? Finally! BG below 150 - dosing advice for tonight?

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It's really not necessary to try to guess what the numbers might be on the different strips. Basically all we need to know is too high, too low, and the amount of change between pre-shot and mid-cycle. So whether it's up or down by some random amount really doesn't make any difference. The only time it might matter is around 50. If you get below that, you could grab the OEM strips to get a more accurate read. But whether a number is 290 or 320 really doesn't make any difference in how we decide on a dose. Either way it's too high. And if the difference between pre-shot and nadir is 120 points or 90 points really isn't that significant either. So I would say to just stick with the generic strips (once they arrive) unless there is a low number, and not drive yourself crazy thinking about what it might be on a different strip or different meter. There is enough to worry about with managing all of this without adding to the stress :)
 
I'm with Djamila. It's hard enough to handle this without all the adjusting numbers. To an extent, what we're looking for is patterns so the numbers don't matter as much unless they're too low. Other than that they're so similar it really doesn't matter which strips you use as much.
 
Even more disappointing - PMPS was 339.

We're back to high numbers again.

What could be causing this?
I raise the dosage, his BG goes down and within a day or so it starts going back up again.
 
Even more disappointing - PMPS was 339.

We're back to high numbers again.

What could be causing this?
I raise the dosage, his BG goes down and within a day or so it starts going back up again.
He's sensitive to the lower mid cycle numbers so he bounces back up for pre shot. It's a fairly common pattern with bouncy cats and its their unique physiology that makes them bouncy. Not much you can do about it. Some calm down eventually and some don't. Mine is one of the latter and I've learned to live with it.

The mid cycle numbers are still blues so that means you can try an increase to 2 u whenever you feel ready.
 
I just started a new thread about a possibility that a vet and I were discussing back in December - that Jester's insulin might not be effective enough.

He just wasn't this dramatically bouncy before the new vial we started on 12-20.
 
Today's AMPS is about the same as yesterday - 285. I just wish it would go down to the mid to lower 200s and stay for a while.....
 
Well, yellow is better than pink, but looking at your mid-cycles, I would suggest moving up to 2u whenever you're ready. I know it sucks to do increases, but sometimes they start getting a little insulin resistance and the increases can break through and bring them back down again. At least that's always the hope.
 
Well, yellow is better than pink, but looking at your mid-cycles, I would suggest moving up to 2u whenever you're ready. I know it sucks to do increases, but sometimes they start getting a little insulin resistance and the increases can break through and bring them back down again. At least that's always the hope.
It's going to get harder to do increases in about two weeks unless it's on a weekend.
I'm starting a job the first Monday of March and won't be able to monitor during the week.

And the vet doesn't believe in giving doses higher than 2u - he prefers increasing the number of dosing instead to every eight hours. There's literally no way I can do that if I have an eight hour a day job.
 
That's just silly. You need and deserve a life...and dosing every 8 hours isn't likely to work with that. You'd never get any rest! I'd say increase instead of going to every 8 hours personally.
 
I'm still crossing my fingers that Jester's BG will come down before I need to do some totally contrary to what the vet says.
He's on 1.75u now and the numbers aren't horrible.
Since the vet is mostly seeing both Jester and Bastian for free (and they work with me when there *are* costs), I'd rather he not know if I'm not actually listening to him.
 
I'm wondering if he's just suggesting that as a very short term thing to get Jester's BG lower and more under control. I've brought up how difficult (or impossible) such a schedule can be and he just says to either go for 2u every 12 hours or something like 1.25u every 8 hours.

All these conversations are via email though. It's hard to get hold of him because he's semi-retired and only works a few hours each week. And that can make a meaningful conversation difficult.
 
I'm wondering if he's just suggesting that as a very short term thing to get Jester's BG lower and more under control. I've brought up how difficult (or impossible) such a schedule can be and he just says to either go for 2u every 12 hours or something like 1.25u every 8 hours.

All these conversations are via email though. It's hard to get hold of him because he's semi-retired and only works a few hours each week. And that can make a meaningful conversation difficult.
Why not follow the advice of people here on the forum and carefully increase his dose while sticking to every 12 hours dosing? Almost every one of us here had to go against vet advice in order to get our kitty’s BG under better control. Better numbers on your SS can be the evidence later on if you feel you have to justify what you did.
 
And if you're emailing with the vet, you don't have to tell him - at least for awhile. See how it goes and how Jester progresses and then if you need to later you can talk with the vet about it.
 
Well, I do send him a simplified version of the ss in pdf format including Jester's dosage.

Speaking of which, I just reluctantly increased him to 2u today. His AMPS was 299.

:(

Part of me wonders if I should try 3 shots a day for just a couple of days while I'm still unemployed and readily available. Obviously I wouldn't be able to sustain that for long - or I'd have to adjust after a while to no less than eight hours between.

It's a thought anyway....
 
