Close hypo last night, we are ok but pls advise doseage moving forward

Sara-Jane

Sara-Jane

Member
My Evie cat keeps me on my toes. After many weeks with some days insulin working great and others just not at all, last night I tested at +3 to find we were nearing hypo! I stayed up with her and when she hit 2.8 gave her a little hi carb gravy food. Took until hour +6 for her to slowly climb up and me to be comfortable to go to bed. She’s fine we are both a ok!!
My question do I drop the dose now from .75 to .5? I’m shocked how much it did last night considering some nights it does nothing at this dose.
Thank you
https://docs.google.com/spreadsheets/d/1Um6bHwTUUj9hHGUtCusUT7eWdfnuRb12UsYrtZ27OkY/edit
 
Well actually I would say last night was an awesome cycle with a great string of greens (it’s what we strive for,) but I know you are not used to seeing those numbers. High carb should be reserved for when the drop BELOW 50, but again I know it was night and also you are not used to seeing those greens. She was not in any danger with your fantastic job of monitoring her and feeding her. Optimally, you would give only low carb (up to 9 percent carb would be fine) and retest in 20-30 minutes to make sure she was surfing in green (50 or above). Many times all it takes is a little LC food to help them surf in green. Of course, if after the 20/30 minute test she was dropping below 50 you would give HC and/or karo to raise BG.

As for reducing the dose, yes, under the SLGS protocol, you would need to reduce her down to .5 units because reductions are taken when the cat drops below 90. If you were following the Modified ProZinc method, she would not have earned a reduction unless she dropped below 50 (2.8). It kind of depends on your goals for Evie. If you are trying for remission and are able to do the testing, then switching to MPM is the way to go. If you are not able to do the testing and want just to keep her BG in the target range of 90-150 then that’s okay too and you can stick with SLGS. Some people need a little time to adjust to seeing greens and low blues before they switch to MPM. You may want to go ahead and reduce her dose to .5 and then see how she does on that dose before deciding if you want to switch to the MPM. She may do all right on .5 or we will see that it wasn’t good for her and just take the dose back up after 7 days. Let me know what you think. It’s all good! You did a great job snagging that +4 last night. Tell me, did she have a snack or a couple teaspoons of her regular low carb food at +2 last night? I am thinking she will be in a bounce from the dive and greens last night.
 
And don’t be discouraged. She is getting a good response to the insulin. You have been seeing quite a bit of blue, and that is progress. The few days where she seems to stay yellow are probably just a result of the previous cycle’s blues that she’s not used to yet.
 
Suzanne & Darcy said:
And don’t be discouraged. She is getting a good response to the insulin. You have been seeing quite a bit of blue, and that is progress. The few days where she seems to stay yellow are probably just a result of the previous cycle’s blues that she’s not used to yet.
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Thanks! I know that my ‘take Actuon’ number is 2.8 but when I saw 2.9 and I knew there was still 2 more hours to go till she peaked, I was ready to give her the high carb gravy food . Only a teaspoon. After that I stayed up with her a periodic snacks of her regular FF pate was all until hour 6. Yes she always snacks at 2 hours, 4, and 6 hours always , Ofcourse I want to push for remission but I’m gonna all day at work so as you know I worry is all. I’m trying .5 for now, maybe just over .5 and we will see how that goes ! I have switched to injecting her in the chest instead of the scruff and I’m finding the insulin is working MUCH better so wondering if this is why those beautiful greens finally. Thank you Suzanne
 
I think that since you are gone at work for long stretches of time— it would be best, for now until we know her patterns better and she’s had a chance to hopefully become more regular in her response, to drop it to .5 units.
 
Hi there. You are doing great.

It’s best to wait at least six cycles before increasing again because bounces can take 6 cycles to clear - although they do not have to take that long (if she is even in a bounce and I don’t see evidence of it on her spreadsheet right now.) If you are following SLGS then doses are held for 7 days.

Anyway, the only reason I mentioned this is because the spreadsheet says you shot .75 units this morning. — but you indicated you were going to give her more time on this dose. I wanted to make sure that the .75 wasn’t a mistake?
 
I went back and looked again. There seems to be some discrepancy between the world and the US tabs on the spreadsheet. On the US tab which I was looking at it says you shot .75 units. Also a few other tests are missing. Here’s what I see:
 

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Suzanne & Darcy said:
Hi there. You are doing great.

It’s best to wait at least six cycles before increasing again because bounces can take 6 cycles to clear - although they do not have to take that long (if she is even in a bounce and I don’t see evidence of it on her spreadsheet right now.) If you are following SLGS then doses are held for 7 days.

Anyway, the only reason I mentioned this is because the spreadsheet says you shot .75 units this morning. — but you indicated you were going to give her more time on this dose. I wanted to make sure that the .75 wasn’t a mistake?
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Strange? I have reduced her dose to .5 ever since she went really low Friday night. I just checked and it says .5 hmm not sure . But yes I’ll hold .5 for a week!
 
