6/8/18 New Question/Answered- Dose (jaxa)

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Glassgoblin

Glassgoblin

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Just tested for PMPS and got a 148, thought that was odd, so tested the other ear and got a 149. Skip the shot or do the stalling/no food for 20? She is pawing at me for her food right now.

I've been told that she seemed normal all day, but I worry what she might have been at nadir (when she was at 321 for AMPS). She also hasn't eaten for at least three hours because she was outside.

*Edited to add- Stalled 20, tested and she was at 146. Decided to skip shot. I'd rather she be a little higher tomorrow than go too low tonight.
 
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I would probably stall and test again.. up to twice... you have up to an hour of 'play' time with ProZinc. If it stays that low, you could skip, or if you will be around to monitor and take action if needed, you could give a reduced dose, maybe half of her normal dose. It looks likes this is your first pre-shot this low, so there is not really any history on how she will do. These situations are when you get that kind of data! If you are comfortable with it.
 
It doesn't help that a stranger just came to our door, so the dog freaked out, and now Jaxa is completely terrified and hiding.
 
If you can, try to grab a test before bed tonight so we can see how she's doing without insulin this cycle. Try to get it sometime after +14 (at least two hours after her usual PMPS time). Prozinc rarely lasts more than 14 hours, so I'd like to see where she's at once that AM shot is out of her system. If you can't, it's okay, but it would be good data to have for next time she gives you a surprisingly low PS number.
 
Djamila said:
If you can, try to grab a test before bed tonight so we can see how she's doing without insulin this cycle. Try to get it sometime after +14 (at least two hours after her usual PMPS time). Prozinc rarely lasts more than 14 hours, so I'd like to see where she's at once that AM shot is out of her system. If you can't, it's okay, but it would be good data to have for next time she gives you a surprisingly low PS number.
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I did get a +15 (+3?) and she was pretty much where she was on the nights we had a furshot. This AMPS was at 281, so I am going to think of it as a purposeful furshot. However, when/if it happens again I will stall at least one more time and then give a smaller than usual dose I think. I'm really not confident about adjusting things on a shot to shot basis- maybe after a few more months of data and experience.

The stranger at the door was a neighbor who was looking for her kitty, missing three days, and I didn't have the heart to tell her about the foxes that I saw in my yard this last weekend. Jaxa is never allowed out at night, but it is so hard when they stage a break-out on their own.
 
Another option is to go ahead and give her some food and shoot when she rises from the food. You can't do that with kitties who are less stable than Jaxa, but she's steady enough and on a high enough dose that it could be a good strategy for you.

That's scary about the foxes in the neighborhood and a missing kitty. Hopefully she's just hiding somewhere or accidentally closed in someone's garage and will come home soon.
 
Djamila said:
Another option is to go ahead and give her some food and shoot when she rises from the food. You can't do that with kitties who are less stable than Jaxa, but she's steady enough and on a high enough dose that it could be a good strategy for you.

That's scary about the foxes in the neighborhood and a missing kitty. Hopefully she's just hiding somewhere or accidentally closed in someone's garage and will come home soon.
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I'm going to try this because I don't want to miss another shot so soon; tonight she was at 167, then 183. (I got two tests of the 1st drop of blood 167 and 182 then stalled and got 183.) She wasn't outside all day today, though she is out of the food room for a while before it even gets put up, so I am not sure why she has been so low these two nights. I worry about what might happen when I am late from training on Monday.

So feeding right now and will test in 30?
 
Okay, so I tested 30 min after she ate and it was at 166. And she is eating again, but I don't really know what to do right now.
 
You can be as late as an hour and still keep your regular schedule in the morning. So if you can, I'd test again at an hour and shoot then if possible. If it's not possible at that point, you can shoot whenever, but then you'll need to start moving your morning shot time later to make up for it. Another option would be to shoot a reduced dose now. So instead of skipping maybe just give 3u.
 
