Resolved - HELP STALLING!!

Status
Not open for further replies.
Hshray

Hshray

Member Since 2021
Stalling...we’re at 152 for pmps. He’s been gradually (very slowly) going up since his nadir +5. Wondering what dose I should give?
 
Youve shot a reduced dose this low before but he was bouncing. Can you stay up/monitor if needed? Plenty of test strips, hypo kit?

He earned a reduction to 3U today. Seeing how low this dose took him, I'm thinking 0.5 or 1U but only if you can monitor. Don't be surprised if he bounces again though.
 
FrostD said:
Youve shot a reduced dose this low before but he was bouncing. Can you stay up/monitor if needed? Plenty of test strips, hypo kit?

He earned a reduction to 3U today. Seeing how low this dose took him, I'm thinking 0.5 or 1U but only if you can monitor. Don't be surprised if he bounces again though.
Click to expand...

Yes, I can stay up and monitor. Do you think I should try 1 unit?
 
Its not clear to me which method you're following, based on reduction you took recently I assumed SLGS but prior thread mentioned MPM.

Regardless, these low preshots are great opportunities to try things and collect data. The 1.5U last time wasn't enough to offset the bounce, but there's no guarantee he'll bounce.

0.5-1U should be pretty safe. If you're feeling adventurous you can try 2U to see what happens, but that may make for a long night.

Did you feed yet? If not, can you test again in 15 minutes? If he's going to bounce the next test will likely show that. If it looks like a bounce I'd suggest something on the higher side, 1-2U. If not, then I'd aim for 0.5-1U.

What you want to find out over time is what numbers are shootable, and with what dose. The lower you can shoot the better, it helps keep the BG in a better range.

Unfortunately it all comes down to your "gut" feeling and comfort level with handling low numbers; I've been at this long enough and am comfortable handling low numbers, so I personally would be shooting on the higher side to get some data. If you want to be pretty safe, 0.5U. If you want to experiment with shooting low numbers, 1-2U.
 
FrostD said:
Its not clear to me which method you're following, based on reduction you took recently I assumed SLGS but prior thread mentioned MPM.

Regardless, these low preshots are great opportunities to try things and collect data. The 1.5U last time wasn't enough to offset the bounce, but there's no guarantee he'll bounce.

0.5-1U should be pretty safe. If you're feeling adventurous you can try 2U to see what happens, but that may make for a long night.

Did you feed yet? If not, can you test again in 15 minutes? If he's going to bounce the next test will likely show that. If it looks like a bounce I'd suggest something on the higher side, 1-2U. If not, then I'd aim for 0.5-1U.

What you want to find out over time is what numbers are shootable, and with what dose. The lower you can shoot the better, it helps keep the BG in a better range.

Unfortunately it all comes down to your "gut" feeling and comfort level with handling low numbers; I've been at this long enough and am comfortable handling low numbers, so I personally would be shooting on the higher side to get some data. If you want to be pretty safe, 0.5U. If you want to experiment with shooting low numbers, 1-2U.
Click to expand...
I know I’ve been trying to do MPM but posted earlier asking if I should take a reduction even though he was still above 50 at nadir. I didn’t get any responses though. He is at 170 now 20 minutes later.
 
FrostD said:
Its not clear to me which method you're following, based on reduction you took recently I assumed SLGS but prior thread mentioned MPM.

Regardless, these low preshots are great opportunities to try things and collect data. The 1.5U last time wasn't enough to offset the bounce, but there's no guarantee he'll bounce.

0.5-1U should be pretty safe. If you're feeling adventurous you can try 2U to see what happens, but that may make for a long night.

Did you feed yet? If not, can you test again in 15 minutes? If he's going to bounce the next test will likely show that. If it looks like a bounce I'd suggest something on the higher side, 1-2U. If not, then I'd aim for 0.5-1U.

What you want to find out over time is what numbers are shootable, and with what dose. The lower you can shoot the better, it helps keep the BG in a better range.

