitably go too far or not far enough...
 
Of course the depot from 1u could still be in play, but better be safe and do 0.25u for the next shot if PMPS is high enough for you to shoot.
 
Girlie's mom said:
Oh man - That will be interesting to try to do! Any tips on how to draw that fine a dose manually without going over or under the line? I inevitably go too far or not far enough...
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Do you have syringes with half unit markings? Then you need to eyeball halfway between 0 and 0.5. Let me find an image for you.
 
025unit-1.jpg
 
85 (4.7) A little relieved, but still low. I am VERY glad that I didn't go to my physiotherapist this afternoon! But this makes going to something on Friday night and Saturday during the day look less feasible.
 
Bron and Sheba said:
I would give her some of the glucose you have.
68 is when you take action with the Alfa track.
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Thanks, Bron. I don't think she'll come up enough for her PMPS without some of the glucose, even if she's come up a little bit with food, but not sure...

Am VERY glad that I didn't follow the vet's advice to continue with the 1.0 Unit and then just assume that she'd be fine without testing...

Oh, this is nerve wracking!!! :nailbiting:
 
Mandy & Rex said:
Do you have syringes with half unit markings? Then you need to eyeball halfway between 0 and 0.5. Let me find an image for you.
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Thanks for the image, Mandy. I know where it should be - I just can't manage to get the syringe to glide to that particular spot without going over or under. I must have a manual dexterity issue... how do you get the plunger to stop where you want it to stop and not go over or under the line?
 
I would skip tonight to drain the depot, and get you some sleep. Without 1/2 unit markings, one way to find 0.25 units is to draw one unit, then twist the syringe until you can flick off even sized drops. Count the number of drops in one unit and divide by 1/4. Draw 0.25 by flicking off the required number of drops from one unit.

UP Girlie please!
 
Add the other number to your SS so people looking at it will know Girlie went low.

You will need to watch Girlie to be sure she's holding her own for 2 hours without food.
Girlie's mom said:
Thanks for the image, Mandy. I know where it should be - I just can't manage to get the syringe to glide to that particular spot without going over or under. I must have a manual dexterity issue... how do you get the plunger to stop where you want it to stop and not go over or under the line?
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I twist the plunger instead of pressing on it. That helped me a lot.
 
Girlie's mom said:
Thanks, Bron. I don't think she'll come up enough for her PMPS without some of the glucose, even if she's come up a little bit with food, but not sure...

Am VERY glad that I didn't follow the vet's advice to continue with the 1.0 Unit and then just assume that she'd be fine without testing...

Oh, this is nerve wracking!!! :nailbiting:
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I wouldn't give any glucose at the moment and see if she comes up on her own..she might bounce after that low of 65 so don't be surprised if she does bounce.
I would post later towards AMPS time and ask what dose to give in the morning after the skipped dose. I know she technically earned another reduction but they were back to back and the depot was probably in play still and reductions achieved like that are often not taken. But post closer to the time when you have more bsl numbers and ask for advice.

You are doing really well managing it all
 
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Bron and Sheba said:
I wouldn't give any more glucose at the moment and see if she comes up on her own..she might bounce after that low of 65 so don't be surprised if she does bounce.
I would post later towards AMPS time and ask what dose to give in the morning after the skipped dose. I know she technically earned another reduction but they were back to back and the depot was probably in play still and reductions achieved like that are often not taken. But post closer to the time when you have more bsl numbers and ask for advice.

You are doing really well managing it all
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I haven't given any glucose yet, Bron, because she went up to 101 (5.6) by 1:41 pm. So her latest readings since we jumped on the diving board:

ATrak is 68 for take action

AMPS 470; 0.5 U Glargine
+2:30 = 178
+3 = 121 Gave 2 tsp LC
+4 = 79 Gave 1 tsp HC
+5= 83
+6:15 = 74
+7= 65 Gave HC wet food and a few pieces of m/d dry
+7:20 = 85
+7:40 = 101
+8 = 95 (5.3)

As a practical matter: why isn't my spreadsheet updating straight away from the World to the US? I had trouble yesterday as well...
 