Djamila said:
You can be as late as an hour and still keep your regular schedule in the morning. So if you can, I'd test again at an hour and shoot then if possible. If it's not possible at that point, you can shoot whenever, but then you'll need to start moving your morning shot time later to make up for it. Another option would be to shoot a reduced dose now. So instead of skipping maybe just give 3u.
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I will try the smaller shot- I've been trying to move the time earlier and earlier now that we are getting light earlier in the day- so I can get more tests in the PM and so I can give the shot before I go to my dad's every Sunday (or leave super early in the morning for work trips). Will get a +3 and +5 tonight and watch her closely. Should I be trying for more +8/+10 tests? She is often fairly level between shots so I don't know why we are getting these low PMPS now. No change in diet, only pill is the B12, she is getting more exercise and playing with the dog, getting outside and probably eating grass but that has been going on for more than a week.
 
Glassgoblin said:
Should I be trying for more +8/+10 tests?
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All data is good data, but I don't know that you need to set an alarm for that. Of course if you happen to wake up anyway...

The lower PS numbers are a little tricky. shooting on lower PS numbers can help keep a cat in better numbers. But it also carries some risk. As you try it (like you are tonight) and collect data, you will start to be able to shoot on lower and lower numbers, or you will start to learn how much to reduce the dose. Lower PS numbers are really good. It's what you want to see. But it does cause a bit of an anxiety attack when they first start to appear, especially when you have a cat on a higher dose. With my cat, I can shoot on numbers that are quite low and he stays steady. Other cats if you shoot on a low number will drop more than you want, so you have to reduce the dose for those kitties. The trouble is that there isn't really a way to predict. you kind of just have to try it, see what numbers you get, and be prepared to give some extra food if they get down too low.
 
I hope she doesn't move too much in # tonight; just did a +2 and she was at 108. She has been eating- little bit at a time, but a few times. Gave her some treats just now.

*adding: +4 test just done and she is at 74. Her nadir usually seems to be +5, so I don't think she will go below 50 tonight, and I will probably get some sleep. I gave her a little more treat though and she is still eating her YAZ. I got the honey out just in case, so will leave it out for now.

I think we will put off increasing the dose to 4.75 for the moment and see how the next several days go for pre-shots- especially Monday PM when my mother will be testing and giving the shot on her own. I don't know if this is breaking through on her doses or if there is something else affecting numbers- I've been adding plenty of food to her dish so she is eating more than she should, not less.
 
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And this morning it looks like we are bouncing, but she is acting like herself and eating her food and devouring the B12/soup mix. I did notice that both nights that had the low PMPS were days that we have had rain so she didn't go outside as much and was more inactive/less grass. Not sure if there is correlation yet, so will continue keeping notes.

Whenever we go to the vet I feel like such a "helicopter mom" because I can tell them all about her litterbox habits, and exact times of food, shots, tests, anything unusual, her energy levels, etc. I think it was telling when my first vet office kinda blew me off when I'd tell them that her urine smelled sweet (they didn't diagnose the diabetes), or that she was showing signs of pain (from the pancreatitis).
 
Glassgoblin said:
And this morning it looks like we are bouncing, but she is acting like herself and eating her food and devouring the B12/soup mix. I did notice that both nights that had the low PMPS were days that we have had rain so she didn't go outside as much and was more inactive/less grass. Not sure if there is correlation yet, so will continue keeping notes.

Whenever we go to the vet I feel like such a "helicopter mom" because I can tell them all about her litterbox habits, and exact times of food, shots, tests, anything unusual, her energy levels, etc. I think it was telling when my first vet office kinda blew me off when I'd tell them that her urine smelled sweet (they didn't diagnose the diabetes), or that she was showing signs of pain (from the pancreatitis).
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I think the more of those clinical signs you can relay the better it is for a thinking vet to diagnose things. They deal with a lot of unaware pet parents and should welcome your thoroughness. If they ignore you they're not doing their job properly. Even if they think some of the info isn't relevant they should listen and tell you what they're focusing on and why - ie., have a dialogue.
 
You've had two long cycles in the past couple of days, and the 3u was enough insulin last night - she didn't rise even though you reduced the dose quite a bit. My hunch is that she's ready for a little less insulin. Today's cycle will likely stay high-ish and rather flat since she was green last night, but do get some tests in today so we can see if that's what happens.

