11/13 Frank PMPS 369, +2 465

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Re: 11/13 Frank +11 84 / AMPS 92

Please get a ketone test if you did not last night.
Throwing up can be a sign of ketones. You do not want ketones. They can show up even with low numbers.
If you did not give insulin yet, then you can change the Subject Line in your first post to "11/13 Frank +11 84 / +12 92".
Is he eating well this morning?

I have to leave, but am worried with the recent ketones and the throwing up. Please ask your vet to get a ketone test if you have not gotten one. Sending good vet visit vines.
 
Re: 11/13 Frank +11 84 / +12 92 / +12.5 102

He is eating fine. He has had a half a can of food this morning and he seems to be feeling well. He is bathing extra well right now. Usually he drags after eating and hovers over his water bowl. Maybe eating so much at once is contributing to him feeling poorly. No pee yet for a ketone test. He eats again in 10 min.
 
Re: 11/13 Frank +11 84 / +12 92 / +12.5 102/ +13 143

Okay, so if I am understanding this correctly... with his number being 143 at +13, if I test him at +13.5 (8am) and he is over 150, I should give him insulin then, 1.5 hours late. And then he would get his second for today 12 hours later(8pm)? Then, was it 30 minute increments we could use to adjust his schedule back? And how would this work with the suggested dose increase? Should I go ahead and increase by .25u as was suggested last night? Or... should I skip a dose and wait until things look more normal to increase? **I say normal in the most relative sense.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+13.5=140

How much food has Frank eaten? How much flexibility do you have with your schedule?

(Generally, if you are stalling, yo don't want to feed.)
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+13.5=140

Hello Marie, congrats on getting those first normal numbers! From the protocol:
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
Click to expand...
I've bolded the relevant part - so no increase today for Frank!

Secondly, I'd encourage you to read the sticky on shooting and handling low numbers. When we get a low number before PS, we DO NOT feed, and wait for the numbers to come up before shooting. Food will influence the numbers, so you don't know whether he was coming up on his own. Generally, for new members, we suggest that you don't shoot until you see numbers rising. The 150 numbers is our suggested number below which you post for help. People here will shoot below 150, but we don't ask you do it alone the first time.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+13.5=140

I see Sienne is up. Great, I'll let her continue. I was just up for a +10 test.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170

Sienne - I've fed him 1 can in 1/4 can increments over the past two hours, since he had an upset stomach last night. All they gray on my spreadsheet is when I am unavailable. Tuesdays and Thursdays I am gone for seven hours. Today, I am home all day. I can shoot at 8 and be fine but I have to be out of here by 8:30.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170

I guess I missed the part about the feeding. Either that or my mind was on a mission. That happens sometimes. The idea in my head takes on a life of its own and robs me of my memory. It may be the ADD. lol

Wendy - Lots of info going around the last 24. Forgive me if you are already up to speed and I am misunderstanding your post. The dose increase was suggested last night based on his number from the past few days. He has been vomiting though, which I am guessing contributed to his lower numbers, so I wanted to see if we were still on for the increase or if we needed to cancel it.

I-) I feel like laying down beside him and taking a nap. Got to get the kitties out in the enclosure before they kill each other. It was 22 degrees here this morning so they had to come in and stay in the kennels. They are not very happy in the kennels. lol
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170

If you're going to be home and available to monitor, have a stock of strips and high carb (HC) food if you should need it, it should be OK to shoot. Please keep in mind that you're shot tonight will be off your usual schedule. You will need to gradually move your shot time in order to get back on schedule. Your shot tonight will be 12 hrs from when you shoot this morning. You may be able to shoot early depending on where Frank's numbers are.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

He is up to 270 now. The only complication I see in shooting at 10am is that the latest I can shoot tomorrow and still get to school on time is 8:25am. I am home all day Friday-Monday though. The best I can do as far as time tomorrow is leave class 15 minutes early, come home, and be 15 minutes late for the next class. Then I can shoot at Noon today, midnight tonight, noon tomorrow, then I will have four days, if that is enough time, to at least roll him back to 8:30. The only drawback to that is that I will have to go back to school and won't be able to test him for the next 2.5- 3 hours. I wish I could stay out of school, but I don't have that luxury at this point.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

With that +15, it looks like Frank is bouncing. Unless something unlikely happens, you should be able to shoot early. I would shoot NOW. The longer you delay, the more off schedule you are. I thought you were going to shoot at +14.

