12/06/10 Tubby AMPS 156 +1/2 126 +1 97

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Shawny2u

Member Since 2010
Tubby is down at 156 and 30 minutes away from his pre-shot.
I am thinking to skip the shot or lower the amount from 4.5 units.

anybody, any thoughts?
 
Re: 12/06/10 Tubby AMPS 156 HELP

i can't give advise on dosing

i'm linking yesterday's topic for the experts to see

viewtopic.php?f=9&t=31408

we link our previous post to the new one.....but you can learn that later...now it's more pressing you get advise on dosing
 
Re: 12/06/10 Tubby AMPS 156 HELP

Good morning guys! This is a really nice start to the day for Tubby! Your first blue preshot, right? I wish I knew what advice to give you .. I hope someone is here before to long to help you out ... are you home today to monitor?
 
Re: 12/06/10 Tubby AMPS 156 HELP

Good morning, I will be home today except for hour or two (dental appointment).
I just gave him some chicken and will wait a little , if he stays around where he is I'll skip the shot this morning.
But if goes back up depending on his number at the time I'll give him injection.
 
Re: 12/06/10 Tubby AMPS 156 HELP

hope the experts can chime in...but i don't think you are supposed to feed before insulin is given as you will have food spike and the # will be a little skewed.....hope they can advise you here shortly
 
Re: 12/06/10 Tubby AMPS 156 HELP

Shawny2u said:
Good morning, I will be home today except for hour or two (dental appointment).
I just gave him some chicken and will wait a little , if he stays around where he is I'll skip the shot this morning.
But if goes back up depending on his number at the time I'll give him injection.
Click to expand...


Generally we don't feed if we're waiting on a shot. We want to know the number is starting to rise naturally and not induced by the food.

How much chicken did you give? And was it straight chicken protein or chicken cat food?
 
Re: 12/06/10 Tubby AMPS 156 HELP

Shawn, no matter what his PS # is, I would not shoot 4.5u. You increased his dose by 0.5u when the protocol clearly calls for an increase of 0.25u...his dose should be 4.25u now, as Sienne pointed out to you in yesterday's condo. You may want to reduce this morning since you won't be home, but starting tonight, you should shoot 4.25u, ok?

You should not feed before AMPS...the 156 was at +11.5, correct? Now his AMPS will be a food inflated number. Next time, please do not feed....post for help. Do you always feed before shot time?
 
Re: 12/06/10 Tubby AMPS 156 HELP

I misread what you said about being home today ohmygod_smile ....if you will be around to monitor most of the day, you could shoot the 4.25u. At what point will you have to leave, + ?.

I would not skip.
 
Re: 12/06/10 Tubby AMPS 156 HELP

Shawn, looking at your spreadsheet ...why did you jump to 4.5u?

You had a nice response a few days ago at 4.0u. It looks like Tubby may have been in bounce for a day or two after. That would mean the 4.5 is too high of a dose at the moment.

Please don't shoot 4.5u this morning. Proceed with a bit more caution. I wouldn't even shoot at 4.25u based on looking at the spreadsheet. Tubby needs a little more time at 4.0u.
 
Re: 12/06/10 Tubby AMPS 156 +1/2 126

I 'll skip the shot this morning and monitor him through out the day!
He was fed right after the first test at 8 am then 40 minutes later was tested dropped to 126.
I'll test him in just a few minutes before taking off!
 
Re: 12/06/10 Tubby AMPS 156 +1/2 126

Shawny2u said:
I 'll skip the shot this morning and monitor him through out the day!`
Click to expand...

Skipping the shot is not the answer. Laurie told you not to skip the shot and I asked if you could give some reading in 15 minutes or so.

What kind of food did you feed and how much?
 
Re: 12/06/10 Tubby AMPS 156 HELP

Please don't skip the shot today. You will be home most of day to monitor.
These are good numbers which is what you wanted. Take Laurie's and Sienne's advice.
 
Re: 12/06/10 Tubby AMPS 156 +1/2 126

It is likely, because of the way Lantus and Levemir work (they appear to work for >12 hours, therefore producing overlap between doses), you will face the problem of having a low pre-shot BG and wondering what dose you should give. Try reducing the dose the first few times to see what happens - in all likelihood the cat will have higher BGs as a result. A second alternative is to feed the cat, wait 1 to 2 hours, test again, and when the BGs start rising, give the normal dose. A third alternative is to split the dose: feed the cat, give most of the dose immediately and give the remainder 1 to 2 hours later when the BGs start rising. However, in most cats none of these alternatives have shown themselves to work as well as consistent dosing. You will have to learn how your cat reacts to Lantus/Levemir before you determine the best way to deal with this problem. http://www.tillydiabetes.net/en_6_protocol2.htm
Click to expand...

Since you fed, this is where we are at ....

A second alternative is to feed the cat, wait 1 to 2 hours, test again, and when the BGs start rising, give the normal dose.

You do not want to skip the shot. In your case you most likely need to reduce the dose as well.
 
Re: 12/06/10 Tubby AMPS 156 +1/2 126

I agree with not skipping the shot. How much longer can you stall? What would you be comfortable shooting?
 
Re: 12/06/10 Tubby AMPS 156 +1/2 126

Let's back up a bit....

You're going to be home most of the day, correct?

