? 1/1/20 - Zhoom PMPS 182 - what to dose?

CRL

CRL

Member Since 2019
Happy New Year! Zhoom Boy has had a great surf late in the cycle today. He is starting to climb a little so I am stalling his shot. His dose is 1.5 U. I have never shot in blue numbers. What dose should I give? Any advice is appreciated.
 
Good job shooting something. It looks like you didn't shoot on the 18th and he was pretty high the next morning.
Your data seems to show him coming up from the 152 by his PMPS. His +1 on the 28th was higher than his PMPS so he likey does trend upwards even after his shot. I think you are safe to shoot a full dose if you can stay up and test in the future. Or at least fed a snack at +3/+4 since his lowest numbers look like they might be +5.
I like to grab more +1 and +11 so I can tell how my guy looks even after his shot and right before it's due. Then I know even If I shot a 150- he's likely going to be higher befor than insulin kicks in. If I find his +3 numbers are lower, I will usually give him a LC/ MC snack so he can glide down when his insulin kicks in instead of crashing.

Well done. A half dose is a good compromise. I freaked out and did nothing the first time we had a lower PMPS.
Shoot low- stay low
 
Si am cat mom said:
Good job shooting something. It looks like you didn't shoot on the 18th and he was pretty high the next morning.
Your data seems to show him coming up from the 152 by his PMPS. His +1 on the 28th was higher than his PMPS so he likey does trend upwards even after his shot. I think you are safe to shoot a full dose if you can stay up and test in the future. Or at least fed a snack at +3/+4 since his lowest numbers look like they might be +5.
I like to grab more +1 and +11 so I can tell how my guy looks even after his shot and right before it's due. Then I know even If I shot a 150- he's likely going to be higher befor than insulin kicks in. If I find his +3 numbers are lower, I will usually give him a LC/ MC snack so he can glide down when his insulin kicks in instead of crashing.

Well done. A half dose is a good compromise. I freaked out and did nothing the first time we had a lower PMPS.
Shoot low- stay low
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Thanks for the words of encouragement. I was trying to decide whether to give him 1.25 or 1 and went with the conservative number. Seeing his numbers now as we move through the cycle, I can see that 1.25 (or even 1.5) would have been fine. I am learning and finding courage. Hopefully we do not lose our good momentum.
 
Given that. you've been managing Zhoom's FD since September, I'd encourage you to think about what number you're comfortable shooting. We tell new members following SLGS to use 200 as your "post and ask for help" number. That's not meant to be static -- you want to ultimately be able to shoot lower pre-shot numbers. As a point of contrast, with SLGS you can shoot anything above 90. At this point, you could easily shoot 180 especially since it's pithing the 20% variability due to meter error.

I also think you are seeing so many high numbers given how long you are holding doses. Zhoom is definitely a bouncy kitty but holding a dose for longer than necessary is going to allow glucose toxicity to develop.
 
@CRL Please PM me. You need a 2020 SS and I’ll be glad to do it for you but I need some info from you. It’s important we start a new SS every year or they get way too long and take too long to load. If you are in need of quick help, it slows it down to have more than one year on a tab. Thank you.

Sue and Luci said:
Are you going to ask @Marje and Gracie to set up your new 2020 SS?

Hope things settle down for Zhoom soon :) You've gotten some great advice above from the best :)
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Thank you, Sue!
 
Sienne and Gabby (GA) said:
Given that. you've been managing Zhoom's FD since September, I'd encourage you to think about what number you're comfortable shooting. We tell new members following SLGS to use 200 as your "post and ask for help" number. That's not meant to be static -- you want to ultimately be able to shoot lower pre-shot numbers. As a point of contrast, with SLGS you can shoot anything above 90. At this point, you could easily shoot 180 especially since it's pithing the 20% variability due to meter error.

I also think you are seeing so many high numbers given how long you are holding doses. Zhoom is definitely a bouncy kitty but holding a dose for longer than necessary is going to allow glucose toxicity to develop.
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Thank you Sienne and Gabby. Sorry it has taken me awhile to respond. We have been having an incredibly difficult 2 weeks. Our dog Pepe has been very very sick and we have been to the ER with him 4 times. He is finally starting to feel better and life is calming down a bit. We are so happy. We thought for sure we were going to lose him.

Can you please help me to understand a few things so that I can learn?

What should I have done when Zhoom was at 182 pre-shot? Should I have given him his regular dose? If he had been at 100 pre-shot would I give him his regular dose?

And when deciding when to increase or decrease doses - if he goes under 90, then I would decrease the dose by .25? And if his nadirs are around 150, I would hold the same dose? If the nadirs are above 150, I would increase by .25? Do the nadirs have to be consistently (every day or almost every day) around 150 to hold the dose?

I really appreciate the guidance. I think I may be misunderstanding about the nadirs and increasing the dose- I have been holding the dose, because he has had a 150 nadir pretty consistently within a week of each other. (There was a time recently when it was 9 days in between a 150 nadir and that was overlooked because of the situation with the dog).

Please let me know if I am misunderstanding about when to increase the dose. I really want to get this right and take good care of my Zhoom Boy.
 
Sorry to hear about your puppy dog. :bighug: Hope all is well now.

CRL said:
And when deciding when to increase or decrease doses - if he goes under 90, then I would decrease the dose by .25? And if his nadirs are around 150, I would hold the same dose? If the nadirs are above 150, I would increase by .25? Do the nadirs have to be consistently (every day or almost every day) around 150 to hold the dose?
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Yes, you decrease by 0.25 if he goes under 90 on SLGS. You hold the dose if his nadirs (plural) are between 90 and 149. If 150 and above, you increase. Don’t look at nadirs on the cycles he is bouncing, those will be higher. The question you want to answer is “how low can this dose take my cat?” It’s been 12 cycles since he saw anything under 150, past time for an increase.

As fo the 182 preshot, it depends on a few things. Can you monitor that cycle? Do you have high carb food and plenty of strips, in case you end up testing a lot? Do you have any previous cycles that were similar? You shot full dose on a 221 and had a lovely flat blue cycle. With meter variance 221 and 182 are pretty close. The 142 told you what happens of you skip. Now you have data that tells you what happens if you shoot a reduced dose. There is no one answer for shooting lower that works in all cases. Which is why it is helpful if someone is around to help at the time. Unfortunately Zhoom chose a holiday. :rolleyes:
 
Thanks, @Wendy&Neko

@CRL - It's been likewise a little hectic here so my apologies for not getting back to you sooner. I appreciate Wendy providing the clarification. It can be challenging in some cases to sort out the issues with whether there are "enough" nadirs to justify a dose increase. To some degree, it's a matter of the majority of nadirs. If you're ever unsure, put a note (with a question mark) in your subject line and someone will reply. Alternatively, tag a few people who's input you've found helpful. There's a lot of information to integrate and it would be far easier if it was always a matter of black or white decision making -- and it's not. Even among experienced caregivers there can be differences of opinion.
 
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