? Too low to dose

RRaptor

RRaptor

Member
Olivia was too low to dose this morning. I'm working during the day and unable to get any midcycle tests during the day, but I check at night. I went up to 3u last night and everything seemed fine, but she was too low AMPS and was in the pink by PMPS, but I cut back down to 2.5 this evening. I meant to ask earlier, but it's been hectic. Right call? Better advice for the future?
 
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Still not sure exactly what's going on here, but I've started hiding the dog kibble containers since she's knocking them down to get them open and steal food.
 
I meant to get a mid cycle last night, but fell asleep. 228 AMPS so I dropped to 1.75 because I'm nervous. I guess I'll see by pmps if it's too low/high
 
I understand your nerves. :) If you feel braver next time you have a low 200s PS you can try giving the full dose and test at +2 to see where she might be heading. If that's still too drastic for now, try lowering by only 0.25 u. These experiments are what teach you a lot about your kitty's responses and they build your dosing confidence.
 
Whoops! Well hello Olivia...decided to drop lower than normal tonight, eh? Yeah 175 is basically the same as 189...you can call them the same since they're so close. Definitely want to drop the dose like Kris suggested!
 
RRaptor said:
Approximately what +2 numbers would indicate I can safely go to sleep?
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If the drop at +2 is about 50 points or less you *should* be OK but one more test at +3 would be worth doing if you can stay up. If the drop is more than that try feeding a small snack of her regular low carb food and test again at +3.
 
I think that’s a great idea! When is her usual nadir? Looks like maybe a little early, maybe +5?

(I use a human meter, btw, so I’m used to seeing lower numbers.)

PS. our internet is misbehaving but hopefully is back up steadily now. Will be checking in on you and Olivia.
 
Probably around +5 or +6, though I don't have a lot of +7 data. These are "good" numbers, but numbers that make me nervous to go to sleep!
 
Yep, totally get it. Was there myself just last night! :) (And now of course am sad that she’s in the yellows.)

I think your next test is on the hour? Will certainly be here. (Internet seems steady again.)

How much of a snack did she get?
 
She ate about 2/3 of a can of friskie, I let her stop when she was ready. I feel great about yellows after DKA and all the black/red.

I think I'll try to get a +5 instead of testing now since she ate so much?
 
Oh, I’m a data junkie :) so if she tolerates the tests well (or likes to be bribed with treats!), i’d get one. I think it’s helpful for “next time” to see the impact of food, which I think starts hitting the BG about 15-20 mins after it’s eaten.

Is Friskies 5.5 oz? If so, then she ate about 3-4 oz?
 
Jenna Josie said:
Oh, I’m a data junkie :) so if she tolerates the tests well (or likes to be bribed with treats!), i’d get one.
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I want to test all the time, and I want to test the civilians too! I am, however, using the AlphaTrak and I'm low on strips. I think I'm going to try to pick up a human meter tomorrow. My wife is very frustrated with the cost of things and hopefully that will alleviate some of it and I can get all the information.
So, with (hopefully) no current danger I can wait.

Yes, 5.5 oz cans. I would say your estimation is pretty spot on. I left the rest out for her or the other kitters.
 
If you’re almost out, then a +5 it’ll be! On one hand, now that the dose is hitting, the difference from the +3 might be on the larger side, but OTOH, she ate a good snack, so I would expect that might help her hold steady.

RRaptor said:
Yes, 5.5 oz cans. I would say your estimation is pretty spot on..
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But only bc I edited the post before anyone saw that my math was wrong. :D

I’ll be here for your +5.

(Also, we use the Relion Confirm. My vet recommended going with whatever had the less expensive strips and that the patterns were more important than the numbers. That works except that I do have to remind him that we are using “human numbers” when I give him updates.)
 
Well, her numbers should be coming up soon now in any case as (I think?) she's nearing +6, but just in case, the protocol would be to feed her like a tablespoon-sized snack and then re-test in 20 minutes until she gets into the "Good Greens" (as opposed to the lime, "take action" greens). If her numbers after 20 minutes are coming up, then test again -- without feeding -- in an hour to make sure she's holding her own. If they are not, then feed again, re-test in 20 minutes, etc. If they're low, then if you have some HC food, feed that. If you have some kind of gravy HC food, you can take off the lid and then lay it back onto the food to kind of squeeze out the gravy and feed her a teaspoon or so of the gravy.

If she went into the limes, then I believe that means she earned a dose reduction for her next shot (tomorrow AM's shot), but this is where I get a bit confused bc after a low cycle, especially if she went into the limes, her next PS number will probably be high due to a bounce, so reducing always feels counter-intuitive even though I know that the shot is based on the previous cycle's nadir as well as the PS number.

(Maybe you already know all this? If so, sorry! I didn't when I was newer than I am now.)

I am tagging @Caitlin M as I think she is here, and it is past my bedtime. Hopefully she can weigh in and clarify that/provide additional information if necessary.

I hope Olivia is doing okay!
 
