Dosing advice

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Douglas_my ginger cat

Douglas_my ginger cat

Member Since 2020
Hi,

In the last two days, the vet and I agreed (upon my recommendation, prior to us blaming the vet;)) to increase Douglas' dose to 2.75IU twice daily, however from speaking to a couple of you on here and also from his results in these days, can I have some advice if this was a good idea?

I have been unable to administer insulin the last two evenings as his PMPS reading has been under 10. I haven't been able to stall due to time restrictions, however would not be comfortable administering the insulin even if the next reading (20 mins later) was up by a couple of points.

I am conscious that the consistency of the insulin has been all over the place with only 3 days in the last week when I gave insulin twice. Any thoughts or ideas?
 
Hi Anna,

Sometimes when you get 'lopsided' preshot BGs it can help if you drop the dose down to a level that allows you to give insulin on both cycles. I'd suggest discussing with your vet whether dropping down to 2.25IU Caninsulin BID might help things (and maybe help a bit with the bouncing??), or switching to a gentler, longer-acting insulin. With current UK veterinary drug regulations I guess that would have to be Prozinc first.

I'm tagging @Panic to ask her to look at Douglas' spreadsheet and perhaps give you an idea of whether a switch to Prozinc might help improve his regulation. (I've not used Prozinc so can't help on that side of things.)


Mogs
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Hi Anna, you already know my thoughts, I think. :bighug: ...My feeling is that lowering the dose might enable you to shoot twice a day, have insulin in the system for more of the time, and help even out the numbers somewhat...
I also think Douglas is producing more insulin of his own and has become able to extend the insulin cycle at times. But the body may find it hard to deal with the skipped shots while the pancreas is still just healing....
 
Yes, ditto to what Elizabeth says - lowering the dose makes more sense at this point. Even if you still get higher than ideal PS numbers, the longer Douglas has insulin in him the better - skipping isn’t doing him any favours. If you can start to dose twice a day, you may find that pre shot numbers start to come down and then you look at the data mid cycle and consider the dose again then.

I don’t know how you tell your vet that you’re going to reduce (if you do) but you seem to have a good relationship so if you explain the logic from what you've learnt, you may be ok!
 
Absolutely makes sense to decrease, the skipping of shots is making me nervous just as his numbers are jumping up and down a lot and I don't know what damage this could do in the long term.

I am definitely hoping that Douglas is starting to produce his own insulin too and getting that one step closer to being regulated. Although I NEVER thought I would get yellow, let alone blue numbers so early on. I am going to drop to 2.25 from tomorrow and let my vet know - always better to ask for forgiveness then permission...right?:woot:
 
Douglas_my ginger cat said:
Absolutely makes sense to decrease, the skipping of shots is making me nervous just as his numbers are jumping up and down a lot and I don't know what damage this could do in the long term.

I am definitely hoping that Douglas is starting to produce his own insulin too and getting that one step closer to being regulated. Although I NEVER thought I would get yellow, let alone blue numbers so early on. I am going to drop to 2.25 from tomorrow and let my vet know - always better to ask for forgiveness then permission...right?:woot:
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Good decision!
BTW have you tested again since the 8.8 at +12? Just to be absolutely sure he’s not still dropping?
 
Douglas_my ginger cat said:
Oh no, I didn't think to test him at that time! I just tested +13 and its at 11.1 (this is food influenced)
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Ok that sounds safe. If it was me I’d probably test again before bedtime just for reassurance. A highish dose this morning coupled with his longer than usual duration (poss because his pancreas is coming out to play) means nothing is certain. And it’s always useful to have the data.
 
Douglas_my ginger cat said:
Hi @Diana&Tom , @Elizabeth and Bertie , @Critter Mom , @jt and trouble (GA) , @Panic

Douglas' PMPS is low again today at 8. I am going to stall for 20 mins and try again but I don't think I will administer insulin regardless of result. He did get a lower dose today of 2.25IU this morning, am I expecting changes (ie higher numbers PMPS) to quickly?

