5/14 Max AMBG+11@39(fed),+11.5@46,+12@86,+14@94,AMPS+15@101

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tremblant

Member Since 2013
Hi Everyone,
Having such problems with Max. He is up down all around. Today super low but with no weird symptoms. We fed him fast and did not shoot yet. Watching and testing. Last few days we have had only been able to shoot once a day bc of numbers. We think his dose is too high. Once he goes over 200 (or maybe 180?)I am hoping to give him maybe 1 unit. Please help!
Mary (on behalf Wade and Max)
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Hi guys .. Wow, bet those numbers popped your eyes open! Good idea to not shoot and feed the 30's/40's .. No shooting advice from me but hopefully others will be along soon to help get you guys back on track .. have a great day!
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Mary

When we stall, we don't feed because you could then be shooting a food spike. If you last fed at 7 am and he's now at 94 at what time? If its been two hours since you've fed, you can give him 1.5u and that should be your new dose. Be sure you get a +1 and +2. Will you be home today to test him?
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Please see post above; just saw on the SS that it has been three hours. Please shoot now...as long as you haven't fed any more and will be home to test. 1.5u.

Next step is a +1 and +2 test.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Hi Marje,

He was 94 at 10:15. He was fed around 7-8 ish. He won't eat all at once, we have to keep nudging him so it takes forever. Thing is I would give him a dose but I will not be here from 11:45 a.m. - 2 pm. So I am afraid to. The rest of the day I can be with him....Not sure- could be too risky to shoot?

I thought when he was that low that he really needed food quickly....
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Mary

Sorry...haven't had any coffee yet and for some reason I was just seeing the 46...just looked back and saw the 39. So yes, you did fine...my apologies.

If it had been the 46, then you would have not fed, retested in 15 mins and if he was still in the 40s, would have given him just one tsp of LC to see if he would come up a bit.

Why don't you see where he is now? If he's still coming up, he will likely continue to do so. Then you could get a +1 or a before you leave test? Is he so difficult about eating that he wouldn't eat HC if you leave it out if he's still below 100?
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Marje,

I JUST RETESTED AT HE IS GOING UP STILL- 101 bg. (sorry- my caplock)
I will give him Lantus now but shouldn't I be a little more conservative- Maybe 1 unit? Then I can test in one hour +1 and also leave out a few small HC treats that I think he will eat?
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Wow, that's a really low preshot number compared to what you usually see from Max. It definitely does call for a reduction. The Lantus Tight Regulation Protocol says "If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit", so you will want to reduce to 1.5 the next time you shoot. Did Max eat normally last night, or did he throw up after he ate? Something like that could cause lower numbers than you usually see.

As far as I can tell from his spreadsheet, this is the first time he has been in "green" or below 99. Although it was for sure very low this morning, and it was good you held off on the shot, remember that you do eventually want to see Max in those blues and greens all the time if possible. As you keep testing and get more data on how Max reacts to each shot, I think you will become more comfortable giving shots at some lower numbers. When you "shoot low to stay low", giving the usual insulin dose even at lower numbers, it can help the cat to even out the blood sugar numbers. For example, on May 7 you gave the PM shot when he was at 185, and it kept him nice and steady for an AM number of 113. You want cycles like that more often.

I'm sure others will weigh in here as well, but I don't see any reason at this point to reduce any further than 1.5 for now since Max's numbers haven't been low at all before. You are getting lots of midcycle tests during the day, so I don't think you are missing low numbers there, but it might be helpful to get the occasional late-night test to see what's happening with the evening cycles.

If you mark your post with a question-mark icon (on your first post, go to "Edit" and click next to the question mark) others will know that you have a dosing question and you will be able to get more advice from lots of experienced members.

And just remember - this shows Max is responding well to the insulin. It may take a while to get just the right dose for him, but you're doing everything that you need to in order to get him healthy. Keep it up!

EDITED TO ADD: Sorry, as I was typing this several other posts were made and the system didn't show them before I posted. So the 1.5 is for sure the next regular shot, but so as not to confuse things I'll let you keep discussing with the others what you should do about this cycle's late shot!
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Thanks, Amy. I already caught her numbers :-D

Mary....you stalled which acts as a reduction and then you are going to reduce when you shoot. You can shoot 1u if you choose to....you hold the syringe.

Just keep in mind that Maxs depot is probably quite full...thus the low numbers today. What will likely happen is that his cycle will play put the same way regardless if you shoot 1u or 1.5u. Where you will see the effects is likely in the next cycle.

IMHO, I'd shoot the 1.5u, feed a HC meal, check before you go, and leave out whatever HC he will eat. But I support you in any decision you make.