Suzanne & Darcy said:
I went back and looked again. There seems to be some discrepancy between the world and the US tabs on the spreadsheet. On the US tab which I was looking at it says you shot .75 units. Also a few other tests are missing. Here’s what I see:
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Maybe it’s bc I use the ‘greater than’ symbol. When she’s a bit higher I’ve been shooting just over .5… but still less than .75. Maybe can you look at my spreadsheet through the world measurement version? I’m not sure clearly a spreadsheet issue
 
Sara-Jane said:
Maybe it’s bc I use the ‘greater than’ symbol. When she’s a bit higher I’ve been shooting just over .5… but still less than .75. Maybe can you look at my spreadsheet through the world measurement version? I’m not sure clearly a spreadsheet issue
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Yes. You can not put anything other than a number in there for it to automatically populate the U.S. tab. I can look at the world tab (and I will in a pinch) but every single number I look at I will have to multiply by 18 to get the U.S. number.
 
Can you please go into the U.S. tab, though, and manually correct the units shot this morning- because anyone looking at the spreadsheet will think you have shot .75 today and they won’t be able to interpret your spreadsheet. No rush, just next time you make an entry.
 
Sara-Jane said:
Maybe it’s bc I use the ‘greater than’ symbol. When she’s a bit higher I’ve been shooting just over .5… but still less than .75. Maybe can you look at my spreadsheet through the world measurement version? I’m not sure clearly a spreadsheet issue
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Oh. And if you are giving a little more than .5, the correct way to enter that in the units cell is .5F. That’s for .5 fat. We have what we call fat and skinny doses that are sometimes used (although it’s usually recommended to just stick with a straight dose adjusted in .25 increments unless we have a situation where the cat is going back and forth between doses and there’s no other option but to fatten or skinny up a dose.)
 
Suzanne & Darcy said:
Oh. And if you are giving a little more than .5, the correct way to enter that in the units cell is .5F. That’s for .5 fat. We have what we call fat and skinny doses that are sometimes used (although it’s usually recommended to just stick with a straight dose adjusted in .25 increments unless we have a situation where the cat is going back and forth between doses and there’s no other option but to fatten or skinny up a dose.)
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Thank you I’ve corrected it on the US version what I could! I will try to just stick to 0.5 then moving forward and we will see how she does . Sorry for this spreadsheet confusion!
 
Suzanne & Darcy said:
I see you had a blue last night :cool: and Evie may even have dropped a little bit more after that. Excellent job on your part!
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Hi Suzanne ok I do have a question! When we haven’t changed a thing and I’m confident I’m injecting successfully.. how come some days there is little to no response to her insulin? I know right after a low curve it can stay high for a bit? But with Evie I find it’s just totally random some times insulin works beautiful and other times not at all. Is this just normal? Or is it the type of insulin? I find myself wondering this alot ! I just want her to feel the better and not put strain on her little body. So I get frustrated! Thank you!
 
It IS frustrating, isn’t it! On this .5 dose, she’s been in yellow a lot. I think she still needs to settle in a little bit to see if she will see some more blue. I just think she may need an increase, but we need to follow the protocol and also give her time to settle.
 
Suzanne & Darcy said:
It IS frustrating, isn’t it! On this .5 dose, she’s been in yellow a lot. I think she still needs to settle in a little bit to see if she will see some more blue. I just think she may need an increase, but we need to follow the protocol and also give her time to settle.
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Sure Ofcourse ! Even on higher doses this cat sometimes would not respond and other times great! ;) but I know this disease is like a roller coaster haha!! We will keep going for now thanks so much !!
 
Suzanne & Darcy said:
It IS frustrating, isn’t it! On this .5 dose, she’s been in yellow a lot. I think she still needs to settle in a little bit to see if she will see some more blue. I just think she may need an increase, but we need to follow the protocol and also give her time to settle.
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Hello Suzanne so it’s been approx one week on reduced dose do you think I can increase to .75 again? .5 is not doing much at all I’m finding…
 
Suzanne & Darcy said:
I definitely would increase back up to .75 units. She’s been too much in yellow — and keep up with the snacks.
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Hi Suzanne! I wondered if you might take a peek at Evies spreadsheet numbers from lately and give me your thoughts! We’ve had a lot of amps numbers in the blue which is great.. but I just can’t seem to decide what doseage with this cat. It seems she is almost insulin resistant except for the very FEW times when she definitly isn’t lol! And as you know I’m not around mid afternoons to keep an eye on her . Thx!
 
Looking at her spreadsheet, I really see that she does a lot better on the .75 units. The couple of times recently when she had a .5 unit dose and a .25 unit dose, it’s clear from the numbers that it’s just not enough insulin.
 
