? Increased dosage, no change in BGs of mid-300s. Thoughts?

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shelaghc

shelaghc

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For the last almost two weeks, I've kept mid-cycle testing down to a minimum to give myself and Jester something of a break. (It's complicated.) With a couple of exceptions, it's mostly been AMPS and PMPS.

However, I've been a bit concerned about Jester's numbers being on the high side - lots of pink, some lower 300s and some higher with occasional forays down to yellow and one up to the red zone.

So a couple of days ago I opted to up his dosage from 1U to 1.25U. (I'm eye-balling with half-unit syringes.)

The last time I increased the same way it made a difference in his AMPS and PMPS by the second day.

However, this time he's only going down for his +5 tests - although those usually wind up being unintentionally fasting tests. But his PMPS and pre-bed BG (+4) the first day were both in the mid-300s - in fact, they were almost exactly the same.

This time we're on the third day of the higher dosage and there's still no difference for his pre-shot testings. (FYI - no pre-bed testing yesterday. I've been severely sleep deprived.)

My plan was to keep him on 1.25 for a few days unless I got a drastic change but I'm getting no apparent change at all.

I'm a bit reluctant to increase to 1.5U as in the past that has dropped him down dramatically.

Any thoughts on this?
 
We pay the closest attention to the nadir in determining dose. The 1.25 u dose is getting him down well but there’s room to go lower. You could try 1.5 u when you can monitor. The approach is to consider PSs but the nadir trumps those in assessing a dose. The goal is to safely get nadir down into dark green and hope the PSs will lower somewhat too.
 
Interesting.
I'm thinking maybe I'll keep him at this dose and do a curve to see what that shows. The last time, his nadir was at +4.

I'd planned to do one within the first week or so of February anyway.
 
Kris & Teasel said:
We pay the closest attention to the nadir in determining dose.
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Wait - this isn't at all what I've read on FDMB in the past. How on earth can you determine dosage based on what BG is after dosing?
Every time I've had a question about dosage, it's always based on AMPS and PMPS.
 
shelaghc said:
Wait - this isn't at all what I've read on FDMB in the past. How on earth can you determine dosage based on what BG is after dosing?
Every time I've had a question about dosage, it's always based on AMPS and PMPS.
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Yes, you look at the PS number to determine if the planned dose is safe to give - ie., the BG isn't too low for that dose, generally under 200. That's different from assessing the overall effectiveness of a dose which requires looking at a few cycles worth of data to see the lowest BG produced by the dose. If the picture is obscured by high, flat bounce numbers or there's no/insufficient middle part of cycle data then it's hard to make a decision about dose effectiveness. That's why we tell people to wait out a bounce (can last several cycles) or try to get more mid cycle data. Make sense?
 
Kris & Teasel said:
Yes, you look at the PS number to determine if the planned dose is safe to give - ie., the BG isn't too low for that dose, generally under 200. That's different from assessing the overall effectiveness of a dose which requires looking at a few cycles worth of data to see the lowest BG produced by the dose. If the picture is obscured by high, flat bounce numbers or there's no/insufficient middle part of cycle data then it's hard to make a decision about dose effectiveness. That's why we tell people to wait out a bounce (can last several cycles) or try to get more mid cycle data. Make sense?
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Sort of.

So, if you looked at Jester's numbers what would you think?
 
I'm confused and looking for guidance.
I read your post.

I'm still looking for guidance. If this was your cat and you saw numbers like Jester's what would you think?

Or are you referring to your reply to my original post at the start of this thread?
 
shelaghc said:
I'm confused and looking for guidance.
I read your post.

I'm still looking for guidance. If this was your cat and you saw numbers like Jester's what would you think?

Or are you referring to your reply to my original post at the start of this thread?
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So far, after six doses of 1.25 u you haven’t had a nadir range BG less than the mid 100s (approximately). Using that as a dosing guide and knowing that nadirs in the high dark greens or very low blues are the goal, the dose could go up to 1.5 u on a day when you can monitor. If you could get a few +3 or +4 tests in the evening that would help in decision-making.
 
Kris & Teasel said:
So far, after six doses of 1.25 u you haven’t had a nadir range BG less than the mid 100s (approximately). Using that as a dosing guide and knowing that nadirs in the high dark greens or very low blues are the goal, the dose could go up to 1.5 u on a day when you can monitor. If you could get a few +3 or +4 tests in the evening that would help in decision-making.
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Thank you.

