2018.04.11 | Emmett | AMPS/428 | +1/394

[Rob W. & Emmett]

Previous post (April 9 -- I thought I posted on the 10th...odd)

Emmett had a big bounce this morning. He had a really good evening. I guess cats tend to have better evenings than mornings? That's what I've noticed with Emmett. ...that said, perhaps he went low between midnight and 6am.

I've been at 3.75 iu for a while, but with his nadir at a low of 54 on April 5, I shouldn't be increasing correct?

@Wendy&Neko
@Stacy & Asia
@Bobbie And Bubba
@carfurby
@Sienne and Gabby (GA)
@Tracey&Jones
@Christie & Maverick


R

 

[Bobbie And Bubba]

Hi Rob, A lot of kitties go lower during the night time cycle. That makes it more interesting for us beans who like to sleep at night.

I would hold off increasing. You got a 61 last night. It's hard to know if it was the additional shot you gave after the FS the PM of the 9th still talking. I think for safety you should let this bounce clear and see where he lands. He might need some more juice since the FS episode happened on the 8th cycle from the previous green.

 

[Rob W. & Emmett]

Ah, the pdf I saved to my phone says this:

• If nadir blood glucose concentration < 200mg/dL but peak is > 200mg/dL (11 mmol/L)

➝ Increase every 5-7 days by 0.25-0.5 IU depending on if cat on low or high dose of insulin

So, I guess, that means I increase as long as he’s having these bounces...just not as frequently? 5-7 days is 10-14 cycles...

At any rate, like you said Bobbie, gotta give Emmett some time to get over the fur shot episode.


Rob

 

[carfurby (GA)]

I agree with Bobbie on holding the dose. I hope Emmett clears the bounce today.

 

[Sienne and Gabby (GA)]

There's a chance he went lower. If it were me, I would have given Emmett some food at your +6 to help prop up the numbers a bit if you were heading off to go to sleep. Generally, the numbers should be rising after nadir.

I think you may have tried to shorten the information on the Tilly Diabetes (TR) page. It actually states:

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

In contrast, the information on the TR sticky here states:

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.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Personally, I find the information on our sticky note much easier to decipher. The caveat, though, is if a cat is in the midst of a bounce and the bounce looks like it's breaking at the same cycle as you're due to increase, you might want to consider waiting for the bounce to clear before increasing the dose. It can be a wild ride if there's downward momentum from the bounce breaking coupled with a dose increase.

 

[Bobbie And Bubba]

Ah, the pdf I saved to my phone says this:

• If nadir blood glucose concentration < 200mg/dL but peak is > 200mg/dL (11 mmol/L)

➝ Increase every 5-7 days by 0.25-0.5 IU depending on if cat on low or high dose of insulin

So, I guess, that means I increase as long as he’s having these bounces...just not as frequently? 5-7 days is 10-14 cycles...

At any rate, like you said Bobbie, gotta give Emmett some time to get over the fur shot episode.


Rob

Give this bounce up to 6 cycles to clear from the green last night. And if he isn't back in greens after 6 cycle, then increase to 4 units.

 

[Rob W. & Emmett]

Hey thanks everyone. Emms is definitely bouncing today. He's got some high numbers this evening which I haven't seen in a while. Anyway, like you say Bobbie, I'm gonna wait it out for a few cycles, I don't feel comfortable increasing at this stage.

I've got my "blue" dose increase marker in my SS on April 14 to remind me. I'll reconsider 4 units at that point.


R