It is possible if you want to give it a try for a couple of weeks. What 8 hour intervals will work for you - make sure you can do those times every day between now and then. I'd recommend starting tomorrow since you only have until the beginning of March, and it takes a few days for their bodies to adjust to the change in hormone flow, and also it will take some experimenting to find what dose works best for him at those intervals.

Make sure you have a large supply of testing strips and lancets. You will need to do frequent testing during this experiment, and you can only shoot when you know he's rising since 8 hours is before the typical duration of prozinc - which means you'll need to find his new nadir, and also be testing enough to be sure he's on a rise before the next shot. I would say a plan on at least two mid-cycle tests each cycle. That includes the middle of the night cycle. That can be decreased over time, but since we're only talking about two weeks, it's unlikely that you'll be able to do less than that.

Here are the directions from the sticky:
DOSING EVERY EIGHT HOURS

If your cat is consistently having an early nadir and the level is consistently rising 6-8 hours after the shot, the insulin may not be lasting long enough. You might consider shooting more often than every 12 hours. BUT PLEASE BE AWARE: This method is very hard on the caregiver because you need to be available to monitor more often and to shoot every 8 hours. If you can’t make that kind of commitment, don’t try shooting every 8 hours. But if you do decide that your cat’s situation warrants trying this, here’s how it’s done:
  • First, divide the total amount of insulin you are already giving over 24 hours by 3.
  • Then divide your 24 hour schedule into (3) eight hour sections.
  • The first time you attempt this it’s wise to do start during a curve, checking the BG levels every 2 hours.
  • If, by +8, the levels are rising, no longer falling, and to a level above your No-Shot range, you could give another shot.
  • Then wait 8 hours, test to be sure the level is rising, not falling, and is above your No-Shot range and give another shot.
Often this method is not long term, but allows the levels to stabilize in a few weeks. Make sure you only try this method with the guidance of this forum’s members and your vet.

I'm leaving on a trip for work tonight, so will likely not be online a ton over the next few days (although I might if it turns out the conference is boring ;)), but if you're going to do this, I would suggest getting started asap since you have a limited window before you start your new job. (congrats on that, by the way!!!)
 
Crap - I just increased to 2u and planned to see if that made a difference in the next few days.
 
Well honestly, if it was me, I wouldn't do the 3 times/day thing. But if you want to do it, we can help you give it a go.

Personally, I think 2u twice/day is the better route. :)
 
Well honestly, if it was me, I wouldn't do the 3 times/day thing. But if you want to do it, we can help you give it a go.

Personally, I think 2u twice/day is the better route. :)
It just seems like I increase marginally, his BG goes down for a day or so, then starts going back up again as if his body gets used to the mini-increase.

I just took his +2 and he's barely gone down at all.

I feel like I need to do something drastic - like a larger increase to sort of shake things up instead or this 3x a day thing.
 
You can do increases every 3-6 cycles, so you could move up more quickly if you'd like. Many folks like to do increases on the 4th cycle so that they are always increasing in the morning.
 
You're really not that far off right now. A good cycle is about a 50% drop from the pre-shot number. More than that and you can end up with bouncing. Also, for many cats a +2 test is recommended, but I tend to prefer a +3 so there is time for the food bump to clear and the insulin to begin its work. A +2 is great if you're leaving, because you can see if there is something dramatic going on, but if you're going to be home anyway, I like waiting a little longer.

It also really depends on the cat and how long it takes your specific kitty to start to respond to the injection. The +2 is a good barometer of upcoming storms, but the +3 is sometimes a more interesting number. It's really just up to you which serves your purpose better, which matters most for your kitty, and whcih fits your schedule and plan for the day.
 
You're really not that far off right now. A good cycle is about a 50% drop from the pre-shot number. More than that and you can end up with bouncing. Also, for many cats a +2 test is recommended, but I tend to prefer a +3 so there is time for the food bump to clear and the insulin to begin its work. A +2 is great if you're leaving, because you can see if there is something dramatic going on, but if you're going to be home anyway, I like waiting a little longer.

It also really depends on the cat and how long it takes your specific kitty to start to respond to the injection. The +2 is a good barometer of upcoming storms, but the +3 is sometimes a more interesting number. It's really just up to you which serves your purpose better, which matters most for your kitty, and whcih fits your schedule and plan for the day.
Funny thing - I was just thinking this morning that I'd rather +3 and +5. But +2 and +4 seemed to be the standard.

Do you think a +5 would be okay now?
 
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+2 and 4 are pretty standard, but every cat is different, and every bean is different, so it's okay to shift those and see if it will give you more helpful info.
 
134 at +5 fasting.
This is now pretty standard.
I increase the dosage by .25u; his BG goes down to yellow / blue numbers for the cycle. And I fully expect in two days to be getting pink numbers again.....

:(

I was so excited about Bastian's good news and hoped things would start looking better for Jester too.
 
Instead, it just seems to keep getting worse.
I just took a +4 on Jester. PMPS was 283; +4 is 328.

