Dosing advice

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Hi Anna, well done for getting those tests last night! :bighug:

It looks like there was a little bounce this morning after that low last night. Remember that the bounce number is temporary, not a 'true' number, and it will come down.....

I strongly suspect that Douglas is going to continue to move down the dosing scale... If he does that then it's great news! ...But it will also mean that more caution may need to be taken with dosage, and you may find yourself needing to reduce the dose, and reduce again...

If the trend continues then it looks like you may get below one unit very soon...
When using the U100 syringes with low doses it's important to check the markings on the syringe barrel. Some of them can be wonky, and that can affect the amount of insulin that you give. This can really affect very low doses...
If you pick a few syringes out of a pack and look at where the markings start on the barrel (at the needle end of the syringe) you may be able to see that there's some variation in how far up the barrel the markings actually start; and you may also see that some the lines are completely straight and some are at a sort of jaunty angle. ...This is because the syringes are made for humans who need much larger doses of insulin, so the markings aren't made to be as precise as we might need them for our kitties.

Some people overcome this issue by using digital calipers to measure the dose on their syringes. I've always just used a lower tech approach and that is to select a syringe that has 'good' markings on it (I've painted the end of mine bright green so I don't lose it!) and then I use this as a 'template' to compare other syringes to. ...So, using the template syringe I draw the plunger to the dose that I want. Then I draw insulin into a fresh syringe and compare that to my template syringe, adjusting as necessary so that the two match.

Eliz
 
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Douglas_my ginger cat said:
With regards to next steps, what would they be? Do I continue for another 5-7 days at 1.5, keep an eye on numbers and if not decrease, imcrease dose by 0.25IU?
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Douglas has done better on 1.0IU. He's starting to look like a cat that wants to walk off the insulin (anti-jinx). He might even need a lower dose than that: those 3.X readings are probably a little too close for comfort to the lower bound of the reference range when using Caninsulin.

You may get some high PS BGs (possibly with a lot of bounce in them from the great numbers Douglas has been seeing), especially the AMPS, but for the range Douglas is now running in, I suggest you dose based on nadir. Caninsulin is very capable of yanking down higher PS BGs, even at lower doses.


Mogs
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Douglas_my ginger cat said:
How can he test at only 7.3 this evening?! I am now really starting to feel out of my comfort zone :banghead:

(please dont get me wrong, love that he is possibly producing his own insulin!)
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because he is producing his own insulin, so added to what you’re giving him, he’s lovely and lowish! It is a case if being very very careful now with dosing and if you have to skip a cycle, so be it - if he’s high at next pre shot you know that even a small dose will drop him nicely again. You may have to do something along these lines to keep him safe - that’s the paramount concern, especially when you're out all day and can’t test.
 
Douglas_my ginger cat said:
Oddly, I'm not sure I'm mentally prepared for that. Selfishly, as I have learnt so much... I feel I should put it into practice for longer:woot: but the words OTJ (anti-jinx) are a little bit exciting
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well we shouldn’t count our chickens really but it’s good to think positive!
I do know what you mean about not being ready for being OTJ but remember, once diabetic, always diabetic (ie if a cat goes into remission he is still diabetic, just controlled) so you’d still be on a journey of sorts making sure he stays that way. And you can use your learning to post to other newbies here and give them support and guidance...
Let’s see what happens but you’re very definitely on the right track :)
 
Critter Mom said:
I suggest you dose based on nadir.
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Douglas_my ginger cat said:
I am not sure I know what this actually means. I know nadir is the lowest point throughout the cycle (I think/hope) but does that mean that I need to test mid cycle to find out?
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It means ignoring 'bouncy' high preshot BGs and looking instead at how low a given dose is taking Douglas when making dosing decisions.

Looking at last night's PM cycle, a 1.00IU dose dropped Douglas to 3.8 (human meter) at nadir. The lower bound of the reference range is 2.8 on human meters. If it were my cat I would not be comfortable with a nadir that low if treating my cat with Caninsulin, quadruply so if there were strong signs that my cat was producing more insulin of its own (see below). I would think the 1.00IU dose was too high. (I think the 1.50IU dose is definitely too high: look at how low tonight's PMPS is, and he may have gone lower earlier in the cycle.)

A tricky aspect of this stage of treatment is that the pancreas may produce pulses of insulin after the cat eats and this can DROP BG levels after meals. If a cat's already being taken very close to the hypo threshold on a given dose then that pulse from the 'awakening pancreas' could possibly be enough to drop the cat too low. If the pancreas starts producing a steady basal trickle of insulin it could keep numbers lower for longer. This is of even greater concern in circumstances like your own, Anna, where you are unable to monitor during the AM cycles on some days of the week. It's safer to have a wider buffer.