BTW, do you know to refresh your browser to see if there are new posts in your thread/condo?
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

I intended on shooting at +14, but I am still hesitant to do anything without confirmation. And yeah, I know how to refresh. I've been a web designer for several years and I have set many of these boards up. I know you didn't know that so I am not picking on you, but it did make me giggle. :lol: Anyway, I have a lot going on so I am posting in between tasks, and earlier, we cross posted. I've got his insulin drawn up so I am going to go now and do his AMPS BG then give it to him. I'll be back.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Okay, that is done. He was at 338. I got a small leak, again. I'd say he probably got his regular dose with the bump. No vomit today, at least.

Thank you for sticking with me this morning. Hopefully I won't be so dang needy before long.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Hi guys .. so glad you had company this morning! The support on this board is so wonderful .. Glad to hear no vomiting today as well .. Hopefully frank does not bounce that bad ... have a great day guys!
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

don't think twice about needing help, tina. really. we've all been there and until you've gotten through all of the "firsts" - first low preshot number, first time in low numbers, first time seeing a bounce - you're going to need help. none of us mind because we've all been in your shoes.

for a lot of these firsts you need to get through them more than once with help. it just takes time to learn it, but fortunately there are a lot of people on here every day who volunteer their knowledge to teach newbies.

glad you got him shot and really glad he has cleared out the dry food carbs and it showed up before we increased his dose!!

it's common for a cat to "bounce" from low numbers. we don't know how low he got before the +11, but even an 84 after he's been used to 300's will feel low to his body. An explanation of a bounce is in this post on New Dose Wonkiness. NDW applies when you are increasing a dose. A bounce is what we call it when the cat has hit a lower BG range than it's become used to and the liver reacts. This looks like a bounce today, so he might be in high numbers for as many as 72 hrs from it. we don't increase the dose to compensate for a bounce because the bounce will clear and we don't want Frank to be overdosed at that point. So we'll watch and see what numbers show up when the bounce clears. You'll be keeping this dose for the next 3 days or so while we watch the bounce, unless he goes below 50 and then we'll reduce the dose.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

nice numbers for Frank!

Question, your spreadsheet says you increased his dose. Is that right?
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Julie - From what that post describes, it certainly is looking like a bounce.

Libby - I did increase the dose, but had a partial leak, so I am not sure how much extra he got. I know we didn't lose a lot, and we have had problems with small leaks/drops coming back out, so he could have gotten a higher dose just due to my previous follies, if that makes sense.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Tina (sorry for calling you Marie earlier, morning head then) - is Frank still keeping his food down today? Also wondering if you've gotten a ketone test lately.

Earlier I posted that you shouldn't increase today. Yesterday there was discussion of an increase because Frank was showing high flat numbers and there was some concern about ketones, but overnight he saw good numbers which changes the plan. The protocol says that when the cat is new to numbers under 200, you should hold onto that dose for 8-10 cycles. Paws crossed that the little leak means you didn't really give an increase today.

By the way, there is a very commonly seen thing here that when you threaten a dose increase, the cat gives you numbers than make you change the plan.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Wendy - I have been called worse. haha

Okay, I think my confusion was with the cause/effect aspect. I was under the impression that the vomiting and not having food on his stomach caused artificially low readings and I was supposed to act on what the conditions would be if there were not extenuating circumstances. Does that make sense? Apparently, I was incorrect and misunderstood how food fits into the equation.