+3 / +4 can difficult at night because currently Jester's doses happen around 9:00AM/PM. That's why I skipped last night.

The kids have been keeping me up pretty late lately and waking me up multiple times during most nights. (I was falling asleep yesterday around 10:00PM and nearly forgot to give Jester his PM shot period I was so exhausted....) Staying up until 1:00AM generally means Jester will want a snack of some kind afterward. He associates food with testing because he gets a meal after both his PSs. And he can poke around for as much as half an hour eating. (I hate to discourage him eating because his weight dropped down so far before and since his dx.)

Which means I don't get to bed before 1:30AM, Bastian takes about twenty minutes of kneading on whatever body part he's decided is the most comfortable before he settles down for the night/morning and he always uses his claws.... Jester doesn't usually come to bed right away and always jumps on my stomach.... Plus, he likes to cuddle next to me with my arm kind of around him in an uncomfortable position. And Sage will wait until the boys have settled in before jumping into the pile and waking me up for the third time in the process.....

And if I try to sleep with the door closed and the kids on the other side, Jester will dig at the carpet under the door until it's shredded.

No, they're not spoiled at all......

o_O
 
Did a non-fasting check at +3 and heading for bed. Unfortunately, Jester's BG was still over 300.

Hoping to do a curve this weekend after a few days of 1.5U.

@Kris & Teasel - is Saturday too soon or would Sunday be better? Presuming 1.5U works out, that is.
There are some things coming up for me and if any of them work out it'll get harder for me to manage the strict routine involved in a full day of blood tests.
 
Ate you able to monitor today? Checking your SS but on my phone so may be a few moments...
 
Rachel said:
Ate you able to monitor today? Checking your SS but on my phone so may be a few moments...
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Yes, I can monitor.
FYI - the test strips I use are generic and tend to register about 10 to 20 lower than brand name strips.

I'm nearly an hour late on his shot now.
 
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Okay I think I’d maybe do 1.25 if you’re okay monitoring and steering with food if needed. It’s a gamble since we don’t really have data at this kind of number recently but I hate to see you lose momentum by reducing too much. How do you feel about that?
 
Rachel said:
Okay I think I’d maybe do 1.25 if you’re okay monitoring and steering with food if needed. It’s a gamble since we don’t really have data at this kind of number recently but I hate to see you lose momentum by reducing too much. How do you feel about that?
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A little nervous, but I'll give it a try.
Tyk
 
Up to you. You can go to 1 too if you want...no way to know what the right choice is. You hold the syringe!
 
To give some background on why I suggested that dose I looked at old data. Generally you don’t want to go back too far for dose advice but I wanted to see what’s happened before. Mid January you had done lower preshots and gave 1 unit or lower...and that never gave you a too low nadir. In fact it was high green or blue always. So now that you’ve got this almost a yellow preshot my thought was reduce a bit for safety but not much to see if we can push to a safe green nadir. I only suggested that because you can monitor. There’s no way to know what will happen but this will be good data either way.

That being said if you DO get a low number post here and on health. Not saying it’ll happen but there’s generally folks around if you need help.
 
Rachel said:
Check around +2. That should give a good indication. If t helps to know I would have done 1.25 if it was my kitty.
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tyk.

+2 will be at 11:40AM EST.

Hardest part about mornings like this is being able to take care of myself. Neither Jester nor Bastian will sit still to eat and Sage pushes the boys away from their food even when I give her something she likes. She gets stashed in the bathroom until everyone else is done (except me).

I have to "attend" to both Jester and Bastian just to get them to eat what they need to since they both have health issues.

And I have a nasty pain in my left arm that I'm supposed to be taking care of, but I can't until after the boys are done with all the morning stuff. The nurse wants me to "take it easy" with my arm and not do the things that gave me the pain in the first place. Unfortunately, one of those things is carrying around my tablet which I needed to do this morning in order to keep an eye on the forum to get advice on Jester's dosage.
Besides that, I'm supposed to take ibuprofen for the pain, but can't do it on an empty stomach. And with all the flurry around Jester's dosage and food, along with Bastian's goofy eating habits, I didn't get anything to eat until just a few minutes ago. Almost completely forgot about taking the ibuprofen too.

