Nico’s getting closer— breakthrough dose achieved! 12/19 AMPS 106

Emily Tuomey

Emily Tuomey

Active Member
Continuing from the previous thread: https://www.felinediabetes.com/FDMB...for-nico-good-whats-next.239213/#post-2693270
Still some ups and downs, but we are making our way. Breakthrough dose was 4.5u, now his pancreas is awake and we get to back off— YAY NICO!! Love you, bubs.
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@Chris & China (GA) @JanetNJ @Deb & Wink Delayed 3.0u insulin injection until +14 due to food avoidance and another bout of vomiting (small amt., clear liquid— water?— 1x only). Tried a different food flavor and he seemed to be fine for a bit of time after, and was able to give 3.0u at ~8:50/9p (+13.75/+14). Please advise on dose scheduling now that we are quite a bit off, will need to know what to expect in the morning. Hoping my sweet boy is okay.. :blackeye:
 
Chris & China (GA) said:
That's pushing it a little too much I think. If he's high enough at 8, shoot.....and we can try to make up that other hour another cycle
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Thank you. He’s still in the 300s +2 so we’re gonna try to rest. I think I’ve caused potentially problematic testing anxiety in him at the moment, he runs away from me any time I come near him since his +2 test. Heartbreaking.
 
Mariette said:
Great job Emily and Nico!
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Thank you!!

Quick update: We are trying to get Nico back on his usual schedule after a brief hiccup yesterday evening, so we tested at his +11 tonight and he was high enough (270) to shoot so was given 3.0u. Had a +2 a bit ago and still rising (347). But, given his trends a +2 is much too early to see any sort of drop. I anticipate if it happens it’ll be between his +4 & +6 overnight. We shall see! Also, say a quick prayer for some tummy upset relief overnight; stress is hard on the gut for both of us, but especially Nico’s at the moment.
 
JanetNJ said:
No bouncy was when you went from 416 to 66 back up to 460. Lol. This is a nice curve down into healing greens. It probably went up at +2 from a combo of the last shot wearing off (looks like you are getting 12-13 hour durations now) and food bringing it up.
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LOL if only I could keep him down in the blues and greens. Back up this morning.. AMPS 384. 3.0u given.
 
Slowly but surely, his body is adjusting to the lower blues and greens. It takes time for a cat to bounce less, when they drop so low.

What do I like seeing on your SS? Rarely any black BG numbers now. Lots more lower BG numbers, in the pink, yellow and blue ranges.
Baby steps Em. You are making progress in baby steps, but definitely some good progress.

Emily Tuomey said:
Also, say a quick prayer for some tummy upset relief overnight; stress is hard on the gut for both of us, but especially Nico’s at the moment.
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Sending healing vines your way.
 
Deb & Wink said:
Slowly but surely, his body is adjusting to the lower blues and greens. It takes time for a cat to bounce less, when they drop so low.

What do I like seeing on your SS? Rarely any black BG numbers now. Lots more lower BG numbers, in the pink, yellow and blue ranges.
Baby steps Em. You are making progress in baby steps, but definitely some good progress.


Sending healing vines your way.
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Patience is usually a strong suit for me, but I guess not this time. Encouraging words are so necessary for me right now, and so appreciated. The fact that you took the time to look at his spreadsheet and then note his progress means so much, when at times it’s hard to see all the bouncing and wish he would just feel better. No diarrhea today, which is AWESOME. And, we are about a half hour from his PMPS and insulin injection. Just praying for an uneventful night. But, speaking of such, we have had some green in the middle of the night. Is it important I test at that +5 overnight to make sure he’s not dipping too low? Thoughts? @Chris & China (GA) @JanetNJ?
 
Emily Tuomey said:
Is it important I test at that +5 overnight to make sure he’s not dipping too low? Thoughts?
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He's looking better...no more ugly black numbers! I'd hold the 3U dose a little longer.

Is there any chance you re-tested last night when you got that 77? Any time you get a number that's that out of character, it's a good idea to immediately re-test to make sure it wasn't just a wonky test strip.
 
Chris & China (GA) said:
He's looking better...no more ugly black numbers! I'd hold the 3U dose a little longer.

Is there any chance you re-tested last night when you got that 77? Any time you get a number that's that out of character, it's a good idea to immediately re-test to make sure it wasn't just a wonky test strip.
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I have been doing that actually, when I get a sort of “out of the blue” number, high or low. I can’t remember what it was overnight though, close enough that I knew it was valid. I could go check if it’s important? But for future, should it be notated on his ss? And if so, what is the format I’d follow? I’m gonna try to get a +4 or +5 tonight just to make sure he’s alright. He seems to be feeling MUCH BETTER though, thank goodness!! Should I give a 3.0u dose tomorrow morning if he’s above 200? Anything below that I’ll come check in with someone first..
 
Emily Tuomey said:
I could go check if it’s important? But for future, should it be notated on his ss? And if so, what is the format I’d follow?
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No, if you DID re-test and weren't worried, knowing now won't make any difference. It's not 100% necessary to put a retest on your spreadsheet....it's just important that you know to do one if you get a number that's just out of whack from what you expect. If you want, you can put "retested 77, got ##" in the remarks or you can put both numbers in the same cell...like 77 @ +6, RT ## (but you will need to color code that cell manually)

Emily Tuomey said:
Should I give a 3.0u dose tomorrow morning if he’s above 200? Anything below that I’ll come check in with someone first..
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I'd like to see you giving the same dose both AM and PM since that's the way we usually dose ProZinc, but some people do use a sliding scale based on the PS number.