Jenna Josie said:
@RRaptor Were you able to get the +5? I am a little worried not to see you. I hope everything is okay?
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Thank you for staying up and for your concern! I lay here until nearly test time and then I must have fallen asleep. I just woke up and it is +7. Olivia appeared fine and tested at 222. She was asleep and seemed annoyed, then went to the food bowl where there was still a bit of the friskies left and began to eat.

I imagine the 222 is a bounce or she had just eaten a bit. I'm very curious about our AMPS numbers.
 
Well your AMPS is definitely a bounce. With that in mind I think I’d probably go 2.25 if you can since 2.5 brought her too low on a pink.
 
I like this meter: https://www.adwdiabetes.com/product/8177/agamatrix-presto-blood-glucose-meter-kit-and-strips

It's cheap and ordering online makes it easy for me (as long as I remember to order well in advance of running out!). If you have a Kroger grocery near you, the test strips are the same as their store brand, so in a pinch you can pick up a box. The downside of this meter is that it takes a .5 blood sample instead of a .3 like some of the meters, but it's cheaper and my kitty bleeds easily enough that it works for us.
 
Well, I suck! I was on here earlier and there was no alert about being tagged! I'm so sorry but so glad that others were here to guide you.
 
@Caitlin M it's alright!

Liv was up to 471 PMPS, but the dog brought out some contraband while we were at work so I'm not sure if it's that, bounce, not enough insulin. I stuck with 2u this evening and I'll check her before bed.
 
Yikes. Looks like you'll have to be very careful about the dog food/treats. That can definitely be a cause of high numbers in cats around here. Especially as we cut carbs out of their regular diet, they get pretty sneaky about finding ways to steal them from other pets.
 
I bought a human meter last night, but haven't updated my spreadsheet. PMPS was 597, +3 was 331. AMPS is 324. Should I stick with 2 for a few more cycles? Is it dropping her too quickly?
 
Hi. I hope someone who can answer your question with more experience hops on to weigh in, but she doesn’t seem ever to drop more than 50%, so if that were to happen today, I would think she’d still stay in the mid blues around nadir?

(When you do put your recent data in, I think it would be helpful to put in a highlighted row that shows you’re changing to a human meter and indicate that in the highlighted row. See JanetNJ’s SS and how she showed her insulin change a couple of weeks ago.)
 
RRaptor said:
I bought a human meter last night, but haven't updated my spreadsheet. PMPS was 597, +3 was 331. AMPS is 324. Should I stick with 2 for a few more cycles? Is it dropping her too quickly?
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No, her numbers are too high overall and that's a concern with a recent DKA. I'd try 2.25 u both AM and PM for a few cycles. If you don't see better nadirs on that, increase to 2.5 u. She seems to be a kitty who'll drop lower periodically and that can make dosing more complicated. I have a lot of experience with this! ;) As hard as it can be you need to focus more on overall trends in numbers and past the odd low bits to decide on a dose. I'm also a fan of keeping the dose the same AM and PM unless the data shows you otherwise. If a kitty is a little volatile - and Olivia is - frequent dose changes can aggravate that.

Re "no shot" if appetite is off: it's best not to skip insulin, especially in a kitty who has had DKA. ProZinc is slow enough in onset that you can give even a reduced dose and try to get her to eat a few teaspoons of food before about +2 or +3 when the insulin is kicking in. How much to reduce the dose is always tricky to figure out. That's where lots of data from other "dose reduction" experiments helps. You just have to try something to see what happens. Maybe 50% of the normal dose would be a starting point. Worst case is that you have to prop her up with some higher carb food. We say often here that it's extremely rare that a kitty who is being monitored the way we (and you) do has a symptomatic hypo. DKA is by far the more dangerous thing.
 
Unfortunately, I had to leave for work before I recieved your guidance this morning and I went ahead and shot 2u. 302 was PMPS and down to 187 at +3.5 on 2.25u.
 
317 AMPS. 233 PMPS. Shooting 2.25 right now. I started a new spreadsheet because I'm not sure how to merge the two, but I've got them both in my signature now.
 
I think that's a good choice for the dose. That yellow after a pink in the AM tells me that the insulin may have brought her to a very nice number at nadir! Get what mid cycles you can this weekend (if you can...I can't remember who has to work weekends and who doesn't) and let's see if an increase is needed or not. If you could get mid cycle tonight or tomorrow, that would be especially helpful since you could then raise the dose and still have a day or two to see how that works out for her.
 
She was pretty steady throughout the day and didn't get too high PMPS. I think earlier high numbers were because she figured out how to open the dog food storage containers. Now everything is stored more securely and I think I'll see better patterns now that she and the dogs are not in league to get contraband.
 
RRaptor said:
I'll see better patterns now that she and the dogs are not in league to get contraband.
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Why can’t we all just get along? Or, when we do, use our powers for something other than mischief!

It may be helpful in the future (if you see another pattern like this one) to put your contraband suspicions in the remarks section on the SS. This is the exact thing that I always am positive I’ll remember and then never do. :rolleyes: Writing it down sure helps.
 
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