So 10:30pm, we go back to the previous 1u dose? Then as far as eating goes, he ate a half of a can last when I gave him his insulin. He is used to eating at 6:30am and 6:30pm. Do I still feed him at 6:30pm, or do I need to feed him at 10:30pm when he gets his insulin? And if so, can he have anything in between? I was told I can feed him something at any time if he acted like he was starving, but that times in between, he wouldn't get much from it outside of not feeling hungry.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Vomiting and lack of food can impact numbers, but so can building the depot. Just to be safe, it would be best to stick at the 1.0 unit dose for a bit.

Theoretically, you should wait until just before shot time to feed Frank. In the last half of the cycle the insulin is waning, and giving food after nadir is like tapping on the brakes can push the preshot numbers up. However, I am all too familiar with a cat that is "starving" before dinner. I give Neko a small mostly zero carb snack at +9. You could try a snack at +6 and see if that holds him over, but if he's "dying" before then you might have to give a bit more. Just be sure not to give any food for the two hours before the shot, as those carbs can influence the PS number.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Okay, that makes sense. He seems okay now, but he has five hours to go so maybe a small snack to hold him over now is better than waiting to see if he is starving in the two hour time frame. Blah... learned my lesson this morning. At this stage, I guess I still need to be asking questions about everything, even the things I think I understand. :lol:

Thank you for your help.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

You've got a good plan for working backwards on the dose time. I'd return back to the 1.0u dose tonight, even though he's high. You never know how quickly a cat will clear a bounce, although probably we'd all guess this will be closer to the 72 hrs than 24 hrs because he's been in high numbers for an unknown length of time. IT was probably quite the surprise to his system to find itself back into less-than-100 numbers.

For your spreadsheet, what most of us do when we have this morning's situation is to pile all the #s into the am preshot column.

I would do it like this:

12=92
13=143
14=170
15=270
338

I'm a teeny bit confused about what time the 338 was if the +15 was 270 - did it end up being 4 hrs late on the shot? if so, i'd finish the column with +16=amps=338.

You can widen the columns at the top. You can also write notes in the far right side to explain anything unusual. People will look over there to see any comments you want to explain.

Just for the future (hehe cuz it will happen again) as soon as see the numbers starting to rise you can go ahead and shoot. Still as a new person, probably i should say as it rises and passes 150. It takes a couple of hours for the Lantus to kick in in many cats, so it will keep rising. Later on when you're more experienced, you'll end up shooting lower numbers. They are a huge asset in getting a cat stabilized. But for now, 150 and rising is a good plan.

Depending on what he does this weekend in order to get him back on time for your sanity, it might mean skipping a shot somewhere. But let's stick it out now with shots at 12 hr intervals and see how he does. If it is too difficult to manage with that time schedule, let us know and lets figure out a good shot to skip to help you get back on track.

great job getting another ketone test today!
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Let me fix the spreadsheet real quick and maybe that will clear it up.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

It would be very helpful if your could get a test about 2 hours prior to your shot time tonight. Depending on where Frank's numbers are, you may be able to shoot early to help you get closer to back on schedule.

I just looked at your SS. It's even more confusing (sorry)! The numbers you have in your subject line are exactly right with maybe one exception. If when you shot, Frank's BG was 270, then 270 is your AMPS. If the 338 was the number you shot, then it's your AMPS. You don't need 2 rows for today. What I would suggest, is putting all the the tests from +11 through to the last test before your AMPS either in the AMPS column or in the +11 column from last night.
 