Maybe 300+, 3U
250-300, 2.5U
200-250, 2U

Hopefully @JanetNJ can add some words of wisdom
 
Chris & China (GA) said:
I'd like to see you giving the same dose both AM and PM since that's the way we usually dose ProZinc, but some people do use a sliding scale based on the PS number.

Maybe 300+, 3U
250-300, 2.5U
200-250, 2U

Hopefully @JanetNJ can add some words of wisdom
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I’ll wait to hear from someone depending on his number in the morning. I’m a bit confused. Maybe we shouldn’t have done 2.0u tonight..? @JanetNJ advised though; now I feel like I messed up..
 
We may be bouncing a bit today— not sure if that’s to be expected or not. Just ran a +5 and he was 324. I guess pink is still better than red or black.. I’d say I anticipate a higher number tonight, but who knows really.
 
Emily Tuomey said:
The fact that you took the time to look at his spreadsheet and then note his progress means so much, when at times it’s hard to see all the bouncing and wish he would just feel better.
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Em, I ALWAYS look at the SS to see what is going on before I reply to a post. It's so important to know what is going on, and the SS is our main way to check that. I look at any notes over in the Remarks column too, and look at past trends in the numbers.

Yeah for Nico not having any diarrhea today! Good poop updates are so important.
Plain canned pumpkin can help firm up the stool, as well as provide more fiber to stave off constipation issues.
You might want to make a note on the SS on what the food was for the cycles, so you could see if a particular flavor or kind of food is a potential culprit in the diarrhea.

Nico is responding so much better to the insulin these days, that I think holding the 2.5U dose that Janet recommended is the way to go for a few days.
 
Deb & Wink said:
Nico is responding so much better to the insulin these days, that I think holding the 2.5U dose that Janet recommended is the way to go for a few days.
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He really is! We stayed a bit higher today than in previous days, 200s-300s— he’s had 2.5u for both AM and PM cycles today. Planning to hold it there and see how he does. So far he’s so much better!! Appetite and thirst are corrected, way less urinating, stools are back to normal, he’s playing well, and he’s back into his healthy weight goal range (set by his vet) which I can’t be more excited about. Goodnight from Nico and the gang. :cat:
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Should I be concerned about this +4 414???? I am.. I plan to check him again at +7 to see whether we are still trending up. Stressful to see those 400s again when I want nothing more than for him to continue to feel better and stay a bit lower more consistently. Mama Em is sad. @JanetNJ @Chris & China (GA) @Deb & Wink
 
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Emily, you have to remember that Nico is still not used to those lows.
So, that lower blue last night 12/9/20, was the likely cause of the higher pink pre-shot this morning, 12/10/20.

No, I would not be worried about the 414 BG at +5. (Was that at +5 or +4? You have the number in the +4 cell on the SS.)

Did you get that +7 test done this morning?
 
You made the right choice, in reducing the dose this morning, 12/11/20.

Woah Nico! That was certainly a dramatic difference at AMPS today.

That is saying to me that Nico is dropping lower at night, and the dose is too high now.
I'm not sure what it should be, but maybe around 2-2.5U?

Yes, I can understand why your SS notes said that Nico was feeling "Yucky" with those higher red and pink BG numbers. At least now, you are able to tell better when he feels worse, by various symptoms.
 
I'd go back to 2.5 and hold that dose for several cycles. As I said earlier, we usually do shoot the same dose both AM and PM and I had thought that's what you were going to try instead of the scale dosing.

Can't hurt to try it. Maybe Nico will settle down (but since he's a cat, I wouldn't bet on it!)
 
Chris & China (GA) said:
I'd go back to 2.5 and hold that dose for several cycles. As I said earlier, we usually do shoot the same dose both AM and PM and I had thought that's what you were going to try instead of the scale dosing.

Can't hurt to try it. Maybe Nico will settle down (but since he's a cat, I wouldn't bet on it!)
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I tried, but he was 60 this morning and I couldn’t really give his usual dose (3.0u), especially since I wasn’t going to be home all day to watch him. @JanetNJ advised a scale dose, and to return to his usual this evening. Now it sounds like 3.0u is too much, so @Deb & Wink advised 2.5u or 2.0u. I can hold a 2.5u for several cycles as long as he’s not dropping down as far as he did this morning (right?!)...
 
Nico is looking ok on the 2.5U dose for now. He got down to the blues today, with that 140 BG at +6. So don't be surprised if Nico's BG level is higher for the PM pre-shot. I still think you should hold the 2.5U dose, as long as Nico's BG is high enough.

Prozinc has a bit more flexibility in adjusting doses, than the depot type insulins like lantus and levemir do. So it's usually ok to shoot the next cycles dose, if you have only stalled the previous cycles dose for 1 hour.

For example, AM insulin shot was 1 hour later than normal, so the PM pre-shot test will be only 11 hours since the morning dose.

Does that make sense Em?
 
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