Wendy&Neko said:
I would skip tonight to drain the depot, and get you some sleep. Without 1/2 unit markings, one way to find 0.25 units is to draw one unit, then twist the syringe until you can flick off even sized drops. Count the number of drops in one unit and divide by 1/4. Draw 0.25 by flicking off the required number of drops from one unit.

UP Girlie please!
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She heard you, Wendy, and is at least blue now: 101 @ +7:40 but down to 95 @ +8

I'm very happy to skip the shot tonight to drain that depot... I'll practise twisting and flicking insulin. Can I practise with something besides insulin like coffee or something else that's coloured, or is it better to use insulin to practise counting drops? :confused:

So tomorrow morning: if her PMPS numbers are ok tonight (high blue or even yellow), should I (attempt) to give her 0.25 tomorrow morning, or should I ask after I've gotten the PM numbers for tonight?

She is very, very tired of me taking tests right now... she's starting to let me know that she's had enough of me touching her ears. I think they're getting sore, even with the Neosporin...poor, poor baby! :(
 
Girlie's mom said:
I haven't given any glucose yet, Bron, because she went up to 101 (5.6) by 1:41 pm.
As a practical matter: why isn't my spreadsheet updating straight away from the World to the US? I had trouble yesterday as well...
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You have to go over to the US SS and update it manually every time you put in anything but a normal number. Eg if you put a number in on the half hour and write.......darn my numbers won't come on on the iPad...something is wrong sorry but I will write long hand. If you write four point three at plus four fifteen then you have to go over and do that manually .but if you just write four point three in the space it will convert itself.
 
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Wendy&Neko said:
You can use juice or tea or other clear coloured liquid to pracrise drawing drops.
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Ta, Wendy, I'll do that tonight. I'm sure you're asleep by now, but just out of curiosity - and "no way to know" might be the answer:
  1. If I had given her 1.0 unit this morning, would she have dropped a) much faster and/or b) much lower?

  2. She did look for food when she dropped to 65, but she didn't look for food earlier at +4 (79 (4.4)) when I gave her some LC food. If I had gone to physio as planned and left out some LC wet and some HC wet, and not gotten home until now, do you think her feeding herself at +7 would have kept her okay?

The vet scheduled a chat with me for this afternoon, and I'm sure she might say that it would have been ok to leave Girlie and she would have self-corrected, so not to create a drama where there would have been none, but I'm just curious what you and others might think. I really don't want to borrow trouble and be a drama queen, but I DO want to do what I can to ensure that Girlie is as safe as possible. I just don't know how to figure out whether I'm going over the top or perhaps my vet is a little too optimistic. But perhaps there's no way to know?

I wouldn't tell the vet she's wrong - I need to maintain a good relationship with her for the future - but I just want to get an idea for myself of what's going on so I can be confident making decisions in the future.
 
Not asleep yet, but very soon. I had 4 hours of interrupted sleep last night with my parents in ER. :blackeye: All good, just tiring.

She probably would have dropped earlier and faster with 1.0 unit in her. Thank goodness you didn't! Hard to say on the food, but if you had gone and left lots of food for her (HC and LC), she probably would be OK. But then you might not have discovered that she needed less insulin.

Are you using the BD Ultrafine syringes? There is a paper attached to the TR protocol document called "Management of Diabetic Cats". In there starting page 255 is a discussion on dosing small amounts, including a link to a document containing a paper ruler for the BD's that marks smaller units. The document talks about how to use the ruler.
 
As for the conversation with the vet, time to learn the smile-and-nod. Nothing wrong with trying to avoid hypo in my books. Safety first is our motto here. I have read too many sad stories of kitties having severe hypo here.:( You might have been one of the lucky ones, but why risk it.
 
