Late nadir?

Tony’s person

Tony’s person

Member Since 2020
Hi. My guy always seems to be lowest at the end of his 12 hr cycle. Many times he is below 80 at end of cycle. I test mid-cycle and he seems higher. On advice of my vet I usually feed him, wait an hour, and then if he’s going up and is above 100 I give his “normal” shot (Lantus 2.5 units). One issue though is that I still give fir shots more often than I’d like. I try amd try to get my technique down, but I still end up shooting through. He’s gained weight for sure (from super skinny), but he’s still not got a lot of “meat” on the bones. so when I give a fur shot I don’t give more, just in case. Seems like I see spiked numbers for a few days after that happens. But also, when I’ve lowered his dose to 2 units, he really spikes and stays that way. It seems 2.5 units keeps him between 80-160, which is desirable, right?
anyway, my question is around the nadir. Is it possible that he gets lowest point at +10 or +11, or do you think he’s just getting too much insulin??
 
Welcome to you and Tony. He is definitely getting too much insulin. With a pet meter he earns a reduction if he falls under 68 which has happened three times and who knows how many other times. You don’t have any tests before +7 and I am pretty certain he has been in dangerous hypo territory. You don’t have any tests after the PMPS and many cats drop lower at night.

He was started on a very high dose unless he’s a huge cat. I’m going to tag some other so we can figure out a dose for tomorrow morning. Meanwhile would you please get a +2 test and if you are past that test now. Thank you.
@Wendy&Neko @Marje and Gracie @Gill & George
 
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To tell you the truth, you don't have enough data to say when Tony's nadir is. You need to get more mid cycle tests, and that especially includes the night cycle.

Tony has also been going too low on this dose, you need to reduce to 2.25 units or possibly lower. It's really help us help you on dose if you indicated in the units column when you think you did a fur shot. So something like 2.5 FS as the units would let us know a possible fur shot at a glance.
 
I don’t think I can get a +2 because I’m almost positive he got a fur shot tonight. So I can retest, but it won’t be +2 really...it will be more like +14, no?
I have tested overnight sometimes and he’s been ok. I have t recorded every single number. More the ones that are around time of feeding so that I can record his pre-feed and pre-shot numbers. He has never acted “hypo” at all. He’s actually doing better each day, overall. He’s playing and walking pretty normally. He wakes up around 6am and is hungry. I always assume that means his sugars are dropping and that’s when I do see low numbers, sometimes.
 
Wendy&Neko said:
To tell you the truth, you don't have enough data to say when Tony's nadir is. You need to get more mid cycle tests, and that especially includes the night cycle.

Tony has also been going too low on this dose, you need to reduce to 2.25 units or possibly lower. It's really help us help you on dose if you indicated in the units column when you think you did a fur shot. So something like 2.5 FS as the units would let us know a possible fur shot at a glance.
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I like the idea of indicating FS. Thanks. As for more tests, I just hate pricking him that often. The poor things ears look bruised to me! I’ve jabbed my own finger twice and it hurts!! Should I just lower him to 2 units and see??? I tried that for a while but he seemed to start spiking to numbers I hadn’t seen in weeks. We even had a red/black!
 
Can you go back in your meter and enter the last two weeks worth of data. An incomplete spreadsheet ties our hands in terms of dosing help.
 
Tony’s person said:
Should I just lower him to 2 units and see??? I tried that for a while but he seemed to start spiking to numbers I hadn’t seen in weeks. We even had a red/black!
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Can you tell me when you did that? I don't see it on the spreadsheet. It's also possible those spikes you were seeing (which I do see at 3 units), were from him getting dangerously low and bouncing.
 
Wendy&Neko said:
Can you tell me when you did that? I don't see it on the spreadsheet. It's also possible those spikes you were seeing (which I do see at 3 units), were from him getting dangerously low and bouncing.
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During thanksgiving week I did 2-2.25 and he got readings regularly over 200.
Just retested and he’s 156. This is +2 or +14 considering I’m pretty sure he got a fur shot tonight.
When, exactly, should I test to get better sense of his true pattern??
 
