? Need Dosing Advice!

PPCW

PPCW

Member
Hello Everyone,

A little history about Coby. He was diagnosed back in 2017 and quickly went into remission. His routine blood work in January showed he is diabetic again. He is receiving sub-q (125ml) once a day. BUN is slightly elevated. His pancreatic number is a bit high as well.

This time around, I started with 1U (SLGS) and gradually went up to 2U then I swithed to MPM. due to lack of control with SLGS. The current dose is 2.5U. The first few cycles showed improved numbers. Especially 2/24!

It seems like he is starting to bounce on 2.5U.

He is 6 cycles in on 2.5U. Should I stick to 2.5U for a few more cycles to see if the bounce will clear and the numbers may return to 2/24? Or should I increase to 3.0U?

Thank you for your advice,

Patricia & Coby
 
I see that Coby got down into the blues last night 2/26/21. Bet he bounces again for today's AM cycle, 2/27/21.

It does look like he is clearing those bounces faster these days. That's a good sign.
 
Hopefully he doesn’t bounce too badly during the day. I hope we are close to finding the right dose. I need some sleep!
 
Decided to go up to 2.8U this morning as he is going back to black pre-shot. I was going to give him 3U but he is so prone to deep dives then high bounce. I will give him a couple cycle of 2.8U then 3U.
 
Hope that dose increase helps to get Coby out of those high black and pink BG ranges.
It usually takes a couple of cycles to see the effects of a dose change.
 
The preshot number this evening is lower than the morning. He got 2.8U again. Not sure if I should go to 3U tomorrow morning. According to MPM, the increase should be 0.5U if nadir is higher than 200.
 
Are you using U100 syringes or U40 syringes? Can't remember. A note at the top of your SS would be helpful.
 
I am using U100. Not sure what happened in yesterday's morning cycle. I am sure I didn't give a fur shot. I didn't test +6 last night because I was just too tired.
 
PPCW said:
I am using U100.
Click to expand...
Thought so. But sometimes it's hard for us to keep track.
PPCW said:
I didn't test +6 last night because I was just too tired.
Click to expand...
That's ok. We all need to sleep some and take care of ourselves, so we can take care of the rest of our families.
PPCW said:
I am sure I didn't give a fur shot.
Click to expand...
Then you probably didn't.

Coby is looking a little better BG wise today. How is he feeling? The 5 P's and appetite?
 
The numbers on 2/24 was like a dream :(. Now back to black.

He is feeling OK. Sub-q helps with hydration so he doesn’t drink like a horse. He gets plenty of food and weight is maintained. His arthritic pain is managed but sleeping is still his favorite activity for an almost 17 year kitty. Just need to find the right insulin dose!
 
Had an interesting yesterday. Went to dark greens during the day and had to stall twice for PMPS to get up to 200. Gave 2.5U based on past data. Numbers probably went into blues after +5. Decided to give 2.5U again since AMPS is not above 300. I am hoping for a gentle dip into the blues or dark green during the day!
 
So now it's time to gradually lower that "decision point" BG number. Sometimes we call that the "shoot/no shoot" number, but it's really not the only option.
You've shot a 195 BG before.
So think about reducing your decision point BG to 180 -185.
You should be able to gradually lower that pre-shot "shoot/no-shoot" number lower and lower.
It's knowing how low a particular dose drops your cat, how well she responds to food, when the low usually occurs, etc.

Expect a few "bobbles" up and down during the first few cycles at the lower dose.
 
I have no problem shooting with low preshot. The decision is the dose. I think 2.5U last night was a good decision but I should have done 3U this morning.
 
I beg to disagree. I DO think the lower dose, the 2.5 U dose was correct for last night AND for this morning.
 
I debated over 2.5 or 3U and ultimately decided to go with the lower dose in the morning. But seeing his PMPS @580 last night, it was hard to convince myself I made the right decision :(.
 
PPCW said:
I debated over 2.5 or 3U and ultimately decided to go with the lower dose in the morning. But seeing his PMPS @580 last night, it was hard to convince myself I made the right decision :(.
Click to expand...
Give it time please.

I know it's hard to see your cat in high BG numbers. But put on your "patience pants" and wait for the bounce to clear.
Coby dropped to the that 87 again today, 3/5/21 and that is another earned dose reduction. If you don't want to drop the dose from 3 down to 2.5U, that's ok. OUr protocols say to reduce by 0.25U.

So his new dose should be 2.75U and you will have to "eyeball" that dose, since it falls between the lines on the syringe.
 
Coby seems to really hate those blue BG levels, and bounces every time.

Come on down Coby, and stay down please.
 
Coby had a wild day cycle yesterday. Started with black to dark green midcycle. What a steep drop. The night cycle was flat and didn't bounce like crazy. It is still hard to tell if 2.5U or 2.75U is better at this point.
 