Any advice would be greatly appreciated
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Hmm it does look as if he’s producing some insulin of his own. It’s unusual for Caninsulin to have such long duration otherwise. It may not be ideal that you can’t shoot again tonight but look at the bigger picture of him being in much nicer numbers than when you started out... this is real progress! I’d get another test in this evening to see what direction he’s going in, and then you’ll just have to take the situation in the morning as it comes. I don’t feel qualified to give specific dosing advice but see what the others say about a dose in the morning perhaps. I’d expect him to be in the reds again but who knows!
 
Diana&Tom said:
Hmm it does look as if he’s producing some insulin of his own. It’s unusual for Caninsulin to have such long duration otherwise. It may not be ideal that you can’t shoot again tonight but look at the bigger picture of him being in much nicer numbers than when you started out... this is real progress! I’d get another test in this evening to see what direction he’s going in, and then you’ll just have to take the situation in the morning as it comes. I don’t feel qualified to give specific dosing advice but see what the others say about a dose in the morning perhaps. I’d expect him to be in the reds again but who knows!
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Looks like its the same cycle and his number will be red again in the morning.

Do I almost need to decrease the dosage again by a larger amount (@Diana&Tom I know you don't feel qualified to give out dosing advice, this is more me talking out loud)
 
Douglas_my ginger cat said:
Looks like its the same cycle and his number will be red again in the morning.

Do I almost need to decrease the dosage again by a larger amount (@Diana&Tom I know you don't feel qualified to give out dosing advice, this is more me talking out loud)
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He’s only going up slowly so far isn’t he, but he will most probably start rising mote steeply soon.
Strictly speaking we’d usually say don’t mess about with dose too much in a short time, to give any new dose a chance to settle and be reflected in bg numbers. But the aim is always to keep insulin in the system so you don’t want to keep skipping. This is where you need the peeps who have a lot of hands-on experience and knowledge. Mogs doesn’t seem to be around today but may be later, or one of the others you tagged in your earlier post may comment. I think though if you do decrease the dose, it should only be in small increments at a time. I must admit that my instinct would be to try 2u tomorrow and see what that does. We’re all only guessing really until we hit a dose that seems to do what we want it to at that point (it may well change again).

Sorry I can’t be more helpful but that’s me thinking out loud too!
 
Diana&Tom said:
He’s only going up slowly so far isn’t he, but he will most probably start rising mote steeply soon.
Strictly speaking we’d usually say don’t mess about with dose too much in a short time, to give any new dose a chance to settle and be reflected in bg numbers. But the aim is always to keep insulin in the system so you don’t want to keep skipping. This is where you need the peeps who have a lot of hands-on experience and knowledge. Mogs doesn’t seem to be around today but may be later, or one of the others you tagged in your earlier post may comment. I think though if you do decrease the dose, it should only be in small increments at a time. I must admit that my instinct would be to try 2u tomorrow and see what that does. We’re all only guessing really until we hit a dose that seems to do what we want it to at that point (it may well change again).

Sorry I can’t be more helpful but that’s me thinking out loud too!
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This is my thinking too, its been 3 days now in a row that only a morning dose has been given. It makes sense to me to go back to a dose that allows me to shoot twice a day and work from there.

I will see if anyone else offers any other advice in the meantime

Thank you!!
 
Hi Anna,

Only just seen this (got a lot of stuff to sort out for my civvie, Lúnasa, at the moment).

With the blues you're getting, I think you need to find out what's happening mid-cycle during the day. Those low PMPS values concern me because it's possible Douglas might be going even lower when the dose is at peak effect. Speculating here but I do wonder whether the rise you see in the PM mid-cycles and then the high AMPS the following day could potentially be a bounce, either from the low PMPS value or, potentially, from an even lower AM cycle nadir. Also, Douglas is going through some really big drops on the AM cycles of late (speed and magnitude not known without the mid-cycle readings). Big drops can also trigger big bounces.