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I’ve gone back to the meter and entered all tests. I actually did have most on there. Whenever it’s low I retest in an hour or sometimes sooner (after he’s eaten). The vet said that Lantus is slow acting so as long as he’s going up it’s ok to give dose. I’m not saying the vet is totally right. I wouldn’t be on the Forum if I didn’t want other opinions from people who’ve been through it. I’m just trying to understand and contextualize what seems like so much conflicting info. I want to do what’s right by Mr Tony. But I’m scared to go too low on dosage and push him back into scary high numbers.
How about if i try 2.25 units for a few days I guess?? Or maybe 2? I have needles with .5 markings so it’d be more consistent to try 2.
.
 
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tiffmaxee said:
Welcome to you and Tony. He is definitely getting too much insulin. With a pet meter he earns a reduction if he falls under 68 which has happened three times and who knows how many other times. You don’t have any tests before +7 and I am pretty certain he has been in dangerous hypo territory. You don’t have any tests after the PMPS and many cats drop lower at night.

He was started on a very high dose unless he’s a huge cat. M going to tag some other so we can figure out a dose for tomorrow morning. Meanwhile would you please get a +2 test and if you are past that test now. Thank you.
@Wendy&Neko @Marje and Gracie @Gill & George
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agree that his initial dose was super high. I actually lowered what he was getting while in the hospital as soon as he came home because it seemed to me pretty quickly that he was worse when the dose was up at the 5-6 range. He’s not a huge cat. He’s pretty small. He was just under 7lbs then. I’d say now he’s probably around 9lbs.
 
Thanks for updating the spreadsheet.
Tony’s person said:
During thanksgiving week I did 2-2.25 and he got readings regularly over 200.
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Sorry, can you tell me the dates? Are you in the US? If so, your Thanksgiving in not the same as mine. If it was last week you are talking about, a few days after that red you saw a string of under 68's. And no testing the days or nights before those high numbers. That tells me those higher numbers were from bounces from going to low, not from too little insulin.

Plus you didn't hold the dose long enough at 2.25 units, the 2.5 unit depot (of a dose that is too high) would still have been influencing the cycle. In spite of that, with fur shots and still getting really low, I'd go down to 2.0 units and try to get more tests in. Better to go a bit lower and work your way up if needed than keeping him at a dose that might be taking him too low.

We all use needles with 1/2 unit markings and eyeball the 0.25 in between, or use calipers to measure the dose.

Size is only relevant for initial dosing, and Tony was started on way too high a dose.
 
Yes, last week was Thanksgiving so I was talking about those dates around 21/23rd or so.
Given everything you’ve explained, I’ll try the 2 units. How long should I try that for and is there a reading at which I need to immediately go higher to avoid a spiking streak? Should I expect/want to see numbers in the green, or blue?? I thought “normal” was 80-120? Am I aiming for higher than that range at pre-shot, under assumption that the nadir (whenever that is??) is lower??
Thanks for all the direction. I have felt really good about his staying in greens and blues...now I feel like I’ve been putting him in danger and I feel terrible.
 
One other question/point - does it ever make sense to give different doses in AM and PM? Meaning, if he’s consistently lower over night, could it work to have his evening dose be lower than his morning dose? Maybe by .25u?
 
I would try the 2 units, and hold it at least six cycles. Unless he goes low again. You need to be patient and let the depot settle at 2 units too. Plus with a fur shot, it can also take six cycles to build back up the depot.
Tony’s person said:
does it ever make sense to give different doses in AM and PM?
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No, not with the dosing methods we use here. Plus, if you are constantly changing doses you are messing with the depot and it can't stabilize. What you shoot at one dose is often not seen until the cycle after that. And a cat will be lower at night until the time they decide not to.
 
Wendy&Neko said:
I would try the 2 units, and hold it at least six cycles. Unless he goes low again. You need to be patient and let the depot settle at 2 units too. Plus with a fur shot, it can also take six cycles to build back up the depot.

