10/18 Noogi - AMPS 198, +3 58, +4 70, +5 83, +7 99 - dose advice please

[Helen + Noogi]

Yesterday

Happy Caturday!

Day 3 of the increase from 0.75 to 1u and what I feared might happen has: Noogi nose-dived this morning into the 50s at +3 and needed quite a lot of medium carb food to keep him surfing. I knew he would be low before I tested him at +3 as he was in starving mode, mewing for food. Getting to 58 always seems to trigger this response in him. He ate two bowlfuls of MC, one at +3 and another at +4. These kept him in the greens but didn't elevate the BG that much.

Also of note: that AMPS was probably a little inflated as he's had a snack about an hour before (left-overs from his nighttime snacks).

This pattern is one I have seen before - happened twice in the last few months when I put his dose back up. Both times I took it down again.

Not sure what I should do now. If I am home I can manage to keep him surfing, but I have to leave him weekdays and I worry he will dip too low and the LC food won't be enough to keep him safe. Do I decrease again to 0.75u to be on the safe side?

Now that he is a long-term diabetic I guess I can try to do a skinny dose and see if I can aim for 0.825? Not sure if I have the skills to be so precise!

Appreciate any thoughts or advice

 

[Staci & Ivy]

Yesterday

Happy Caturday!

Day 3 of the increase from 0.75 to 1u and what I feared might happen has: Noogi nose-dived this morning into the 50s at +3 and needed quite a lot of medium carb food to keep him surfing. I knew he would be low before I tested him at +3 as he was in starving mode, mewing for food. Getting to 58 always seems to trigger this response in him. He ate two bowlfuls of MC, one at +3 and another at +4. These kept him in the greens but didn't elevate the BG that much.

Also of note: that AMPS was probably a little inflated as he's had a snack about an hour before (left-overs from his nighttime snacks).

This pattern is one I have seen before - happened twice in the last few months when I put his dose back up. Both times I took it down again.

Not sure what I should do now. If I am home I can manage to keep him surfing, but I have to leave him weekdays and I worry he will dip too low and the LC food won't be enough to keep him safe. Do I decrease again to 0.75u to be on the safe side?

Now that he is a long-term diabetic I guess I can try to do a skinny dose and see if I can aim for 0.825? Not sure if I have the skills to be so precise!

Appreciate any thoughts or advice

Hi Helen, Do you have a calipers to get a dose in between the 2? Perhaps he just needs that Goldilocks dose mid way between the 2 doses?

It’s so good he communicates with you to let you know he’s low and needs food!
Safe surfing, Noogi

 

[Mary & Jude]

I completely understand your predicament: lower numbers + work/inability to monitor = WORRY

On the other two times you mention, how long did you hold the dose before going back down? I'm looking at his numbers since the increase, and I'm wondering if he's bouncing and if he will eventually (quickly, I hope) clear his way to lower (safe), flatter numbers?

This is a hard one, but, again, I get it. I'd rather have Jude a bit high as opposed to worrying he's going to go too low when I'm at work.

Good luck with the decision, Helen. I hope someone will weigh in with some advice soon.

Let's see if @Bandit's Mom is around.

 

[Helen + Noogi]

Hi Helen, Do you have a calipers to get a dose in between the 2? Perhaps he just needs that Goldilocks dose mid way between the 2 doses?

It’s so good he communicates with you to let you know he’s low and needs food!
Safe surfing, Noogi

I don't have calipers but I did remember that I have the insulin ruler for BD syringes (the brand I use) so I will use that. Reckon I'm going to try a skinny dose and see how he gets on with that.

 

[Helen + Noogi]

I completely understand your predicament: lower numbers + work/inability to monitor = WORRY

On the other two times you mention, how long did you hold the dose before going back down? I'm looking at his numbers since the increase, and I'm wondering if he's bouncing and if he will eventually (quickly, I hope) clear his way to lower (safe), flatter numbers?

This is a hard one, but, again, I get it. I'd rather have Jude a bit high as opposed to worrying he's going to go too low when I'm at work.

Good luck with the decision, Helen. I hope someone will weigh in with some advice soon.

Let's see if @Bandit's Mom is around.

Thanks Mary. I know you get it
I didn't hold the increase for more than a couple days previously. Was too worried about going too low.
Feels like I have been in this exact predicament several times before and it doesn't get any easier

 

[Mary & Jude]

I don't have calipers but I did remember that I have the insulin ruler for BD syringes (the brand I use) so I will use that. Reckon I'm going to try a skinny dose and see how he gets on with that.

I hope the skinny dose is the goldilocks dose for Noogi!

 

[Bandit's Mom]

Hi Helen, it did look like he needed more juice than 0.75U. Sometimes you do see more action in a cycle on a dose, but unless it happens more often, it makes sense to just hold the dose. It's also possible his pancreas just needed a little kick. Since you've have shot a skinny 1U tonight, you could stay on it for a few days and see how he does on it. Normally we fatten/skinny doses only when a cat toggles between 2 doses often enough for it to be clear that it needs a dose in between.

 

[Sienne and Gabby (GA)]

Ideally, you would want to see Noogi earn a reduction. It might have helpful to feed some of his usual low carb with the 58 at +3 and then test at +3.5. The low carb could keep him surfing or at least not dropping fast.

Also, what date was Noogi diagnosed? After a year from diagnosis the dose reduction number is below 40 with TR.

 

[Helen + Noogi]

Hi Helen, it did look like he needed more juice than 0.75U. Sometimes you do see more action in a cycle on a dose, but unless it happens more often, it makes sense to just hold the dose. It's also possible his pancreas just needed a little kick. Since you've have shot a skinny 1U tonight, you could stay on it for a few days and see how he does on it. Normally we fatten/skinny doses only when a cat toggles between 2 doses often enough for it to be clear that it needs a dose in between.

Thanks Bhooma
I think you are on the money there with his pancreas needing that little extra encouragement.
I agree too about sticking with those for a few days. Even after all this time I get so anxious about dose increases. Just need to try harder to hold my nerve.

 

[Helen + Noogi]

Ideally, you would want to see Noogi earn a reduction. It might have helpful to feed some of his usual low carb with the 58 at +3 and then test at +3.5. The low carb could keep him surfing or at least not dropping fast.

Also, what date was Noogi diagnosed? After a year from diagnosis the dose reduction number is below 40 with TR.

Thanks Sienne
I agree - I should have tried some LC first yesterday. I just got panicky as I was not expecting a low number. I'll try to remember that if/when there is a 'next-time'.

Noogi was diagnosed a year ago (almost to the day) so yes, he is now officially a long-term diabetic
I had not realized that his dose reduction number drop to 40. But that is interesting to know, and maybe make it a little easier for me to handle the dips into the 50s.

If I could check on him all day I think I would be more relaxed but as I work full time in the week I need to leave him alone, and would prefer him a smidge higher for safety's sake. I was so lucky to have him nicely regulated for many months and it has been quite unsettling and confusing for me to have him return to more instability and unpredictability, especially at a time when I have a lot of other stuff going on in my life. Somehow I feel like a beginner again

 

[Sienne and Gabby (GA)]

Like you, I worked full time when I was managing Gabby's diabetes. One of the things I found helpful was that I moved her shot time to 5:00. That gave me time in the morning to monitor before I left the house. She had an early nadir so it gave me some buffer and I knew if I needed to bump up her numbers with food as well as guided me with respect to whether I needed to use a higher carb food in her timed feeder. I was able to get home within 30 min of her PM shot time so it worked out.