Wendy&Neko said:
As for the conversation with the vet, time to learn the smile-and-nod. Nothing wrong with trying to avoid hypo in my books. Safety first is our motto here. I have read too many sad stories of kitties having severe hypo here.:( You might have been one of the lucky ones, but why risk it.
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Smile and nod: I can do that. I tell you what - I'd much rather be too safe than too sorry. I don't want to look back and regret that I didn't make that extra effort for her - she's too, too special to me (me being selfish there, but that's okay!) :-)
 
Wendy&Neko said:
Not asleep yet, but very soon. I had 4 hours of interrupted sleep last night with my parents in ER. :blackeye: All good, just tiring.

She probably would have dropped earlier and faster with 1.0 unit in her. Thank goodness you didn't! Hard to say on the food, but if you had gone and left lots of food for her (HC and LC), she probably would be OK. But then you might not have discovered that she needed less insulin.

Are you using the BD Ultrafine syringes? There is a paper attached to the TR protocol document called "Management of Diabetic Cats". In there starting page 255 is a discussion on dosing small amounts, including a link to a document containing a paper ruler for the BD's that marks smaller units. The document talks about how to use the ruler.
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I'm slowly working my way through that document; Girlie keeps distracting me with being too entertaining and needing BG tests, etc. I've looked at the ruler, but I don't think I can use it because I've got the BD Micro-Fine 1/2 Unit 0.30 mm (30G) x 8 mm, and the paper ruler says it's for the BD Ultra-Fine™ Needle 0.3 ml 31Gx5/16" (8mm) with 1/2 unit markings: so mine are 30G and the paper ruler is for 31G - does that make a difference (30 vs 31G)?

Glad to hear your parents are okay - that must have been a long and scary night. Not easy, taking your folks - or anyone - to the ER. Scary stuff. :(
 
The gauge of the needle doesn't impact anything - it's the size of the barrel of the syringe that counts.

My parents live on an island a ferry ride away from me and the hospital which I live close to. Logistics just added to the fun. I had to drive them back today, as they took the ambulance/water taxi combo last night.
 
Wendy&Neko said:
The gauge of the needle doesn't impact anything - it's the size of the barrel of the syringe that counts.

My parents live on an island a ferry ride away from me and the hospital which I live close to. Logistics just added to the fun. I had to drive them back today, as they took the ambulance/water taxi combo last night.
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And here I thought MY mom was "entertaining"! You get the gold star for ambo/water taxi combo, hands down. :eek:
 
Hi @Wendy&Neko and @Mandy & Rex and @Bron and Sheba
I just wanted to double check that Girlie should probably go down to 0.25 tomorrow morning.
I didn't give her any insulin tonight as suggested to clear whatever is left in the depot.
Unfortunately, she got into some dry Purina DM, but I don't think she had that much - maybe a tablespoon max. She doesn't like it very much. (Good kitty!)

Her PM BG levels so far after her crazy green day today:
AM +9: 112
PMPS: 157 (but no shot)
Got into dry Purina DM, so following number might reflect that:
PM +2: 301

I'm happy to go for the 0.25, but just thought I'd check whether you think I should try for the 0.5.

I'd like to be able to be out tomorrow night (after shot to +5 or so) and also hoped to be out the next day from AM +3 to AM +11 (all day). However, I am happy to not go to either/both of those if you think Girlie might decide to get really creative and do a repeat of today and dive low again.

Thanks so much - everyone - for your support during this roller coaster of a day! I learned a lot... :bighug:
 
Those high numbers you are seeing are a combination of the dry food and a bounce from the 3.6. That 3.6 tells you that dose is too high. Bounces can last up to 6 cycles. Stick with 0.25 units, especially given you want to be out.
 
Glad you went with the .25, Girlie is giving you a big bounce :) will be interesting to see how long it takes to clear. Good job keeping her safe :bighug: :cat:
 
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