No, not with the dosing methods we use here. Plus, if you are constantly changing doses you are messing with the depot and it can't stabilize. What you shoot at one dose is often not seen until the cycle after that. And a cat will be lower at night until the time they decide not to.
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Ok. And is a “cycle” a 24 hr period, essentially? So since I almost certainly gave a fur shot tonight, I should expect to see higher numbers for a few days? That, combined with dropping to 2 units sounds like he will definitely go up for a few cycles/days? After how many days (approx) would I decide if I need to increase or decrease?
Btw, it’s late here now so I’m going to bed if I don’t reply again. I’ll try 2 units tomorrow morning and hold that for a few days (6??) and test 3x/day or so...unless you suggest another testing cadence.
Thanks for everything.
 
There is one cycle per insulin shot, so two cycles per day. Wait at least six cycles, three days, for the depot to stabilize and let you see what 2.0 units can do. Unless he goes below 68 in that time frame.
 
So, this morning Tony was at 98 an hour or so before his normal testing time. I withheld food and retested at “normal” AMPS time. He had dropped to 77. So I fed and didn’t give him any insulin.
Is that correct??? I’m worried he’s going to be super high later on amd that now I won’t be able to gauge if 2 units is too much??
 
Tony’s person said:
So, this morning Tony was at 98 an hour or so before his normal testing time. I withheld food and retested at “normal” AMPS time. He had dropped to 77. So I fed and didn’t give him any insulin.
Is that correct??? I’m worried he’s going to be super high later on amd that now I won’t be able to gauge if 2 units is too much??
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Back in a mo just looking at the ss
How long ago did you feed?
 
You were correct not to shoot. I suspect it is too much and he might be dropping too low but without more tests it’s impossible to know. You need some tests between +5-7 in the day and night. You need to follow SLGS in my opinion and need to do a curve. It calls for a reduction if the BG is under 90 but I don’t know if even 1.75 will be too much without more spot checks.
 
Tony’s person said:
I like the idea of indicating FS. Thanks. As for more tests, I just hate pricking him that often. The poor things ears look bruised to me! I’ve jabbed my own finger twice and it hurts!! Should I just lower him to 2 units and see??? I tried that for a while but he seemed to start spiking to numbers I hadn’t seen in weeks. We even had a red/black!
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Tony’s ears are resilient! If you’re new to pricking them they will show some bruising or marks but they heal up quick. I rotate kittens ear pricks and locations on the ear. However she hates her left ear being done. When I started testing more often to get more data I thought her ears would forever be bruised but now her ears are barely affected by the pokes. In time Tony’s ears will adjust. It’s definitely a shock to see and we can’t help but feel bad but it’s much needed to be sure the data is there to learn and provide the best support for our kitties :bighug:
 
With the limited data skipping was the safe and best option in this case.

Are you home and able to get more tests like Elise has suggested? If the ears are worrying you, to minimise bruising apply gentle pressure with a cold cotton ball, hold for the count of 10, if you can, that's what I did for George, his ears were fine, and I tested a lot:oops:

The dosing is based on how low a dose takes the cat, at the moment there is no way of making any call on what that is. Though like Elise we suspect he i going low midcycle.

He came back down quite quick after the possible FS so I wouldn't worry about skipping.
Even though you haven't given any insulin he may still continue to drop, especially if this dose is too much for him. I would get a test this morning at +2, gather some data.

I think you should aim to test amps and pmps and then a couple of tests in each cycle (so a total of 6 cycles a day) if you can do this for the next few days we can help you figure out if this 2u dose is good for him or too much.
Would you be able to do that?

If you do the above you might find a low number, and it might mean you need to monitor a bit more in that cycle. So the above is a starting point.

How would you feel about that?
 
Good job with the +2.
He's likely going to be high by PMPS., try not to worry.
Last time his numbers came back down quite quick.

Do you think you will be able to test 3 times in each cycle? would that be possible for you?
Even if it something that you don't think you can sustain long term, in the short term it can help us help you find a sensible dose for him.

You may want to take a look at the two dosing methods we use on this board and see which one suits you best. That way we can help you decided on a plan that works for you.

Skipping doses is not ideal, it keeps the cat safe when you don't have enough data to support the choice of dose, but it does mean that kitty ends up spending to much time in not so nice numbers, it was the right choice today, but it's not a good long term strategy.
 