I think the 2.5U dose is a good call for now. If Coby doesn't hold the dose reduction, then bump up the dose again
 
His day and night cycles are on the opposite ends. The day cycle sems to last longer with low PMPS but the night is short with very high AMPS. The only variant I can think of to account for this difference is he gets a small amount of kibble before 10pm but none during the day.
 
PPCW said:
The only variant I can think of to account for this difference is he gets a small amount of kibble before 10pm but none during the day.
Click to expand...
So try without the dry kibble at night. See what happens.

Yes, such a simple change can make a difference.
 
Deb & Wink said:
So try without the dry kibble at night. See what happens.

Yes, such a simple change can make a difference.
Click to expand...

I tried no kibbles at night back in February. He was too bouncy to see the effect. He didin't have any kibbles last night and had a yellow AMPS. Hopefully, it wasn't just a one-time thing. I will keep the no kibble routine and fingers crossed!
 
The night cycle continues to be stubborn. I couldn't decide if 2U or 2.25U for last night's cycle since I had to stall for an hour to get PMPS to 184. Maybe I should have given him the full 2.5U because of his history of high numbers at night. I decided to give 2U because it is getting difficult to wakeup to catch any potential hypo event.

The experiment continues: no kibbles and smaller/frequent meals at night.
 
Experiment 1 - Correlation between high night BG and kibbles/meal size

Hypothesis 1: If Coby doesn't have kibbles at night, night BG will be lower resulting in lower AMPS.
Hypothesis 2: If Coby has smaller more frequent meals and no kibbles, night BG will be lower resulting in lower AMPS.

Result: night BG and AMPS remain high while he didn't get any kibbles and with smaller meals.

Conclusion: hypotheses - rejected. Night BG and AMPS remain high.

Experiment 2 - Correlation between low day BG and night high BG w/ high AMPS

Hypothesis: If night BG is high, it is a bounce to the low dark green day BGs.

Experimental design: gradually lower day insulin dose to produce a more gentle curve.
 
Last edited:
Hypothesis 4: You aren't catching the nighttime nadirs.

Cats are more active at night, so their BG levels can drop due to their burning off more glucose due to the increased activity levels.

Hypothesis 5: Prozinc isn't the best insulin for Coby.

Try another insulin.
 
Hypothesis 4:
The nighttime nadirs have been more difficult to pin down. Sometimes it is before +6 and sometimes at +6. Plus, I need to get some sleep for work. He is actually more active during the day. He goes to the litterbox or drink a couple times during the night and comes right back to bed next to me.

Hypothesis 5:
Prozinc is too expensive to throw out with half of a bottle left. I will definitely give it try when Prozinc is done. Maybe he will much more regulated by then.

Coby had low numbers last night which continued with AMPS. I gave 1U. Hopefully he is able to hold the BG down today!
 
PPCW said:
Experiment 2 - Correlation between low day BG and night high BG w/ high AMPS

Hypothesis: If night BG is high, it is a bounce to the low dark green day BGs.

Experimental design: gradually lower day insulin dose to produce a more gentle curve.
Click to expand...

Since March 20, the dose has been lowered to 1.4U. More blues and yellows. The night cycle is flatter and results in lower AMPS but the day cycle is still more acitve. 1.4U seems to be the dose for night but still uncertain about the day.
 
Coby may still be dropping lower in the PM cycle. A test or 2 around the +8 to +10 hour time frame would be useful information.
 
I get up around 4:45am, feed my cats first, go out to feed my feral kitties in the neighborhood, come back to test/feed/insulin Coby, then get ready for work! I just can't fall sleep again after getting up for a +8, +9 and +10 :(.

But he had a great cycle last night!
 
Maybe sneak in a test for Coby, before you feed your cats and then the ferals?

Yes, he did have a great cycle last night. Maybe do another dose reduction?
 
I think I should tell my other cats to wake me up at certain hours LOL!

I was going to do a dose reduction this morning but wasn't sure. Hopefully he doesn't bounce tonight from the dark green.
 
Coby’s numbers stay mostly in the blue now. There are still more yellow PMPS numbers but he stays relative flat during the cycle. It is a bit difficult to decide what dose is the best right now, so he has been getting 0.6 to 0.8U.
 
Managed to stay out of yellow preshots for many days but he went all yellow last night! I don’t know what triggered it but he was somewhat agitated before PMPS. He is eating well, peeing/pooping well. The one thing I can think of is the insulin. I started the new bottle this morning. Sigh, we were doing well on 0.25U. I am feeling nervous that he may go back up again.
 
If he does keep getting increased BG numbers, you know how and when to adjust the dose.

Hang in there and sending positive vibes your way.
 
You must log in or register to reply here.
Back
Top