Unfortunately it all comes down to your "gut" feeling and comfort level with handling low numbers; I've been at this long enough and am comfortable handling low numbers, so I personally would be shooting on the higher side to get some data. If you want to be pretty safe, 0.5U. If you want to experiment with shooting low numbers, 1-2U.
Click to expand...
I have not fed yet so he is going up on his own.
 
Ok that's still a fairly slow climb, doesn't look like a bounce. So I'd stick with 0.5-1U. He may start to bounce in another hour or two, but that is what it is.

I'll reply to reduction in a minute...
 
FrostD said:
Ok that's still a fairly slow climb, doesn't look like a bounce. So I'd stick with 0.5-1U. He may start to bounce in another hour or two, but that is what it is.

I'll reply to reduction in a minute...
Click to expand...
Thanks! I went ahead and gave him 1 unit just now. If nothing else it will be more data/learning for me for next time!
 
Hshray said:
I know I’ve been trying to do MPM but posted earlier asking if I should take a reduction even though he was still above 50 at nadir. I didn’t get any responses though. He is at 170 now 20 minutes later.
Click to expand...
I think Chris explained it pretty well. Since you're seeing nadirs in the 50-99 range, hold the dose. It doesn't mean you have to see every nadir every cycle in that range, but when you start to see them pretty often, hold for about 5 days to see.

Your first cycle or two at this dose was the middle of a bounce. But you did see green today, so hold the 3.25U. Hold it for at least 5 days total, then reevaluate. If today is the only green you see in those 5 days, then yes you'll want to increase. But if you keep seeing green, continue to hold it.

Like she said, insulin is a hormone. While often fairly predictable, it never works exactly the same way twice lol

Edit: obviously reduce any time you see a number under 50
 
FrostD said:
I think Chris explained it pretty well. Since you're seeing nadirs in the 50-99 range, hold the dose. It doesn't mean you have to see every nadir every cycle in that range, but when you start to see them pretty often, hold for about 5 days to see.

Your first cycle or two at this dose was the middle of a bounce. But you did see green today, so hold the 3.25U. Hold it for at least 5 days total, then reevaluate. If today is the only green you see in those 5 days, then yes you'll want to increase. But if you keep seeing green, continue to hold it.

Like she said, insulin is a hormone. While often fairly predictable, it never works exactly the same way twice lol

Edit: obviously reduce any time you see a number under 50
Click to expand...
Thank you so much for responding and for the quick advice tonight! That sounds good. I will monitor to see where he is going tonight with the 1 unit and then stick with the 3.25 as long as he stays high enough and continues to do well on it.
 
Hshray said:
I know I’ve been trying to do MPM but posted earlier asking if I should take a reduction even though he was still above 50 at nadir. I didn’t get any responses though
Click to expand...

Just so you don't think anybody was ignoring you, the board was down for several hours this afternoon so nobody could reply!

Just FYI...With his number climbing from 150 to 170 in just 20 minutes that's a pretty good sign that the last dose was wearing off and you could have shot the scheduled 3.25 dose (or you could have stalled without feeding for another 15-20 minutes to make sure he was still going up if you were concerned).

Remember...as long as you are able to test as much as necessary, have plenty of supplies (test strips, HC food, Karo/honey/syrup), YOU are in control of his blood glucose. (I'm going to keep saying this until you believe me....LOL)

On the MPM, he didn't earn a reduction in dose yet (so he should stay at the 3.25U dose)
  • If there is a significant drop in blood glucose that results in a number below 50 on a human meter (or 68 on a pet meter), then the dose should immediately be reduced.
Click to expand...
Reducing the dose:
  • If your cat is in the first 3-6 months of diagnosis, reduce the dose by 0.25u anytime you see a BG below 50 on a human meter or 68 on a pet meter.
Click to expand...