Tony’s person said:
Just retested (at 2.5 hrs later) and he is up to 260. He ate in between...not super well, but pretty well.
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sorry I wasn't about, had some errands to run

Could you update the SS with the tests you have done and could you put NS (No Shot) in the unit column, that way we know you didn't give insulin as opposed to just forgetting to put the dose in.:)
 
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JaxBenji said:
Hi @Tony’s person :bighug: When you are back on your spreadsheet, can you enter "NS" for the insulin dose this morning (NS = No Shot)? Here's a link to the Dosing Methods Gill mentioned above in case you want to read through. Hope you and Tony have a great day!
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Thanks I meant to post the link and got sidetracked by cats demanding their dinner and sitting on my keyboard.
 
Thanks all. I had an insane workday and although I did test Tony several times I didn’t get a midday test. I was at a doctors appointment for myself during midday. He’s up into the pink tonight but not as awful as I’d feared. He was pink last night and low by morning after a 2u shot last night. I’ll give another 2u tonight and see how we do. I did update the sheet to say NS this morning. I’d previously put in “0” thinking that was clear but I’m fine with NS if that’s what everyone uses for ready understanding.
I have read the two types of monitoring. I would prefer him to be more tightly regulated but I’m not sure I can stomach pricking him that many times a day ongoing. We’d tried libre when he was first dig nosed but he was too skinny. Maybe I can revisit that with vet as he gains weight.
 
You will see the ear pricks don’t hurt them. Many cats go to the testing area willingly. I used to test Max in the bathroom sink. If I forgot something, he would wait there for me. Treats helped and he wasn’t a foodie most of his life.
 
No, I use regular needles. U100 insulin syringes with 1/2 unit marks. UltiCare VetRx brand. 31guage.
What sort of treats are ok to use? He had CKD so I’m already slightly worried about the increased protein in the FF that I’m mixing with his KD food. He far prefers the FF!
 
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Wendy&Neko said:
I would try the 2 units, and hold it at least six cycles. Unless he goes low again. (emphasis mine)You need to be patient and let the depot settle at 2 units too. Plus with a fur shot, it can also take six cycles to build back up the depot.
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Roberta and Chloe said:
I would stick with 2 units and give it consistently for 3 full days / 6 cycles. Are you using the Lantus pen? It took me a long time to figure out how to make sure there was insulin in the syringe.
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I would recommend a drop to 1.75 units unless you can get more tests in during the cycles.

Are you still feeding k/d wet? It could be artificially influencing the numbers.
 
I’d understood that I’m to keep at 2 units for 6 cycles?
Yes, still feeding 1/2 wet KD and 1-2 FF or the glyco control prescription stuff from Hills or Purina. The internist vet is already annoyed with me for not doing only KD. She feels it’s playing with fire Dow his kidneys. We have a full blood panel checkup in about 10 days, so we’ll see.
 
Tony’s person said:
I’d understood that I’m to keep at 2 units for 6 cycles?
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That would be contingent on having a very high confidence level that the dose is safe. Currently there are not enough data to meet that criterion and I disagree with that member's suggestion.

I agree with Red's suggestion to drop to 1.75IU. Getting a low AMPS like that 77 right at the end of the cycle can sometimes be an indication that a dose is a bit high. Until you can get more tests in to better determine how Tony's responding, erring on the side of caution and dropping to 1.75IU would be safer.


Mogs
.
 
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I agree on the 1.75 units, as you saw a lower number that I said would trigger a reduction, in spite of the fur shot two nights ago.

Could you start a new post tomorrow, with a link to this one? This post is getting long and it's easier if there is just one post per day.
POSTING GUIDELINES PLEASE READ
 
Sure. I’ll read tomorrow and repost. I’m doing it on my phone so the instructions and linking and all that are a bit tricky for me. But I’ll try to figure that out.
I’ll start with 1.75u tomorrow if he’s ok to shoot in the morning. I’d done 2u tonight before this advise came in. I just retested at +4 and he’s down to 198. So trending downwards but nothing scary as of now. I have to go to bed now. Updates tomorrow. Thanks all.
 
Just copy the url at the top of this thread and paste it on the new one. If you can’t do it one of us will. Good night.
 
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