5/21 Pete (AMPS 456 / +3 HI / +4 HI) - guidance please

[CrazyKaitLady]

https://felinediabetes.com/FDMB/thr...onsistent-after-dose-inc.289970/#post-3178835

Petey's blood sugar is a little crazy at the moment... he has been on 3.25u for 14 cycles and I just increased to 3.5 this morning (TR protocol). I was originally going to increase a few days ago but the day I planned to increase he was unusually low pre-shot (for him... it was 191) so I kept it for a few more days. Even with the increased dose this morning, Pete is now reading HI at +3 and +4. I checked his ketones with a blood meter yesterday and they were 0.1 so that's good.

I'm assuming I should just stay the course right now and see if it goes down by tonight?

I switched his food flavor to beef+liver several days ago and his BGs seemed a little lower on that but he'd stopped eating as much. Switched to turkey+giblets last night and he's back in the clean plate club but BGs not so great. I have some grilled feast flavor that I'm planning to switch to for dinner today. He may also be high right now because of stress. Before he was part-time in my foster room (he's a rescue foster) but slept in his own bathroom at night. I now have him in the foster room full time so maybe he's just adapting to that.

My plan is to switch to grilled feast flavor with dinner tonight, keep the newly increased dose of 3.5, keep an eye on him and keep checking BGs today, and check his ketones tomorrow morning. If there's anything you lovely experts think I should be doing differently please let me know! Very grateful for the support on this forum!

Editing to add: I do have humulin on hand from when he was coming out of the DKA at the beginning of April but not sure what the recommendations are on adding in short-acting insulin

 

[Angela & Cleo]

Your instinct to increase is a good one, especially with DKA in the past. Hooray for the low ketones. Please do stay on top of getting those ketone results and it would be good if you could put them in the remarks column in the spreadsheet. With recent DKA and when following TR you don't want to hold doses that aren't seen good green nadirs. Hold this dose for 3days-6 cycles then post for help to reevaluate. And great job getting those mid cycle tests.

 

[Wendy&Neko]

My recommendation on Humulin R is to keep it in the fridge for now, especially as ketones are low.

Doses with green nadirs (note the plural) we hold for 10 cycles/5 days, blue nadirs for 3-5 days. Longer for low blues, shorter for high blues. If you hold the dose too long, glucose toxicity can set it. That's where they start getting used to those higher numbers. TR gives you the opportunity to safely increase sooner.

I see the night of the 19th, insulin was late? How late? A delayed shot can act a bit like a decrease.

As long as what you are feeding is low carb, the flavour should not make that much difference in the numbers. I kept rotating proteins, to try to avoid boredom.

It's also possible you are seeing New Dose Wonkiness. NDW is a temporary phenomenon that causes higher numbers the first few cycles after an increase. We aren't sure why it happens, maybe depot related?

 

[CrazyKaitLady]

Ok it's sinking in that I'm consistently not being aggressive enough with the dose changes. It makes me nervous so I want to be conservative about it but I'm not doing Petey any favors that way. We went to 3.5 this morning and I will stick with 6 cycles and post the night before he's due for an increase to get some reassurance that I should be changing based on his numbers.

I see the night of the 19th, insulin was late? How late? A delayed shot can act a bit like a decrease.

Yes it was actually the morning by about 45 minutes but could have thrown things off.

it would be good if you could put them in the remarks column in the spreadsheet

Good call, I will start doing that, thank you.

I'm really thinking that stress was a factor with him being so high today. He was in a larger room and I think a few of the other fosters were making him edgy. He interacts with them well with visits into the main foster room but not usually for the whole day. I have him back in his own space at night now and I'm hoping his BG goes down tonight. I will post an update either tomorrow if he's still off or in a couple days based on his numbers. Thanks!

 

[Wendy&Neko]

45 minutes is a bit earlier than we suggest. 1/2 hour is OK. But looks like it turned out to be no an issue.

Another suggestion for the spreadsheet, is to put things in the cells that can impact dosing. For example, night of the 13th you commented on a partial fur shot. I used to put the units, followed by PFS (partial fur shot, or FS is a complete miss) in the Units cell so I could see at a glance that kitty didn't get all the insulin. Given the over 500's the next AM, you were right on that. Another thing you can put in there is a time difference that might impact numbers. Such as the PM of the 19th you could put 235 @+12.75. That means it was .75 of an hour late. You don't need to bother if within 1/2 hour.