Help Needed for Stabilizing Manu

[MsF & Manu]

Hi, Manu is making great strides, and his blood sugars are remaining consistent in the mid-100s! This is a big improvement. I have now skipped his 4th (!) shot because it was under 150 at injection time. But I need to figure out how to get his blood sugars down to a more normal range. Please remind me of the stall and test tactic? Unfortunately, I can't do that this morning because I have a doctor's appointment, but can do it at dinnertime if his number is still low enough. How often should I be testing him? I've been testing about 3 or 4 times a day.

Here are his current numbers:
https://docs.google.com/spreadsheet...aLMkfqp_aubPMigjtrO_eBfeBq1QM0#gid=1182885903

 

[FrostD]

What is the latest advice from your vet? I know they had given you a sort of sliding scale like full dose above 200, half dose from like 150-199?

 

[MsF & Manu]

What is the latest advice from your vet? I know they had given you a sort of sliding scale like full dose above 200, half dose from like 150-199?

Hi! Yes. Manu's vet directed me to skip dose if under 150. Give 1/2 dose if 150-250; and full dose over 250. But the last time it was just slightly above 150 I really only gave about 1/4 dose because my gut told me it would have been too much (after the scary lows on 4/14). I am due to do another curve tomorrow. Can giving small doses help him to get to lower numbers overall?

But then, I'm not really sure what a full dose should be at this point. It changed so quickly. He was taking 3 units, two weeks ago when I did the curve. He started doing much better as soon as I dropped that to 1-1/2 units.

 

[FrostD]

That's why I asked lol it all looks a bit convoluted on the SS

And yes, being able to shoot the full dose at lower numbers (while still keeping him safe!) as well as shooting token/reduced doses at lower preshots (again while still keeping him safe) will help ease him into lower numbers.

I would consider your full dose 0.5U for now. I would give that if he's 175 or higher. From 140-174 I would give 0.25U. For now, skip if he's under that. Let's give that a week and see how he does BUT -

He's on a bit of a mission, and when this happens its more unpredictable. If he drops below 90 (or you think he might have based on tests) take a reduction and let us know before the next shot. And if you can't be around to keep an eye, I would err on the side of skipping.

Your testing is good. I would focus more on the +2 and +3s as I suspect that's when his nadir is.

The stall tactic is when you get a preshot you haven't shot before, stall without feeding and ask for help. Retest in 20 minutes to see if he comes up to a number you're more comfortable shooting.

 

[MsF & Manu]

That's why I asked lol it all looks a bit convoluted on the SS

And yes, being able to shoot the full dose at lower numbers (while still keeping him safe!) as well as shooting token/reduced doses at lower preshots (again while still keeping him safe) will help ease him into lower numbers.

I would consider your full dose 0.5U for now. I would give that if he's 175 or higher. From 140-174 I would give 0.25U. For now, skip if he's under that. Let's give that a week and see how he does BUT -

He's on a bit of a mission, and when this happens its more unpredictable. If he drops below 90 (or you think he might have based on tests) take a reduction and let us know before the next shot. And if you can't be around to keep an eye, I would err on the side of skipping.

Your testing is good. I would focus more on the +2 and +3s as I suspect that's when his nadir is.

The stall tactic is when you get a preshot you haven't shot before, stall without feeding and ask for help. Retest in 20 minutes to see if he comes up to a number you're more comfortable shooting.

Thanks so much Melissa! I'm trying to stall right now! I just tested pre-shot and it's 121! I'm waiting 20 minutes, and will report back.

Your numbers are for the Alphatrak monitor, right? I know that the normal range for non-diabetic cats is 64 - 170. Is that right? I really, really am hoping I can get his numbers down!

 

[FrostD]

So the numbers are specifically for Manu and his patterns, so technically yes an AlphaTrak lol

We define normal for cats as 68-150 (on an AlphaTrak) usually, though you'll see that vary depending where you look. With Vetsulin though, we want them more like 90-150. I'll check back in 10 minutes.

 

[MsF & Manu]

I just tested again. It went down to 118! It seems to be staying pretty steady, so I'm going to skip his shot. But I am going to do a curve tomorrow. So I'm hoping it's still relatively low in the morning! Do you think that's a good idea?

 

[FrostD]

I just tested again. It went down to 118! It seems to be staying pretty steady, so I'm going to skip his shot. But I am going to do a curve tomorrow. So I'm hoping it's still relatively low in the morning! Do you think that's a good idea?

Yes, definitely skip. Don't be surprised if he's high in the morning, but he may have some tricks up his sleeve!

No need to test more tonight - no insulin, no hypo risk (with Vetsulin anyway).

Yes, a curve is a good idea - if you end up giving a shot. If you end up having to skip again I wouldn't bother.

 

[MsF & Manu]

Yes, definitely skip. Don't be surprised if he's high in the morning, but he may have some tricks up his sleeve!

No need to test more tonight - no insulin, no hypo risk (with Vetsulin anyway).

Yes, a curve is a good idea - if you end up giving a shot. If you end up having to skip again I wouldn't bother.

Oh! Well it's been two weeks since his last curve, so I thought I should do every two weeks? C'mon Manu's little pancreas... let's do this!

 

[FrostD]

Every week is ideal, but the reason for doing a curve is so we can see how he does with a particular dose of insulin. So - no insulin - curve doesn't tell us much!

 

[MsF & Manu]

Fingers crossed for tomorrow morning! Thank you for your great guidance!

 

[MsF & Manu]

UPDATE! Manu's Blood Sugar tested at 118 this morning! And that's AFTER he coerced me into giving him a small, low-carb wet food snack an hour before he was due for his test. (I basically gave in while half asleep in bed; he's pretty relentless. I keep a tiny refrigerator next to my bed now!) So, I skipped his morning shot, and will test him in a couple of hours. Oh gosh, I sure hope this trend continues!

 

[MsF & Manu]

Yay!