12/9, Dusty, AMPS 265 PMPS 274, and a dosing question

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Michelle & Dusty

Michelle & Dusty

Member Since 2012
Curve day today! Again not feeling great about the insulin injection. When I see my vet on Tuesday I think I may walk through the steps again with her, just to make sure I'm doing it correctly. I think a lot of it comes from the fact that 1 unit is so little that it doesn't at all feel like I'm actually injecting Dusty with anything. And then, because of her quite long, dark hair, I am going more from feel than from sight. (I like that with the glucometer I can see the blood and then it beeps at me and tells me a number to let me know all went as planned. If only I could hear a beep whenever I've actually managed to inject Dusty. That would make me feel a bit more at ease. ;-) )

Ah well. With practice comes, if not perfection, then at least a great deal of improvement. For now, though, I'll be checking her levels every two hours throughout the curve. Curious to see how it plays out.
 
Re: 12/9, Dusty, AMPS 265

End of the curve today and I confess I'm perplexed and a bit frustrated by what appears to be very little movement. The results (also on the SS are)

AMPS 265
+2 296
+4 318
+6 301
+ 8 286
+ 10 293
PMPS 274

I'm meeting with my vet on Tuesday and I'm sure we'll talk about increasing the dose. That seems like the right move. I'm planning to print out the dosing protocol here and bring it with me when I meet with her.

Question: If I'm reading the protocol correctly, I should increase by only .25, right? Or should I increase by .5 instead? My vet started Dusty on 3 units, that I dropped immediately to 1 unit based on the advice of folks here. I think she may balk at such a low (.25) increase.

Question: should I run another curve tomorrow? I am planning to work at home tomorrow and can run another curve. I'm tempted to just to see whether today was a weird day or whether this is a fairly typical day for Dusty. (Yesterday's numbers are similar, which may be an indication that Dusty has settled but her dose is too low?) What makes me hesitate is that Dusty is, at this point, clearly frustrated with my frequent testing and I think she might mutiny if I repeated the process tomorrow. If it could reveal new information, I'm happy to do it. If it would be relatively useless, though, then I'd just as rather not bother and just do a couple of more random spot tests throughout the day. Suggestions?

Thanks for your advice, and I hope everyone is doing well!
 
Re: 12/9, Dusty, AMPS 265 PMPS 274, curve results and some ?

Sorry, no dosing advice - I'm not confident enough in that :sad:

Dusty does look very flat, however and I know you don't want to stay too long like that.
I had to put Honey's dose up by .25 after a couple of weeks and it was the magic level that started her on a reduction route.

But, I did wait 2 full weeks before doing the first curve to make sure the depot was full.
Also, you don't have much data in the pm cycle. Many cats, including Honey, would be lower in the pm than the am- no idea why. In fact, we got a lot of reductions in the pm cycle.

Keep the question mark icon on and change the subject to include "dose ?"
 
Re: 12/9, Dusty, AMPS 265 PMPS 274, curve results and some ?

Thanks, Denise. I'll change the subject header as you suggest.

I don't have PM numbers mostly because I can't bring myself to wake up to get them. Doing so would be a bit of a production and I don't fall back asleep well...so it's mostly a matter of finding a balance between Dusty's health and mine.

I hope you and Honey are doing well this evening!
 
I know, its a bit of a killer getting up in the middle of the night!
I work from home so that's a real help but I usually start conference calls around 6am so I get up early - testing at 3 or 4am totally knocks me out cat(2)_steam

I did find bringing the shot times earlier helped - I've just pushed them back to after 8pm as we went out for a meal tonight but usually, I'm shooting aroun 6:30am/6:30pm.
It makes a big difference being able to get a +6 before going to bed rather than getting up later.
Honey's usual pattern is to drop early and then level out so I usually do +2 or +2.5, then +5 and then get a +7 if her number is low.
 
Yeah, figuring out a good 12/12 split has been a challenge. At the moment my schedule is very flexible and the 8/8 (or, now, about 8:30/8:30 split has been good because I often have afternoon/early evening engagements). Once next semester starts up, though, and I have to be to school by about 8, I think I may bring it to that 6/6 timing you're talking about, which should let me get at least to a +5 before I crash. (I'd be pushing it with a +6. Lack of sleep is one of those things that really does me in.) That said, I probably should just buck up and set my alarm and get her a couple of times during the night, at least once a week or so.
 
With respect to dose, Dusty's nadirs are under 300. When nadirs are in this range and the dose is low, as Dusty's is, you would increase by 0.25u. If you increase in larger amounts, you risk missing what would be a good dose and potentially putting Dusty over dose. The goal with tight regulation is to be aggressive about increasing but to balance that with safety. As a result, unless nadirs are under 200, you increase the dose every 3 days/6 cycles and you increase in small amounts. This allows you greater control.

I would print out the article I'm attaching for your vet. It's from one of the leading veterinary journals and most vets will trust that more than anything else we could hand them.


It is important to get PM tests. Getting a before bed test is fine. If that test is telling you that numbers are dropping, then you may have to get more tests. However, getting one or more tests as late as you can will let you sleep with the knowledge that Dusty is safe.
 

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Hi Michelle & Dusty,

You've been at this for about a week, so Dusty's shed should be filled by now. The protocol recommends increasing by .25, holding the new dose for 6 cycles (3 days) and reevaluating. (This is if nadirs are between 200 and 300, as Dusty's seem to be.) A more-or-less "flat" curve is desirable, but not in the higher numbers, like Dusty's latest curve. If Dusty were my kitty, I would increase the dose by .25 and give the new dose a chance to settle in (6 cycles). I would wait to do another curve until this settling-in period is finished. Don't forget that the shed will need to re-adjust. You may see higher numbers at first (New Dose Wonkiness: NDW). This is common. But by the end of the 6 cycles you should see some improvement. Dusty's particular set of circumstances may require more experienced eyes than mine. I hope that one of the very knowledgeable dosing people (Sienne or Marje or Dyana) will be along to help you.

With regard to finding skin through all that long hair: I used to have this problem with Rusty. Stu (GA) was a short-hair and I injected him behind the shoulder without problems, but that was impossible with Rusty. I could never find skin. I switched to shooting in the scruff. I find skin by pulling up his hair to make the tent. Lo and behold: skin is visible!! Make sure to hold the syringe as parallel to Dusty's body as possible, so that you will have a good angle and get that insulin under the skin (not into muscle).

Good luck. Don't let your vet pressure you into increasing the dose more than .25. We increase gradually, by small increments, so that we don't miss a good dose and go beyond. It is a very safe protocol to follow. My previous vet overdosed Stu by raising him by 1 or 2 units each time. (I wasn't testing then and didn't know any better). If I hadn't found this board, I would have lost Stu.

Ella & Rusty

p.s. I think that given your schedule, a 6 A.M./6 P.M. shot schedule makes sense. If you can't test at night, leave out food for Dusty to graze on (that's what I do; I'm an "old lady" and I need my 5 1/2 hours of sleep :lol: )

p.p.s. Oh good! I see that Sienne has given you the important information as I was struggling to write this. Carry on!!
 
Sienne and Ella - thanks so much for your helpful advice! I plan on printing out that protocol to give to my vet when I meet with her tomorrow. Gotta be like the tortoise - slow and steady wins the race.

Ella - I've been trying the scruff and having only moderate luck with it. But will certainly keep trying (and will talk to my vet about it tomorrow, just to make sure I'm trying to tent her in the right area (i.e. the scruff rather than the upper neck?).

I hope you both have a wonderful Monday!
 
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