10/27 Zeke Dosing Question - Please advise

[MrZ]

Hi Guys,

Well every time I start asking about increasing the dose, Zeke goes just low enough that I decide to hold the dose (for example 10/21 and then the low PM 10/22). When that happens, soon after he seems to go back up the BGs that compelled me to ask about an increase in the first place. My concern about this pattern is that I end up holding a dose too long. So here we are back in that exact same situation. As you can see from his spreadsheet, he's been on 1.25U for 9 days. He's had some blues and greens, but still a lot of pinks. Unfortunately, this PM 10/27 we had a fur shot, so of course don't know if he would have had some nice numbers this evening.

Anyway, just wondering since we're going into day 10, should we increase? Would really appreciate if a few people would chime in.

Thanks,
Laura

Zeke'S Condo from yesterday

 

[Dyana]

It looks like he's in a bounce right now, or it's just because of the fur shot, last night. I would stick with the 1.25 this morning.

 

[Sienne and Gabby (GA)]

It helps to remember that Lantus dosing is based on the nadir, not on the pre-shot numbers. It's also best to not increase during a bounce. When a bounce is clearing, numbers can drop. If you increase the dose on top of a bounce clearing, it can take a lot of work to keep the numbers in a safe range.

 

[MrZ]

Sorry, but I obviously have difficulty distinguishing a bounce from high numbers due to too low a dose. From what drop are you seeing he's bouncing from? The lows from 10/25 PM and 10/26 AMPS or all the blues that followed?

 

[rhiannon and shadow (GA)]

The bounce is the 342 you had yesterday.... before you had the furshot.

Your count on this dose started over when you reduced the dose on 10/26. And now starts over again with the furshot. :YMSIGH:
Zeke was getting some greens so the dose was looking fair... he just bounces when he sees the greens.

 

[Marje and Gracie]

I also think you should hold this dose and let the depot refill due to the reduced dose you shot 10/26 a.m. and the fur shot.

Any reason in particular you shot 1u on 10/26? That 89 was a great number to shoot the full dose and he wasn't dropping (you did a super job of getting the +9/+10 tests from the PM cycle of 10/25). The data you collect...and you have great data...helps you learn when it's safe to shoot. At this point, you should be shooting every number above 50 with the current full dose as long as you have supplies and will be there to test.

Shooting those green numbers above 50 will help him immensely. Let us know if you need someone to help you. We are happy to walk you through it and someone stay online with you. The thing about shooting a reduced dose is it likely will not affect the current cycle that you shoot it because of the depot. You would see the effects more on subsequent cycles and I think that is, in part, the reason why he hasn't come back down.

 

[MrZ]

Any reason in particular you shot 1u on 10/26?
Let us know if you need someone to help you. We are happy to walk you through it and someone stay online with you.

When I got the 89 the morning of 10/26 I asked for advice (see here Advice 10/26 AM). That was the first time I was faced with that low of a number at PS. I know that the Protocol is a guideline and not hard fast rules (as per the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCO) but as per the protocol, I understood the following to be my options and I opted for(a), unfortunately my choice resulted in "Increased blood glucose concentrations - the last paragraph":

If blood glucose at the time of the next insulin injection 50-100mg/dl (2.8-5.6 mmol/L)
Initially test which of the alternate methods is best suited to the individual cat:

a. Feed cat and reduce the dose by 0.25-0.5 IU
depending on if cat on low or high dose of insulin

b. Feed the cat, wait 1-2 hours and when the glucose
concentration increases to >100 mg/dL give the
normal dose. If the glucose concentration does not
increase within 1-2 hours, reduce the dose by 0.25 IU
or 0.5 IU (as above).

c. Split the dose: feed cat, and give most of dose
immediately and then give the remainder 1 to 2 hours
later, when the glucose concentration has increased
to >100 mg/dL.

If all these methods lead to increased blood glucose
concentrations, give the full dose if pre-insulin blood
glucose concentration is 50-100 mg/dL and observe
closely for signs of hypoglycemia. In general for
most cats, the best results in phase 2 occur when
insulin dose is as consistent as possible, giving the
full normal dose at the regular injection time.

This was the first time I was faced with such a low PS number so I had to test the waters. I didn't want to stall so I shot what I was advised and what I thought I was supposed to do - shoot a reduced dose. Now that you've advised me to shoot anything over 50 (and I have an idea of how Zeke will react), I'll know to do that next time (assuming I'll be around to test). So, what should I do if I'm not gonna be around to test?

Based on where Zeke's numbers have been since that morning, I wish I had shot the whole dose. Ok, so what should I do now? I'm being told to hold the dose. Because Zeke's numbers continued to rise after his shot, I assumed we'd given him a fur shot last night. However, today his numbers are even worse than last night (and I know we didn't give him a fur shot this morning), so last night may very well have been his reaction to a full dose. Guess what we're seeing is the ramificaitons of my having given him a reduced dose the morning of 10/26. So, I guess since my information is not 100% reliable (fur shot or no fur shot), I should just continue to hold the dose. Do you still agree?


Here are his numbers for today:

AMPS 390
+2.5 = 370
+5.75 = 439

 

[Wendy&Neko]

Hi Laura - I'm chiming in on "hold the dose" too. Take a look at Jill's post on counting cycles.

Time to don those patience pants and wait. I recommend the relaxed fit style. :lol: The effects of a fur shot can be seen in subsequent cycles, not just the one immediately afterwards. I just did a fur shot a few days ago and didn't see green until the 6th cycle, so I have recent experience in this. :roll: I also saw some wonky numbers in later cycles.

 

[Marje and Gracie]

Laura

I apologize that I didn't go back and look at that condo to see the advice. I knew it was your first green number when I looked at his SS this morning but felt you had plenty of data to shoot because he was flat. If he had been dropping, it might have been more worth a reduced dose. Sometimes we suggest reduced doses for the caregiver's comfort or if we don't have much data or if the CG has to leave. It doesn't do anything beneficial for him if the number is safe to shoot and you will be there to test. If we sense that you are really worried about shooting a low number, we can suggest you stall or shoot a reduced dose.

If you get a green number above 50 that is not dropping (eventually, you can learn to shoot dropping green numbers but that takes a little more data on how they do with green) and you have to leave, you can stall to see if it will come up or you can shoot the reduced dose and leave HC food out. Or skip. Skipping is always a safe option if you get a low number and need to leave for a good portion of the day. My comments about shooting low were geared towards being able to be there to test.

The info you quoted is from THE TR protocol and we use a modified protocol here. We typically follow Shooting and Handling Low Numbers. If you look at SSs, you'll find that most of the members who've been here a bit (even a few months), don't do any of the options in the TR protocol that you listed. If a new member needs to stall because they get their first green, we have them stall without feeding, test every 20 mins or so, and shoot as numbers start to rise.

I agree with Wendy that it's time to put on those patience pants and let the depot refill. I've had to skip two shots and it also took 2 or 3 cycles minimum for the depot to refill and numbers to come back down. But EVERYONE shoots a fur shot at one time or another. It happens. Even the most experienced CGs do it so don't worry. He'll come back down and then we'll see what he does with the dose again after he's had a total of six cycles to refill his depot.