On June 2, look how much she rose by +3. She did a little better the following day with the .5 units, but she still needed the .75 dose. Same thing in the evening cycle when she had .5 units with a 175 preshot. Not enough insulin to keep her out of the yellows. I would not decrease her dose each time she has a blue preshot. Perhaps if the preshot was 125 or below I would try .5 units and gather test data to see if that was a good decision or not.

Also, on most days, you seem to be able to get tests on her up to her nadir or pretty close to that time, so you probably don’t need to worry about the second half of her cycle. W would give her a snack before leaving the house and not worry. She doesn’t appear to be a cat who trends downward all the way to PMPS.
 
Suzanne & Darcy said:
On June 2, look how much she rose by +3. She did a little better the following day with the .5 units, but she still needed the .75 dose. Same thing in the evening cycle when she had .5 units with a 175 preshot. Not enough insulin to keep her out of the yellows. I would not decrease her dose each time she has a blue preshot. Perhaps if the preshot was 125 or below I would try .5 units and gather test data to see if that was a good decision or not.

Also, on most days, you seem to be able to get tests on her up to her nadir or pretty close to that time, so you probably don’t need to worry about the second half of her cycle. W would give her a snack before leaving the house and not worry. She doesn’t appear to be a cat who trends downward all the way to PMPS.
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Great thank you! Today she was 11.6 (not even a blue number yet) and I shot 0.75 and I ended up staying home and being late for work bc of her downward trend which moved so fast! Was great to see the greens but just scared me to leave her when I was getting 3.2! It’s times like this that I’m always afraid to give 0.75 on a blue number … what do you think?
 
I am sorry about your work today. I know you can’t keep missing work. It wasn’t a super fast drop today. See how it took her 3 hours to get to about half of her preshot number? Today’s cycle is a very good ProZinc cycle with a great nadir. I do understand if you were too nervous to leave the house though. If we are eventually able to gather enough data to show that she can surf in green on her own with just a little LC food on Board, it would be so good for her to spend time in those healthy green numbers.

It’s really really important for Evie to have a +2 BG test and to have her first snack at +2 when the ProZinc begins to onset. Can you do that? It would help smooth the cycle. I would rather see BG tests at +2 and +4 rather than waiting until +3. The +2 test will give you an indication of how the whole cycle is going to go. If it’s the same or higher than the preshot then the cycle will likely be uneventful. If it’s dropping at +2 then you just need to pay attention and perhaps adjust carb percentages for the snacks
 
Suzanne & Darcy said:
I am sorry about your work today. I know you can’t keep missing work. It wasn’t a super fast drop today. See how it took her 3 hours to get to about half of her preshot number? Today’s cycle is a very good ProZinc cycle with a great nadir. I do understand if you were too nervous to leave the house though. If we are eventually able to gather enough data to show that she can surf in green on her own with just a little LC food on Board, it would be so good for her to spend time in those healthy green numbers.

It’s really really important for Evie to have a +2 BG test and to have her first snack at +2 when the ProZinc begins to onset. Can you do that? It would help smooth the cycle. I would rather see BG tests at +2 and +4 rather than waiting until +3. The +2 test will give you an indication of how the whole cycle is going to go. If it’s the same or higher than the preshot then the cycle will likely be uneventful. If it’s dropping at +2 then you just need to pay attention and perhaps adjust carb percentages for the snacks
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Ok thank you yes I can absolutely go back to trying to get the +2 numbers . I always make sure Evie has a snack at +2, +4, +6. I’ll keep that up. Today she had a +2 snack and when I tested her at +4 I made sure she had another snack. It was a significant snack. I thought it would slow the drop a bit but when I tested her at +5 she had dropped in one hour (with food) from 4.6 to 3.2. That’s when I called work, stayed with her, and gave her quite a bit more to eat. By +6 she was finally up a bit to 3.6 so I felt ok to leave for work. These days are VERY rare with this cat! Most days .75 hardly does much at all !! Thus why I struggle with dosing ;) I agree will continue to try and get more data. Just an uneasy cat mom that always worries! Thanks Suzanne !
 
I totally understand! And the top priority is keeping Evie safe. You are a great cat mom!

We will find something that will work for you both! I will write more later after I get back home. I’ve been thinking about the situation. I will check her spreadsheet again later. I know you will be at work this afternoon.
 
Oh, and the only reason I was emphasizing the +2 snack is that it didn’t say on your spreadsheet that you gave one — it said +5 so I wanted to make sure. I was afraid that the first food she had after her shot was at +5. I have worked with people before who have cats who needed more like 8/9 percent carbs early in the cycle.
 
Suzanne & Darcy said:
And another thing you can do is to use U-100 syringes with the conversion chart in order to be able to dose a little more precisely.
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Thank you! I was actually thinking that about the syringes. Ofcourse just bought two new boxes .. but I’m gonna try the .75 skinny when I need to. I’ve started increasing the snack at +2 to just a little more than what I used to especially when I notice a significant drop in first two hours . I think you are right it definitely helps !
 
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