As a precaution, it might be a good idea to drop the dose down again and see how that goes. Also if you could get some AM mid-cycle tests tomorrow that might help you get a better picture of what's going on.

Note: Particularly when a cat starts seeing lower numbers on Caninsulin then by and large you may need to ignore high PS values when determining the safety of a dose because a dose that can drop a cat from, say, high yellows down to mid-low blues can also be capable of yanking down reds to mid-low blues.

Caution needed.


Mogs
.
 
Critter Mom said:
Hi Anna,

Only just seen this (got a lot of stuff to sort out for my civvie, Lúnasa, at the moment).

With the blues you're getting, I think you need to find out what's happening mid-cycle during the day. Those low PMPS values concern me because it's possible Douglas might be going even lower when the dose is at peak effect. Speculating here but I do wonder whether the rise you see in the PM mid-cycles and then the high AMPS the following day could potentially be a bounce, either from the low PMPS value or, potentially, from an even lower AM cycle nadir. Also, Douglas is going through some really big drops on the AM cycles of late (speed and magnitude not known without the mid-cycle readings). Big drops can also trigger big bounces.

As a precaution, it might be a good idea to drop the dose down again and see how that goes. Also if you could get some AM mid-cycle tests tomorrow that might help you get a better picture of what's going on.

Note: Particularly when a cat starts seeing lower numbers on Caninsulin then by and large you may need to ignore high PS values when determining the safety of a dose because a dose that can drop a cat from, say, high yellows down to mid-low blues can also be capable of yanking down reds to mid-low blues.

Caution needed.


Mogs
.
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Hi Mogs, thank you for replying

You are absolutely right about needing to test throughout the day. I will be home at the weekend so can get this data together.

I gave Douglas 2IU this morning, just in case. It didn't occur to me that his numbers may go even lower throughout the day, but that makes perfect sense. doh!
 
Douglas_my ginger cat said:
Hi Mogs, thank you for replying

You are absolutely right about needing to test throughout the day. I will be home at the weekend so can get this data together.

I gave Douglas 2IU this morning, just in case. It didn't occur to me that his numbers may go even lower throughout the day, but that makes perfect sense. doh!
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Yes without other readings in context of whether it’s higher or lower than the last one, you can’t see what a single reading means. That’s why I’ve been saying test again in the evening after your +12 no-shoot readings... Douglas may have been still dropping. Can’t take anything for granted!

A curve at the weekend on a lower dose will be very interesting.
 
Nice curve today Anna and interestingly, almost identical to the one on 13/9 on a slightly higher dose.
Are you going to dose tonight?
Are you planning a curve on another dose tomorrow?
I wonder what others think...
 
Diana&Tom said:
Nice curve today Anna and interestingly, almost identical to the one on 13/9 on a slightly higher dose.
Are you going to dose tonight?
Are you planning a curve on another dose tomorrow?
I wonder what others think...
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Hi Diana,

I am planning on dosing tonight, todays curve was very good but that was on a 2.25IU dose. Should I increase the dose tomorrow already? With the last few days, I'm a little confused with dosing now.

Tomorroe is a curve day too
 
Douglas_my ginger cat said:
Hi Diana,

I am planning on dosing tonight, todays curve was very good but that was on a 2.25IU dose. Should I increase the dose tomorrow already? With the last few days, I'm a little confused with dosing now.

Tomorroe is a curve day too
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I wish I had an answer for you Anna. Personally I’d reduce to 2u just to see if it evens out numbers during the day - but as you know I’d rather not give definite advice. I wonder if Mogs is around @Critter Mom
 
Diana&Tom said:
Personally I’d reduce to 2u just to see if it evens out numbers during the day -
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Agree.

Douglas seems to run lower at night in general. The higher AMPS values may possibly be influenced by a bit of bouncing off lower numbers in the PM cycles. AM BG levels can also sometimes be influenced by dawn phenomenon. Not being able to give any insulin safely on some PM cycles doesn't help things either.