Re: 11/13 Frank +11=84 /+12=92/+13=143/+14=170/+15 270

Haha, yeah... you caught me while I was editing it. It should be fixed now. Let me know if it is more or less clear now. :)
 
Re: 11/13 Frank AMPS 338 +1=476, +3=488, +5=481, +8=345, +10

it looks far more clear - thanks!

if ya feel like tinkering with one more thing . . . i'd change the cell color for this morning to green, just because that was the reason you delayed and when we look at the ss, one of things we're looking for is nadirs to help make dosing decisions. if that's green it will pop out and everyone will notice it! :lol:
 
Re: 11/13 Frank AMPS 338 +1=476,+3=488, +8=345,+10=413,+11=3

Sorry, we had been talking about him getting his insulin at 10:30 earlier. I forget how many people and how much data you guys must keep up with. Let me rephrase:

Waiting for +12, which is in about 20 minutes.
 
Re: 11/13 Frank PMPS 369

So, I guess I have one more question. He just got his shot at 10:30 (+2) The latest in the morning I can give him insulin is at 8:30am (+10) unless I come home at 12:00(+13.5) pm tomorrow between classes. What information do I need to gather to decide when he can have it and what does that info need to look like? Does this work the same as Julie explained it, if he is above 150 and rising, I can give it to him at 8:30am(+10)?
 
it is confusing - let me see if i can explain more.

we really try to give shots at 12 hr intervals. so when you were late this morning, the shot time 4 hrs later became your new amps, which = +0. the clock started over. your next shot was then due 12 hrs later. Sienne was asking you to get a +10 and post that number - but she meant 10 hrs after this morning's shot. it looks by the ss and by the times on your posts saying you'd shot that it was 12 hrs, but it sounds like it might have been 10hrs?

just clarify for us, how many hours after this morning's shot was it until he got his insulin tonight?

If you shot today with less than 12 hrs between this morning and this evening's shot, you can't do an early shot in the morning. Better to go with the 13.5hr interval. Lantus is a depot-type of insulin - it forms a precipitate in the body and then slow releases. so when we shoot early it acts like a dose increase. Frank doesn't need a dose increase right now and we definitely don't want him to get more.

we'll get this all straightened out - there is a lot to learn!

for tomorrow morning, you are looking for a number that is above 150 and rising. don't shoot less than 12 hrs after tonight's shot, though. if your choice is between shooting 10 hrs after tonight's shot or 13.5 hrs after the shot, which i think is what you're saying, i would go with 13.5 hrs.

if you have any doubts at all about it, please post and ask for help in your subject line. There is almost always someone experienced online who will help you make sure it's safe to shoot.

In the meantime, you're doing a great job at keeping up testing him and checking for ketones. so far so good. you don't have to test every hour when he's high like this. every couple of hours is plenty. can you get a test in the morning before you head out the door? i think at 8 or 8:30am?

Just in case you end up with low numbers (less than 50), I want to make sure you have the information in this link about low numbers. The basic routine is pop open a can of high carb cat food, squeeze out a teaspoon of the gravy and give it to Frank. Then wait and retest him in 20ish minutes to make sure his blood sugar is rising. if you don't have high carb cat food, you can use a drop (maybe 1/2tsp) of karo syrup, maple syrup, pancake syrup or honey. I just want you to be prepared. it's part of the routine and important to have supplies on hand.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

so to summarize:
- whenever you post next, either on this post or first thing in the morning, the thing we most want to know is how many hours between the 2 shots today
- if you can get a test at 8 or 8:30am that would be helpful.

i've reread and edited this about a dozen times - it's complicated because i'm not sure how long between today's shots. so i apologize for it being confusing!!! i promise that it won't always be like this. it not only gets easier, it becomes routine. you're doing great, so just hang in there.
 
Hi TIna - Could you get a test either 1/2 hour or one hour before you have to leave tomorrow and create a new posting asking for advice on shooting? It's hard to advice this early in the cycle as we'd be guessing where he'll be in the morning. That green this morning sure was a surprise. It may be that you'll have to shoot when you get back from lunch, but hopefully someone can help you decide tomorrow morning.

For future reference, and just to add to the reading material, here is Marje's post on getting back on schedule.
 
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