This is nuts.
 
Give 2 units a chance...you can always increase if it doesn't work. And if you decide you want to try 3x a day, let us know and we can help you figure it out.
 
311 this morning.
218 at +3
Nothing new. This happens every time - in fact, generally he used to down to blue numbers.
 
+5 was 143
PMPS was 302

Neither were out of the ordinary for what's been happening on a new higher dosage.

Planning to do a +3 to see what's up before bed tonight.
 
This makes no sense to me.
I just did a +3 and Jester hasn't eaten for about two hours.
The reading was 332!

How can his BG be *highet* than his PMPS?!
 
This makes no sense to me.
I just did a +3 and Jester hasn't eaten for about two hours.
The reading was 332!

How can his BG be *highet* than his PMPS?!
He’s bouncing. The precise pattern of a bounce can vary from one bounce to another. His BG profile today was a classic smile shaped curve with nadir about 50% of the PS values. Yes, ideally the whole curve can come down but it isn’t bad. You’ll drive yourself nuts trying to figure out every number. Focus on trends.
 
He’s bouncing. The precise pattern of a bounce can vary from one bounce to another. His BG profile today was a classic smile shaped curve with nadir about 50% of the PS values. Yes, ideally the whole curve can come down but it isn’t bad. You’ll drive yourself nuts trying to figure out every number. Focus on trends.
I guess I just don't see what you're seeing.

All I can see is that no matter what dosage I give him, his numbers are staying nearly the same.
 
I guess I just don't see what you're seeing.

All I can see is that no matter what dosage I give him, his numbers are staying nearly the same.
Actually your doses have all fallen within a narrow range from (mostly) 1 to 2 u. If you'd been going from, say, 1 u to 6 u and seeing very little change that would be a very different situation.
 
The vet wanted me to go up by a half a unit. Everyone here told me to go up by .25 units.

Are you saying I should have done the half unit instead? Should I go up to 2.5 next then?
 
The vet wanted me to go up by a half a unit. Everyone here told me to go up by .25 units.

Are you saying I should have done the half unit instead? Should I go up to 2.5 next then?
No, I didn't say that. I was just pointing out that the range of doses you've been trying and assessing has actually been very narrow. We recommend dose changes of only 0.25 u because a small amount of insulin can make a big difference in a cat. It's your call: if you want to increase tomorrow, try 2.25 u. You can also stay at 2 u a bit longer. If a cat is bouncy and volatile in his responses you won't often see a smooth progression up a dose ladder that gives you an ever better BG range. They respond in fits and starts, stay stuck for a while, leap ahead in response and throw a green, etc. That's the way it works for them.

If you want to try for flatter and lower numbers you might have to move to a depot insulin like Lantus and, even then, there's no guarantee that everything will become simpler. I can certainly attest to that with my cat.
 
Cautiously optimistic - +6 was 99.
I could tell by the way he's been behaving this afternoon that something was different. Way more cuddly and hanging out in the livingroom more than he has been.

I'm hoping this is the break Jester and I have been waiting for.

@Kris & Teasel @Djamila is this anything to be concerned about right now?
I have a doctor's appointment and have to leave in less than an hour. Won't be back until 6:30ish ET.
 
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Cautiously optimistic - +6 was 99.
I could tell by the way he's been behaving this afternoon that something was different. Way more cuddly and hanging out in the livingroom more than he has been.

I'm hoping this is the break Jester and I have been waiting for.

@Kris & Teasel @Djamila is this anything to be concerned about right now?
I have a doctor's appointment and have to leave in less than an hour. Won't be back until 6:30ish ET.
He should be OK.
 
PMPS - 268

Now the fun. He only wants to eat carby foods......
Because he was over 200, I still gave him 2U and I'll check him at +3 - hopefully fasting since that's what he'll be doing overnight. But he left the eating area already having eaten just a smidgen of lower carb pate.

I'll try to tempt him in a few minutes.
 
@Kris & Teasel or @Djamila - Just did a +3 on Jester.

PMPS was 268
+3 was 246

But he hasn't eaten much since I gave him his 2U of insulin.

Do you think it's okay for me to go to bed on the strength of the previous numbers? Or should I hang around until 2:00AM for a +5?
 
I did - although I didn't wind up getting to sleep until after 2:00am anyway.

And the good news is:

AMPS - 193!

So do I stay at 2u this morning? Or do I reduce?
That's a call you have to make. He's close enough to the 200 no shot number that you could reduce a little back to 1.75 u or you can try the experiment of giving 2 u to see how it plays out. Get that predictive +2 test of course and monitor more if it shows a significant drop. This "envelope pushing" is how we figure out how much we can lower the no shot number. Most of the time it can be lower than 200 after you have enough data.
 
I’d be awfully tempted to stay at 2 if you can monitor. Now that you’ve got this momentum going I’d want to keep it up. It’s totally up to you but that’s what I would do if he was mine. :)
 
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