One possibility is that when she's outside she's found a food source that isn't low carb. Lots of folks leave cat or dog food on the back porch, and cats travel long distances when they are outside. If she's sneaking even a piece or two of kibble from somewhere it could be the difference between her lower inside-numbers and her higher outside-numbers.
 
Djamila said:
You've had two long cycles in the past couple of days, and the 3u was enough insulin last night - she didn't rise even though you reduced the dose quite a bit. My hunch is that she's ready for a little less insulin. Today's cycle will likely stay high-ish and rather flat since she was green last night, but do get some tests in today so we can see if that's what happens.

One possibility is that when she's outside she's found a food source that isn't low carb. Lots of folks leave cat or dog food on the back porch, and cats travel long distances when they are outside. If she's sneaking even a piece or two of kibble from somewhere it could be the difference between her lower inside-numbers and her higher outside-numbers.
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I don't think she has found another animals food (unless it is a wild animal) though I will watch for signs; Jaxa is really good about staying on or next to our deck (she is a chicken and runs to the door anytime she hears a car or the dog barks). Every time I look for her I can find her immediately. We are pretty rural, so we have neighbors but they are not very close. However, she might be getting into the dog's things inside occasionally since that is down almost all day unless the dog actually eats it all. I make sure it is put away at night if there is anything in bowl, but my mother doesn't watch during the day and she gives the dog a lot of treats too.

Would insects be higher carb? She has been catching flies, butterflies and beetles outside, and ate a spider last night. We used to toss out some produce scraps for the bunnies but I stopped doing that so the cat wouldn't be tempted to eat strawberry tops, or peels of anything.
 
Kris & Teasel said:
I think the more of those clinical signs you can relay the better it is for a thinking vet to diagnose things. They deal with a lot of unaware pet parents and should welcome your thoroughness. If they ignore you they're not doing their job properly. Even if they think some of the info isn't relevant they should listen and tell you what they're focusing on and why - ie., have a dialogue.
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I think our new vet office is better, but it is hard to say since the last several visits were just for them to get blood tests done and I never even spoke to the actual Vet (we go on the day the specialist is there). The Vet Techs and Assistants are pretty awesome about going over results, getting data from my spreadsheet and following up later. They let me contact them through Facebook messenger too, and actually respond in a timely manner.
 
A bit lower than our average this AMPS too- 202. I fed and gave 4.25u shot. In the morning she does get a little carb with the b12/bisque even though it is only a Tbsp. Will be home doing chores most of the day so will get a few tests in and watch. I can give some more bisque later if she swings too low, but she was pretty steady yesterday. I hope these are good signs.

Reduce doses by the same 1/4u? Like this AM, 4.25, test and if okay a couple more cycles?
 
Well, my mother tested and gave the shot this PM since I hadn't gotten back in time. Mostly good that she managed both, though she read from the starting line on the needle as though that were 1 instead of 0, so we had a slightly smaller shot. She didn't have that trouble when I was walking her through it or showing her how over the weekend, but I suppose she was nervous without me there to oversee it. No worries at the moment though- no more trips until August. Jaxa seemed a little traumatized, but came back into the room with me and I added some fresh food to the dish and made sure she ate a bit more.
 
We are continuing to get some lower pre-shot test numbers, but when we got the 202 and today at 206 I gave the 4.25. I did get mid-day tests in on the 202, but today is a workday and she will likely be inside due to rain/thunderstorms so I am hoping she will eat more than she did yesterday. She wants to be outside so much and she doesn't typically eat a lot during the day (especially when it is warm and humid.) We had the slightly higher numbers after my mother's lower dose on Monday but she is swinging downwards again. I'm just not sure of anything- stay at 4.25 still or go to 4?

I asked my vet to look at the spreadsheet (shared it with his office) and they called to say they liked the current trend and to keep up the testing; he suggested if she was under 200 and I were to give a lower u shot to just do half of her usual dose that night.
 
Glassgoblin said:
We are continuing to get some lower pre-shot test numbers, but when we got the 202 and today at 206 I gave the 4.25. I did get mid-day tests in on the 202, but today is a workday and she will likely be inside due to rain/thunderstorms so I am hoping she will eat more than she did yesterday. She wants to be outside so much and she doesn't typically eat a lot during the day (especially when it is warm and humid.) We had the slightly higher numbers after my mother's lower dose on Monday but she is swinging downwards again. I'm just not sure of anything- stay at 4.25 still or go to 4?