:::sigh::::
 
@Rachel - should I plan to check Jester's BG today as if I'm doing a curve? Or am I just checking sporadically after the +2?
I had planned one for this weekend, but - of course - that's likely going to have to change now.
 
The +2 should tell you if you’ll need to check more often or not. I’d definitely plan for a nadir as well though...
 
+2 was 124 - non-fasting, but he didn't eat a lot.
He only just asked for more food a few minutes before the testing.
 
Great number! It’s fine that he ate...you want him eating like normal today. I’ll be interested to see where he goes!

I have to run an errand on lunch so I’ll be out of pocket for a bit. Still post if you need..usually someone is around. :)
 
And this is where it gets tricky.
Jester is giving me problems feeding him. He's eaten less than half a can of food so far today. He's sitting like he wants me to feed him, but won't eat the food I set down in front of him - won't even sniff it.

This is why I get nervous about changing his dosages.

EDIT: Jester can be a real momma's boy sometimes. I guess he was still upset about two BGs in a row with that stall this morning. I picked him up and cuddled him for a few minutes, then set him back down.
I still had to heat the food a little, but he settled in and ate more than half a can of his medium carby favorite afterward.
 
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Haha he knows what he’s doing doesn’t he?? How is he now? You’re nearing +5 right? I’d grab a test and see how things are going.
 
+5 was nearly fasting and BG is 62.
Remembering that I use a human meter and generic strips - the strips go about 10 - 20 *under* the reading of the OEM strips.

So conservatively his BG is more likely between 80 and 100, yes?
@Rachel
 
Wow! If your strips stay consistently below normal ones than yes that sounds like really 100 or so. Since he’s eating some he should be good...but keep an eye and I’d get another test at +6 to be sure he’s staying up there. I’m guessing +6 is his nadir?
 
Rachel said:
I’d get another test at +6 to be sure he’s staying up there. I’m guessing +6 is his nadir?
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That's a good question.

It hasn't been consistent. I've only done one curve on him.

+6 is less than an hour from now though.
 
@Rachel - another good question is: What about Jester's 2nd dose for the day?

What would I use to determine an appropriate dosage for tonight?
I've been doing the equivalent of a curve today with all these checks, although I know it's not considered legit because this was done to monitor rather than determine how things go with his regular dosage.

If his BG is either close to what I got this morning or higher, should I keep him on 1.25U and monitor again? (That would be *really* hard because he won't get his second shot until around 9:00PM.)
If it's much lower (and how much lower), should I reduce to 1U and just do a +4 to make sure everything's going okay?

I only ask these because I really need to get his shots earlier in the day than nearly 10:00AM/PM and Friday night is a bad one to ask for advice on short notice.
 
That’s a good number. Might get a +7 and see if he’s headed back up and if so can probably take a testing break then.
 
It’s hard to say what to do for tonight. I probably won’t be around...if you’re not okay monitoring and get a low # you could reduce and grab a +2 to see if he’s dropping fast..
 
Rachel said:
That’s a good number. Might get a +7 and see if he’s headed back up and if so can probably take a testing break then.
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Whoops! Too late for a +7 now.

But he's been getting very cranky about all the testing. Almost none of the tests have gone smoothly with a single poke getting the blood I need.

And I can't risk using neosporin w/ pain relief. My cats love to groom each other and that stuff is toxic to animals.

I think I'm going to go on faith for the rest of the cycle.

Thanks for all your guidance today.
 
@Djamila or @Kris & Teasel - will you be around in around three to four hours (between 8:00 and 9:00PM EST) just in case I need some advice / guidance about Jester's dosage tonight?

One of the last times Jester's BG was this low at +6, the vet had me suspend insulin for a few days until his AMPS was above 150 again. (That was in early December, btw - 08-Dec-2017.)
 
shelaghc said:
@Djamila or @Kris & Teasel - will you be around in around three to four hours (between 8:00 and 9:00PM EST) just in case I need some advice / guidance about Jester's dosage tonight?

One of the last times Jester's BG was this low at +6, the vet had me suspend insulin for a few days until his AMPS was above 150 again. (That was in early December, btw - 08-Dec-2017.)
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Just seeing this now. Yes, I'll be around. Nice greens today.
 
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