4/12 Zeke +56/83, +60/68 - Need dosing advice please

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MrZ

Member Since 2013
Hi Everyone,

It's been quite a while since I've been on the board (Zeke's previous post http://www.felinediabetes.com/FDMB/...-question-supplement-course-of-action.125472/). I see some familiar faces, many new members, a few former members that I'm sad to see have had to help their babies cross, and gladly some that have helped their babies make it to the Falls.

Zeke has been doing very well. He's been on 0.5U since July 2014. As a long-term diabetic, I'd been holding his dose waiting for him to drop below 40 (not 40, this should be 50) three times, or waiting for him to stay consistently below 100 for seven days, before reducing his dose. There were a few times where he'd gotten close to staying below 100 but then he'd have a disappointing PS, so he just never earned a reducie. We'd gotten to the point that we decided we were not going to continue putting off the travel we had so much enjoyed prior to his diagnosis, which we had done while we were stringently adhering to the Tight Regulation Protocol in hopes of getting him diet regulated. We purchased a kitty "pack and play" and started taking him with us on a few trips. He's continued to become less and less uncomfortable with these adventures. We've been pleased with his progress in this regard.

On March 27, he had his 6 month wellness evaluation where his vet found that he was suffering from a UTI. He has been on Zeniquin for a little over two weeks, with only five more days to go before his follow up with the vet. He definitely appears to be feeling better.

This weekend we decided to skip his shot as we had friends coming in from out of town and plans to make an overnight trip out of town with them. In anticipation of this skip, I started transitioning him to a little lower carb food. When we returned from our evening away from home, we were pleasantly surprised to be greeted with a AMBG of 74. As we had plans yesterday evening with our friends who were spending the night with us, we decided to skip both his shots yesterday. Despite the stress of having strangers in our house, Zeke has been able to actually maintain better numbers than he has on 0.5U. He has now not had insulin in over 48 hours. I just tested him at what would have been his normal +8 snack time and he tested at 87. I offered him his usual 0.5T/05t snack but he only had about 0.5t.

Could you please advise as to what we should shoot tonight? I'm really not sure what we should do. Since he's been keeping such good numbers without insulin, it kinda doesn't seem to make sense to shoot his usual 0.5U. However, if he has a high PMPS tonight, then should I assume his great numbers have just been due to depot and therefore should resume his usual dose? But what if he's below 100, should we not shoot and just wait to see what happens? I'm somewhat unsure that that would be the best option as I know stopping insulin abruptly is not recommend. What is really puzzling though is that when tested in the last 48 hours his numbers have been a lot better than what they've been in a long time. He was 61 when we tested him last night. Since about December 2013, I think only once he has had a PS in the 60s. He was a little higher this morning at 83 but that could have been attributable to the stress from the presence of our friends.

Could you please take a look at his spreadsheet and let me know what course of action we should take and what dose if any we should shoot? I would so greatly appreciate it.

Thanks so much,
Laura
 
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I want to have a couple of more people take a look but I'm inclined to suggest a reduction. I suspect you should have reduced. One or two numbers above 120 in an otherwise largely green string of numbers warrants a reduction.

Let's see what others have to say.
 
He's got such great numbers overall. I think I might try a trial and see if it holds.

Did you know that if their numbers stay below 120 for 7 days, (14 cycles) that too can be a dose reduction?
That was how Shadow did it back on her first run. She rarely did big drops.... she just earned her reductions the slow way.
 
Thanks Sienne and Rhiannon for your responses. I just tested Zeke and he's dropped from 83 to 68 so I decided to skip tonight's shot. I'm very torn as to what to do in that I know it is not recommended to abruptly stop insulin and I'm concerned that doing so may come back to haunt us later. If I resume shots tomorrow, what reduced dose would you suggest?
Thanks again,
Laura
 
since you hadn't tried the next dose down... that may be where to start.
If numbers go above 120, you can always go back up.

Mr. Z might not be one to drop really low. Shadow doesn't seem to be.... she seems to be most comfortable around 75-100.
 
Hi Laura, Long time no see!
The "3 below" rule is 3 below 50 (not 40). One number below 40 is an automatic reduction, according to the TR protocol. So it looks like you could have taken at least one reduction in the past few months.
Interesting to see how Mr. Z. is doing. I don't know what to say with regard to the dose.

Have a good evening. It's great that Mr. Z is going on trips with you. Do you know this Google Doc (written by one of our board members) about camping with diabetic cats?
https://docs.google.com/document/d/1gMwbpx3Lnrq5KDiKk0lhyQIRZylEmhztYhxZCpNcDqM/edit

Ella & Rusty
 
Thanks Ella, I've updated my post to reflect 50, not 40. Way cool that those kitties were into camping.
 
Hi laura, great to see you and zeke!

I think you have a choice...you could wait and continue to see how he does skipping shots, or if you think you want to restart I'd try 0.25u.

Kinda exciting! ! I'm so glad you've got this problem!
 
Hey Laura!!! It's super to see you and Zeke back and I'm so glad you all got to start traveling again.

I'm a little torn....he's had a lot of blue PSs and not just normal numbers. I don't see any inverted curves indicating he might have too much insulin but I sure am liking the way he looks without insulin.

I think I'd go Julie's route...if he starts eeking back up, I'd restart 0.25u. Keep feeding him about three hours before AMBG and PMBG, if possible, to see if his PSs stay down.

Let us know how he does. :bighug::bighug:
 
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