I asked my vet to look at the spreadsheet (shared it with his office) and they called to say they liked the current trend and to keep up the testing; he suggested if she was under 200 and I were to give a lower u shot to just do half of her usual dose that night.
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I think you can give 4.25 u. She hasn't given you any greens on that dose and you've given it recently on similar PSs.
 
Kris & Teasel said:
I think you can give 4.25 u. She hasn't given you any greens on that dose and you've given it recently on similar PSs.
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I worry about everything; her PMPS was "low" too, first at 194, and then going upward just a touch. I gave the normal shot since I had done that this morning on similar numbers. Jaxa doesn't eat as much during the day lately; today was very hot and humid with a big thunderstorm before it went back into the high 80s outside. She ate and I let her out again though. Will try for a +2/+4 or +3/+5 to see how she is doing on these pre-shot numbers.
 
I can't edit the spreadsheet on my kindle, but we've been getting some good numbers; +2 was 180, +3 143, +4 at 122. I don't think she will have a sudden drop, but she might go under 100 at nadir. Still grazing, had some Orijen tundra treats and she has been playing, but it is still hot so she really wants me to come her some more.
 
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Do our general results, in the last few days, suggest that we are going in the direction of becoming regulated? She has been getting some really good numbers; not over 300 since my mom gave the lower shot and we had higher numbers the next day but that has been less than a week. I'm hoping this trend continues. I'm trying to gradually change our shot time so it is a little earlier, so that I can try for a nadir test more nights, but we are still in the process.

I can just see the difference in her, the longer she is getting treatment and taking the B12; last night she was catching mosquitoes and hunting spiders outside. She has become more affectionate with my mother and playful with the dog, and less scared in general. Her whole quality of life is so much better than what it was last year when she was 5 lbs heavier and barely wanted to go outside. I think she is finally moving past losing Bogie (our dog) last summer too.
 
Glassgoblin said:
Do our general results, in the last few days, suggest that we are going in the direction of becoming regulated? She has been getting some really good numbers; not over 300 since my mom gave the lower shot and we had higher numbers the next day but that has been less than a week. I'm hoping this trend continues. I'm trying to gradually change our shot time so it is a little earlier, so that I can try for a nadir test more nights, but we are still in the process.

I can just see the difference in her, the longer she is getting treatment and taking the B12; last night she was catching mosquitoes and hunting spiders outside. She has become more affectionate with my mother and playful with the dog, and less scared in general. Her whole quality of life is so much better than what it was last year when she was 5 lbs heavier and barely wanted to go outside. I think she is finally moving past losing Bogie (our dog) last summer too.
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Yes, you're certainly moving in the right direction. The general guidelines for regulation with ProZinc are PSs in the low to mid 200s and nadirs in the high double digits to low 100s at/around the same dose over an extended period of time. Those clinical signs of her feeling better are equally important. This is good news! :)
 
I'm going to be second guessing myself tonight because she was at 173, and I don't have time to stall and retest- heading out soon, but will be back in a couple hours. So I did what I did the last time and went between that shot and what the vet suggested, so she got 2.5u. I should be back in time for a +3. Tomorrow I really need to get a +8-10 because I don't know if her nadir has shifted to be later, or if it is just a day time thing because she was 159 at +5.
 
Low again this morning; I was half expecting a 300+ AMPS. She is eating well, playing, getting her B12. A little jealous that the dog can have temptations and friskies treats and she can't anymore, but that isn't unusual. She might be stuck inside today if we get the thunderstorm they are predicting though. Tomorrow I work in the AM, but then come home by noon (probably) so will try to get some day tests then too. I really want to fill in the picture of how her bg changes on her regular shots during the day.
 
Hmmm....that's surprising to see a low AMPS after such a reduced dose last night. Have we already talked about changing the dog over to low-carb treats as well? Please forgive me if we have, I have a terrible memory. It might help if they are both on healthy treats, and many of the freeze-dried treats are fine for both dogs and cats.
 