You got a PMPS value that was closer to being safe to dose on the 2.0IU dose yesterday evening. The 2.25IU dose on the AM cycle of the previous day gave you a PMPS that was too low to dose safely with Caninsulin.

My two penn'orth.


Mogs
.
 
+12.20 test is sitting at 9.3 so it is going up. Shall I stall and retest in another 20 mins?

I ideally would like to administer insulin, I am home all day so can monitor (just dont want to go back to high red numbers again and feel like starting from scratch (I know this is no my choice but Douglas and his insulin)
 
He’ll probably go up a smidge and stay around that number for a little while then rising faster (guessing) so I’d suggest not to under dose too much.

A token dose is a small dose. A skinny or fat dose is a tiny bit under or above the usual dose. So for example 0.5u or 1u could be a token dose. A skinny 1.5u would be just under that.

Try to look at the trend of numbers in the last few days and try to forget the instinct to increase the dose - if anything, err on a slightly low side so you can see what that does and make it more likely he will be shootable for the next cycle.
 
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Douglas_my ginger cat said:
I mean, the look he is giving right now suggests he isnt but I will give some extra lovin'.
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Aw, bless him...

Another option - if it's still not shootable - is to feed Douglas and then retest in a good couple of hours. If the numbers are really scooting up at that point you could give some insulin, although still probably a reduced dose. And it may affect the timing of your PM shot... However, this is something that can be done with Caninsulin, unlike some other insulins....
 
Elizabeth and Bertie said:
Aw, bless him...

Another option - if it's still not shootable - is to feed Douglas and then retest in a good couple of hours. If the numbers are really scooting up at that point you could give some insulin, although still probably a reduced dose. And it may affect the timing of your PM shot... However, this is something that can be done with Caninsulin, unlike some other insulins....
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Looks like this is your best option, Anna. If you shoot something at say 10am, monitor all day and see where you are at shot time this evening.
 
Thank you both! I will feed him as I think I am 10 seconds away from him clawing at me :D

I will test again at 9am and see (is 9 too early, I know you suggesting 10am but I don't want to be too out of whack with his shot timings).
 
Douglas_my ginger cat said:
Thank you both! I will feed him as I think I am 10 seconds away from him clawing at me :D

I will test again at 9am and see (is 9 too early, I know you suggesting 10am but I don't want to be too out of whack with his shot timings).
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See what Eliz says.
Remember that there is a bit of wiggle room with Caninsulin so if you shoot a lower than usual dose this morning and data shows he is definitely rising by pmps, you can shoot then.
 
Douglas_my ginger cat said:
I will test again at 9am and see (is 9 too early, I know you suggesting 10am but I don't want to be too out of whack with his shot timings).
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The food will most likely elevate the blood glucose. ...The reason for waiting at least a couple of hours to do a preshot test is so that the preshot number isn't food-influenced.

So...you could indeed test at 9am, but that number may not be sufficiently 'true' to use as a reliable preshot number... It could however still be useful data.... And, thinking about it, if the number is rocketing up at that point (more than would be expected just from eating low carb food) that could indeed indicate that it may be OK to give 'some' insulin, albeit maybe a reduced dose.

I do totally hear you on wanting to give some insulin so that the blood glucose doesn't just skyrocket. And since you are home and can test, then you do have a bit more freedom to experiment a bit...
 
I think wait and see what bg is when you get to ps time. If he’s having a nice little surf, he may not be in a hurry to go up too high. But then on this morning’s dose he may be well up again this evening.
I do have a bit of a fixation with a dose of 2u and would have liked to see yesterday’s curve on that number... but even 2u might be too high if he does really well today.
It’s really hard to say - not only do you need a degree in some kind of statistics to work this out, but you also don’t know if he’s producing insulin of his own, how much, and when.
Just take it one dose at a time for now.
 
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