I don't know that I would have increased the dose after getting those lovely greens on 12/3. The subsequent yellows may have been a little bit of rebound. It can take up to 72 hours for a bounce to clear so it's not entirely evident if the blues yesterday were the result of the bounce ending. If, in fact, this is the case, you want to hold the dose at 4.0u to better evaluate whether it's working.

If you're intent on increasing, I would not increase by more than 0.25u. There are certainly times when we are aggressive about dosing but I'm not sure that Tubby is at a point where raising the dose by 0.5u is called for. (Generally, either the cat is on a much larger dose of insulin than Tubby is getting or the nadir is over 300 to warrant that large of an increase.)

I would discourage skipping the shot. It depletes the shed and you will lose the momentum you have been building. Given how concerned you have been about the long term effects of hyperglycemia, I would think that giving some insulin would be better than giving no insulin. It would be better to give what we call a BCS (big chicken sh*t) dose than to skip. What about lowering the dose to 3.0u (or whatever you are comfortable with) if you are uncomfortable with giving the full dose and shooting 4.0u tonight?

You may find this not on dealing with low pre-shot numbers helpful.
 
He's keep dropping with food so I'll be monitoring when I get back.
He just asked and had a whole can of FF with carb around 10.

12/06/10 Tubby AMPS 156 +1/2 126 +1 97
 
If you skipped the shot this morning, the 156 is not a preshot number, but rather the hour that the test was taken. A +11.5 or +11.75...whatever it was. Each hour is added to the +12 since there was no shot. The PMPS will actually be PMPS+24 if no shot was given this morning. It will be 24 hours from the last insulin shot, right?

You may put that 156 on your SS in the +11 box from last night...with a note that it was +11something.
the dose for today would show n/s no shot. Your header should read :+11.5=156, +12.5=126, +13=97 and so on through the day till your PMPS....does that make sense?

When you have AMPS, it indicates a preshot.
Tubby's shed will drain today if no insulin was given. Tonight's numbers might be higher as a result. make sense?
That is why some insulin is better than no insulin...to keep the shed going.
A reduced BCS dose is always among the choices when we get a low number.....here is a post that talks about low preshots. viewtopic.php?f=9&t=27894

Good luck at the dentist!
 
Shawn2u & Tubby said:
Hello, I know what I'm doing is sort of unorthodox but honestly don't know how else to inform those who are concerned.
Perhaps somebody could show me the proper way. I had to leave this morning and did not shoot because of unusual low numbers.
However by the time I got back did inject 4 units when BGL was at 233.
His spreadsheet might look confusing but I tried to explain the circumstances.

Here is what the chart looks like today, please don't hesitate to express your thoughts!

12/05 Tubby PMPS 283 4.5 units +2 264 +4.5 262 +8.5 242 +11.5 156
12/06 Tubby + 12.5 126 +12.45 97 +13.5 89 +15 169 AMPS +16 233 4 units
Click to expand...

Shawn:

Because the forum is so big, we open only one condo (i.e., thread) per cat per day. It keeps all of the information in one place so when we're linking condos on a daily basis, the information is consolidated and the forum doesn't get more overwhelming than it already is.

I'm glad you wet back to the 4 units.

Here's the conundrum....
By shooting 4 hours late for your morning shot, your PM shot will need to be 12 hours from when you actually gave the morning injection -- in other words, you are now 4 hours off of your usual shot schedule. That's not an issue providing your schedule can accommodate being that far off. For most of us, due to the need for sleep (since we are monitoring BG levels during the PM cycle) and work, we don't have that flexibility. Your schedule may be more forgiving. The most that it's recommended that you shift shot time, under ordinary circumstances, is by no more than 30 min. per day (either 15 min. per shot cycle or 30 min. at one time) in order to get back on schedule.

I can readily understand your being apprehensive regarding shooting lower numbers. I believe I linked this note on handling low pre-shots previously. We try to encourage shooting the full dose, on time, if it is possible to do so safely and, most importantly if you're data ready.

What you decide with respect to dealing with a low pre-shot test needs to be safe for Tubby and a comfortable decision for you. So, what did today tell you? It looks like Tubby's numbers were going back up within a few hours. In all likelihood, it would have been fine to shoot something closer to your usual shot time. However, if I had seen the 97 at +12.45, I would not have suggested that you shoot a dropping number or shoot that low. You don't yet have sufficient data yet. (See the "Data Ready" sticky for more information.) The bottom line is that your strategy was fine, except you are way off schedule. Again, it's not an issue providing you have the flexibility to migrate the shot time back in a slow and measured manner.
 
first, what Sienne said about the next shot time is important - Tubby's next shot is due 12 hours after this one was given, which looking at your spreadsheet looks like it would be 12am. You might be able to shoot a little earlier, if his numbers are high, but not more than 30 minutes ir *maybe* an hour if he is very high. Don't shoot at your regular time, ok?

I'm glad you're going back to 4 units. It might end up not being enough, but we need to give that dose a fair chance. According to our General Guidelines, because Tubby had green on the 4 unit dose you would want to hold that dose for at least 10 cycles (5 days) and maybe longer depending on the numbers. I recommend going back to 4 units and holding it for a few days to see if he can get back to green on that dose. If not, then move upward. The next dose after 4 units would probably be 4.25, again because he had some green on 4 units so now you're at the "fine-tuning" stage.
 
hi, guys!

looks like you had quite the morning...

just dropping in to wish you luck with the tubby cubby!

celi & binks
 
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