Later today, I can help with your SS and give you some other info but I know now is not a good time for you.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Dear Amy and Marje,

Thanks very much for your help. I guess I still don't entirely understand Max's "depot"

I think I will shoot the remaining .5 and leave out the high carb. and test again bf I leave. Can I shoot him again with .5 as I already shot 1 unit?
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

If you just shot and you make sure it is really accurate...as the syringes will allow...then yes.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

When did you shoot the 1u? It will get super confusing if you shoot more at a different time as you won't know when to expect nadir, but like Marje says if you JUST shot and are accurate then I guess it's as if you gave him the 1.5 at the same time.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

I shot at 11 am. Yes, our syringes are super accurate, so will not be a prob this way
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

When I said just shot...I meant within 5 or 10 minutes. If its more than 30, I'd just leave it at 1u for today.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Okay I will leave it be. Thanks. Fingers crossed...
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

That's fine. Don't worry. We will get him back on track ok? :-D

So test before you leave, leave out HC, test when you walk in.

And I'll put some info on here for you later. You did absolutely fine this morning! It's all a learning process and Max will be ok. It's hard when you get a low number and you have something you must do.

Have a good morning Mary.

Thanks, Amy :-D :-D
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

You're welcome. After you are back, I just want to take this scenario and go through a couple options for the next time cause there will be one ;-)
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Mary

If you are still there could you please update the subject line to show the AMPS as the number you shot? Thanks.

If you are stalling, then you just continue to count the hours since his last shot.

For example: +12 39, +12.5 46, +13 86 +13.5 94

Anyone looking at your subject line could tell you are stalling. Right now, it looks like you shot a 39 ;-)

If you skip, then the number you got when you decided to skip is the AMBG. That shows us you skipped.

Then when you shoot, that's the AMPS. :-D

Thanks, Mary!
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Ok....just back for some lessons learned.

With the +12 of 39, you did great by feeding; usually at the end of the cycle like this, you want to feed 1-2 tsp of LC and retest in 20-30 mins and see where he is. You might need to repeat to get him coming up but stay with LC and just tiny amounts so when you do get to shoot, you aren't shooting a food spike.

IF the +12 had been 46, then from Dealing with Low Preshots:

When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
--- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

I added the bold. I'd print out that entire post and keep it handy for days when you don't have time to get on the board.

On spreadsheets and in the subject line/condos, we don't use actual times such as 8:15 am because we are all on different time zones. We use the number of hours since the last shot. If you look back at the a.m. shot on 5/8, for example, you would put in the AMPS column "113 @ +14". that tells us right off the bat that you shot two hours late. You can look at Gracie's SS for examples on that although I pretty much shoot on time. Mike had to stall the PMPS shot on 5/12 so you can see how he did it. If you would like help in getting the SS sorted out, please PM me and I can fix it for you since I know you are short on time. Then you would have it as an example.

I just wanted to give you some thoughts on Max's dose and cycles.

You've been skipping or shooting a BCS dose on very shootable numbers. That makes Max's numbers really wonky. Any time you get a number you aren't comfortable shooting, if you can post, we can help you. I know it has to be busy around your house in the mornings and evenings with small children. But the more you can shoot his normal dose, on time, the better for him. It gives him the best chance of going into remission. You are doing a GREAT job of testing during the day and you are getting at least a before bed at night....SUPER!!!

On 5/10, you gave him a bit of a dose on what would be midcycle and then shot again at PMPS. It would have been better to wait until +22 (or what you would probably think of as +10) and just shoot the full dose two hours early. What is your "normal" shot time? I know you have to move it a bit depending on what is going on there but what time would you think of as his "normal" shot time....8:30?

You're a busy mom and I know you are being as consistent as you can. What I want to help you do is get over the fear of shooting numbers that are totally shootable. We need to do it slowly, but we can do it and you'll be a pro. It will make a huge difference in Max's treatment. Of course, safety is always first so if you don't have supplies, are not rested, cannot test, etc., then we just deal with it and move on but I think we can get things a little more stable for him.
 
Re: 5/14 Max AMPS-39(7 am),fed, 46(7:30 am), 86(8:15 am),94

Marje,

Thanks so much for last 2 posts. Going to read tonight when Maddie is in bed so my husband and I can focus. Found a better vet today also so that feels good! Responses to come ! Many thanks!
 
Re: 5/14 Max AMBG+11@39(fed),+11.5@46,+12@86,+14@94,AMPS+15@

Morning Marje,

Tried to address posting line and SS...hopefully more understandable....

Have a good day! Mary, Wade and lil' Max
 
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