Seeing as Douglas seems to be racing down the dosing ladder, I recommend that you take a very conservative approach with the insulin now. He has been doing better the lower you go. The recent pinks all seem to be bounces from earlier lower numbers and therefore not representative of where Douglas is at overall.

If Douglas needs to continue insulin treatment for a while longer you need to find a dose that is safe to give while you are away from home and can't test. Given your schedule, getting mid-cycle tests on every PM cycle for the time being is the only course of action open to you to determine how low a given dose may be taking him. At the rate things are going, you might not need to do this for very long (anti-jinx).

If you do give insulin on AM cycles when you can't test, perhaps consider giving a smaller/token dose and leave lots of food out for him.

Caution strongly advised.


Mogs
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Ok, so less is more with insulin by the sounds of it (I know that might sound quite rudimental, but I'm trying to wrap my head around this next step of thinking)

I do have some time off in about 10 days so can shot on nadir numbers then, but as you say for now...more conservative with the insulin.
 
Douglas_my ginger cat said:
Ok, so less is more with insulin by the sounds of it (I know that might sound quite rudimental, but I'm trying to wrap my head around this next step of thinking)

I do have some time off in about 10 days so can shot on nadir numbers then, but as you say for now...more conservative with the insulin.
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yes Anna that’s what we’re all saying - caution and more conservative dosing. Even what you may consider a small dose of say 0.5u could still be too much at times. When in doubt and you can’t test - don’t dose.
 
Douglas_my ginger cat said:
Ok, so less is more with insulin by the sounds of it (I know that might sound quite rudimental, but I'm trying to wrap my head around this next step of thinking)

I do have some time off in about 10 days so can shot on nadir numbers then, but as you say for now...more conservative with the insulin.
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You already have nadir numbers to work with from last night's PM cycle. They show you that the 1.00IU dose is taking Douglas quite low.

If you get PM+3 (maybe even PM+4) tests every evening for the time being, they will also give you some guidance on what effect a dose is having, especially as you won't be able to run a full curve until 10 days from now. I am recommending this because I think it's the safest thing to do.


Mogs
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Douglas_my ginger cat said:
'll take it down to the non dose previous night. Gonna try 0.5IU, see how we get on.
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Anna, if the 0.5 doesn't seem to be enough then you can always try a 0.75, or some subtler dose... You don't 'have' to increase or decrease in half units. There are very many shades in between, including just 'fattening' or 'skinnying' a dose (a tiny smidge more or less than a unit or half unit, etc...)

Please don't be overly concerned about these higher numbers. These will almost certainly pass... (((Hugs))))
 
Elizabeth and Bertie said:
Hi Anna, how are things going? Are you OK?
Do shout out if you need any help or if you want to talk anything through. x
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Hi Eliz, thank you. Things are good over here. Douglas is becoming extremely needy, following me around (which I don't mind, of course) but feel bad when I step on him as he's right under my feet!

I have been keeping Douglas on 0.5IU as the insulin I had was a few days out of the 28 day expiry window. I picked up his new insulin yesterday so want to keep him on 0.5 for the next couple of days to see if the numbers stay the same. If they do, then I will go up to 0.75IU.

If you have any thoughts or advice, I would gladly take these on board :D

I hope you are keeping well too x
 
Hi Anna, glad to hear all’s well. It sounds as if Douglas is just being affectionate really - it’s definitely a bonding experience caring for a diabetic cat and he knows you’re doing your best for him and appreciates it!

Eliz and maybe Mogs will offer dosing advice if they’re around but it seems to me that a dose increase is definitely needed. I would think the insulin is still ok. You’re wise to be cautious of course, so see what the new insulin does today with 0.5u and if there’s no change then increase. You don’t want Douglas to spend too long in these higher numbers - the longer he does, the harder it may be to drop him again. That said, he is pretty responsive to insulin so hopefully you can get back on track again soon.

Good luck, keep us informed!
 
Douglas_my ginger cat said:
Hi Diana, will get some more tests in. I was convinced that the 0.75 wasn't going to make any difference... But Douglas is always full of surprises :D
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Yes he is! But he’s not unusual - if you look at other people’s spreadsheets you’ll see that there is often no rhyme or reason to the numbers. There are so many factors that can affect bg - not only the dose given, but food, stress, any kind of infection, time of day, moon phases... you name it, and it’s impossible a lot of the time to pinpoint which of those may be contributing.
Remember what we’ve been saying that he is quite possibly producing some insulin of his own and a dose that may produce one result on one ps one day might have a different effect on the same ps another day. On today’s amps of 13 it’s worth keeping an eye. I think you’ll be fine but if you’re at home it’s all good data to have.
 
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