1/16/15 Keiko AMPS 113; +6 - 36; +7- 36

Status
Not open for further replies.
Hi Maria - yesterday I suggested doing a 10.0 unit dose. That 10.5 units is clearly too much. You need to get him out of the 30's. You should be giving him high carb food/gravy and/or karo/syrup/honey - a couple drops. He's at a dangerous low level. Keep feeding and testing until he stays above 50.

Since Keiko is at a higher dose and he got really low today, it looks like his depot is really large. One trick you can do to help when you are on a higher dose is to do a one time only reduced dose tonight, say 5.0U, then resume with 10.0 units tomorrow morning.
 
That's better, but he still needs to come up more...you want him well into the 50 or above. Did you give him more High Carb? It not, give him a little more and retest in 20 minutes...30 minutes max.
 
Maria

I agree with Wendy....and you also need to stay on top of the 47. That is still too low. It isn't dangerous but there is no room there and when the HC wears off, he could end up back in the 30s.

I know the high numbers are hard, but I feel you've been hopping around in dose a little too much lately. And to be honest, I'm very concerned about shooting with no PS tests. Changing the dose so much when you don't have much data....no PM Preshots and no PM tests.. just further confuses things.

I agree with Wendy, also, that you should take him down to 10u tonight and monitor him a bit more. You want to be sure and get a PMPS test because you don't want to shoot a low number with as low as he is today and how full his depot must be. 10.5u is a huge depot. If he doesn't come up to a good number and/or you can't test tonight, you might need to skip the shot for safety.

Once you get him on the 10u, I'd hold that dose at least six cycles unless he earns a reduction. It's going to be important to watch him because if he drops low again in two cycles, we will need to decide if that is depot or it's really an earned reduction.
 
Last edited:
just a note, Maria...I accidentally wrote 10.25u above but I've corrected it. The new dose should be 10u as Wendy and Julie suggested.
 
I'm going to jump on the same bandwagon as Wendy, Amy, and Marje. When you catch a dangerously low number like you did today, we typically advise testing every 20 - 30 min. so you have better control over the numbers and can feed frequent, small amounts of high carb food to bring the numbers into a safer range. Please take a look at this sticky note on shooting an handling low numbers.

It concerns me that you didn't get any tests after seeing the 49 the evening of 1/13. You have no idea of just how low Keiko's numbers went especially since you saw an AMPS of 88 the next morning. Unless you are going to allow Keiko to stay in higher numbers, in order to keep your kitty safe, you do need to get a few more tests when you see low numbers.
 
Great to see Keiko getting some green but whoa! Did you really get a 36 and then not test again for an hour, that is way scary :nailbiting:
 
He's at 69 a short time ago.
I can't always give him a shot at exactly 12 hours so it may be 11 or 10 sometimes.
Should I feed him a high carb meal tonight? Is it 10 units or 5? I know it's not a completely answerable question.
 
Marje, you wrote: 'If he doesn't come up to a good number and/or you can't test tonight, you might need to skip the shot for safety.'
What would be a good number?
 
I can give him the shot at 12 hours tonight.
What would be a good number in terms of giving him a shot or not?
I can test him tonight until +4.5 but I won't be reliable testing him through the night.
It's been a half hour and he's 60 (down from 69).
 
I wrote a couple of other posts but I dont see them. Since he's 60, should I give him more food? I read the article about low numers and will print it out.

I mentioned that I can't always give him his shot at exactly 12 hours so sometimes it's 10 or 11 or 13.
 
You don't need to feed the 60 and, unless the numbers say otherwise (in which case you would be delaying or skipping the shot) you don't want to feed in the 2 hours prior to a shot because you want to be sure that the preshot number you have is not influenced by food. The 60 isn't on your spreadsheet yet but I'm thinking that you must be getting pretty close to the cut off.

I can't always give him a shot at exactly 12 hours so it may be 11 or 10 sometimes.
Click to expand...
Shooting that early can act like a dose increase and is really not a good idea, particularly when the numbers are low. From your spreadsheet there's no way for people to tell that you've been doing this. From now on can you please add the time you shot in the cell with the number of units that you shot so that people are aware of this (see how I've done it in Vyktor's spreadsheet) otherwise people will be assuming that you're shooting 12 hourly. For safety it would be better to go late than early if you have to unless the numbers are very high.