If you're in the Feline Diabetes group on Facebook (which I think you are) we are associated with this board so IF the board goes down, there's someplace you can go to get help. As soon as the board is back up, you should come right back to continue (we don't like giving dosing advice on Facebook but we can if the board is down or it's an emergency)

I expect he'll probably bounce by tomorrow again, especially with the reduced dose. George!! This is auntie Chris speaking! Pay attention now! NO bouncing in the house, got it?! ;)
cat1.gif
 
Oh yeah...forgot one thing.....On your spreadsheet, the PMPS would be the number you actually shot....so if he was at 170 when you shot, that's his PMPS.

You can either put the 152 in the +11 cell and put "152 @ +12" and then color code it yourself, or "stack" both numbers in the PMPS cell so you'd put "152 @ +12, 170 @ +12.5"

That way, the + cells still correspond to the number of hours since you actually shot. Make sense?
 
Chris & China (GA) said:
Oh yeah...forgot one thing.....On your spreadsheet, the PMPS would be the number you actually shot....so if he was at 170 when you shot, that's his PMPS.

You can either put the 152 in the +11 cell and put "152 @ +12" and then color code it yourself, or "stack" both numbers in the PMPS cell so you'd put "152 @ +12, 170 @ +12.5"

That way, the + cells still correspond to the number of hours since you actually shot. Make sense?
Click to expand...
Thanks! I updated it. I did post on Facebook too at the same time but didn’t get any responses. I was afraid this would happen today (or soon) so I almost asked preemptively earlier but probably wouldn’t have mattered since the board was down. So if this happens again and he’s going up, go ahead and give the full dose? I will get the hang of it eventually!
 
Ah another bounce.

I'd say next time you get a flat or rising number above 150 try the full dose if you're comfortable and can monitor. You could also do baby steps and try 2/3 of a dose, so 2U. Eventually the hope is to do a full dose at lower and lower numbers over time
 
If the pattern holds, he stays high for 4 cycles, starts to come down on the 5th cycle, then the 6th one is greens. Though hopefully over time he bounces for a shorter time.
 
FrostD said:
Ah another bounce.

I'd say next time you get a flat or rising number above 150 try the full dose if you're comfortable and can monitor. You could also do baby steps and try 2/3 of a dose, so 2U. Eventually the hope is to do a full dose at lower and lower numbers over time
Click to expand...

Yep another bounce…at least I was mostly expecting it this time. I was hopeful when he wasn’t spiking too quickly last night and was still in the yellows at +4.

I agree, I will either try a full dose or at least something close to a full dose next time this happens. It’s taken us so long to start seeing some good pre-shot numbers that this part is all new to us!
 
You’re doing fine Hilary. The message board being down yesterday was a real difficult experience for many, caregivers and those of us that help too.

It’s why printing out and having hard copies of the dosing protocol document and the hypo document are highly recommended. That way, you have something you can refer to and make your decisions based on the best information available to you.

This isn’t the first time the board has been down for an extended period, and unfortunately it won’t be the last time either.
 
FrostD said:
If the pattern holds, he stays high for 4 cycles, starts to come down on the 5th cycle, then the 6th one is greens. Though hopefully over time he bounces for a shorter time.
Click to expand...
Looks like maybe a shorter a bounce this time…we were in the yellows atamps this morning, which is a color we haven’t seen at amps in almost two months.
 
He sure does like to drop hard.

I'm not sure if anyone's mentioned, but the bounce breaking cycles usually drop them a little harder/lower than a normal cycle would. It can sometimes make it a little hard to know whether to intervene with food or not (I'm not saying to do that now, just mentioning it so you know that drop from 223 to 96 isnt surprising and I wouldn't worry about it just yet)
 
FrostD said:
He sure does like to drop hard.

I'm not sure if anyone's mentioned, but the bounce breaking cycles usually drop them a little harder/lower than a normal cycle would. It can sometimes make it a little hard to know whether to intervene with food or not (I'm not saying to do that now, just mentioning it so you know that drop from 223 to 96 isnt surprising and I wouldn't worry about it just yet)
Click to expand...
I will plan on testing him every hour until he starts going back up.
 
Status
Not open for further replies.
Back
Top