5/6 Jenks goes green. Need a lot of help here.

[AZJenks]

5/5

The day started out with a surprise 62. Technically, this number happened at about +11.5

Other human did the right thing and stalled him, but also fed at the same time. I'm sure that's the result of my unclear instructions. Anyway, one hour later he was 98. Because he ate, it's impossible to tell what part of that is a food bump versus any natural rise from the depot wearing off.

Due to a rising number, and the fact that any dips could be steered with food, we gave him his full dose approximately 30 minute later than usual. He was closely monitored. 90 minutes later he rose to 252.

Firstly, I'm concerned by the precipitous 40% drop in morning readings in just a 24 hour period. If that trend holds, tomorrow morning could reveal something dangerous. I need to know what impact, if any, this should have on his upcoming nighttime dose.

Secondly, I need to be able to instruct other human how to respond to these kinds of numbers. We haven't even had the luxury of a run of blue numbers to develop a system or get any useful data. And now we're facing middling greens at times when there are no experienced caregivers on the board. I feel confident about stalling techniques. I'll make it more clear that we do not feed him and to look for a rising number before shooting and then closely monitoring.

What I am unclear of is when any particular low number calls for an immediate dose reduction (the sticky seems to indicate a drop below 40-50), or skipping a shot entirely.

Thirdly, I'm also going to have to burden other human with having to do additional tests. From all accounts, Jenks is approaching his lowest point somewhere between 5-9am (+8 to +12). They are going to have to get a +10 or +11 in that window to figure out just what he's doing. How many of these tests do we need? Is it ok to do a +11 one day? A +10 the next? A +2 the next? For how long? These Micro/Confirm strips are not cheap by any means, so there's a cost component to indiscriminate testing. So we have to work within certain limits.

Finally, why is this dose producing such a drastic and sudden movement now after two weeks of seemingly no results?

NOTE: As of this writing, we are 4 hours from his PM shot time. It is imperative that I figure out the proper dose to give him to avoid a morning number that is too low.

 

[julie & punkin (ga)]

reductions for a newly diagnosed cat (less than 1 year, so that includes Jenks) is when they go less than 50. so if he gets less than 50, you want to reduce by 0.25u at the next shot.

i think right now he's headed up into a bounce. you've got numbers headed up from this morning 62-98-252 during a time in the cycle when you'd expect him to be going down into a curve. it wouldn't be unexpected for him to bounce from this morning - he's not used to green numbers. they may last as long as 3 days. during that time, you hold the dose (ie, don't increase to compensate for high numbers) and wait for the bounce to clear. you'll know it clears when you see numbers like this morning's again.

i think if your partner can test you're going to be able to keep jenks safer and you're going to feel more confident about dosing him.

i'm not sure that you can compare yesterday's morning numbers with this morning's numbers and learn anything. what it does look like is you've gotten to a dose that's making his numbers move, and testing a little more will fill in the rest of the picture.

as far as when you should stall and when you should skip - have you read the sticky on handling low numbers? it has a section on what to do when you're faced with a low preshot number. a lot of the decision on what to do when faced with a low preshot number is based upon if you're going to be able to monitor and if you have supplies. If you haven't printed out that entire sticky, you should. just in case the board is wonky when you need help.

take a look at that and ask any questions it brings up.

your last question - why is this doing causing action now but not before, i don't know. we know that any dose of insulin can vary in how much is absorbed by as much as 50%. beyond that . . . it's possible he moves quickly and hits low then zooms back high. this morning you had 2 tests in a 2 hr window that showed green, otherwise you'd never have known that he hit green. i'm just wondering if he's done this at other times - gone green for 2 hrs and immediately risen back up - and it just hasn't happened to have been caught.

 

[rhiannon and shadow (GA)]

all you need to earn a dose reduction is 49..... ( below 50 is the rule for within one year of dx)

You should continue with your current dose tonight unless you can't monitor.....
and by all means, make sure you have a print out of what to do with low numbers..... in case the board is out again.....

It would be prudent if you can get that +10 or 11.... helps you learn more of his pattern....

You test as often as the numbers call for.... so lower numbers mean more tests....
that way you are in control.... and can give gravy if needed to raise numbers if they go down....

 

[Ann & Tess GA]

Here's the link for the "How to shoot Low numbers" stickey. It helps to print it out and have it handy, for situations like these. The dose reduction line is once below 50 for a newly diagnosed cat like Jenks.

For cats w/ a late nadir like Jenks (and Tess) it helps to see whre things are headed by getting that +10 or +11 test. You can do either or switch it around. We get a +11 for Tess in the morning (because I refuse to get up at 5am to test every day! ohmygod_smile ) and a +10 in the evening, for a little longer early warning system. It gives you some breathing space and time to think. When you shoot a low number getting a +1 or 2 will let you know if he is continuing to go down and to start trying to slow the drop w/ food.



Why is the dose showing results now? Julie has a couple of good points, also his pancreas could be starting to heal and produce some insulin on it's own.

 

[Ann & Tess GA]

I noticed on your SS that you had gotten a Relion meter, is there a reason you stopped using it? The strips are much cheaper. Target also has an inexpensive meter the Up & Up (store brand, it is actually the Agamatrix Wavesense Presto.) In store the strips are the same price as the Relion, but online at ADW you can get them for half the price as retail, about $10 a box.

 

[Chris & China (GA)]

Since you've been testing awhile, it might be worth it to trade in your Confirm/Micro for the Relion Prime meter

The Confirm/Micro is a great meter, and uses the tiniest sample size, but the strips are about twice the cost of the Prime, which takes a little bit larger sample size (but really not much .5 microliters instead of .3mL)

The Prime strips are only $9 for 50, so about half the price of the Confirm/Micro

Now that Jenks ears have "learned to bleed", you can probably do fine with the Prime and save your other one for a back up meter