It's also good if you can add what you've fed and when for low numbers in the remarks column so we can easily see which numbers may be food affected. I think that 69 was food influenced though so Keiko still isn't keeping the numbers up on his own.

Doh - I'm taking to long writing this post and I see you've just fed, which means your shot would need to be delayed (assuming we're past +10) and that reduces the time you are able to test after the shot (I see you said not past +4.5). For safety's sake I think it would be best to skip tonight and then start fresh tomorrow.

You'll started with the 10u as suggested.
 
I would still get some further tests tonight to make sure that the food doesn't wear off and have Keiko drop into dangerous territory again - see the handling low numbers page Sienne gave you
 
Hi Maria!

You've had quite the day!

I don't think I'd worry so much about feeding in the 2 hours prior to pmps tonight, just know that he might be a tad bit higher because you've fed. If I've understood correctly.

I think what Marje is saying is that when you've got a string of green numbers like this and don't know what will happen in the next cycle after you shoot, it might be a good idea to skip the pm shot if you can't monitor.

One technique many of us with high dose kitties use is to give a 1/2 dose shot after you've had a string of green numbers in order to drain the depot and interrupt the string of low-numbers. Keiko hasn't bounced from hitting the 30's - which is probably telling us that he's become used to fairly low numbers. I think since you can monitor tonight til +4.5, if he were mine, I'd go ahead and give him a 1/2 dose (5.0u) and then make sure to test him at +2 and see where he's going. If he's under 100 at pmps, I might even give less, 3.0u or so, since you can't monitor after +4.5.

The idea is to always err on the side of safety when you know you can't monitor if it's needed.

I would come back tomorrow with a new dose of 10.0u and then stick with it for 6 cycles unless he goes below 50 again.

Serryn's also offering the option of skipping, which is ok to do as well. I'd probably want to get a little bit of insulin in him, but skipping is ok.

As far as shooting early - it's better to save that for when he's high. When you shoot early, as Serryn said, it acts like a dose increase - you're increasing the overlap between one shot wearing off and the next shot onsetting (starting to work) and that can lower numbers. If the kitty is high it can be helpful, but if the kitty is low that can cause problems.

You can see that something's changed with Keiko. Maybe he's got acromegaly and the tumor is producing less hormones. Maybe he's just gotten used to normal numbers and he isn't bouncing. Maybe he has insulin autoantibodies and its run its course and he's going to need less insulin now. Whatever has changed, it's a good thing, but along with it you have to be more vigilant. I know you can't test him all night, so that might mean it's safer for him to be running a little higher.

Does that all make sense?
 
He's to have his shot in 1 hour, 8pm EST. He's still just 60.
Not sure yet if its no shot, 5 units or 10 units. I would hate to see him rise into the 200s or 300s but I've never seen him this low. He may have been before diabetes but I did not est him. My healthy cat is between 40 and 60 before meals.
 
Most non-diabetic cats run in that 40-60 range.

I'd wait to see what you get at pmps to decide. If he bounces, then that will help you decide. If he's low, though, I'd be conservative.

One thing about a high dose kitty, as i mentioned yesterday, when you've got a large dose you can sometimes even skip a shot and not be able to tell from the BG tests. So if you are at all worried, give a small amount ot skip entirely.
 
I'm here tonight but if I'm sleeping I won't know if he's having trouble. That would be the case any night unless I tested him late and he was low again.
 
I wish i had the perfect answer for you. If he were mine, I'd want that green streak to continue but I stayed up late with punkin, or set my cell phone alarm and got up to test him again. I'd probably shoot something, but not the full dose. There's just no way to be certain what will happen after you shoot.

It's really up to you. i know that's not much help, but you're the person there who has to do the follow-up with him.
 
I decided to give him a half dose - 5 units. I'll check him at +2 and +4.
Part of me wanted to give him 7 or 8 units but his pattern has changed so much lately and getting this low was unexpected. I was so used to increasing. Then he seemed to stabilize on 11 units for 2 or so weeks. I was not expecting the need to lower the dose so soon.

Thanks Wendy, Julie, Marje, Sienne, Vyctors mum, Amy! Keiko says thank you too!
 
I'm sorry, Maria, that I didn't get back here. I was working.

Julie explained my point just fine. Like her, I would want to keep the green going but only if it's possible to test. If a caregiver can't stay up and test, it's not a good idea to shoot a lower number ...even 105.... With a full dose like Keiko is getting.
 
Status
Not open for further replies.
Back
Top