12/2 Chloe AMPS 161/ nadir 51 @+6

@Roberta and Chloe
Please get a “before bed” test tonight and post the result here.

Given that you had a PMPS of 122 (which is the lowest you’ve seen in awhile) and saw a 51 earlier today (which might not have been the lowest Chloe went), and given that you are using the Start Low Go Slow (SLGS) dosing method, it would be a good idea to get a few tests in tonight.

I don’t like to give dosing advice but the 51 might have earned Chloe another dose reduction (typically taken if you get a number below 90 on SLGS). Let’s see what others who have helped recently think given that Chloe just had a dose reduction yesterday.
@Gill & George
@Critter Mom
@tiffmaxee
@Christie & Maverick
 
@Roberta and Chloe
Please get a “before bed” test tonight and post the result here.

Given that you had a PMPS of 122 (which is the lowest you’ve seen in awhile) and saw a 51 earlier today (which might not have been the lowest Chloe went), and given that you are using the Start Low Go Slow (SLGS) dosing method, it would be a good idea to get a few tests in tonight.

I don’t like to give dosing advice but the 51 might have earned Chloe another dose reduction (typically taken if you get a number below 90 on SLGS). Let’s see what others who have helped recently think given that Chloe just had a dose reduction yesterday.
@Gill & George
@Critter Mom
@tiffmaxee
@Christie & Maverick
She's 107 at +4 (11:30 pm)
 
Hi Roberta, those have been some nice numbers.

I think that 51 could be the depot talking from what went on 3 to 4 cycles ago.
The insulin you shoot doesn't all get used up at once some of it gets to work straight away and some of it gets stored and released slowly, the amount that is stored is directly related to the size of the shot.
So with the split shots, the two one unit shots (after the 35, which were too high) this could all be affecting the cycles now on the 0.75u. It can take up to 6 cycles for the depot to settle and for you to stop seeing this effect.

*Advice specific for Chloe/ do not copy*
On SLGS the guidelines are that you would reduce under 90, I am not sure that would be a good idea in Chloe's case, given the history of DKA.
However, not taking the reduction does mean that you may see lower numbers than you are used to, and it increases the risk of her dropping below 50, 50 is the take action number for TR, it is not to be ignored.

If Chloe were my cat, I would hold on to this 0.75u dose, but I would monitor her BG much more closely than you have done yesterday. You must to follow up a drop like that, and more specifically you must follow up on a 51. I know it was at +6, but with Lantus an unregulated cat can nadir at anytime between amps and pmps. Chloe is not regulated and as such she can nadir at any time (my cat had nadirs as early as +1 and as late as +12, though it was usually around +5/+6).
I would suggest that until things settle down you check her routinely
+2 +5 +8 in the am cycle +2 +4 +5 in the pm cycle maybe grabbing a test when you first get up in the morning at +10 or +11
If any of those tests show a sharp drop or a number in the 50's or lower you should take action, that might be some extra food, and certainly you would follow up either 30min or 1 hour later with another test.

If you don't monitor closely with the 0.75u dose I would be extremely worried that she could drop without you knowing it and get into some really dangerous territory BG wise.
If you monitor like I have described or more, then you should be able to catch things before they would get out of hand. If you can do this for a few more cycles until we are sure that all the messing about with the doses is not having an effect on the current BG, (at least 6cycles), then you could take a reduction to 0.5u if the nadir was still below 90.

If it were not for the DKA I would suggest a drop to 0.5u, this would keep the BG higher, and safer with limited testing, but the problem with that in a DKA cat is that is also very dangerous for her, as you well know with 4 episodes of DKA in the past. Not enough insulin, loss of appetite, stress/infection/inflammation are all ingredients that can quickly combine to lead to a very serious episode of DKA.
Are you checking for ketones? Whenever you take the dose down with a cat prone to DKA you should really be checking for ketones.


The choice is yours, I've tried to give you the information you need to make a decision. Let me know if you have any more questions.
 
I see you shot a 68, this morning.

Even though you reduced, which was good, this will not have an effect on the earlier part of the cycle, she could still go into the lime greens, or hypo.
PLEASE get a test no later than +1 like I suggested above, when they are low, and in particular with what has gone on with her BG recently it is important to monitor closely.

With SLGS you would not normally shoot below 90.
With TR folk gradually learn to shoot anything above 50
 
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Hi Roberta,
I am glad that you are about (I sent a PM to make sure roberta got a notification).
Please test and post the number for her BG if it is over an hour since you shot.

I got a ketone test, but the ketone box turned blue, which isn't on the chart.
How long have you had the strips, have you left them open? they may have gone bad.

Meanwhile, my civvie squated in the litter box for a good 5 minutes and nothing came out
I'm sorry, how is he otherwise? I hope he poops.
 
Are you checking for ketones?
I caught some urine on the ketone strip, but the box turned blue, which isn't even on the chart. When I last checked for ketones but the strip got litter on it, it was also blue. Meanwhile, my civvie squated in her litter box for a good 5 minutes and nothing came out. I took her out of the box and put food in front of her. The ketone strips expired 2 years ago. That might be the problem. Meanwhile, my civvie barely touched her food and is crouching in the litter box again.
 
Meanwhile, my civvie barely touched her food and is crouching in the litter box again.
poor girl. She's probably feeling uncomfortable. did it look like she was trying to pee or poop?

The ketone strips expired 2 years ago.
That might give you iffy readings. I think the blue might have been from the litter which you said was blue.

I'm glad it has only been 30min since the shot, hopefully the +1 is up and the whole thing is a non event.
 
The ketone strips expired 2 years ago.
From the St Jude's Children's Research Hospital website. Multiple websites say the same thing.
  1. Do not touch the test areas of the strip. (The first time the bottle is opened, record the date it was opened. The test strips should not be used after 6 months from that date.)
 
From the St Jude's Children's Research Hospital website. Multiple websites say the same thing.
  1. Do not touch the test areas of the strip. (The first time the bottle is opened, record the date it was opened. The test strips should not be used after 6 months from that date.)
Thanks. I didn't know they had expiration dates.
 
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