? 10/12 Max AMPS 440 +2 367 +4 255 +8 114 +10 105 +11.5 99 PMPS 94 then 104 30 min after food

Max’s schedule and dose have been all messed up since his ER visit and I am trying to get it back as close to normal as I can before his SRT which is scheduled for this Thursday (10/14) The ER gave half doses and gave injection way past the time it was due (3 hours later). Of course the BG were reported high there. Not sure of the numbers. They told me to work my way back up to his normal dose and schedule so that’s what I’ve been trying to do. I don’t want a repeat of last week when they didn’t give his injection after we arrived at the hospital for his MRI. He spiked to 700 and then it’s been all messed up since then with them giving the regular insulin and partial doses. I hope I haven’t messed up but I was trying to catch up each cycle by giving 15 minutes early and increased to close to his normal dose. Well he was so high today that I gave 1 hour early and increased to 10.5. I know that giving early can be like a dose increase so I hope he doesn’t go too low on me. I’ve been giving very small frequent meals after each glucose check as well. I plan to give tonight’s dose 12 hours after AMPS as usual but I want to know if he should be okay with the 10.5 units? I’m still 1 1/2 hours off of his schedule but I don’t know if I should give anymore early since he’s responding like he is now. So I don’t know how I can get it to his normal schedule where I can feed him and give his shot before we leave the house. He has to be at the hospital between 7:30-8:30 Thursday. It takes at least an hour to drive there. His normal dose time was 6:30 am prior to all of this that happened. I’m reaching out to see if I can get some advice with this. @Wendy&Neko @Marje and Gracie. Y’all have helped me in the past. Have I messed up? What can I do about this situation if anything? I’m not doing anything else until I get some advice here from someone. Thank you! Max is feeling so much better. I don’t want to mess him up! @Sienne and Gabby (GA)

 

I wouldn't "work his dose back up", but rather would have gone back to his old dose. But the past is the past. If you want to run him a little higher so you don't get surprises, stick with 10.5 units for now until the SRT date. They should be telling you to give a half dose the AM of his SRT. Which would help him not get so high as a skip would do.

You can move his shot time up 1/2 hour tomorrow too. Any chance you can take the insulin and syringe with you and give him a shot in the car as you get to the parking lot at NCSU?

Great news!

 

Yes I think that’s what I will have to do is give it in the car. I’m just so afraid because he keeps going down that if I give the 10.5 he will become hypo. I didn’t know if I messed things up by giving that early (1 hr early) and upping the dose at the same time. I should have asked you first. Do you think he will drop too low if I give the 10.5 at 12 hrs past his AMPS? I can’t stay up at night. @Wendy&Neko

 

Test at +11.5 and post again, to see if he's changed directions by then. Hard to guess where he'll be at PMPS with just +10 data.

 

Okay will do. That will be in 40 minutes from now. Thanks!

 

Looks like he’s clearing a bounce from that 191 on 10/10 so I won’t be surprised if he’s still dropping at PMPS.

Do you mind adding “@ +11” to his AMPS today so we can see you shot an hour early? Thank you. I’m glad he’s feeling better.

 

@Wendy&Neko @Marje and Gracie thank you. He is 99 @+11.5. I'm really scared to give 10.5 since I gave his insulin 1 hr early this morning and increased too. What do y'all think?

 

I’m hoping Wendy will give her thoughts on this but with a depot that big, even if you shoot a half dose, he’s still likely to have at least the first several hours of this cycle look the same as if you shoot a full dose although shooting a full dose, he’s likely to have a fairly big drop at onset unless he bounces.

While the best option might be to stall, I know you are trying to get him back to a better shot time before Thursday. My thought is to give a half dose and feed a good meal but you are going to have to test him tonight until he heads up. I know you can’t stay up but shooting a half dose will not guarantee that he won’t drop low without some monitoring and skipping isn’t an option.

Hopefully, Wendy will also drop in. She has more experience with these high doses with dropping BGs.

 

Okay. Thank you @Marje and Gracie. If I have to stall some, that's just what I have to do. I can take his insulin give it in the parking lot if the time works out. Or I could give it to the staff at NCSU. Problem is, last time I did that they didn't give it to him and he spiked to over 700.

 

I like the idea of a 1/2 hour stall, without feeding, to see where he's going. Neko often nadired at PS.

 

Just realized the 1/2 hour stall just puts you at PMPS time, so not really a stall. If he's flat or rising, or even down just a few points so essentially flat, I think that half dose would be fine.

 

He went down to 94.

 

Try again in 15 minutes. I don't want to wait too long, or he might drop further without food.

 

Oops I just fed him. I didn’t see this until now.

 

He's really slowed down, and the food will likely stop the drop. Though if you had a few more +1 tests, we'd have a better idea how much that food would bump him up. How is his appetite today?

 

He’s eaten a lot today because I was giving him small amounts after each test. He ate his food just now. It was a small amount. He still seems nauseous a little but still eating. He’s been licking his tongue out a swallowing a lot. I guess give the 5 units right?

 

Do you have any antinausea meds for him?

 

I would try a test 30 minutes after you fed him and see where he is.

 

I gave him 4 mg of zofran. I also have cerenia here.

 

Lori, I know you don’t want to hear from ME, but I just wanted to say that I am really relieved that Max is doing better now. I was looking for a post from you. I am excited that he is really going to be able to have the SRT on Thursday. Keep us posted as you can. I will be thinking of y’all!

 

Okay @Wendy&Neko he is 104 now 30 mins after eating.

 

Was it his regular LC food and amount?

 

Yes 1/2 can fancy feast pate

 

How do you feel about a half dose tonight?

 

Yes that’s what I think. What about tomorrow morning. Give what dose and at regular time+12 from now?

 

He'll likely be higher tomorrow morning, so you could move it up 1/2 hour. How about 10 units, and stick to it. Numbers are wonky from all the different dose, but at this point I think you'd be more comfortable with him a little higher before SRT.

 

Yes you are right. I would be more comfortable. I guess I did all of this for nothing, except create more of a mess. I will monitor for a little while. Thank you Wendy. I’m so sorry about all of this. I thought I was helping the situation but I should have asked. Thank you!

 

Thank you Suzanne. It's always great to hear from you.

 

You didn’t create a mess. You made the best decision you could at the time. You have a solution for tonight and a plan. Don’t beat yourself up. None of us ever got it right all the time

I probably won’t be back in before the SRT so tons of great wishes for a very successful procedure. I’ll check back in once we are back in AZ. Take care & hugs for your sweet boy.

 

Thank you Marje! I hope you have a wonderful time and safe travels!!!

 

You should probably get a +1 to start.

Don't beat yourself up, you were following vet advice.

 

Wow that shot up fast. 184 @+1.5. I need to check at +1 on him sometimes. I rarely check +1. I don’t know if I will ever be able to even come close to understanding Max’s unpredictability.

 

That looks more promising for sleep tonight. Next test will say if it's a bounce for sure. Getting a few +1's helps you figure out the food bump he gets before the insulin onsets again. And helps you decide how comfy you feel shooting lower numbers. I knew Neko got around a 30 points bump, plus there was still time before the insulin onset for her numbers to rise. Made it easier for me to shoot lower numbers. Gathering data in this type of situation will help you figure Max out.

 

Good to know. I’m gonna try and get a +2.5 in 30 mins but then I may fall asleep. It’s about 11 pm here. I will set the alarm to get up and check later too if you think I should.

 

If up more, sleep.