Djamila said:
Hmmm....that's surprising to see a low AMPS after such a reduced dose last night. Have we already talked about changing the dog over to low-carb treats as well? Please forgive me if we have, I have a terrible memory. It might help if they are both on healthy treats, and many of the freeze-dried treats are fine for both dogs and cats.
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I have gotten the dog some different treats that are from YA, and some freeze dried chicken treats, but she has a treat ball that my mother likes to put the cheap treats in to keep her occupied- she is not the kind of dog to share and it is not left down for the cat to get at it. I have been keeping some of the cheaper treats as an emergency stash in case of a hypo since I know it is something Jaxa would eat no matter what. The dog is my mother's pet, so Jaxa is used to there being times when she doesn't get something the dog has just because I was trying to keep her on a diet, and I don't give table scraps. I usually comb her and give her attention instead when the dog is getting extra food. She still needs to lose some weight.
 
Glassgoblin said:
I usually comb her and give her attention instead when the dog is getting extra food. She still needs to lose some weight.
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I've been doing this more lately too. Sam is a good weight, but my non-diabetic is a little chubby. He only eats Rad Cat raw, so theoretically he shouldn't be overweight, but somehow he is. So when he asks for food, I've been trying to replace it with grooming or playing to distract him from boredom eating. He's sloooooowly started to shed some weight, so hopefully we can keep this up!

I've read that temptations are great for hypos. Some cats only need like two of them to start rising. They must be crazy high in carbs which is probably why they're so yummy!
 
I have gotten a +3, +6 and +8, and the +8 is the lowest # so far. I might try to get a +10 in there too. Tomorrow I work in the AM right after her AMPS, but might be able to do at least two of the following; +5, +7 and +9. If her nadir has shifted to be later, maybe that explains why she would be higher after a night with greens in the middle of a cycle; she may have gone further down than I had realized, which worries me a bit, though we haven't seen greens early in the cycle for almost 10 days.
 
You can try keeping this dose but I suspect you'll need to bump her up to 4.5 u again in the near future. Those greens on that dose are 3 weeks ago now so ancient history. The more recent green on the 3 u dose could have been a one off strange occurrence. You have to do what you're comfortable with while you're at work and your mom is still new to testing, etc.
 
Kris & Teasel said:
You can try keeping this dose but I suspect you'll need to bump her up to 4.5 u again in the near future. Those greens on that dose are 3 weeks ago now so ancient history. The more recent green on the 3 u dose could have been a one off strange occurrence. You have to do what you're comfortable with while you're at work and your mom is still new to testing, etc.
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I was thinking about that earlier; tomorrow might not be a bad day to increase again since I'll be home most of the day.
 
She was at 204 this AM, gave 4.5u, and she had her B12/bisque. I know that is a little higher carb though she doesn't have a lot with her regular food. Will be home to give a +5 later I think, depending on how fast I get my work done. Will have my mother watch her for any odd behavior.
 
And this is why I get scared about giving shots on those lower numbers- we went to the 4.5 this AM, but she was having a low AMPS again. Just got home from work and did a +6 and she was at 51. I gave her some treats and then had to comb her because she was a little messy on her bottom. She seemed a bit tired, which isn't unusual but after treats and combing she perked up a lot, will test again soon to see if we are going up.
*And an hour later she is at 55 so I gave her more treats, but she is acting normally. It is so hot outside, I don't know if I dare let her out until there is more shade in our yard.
*And +8 is 75.
 
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Remember that the 50 "take action" number is still quite safe. That's just the number when you want to give a snack, as you did, but no need to worry at that point, especially since she was there at +6. If it's earlier in the cycle it can be more concerning.

Do your syringes have half-unit marks? If so, you might try giving a "fat 4.25" - it's a smidge more than 4.25, but not as much as 4.5u. Sometimes a kitty just needs a little more, not a full increase.
 
Djamila said:
Remember that the 50 "take action" number is still quite safe. That's just the number when you want to give a snack, as you did, but no need to worry at that point, especially since she was there at +6. If it's earlier in the cycle it can be more concerning.

Do your syringes have half-unit marks? If so, you might try giving a "fat 4.25" - it's a smidge more than 4.25, but not as much as 4.5u. Sometimes a kitty just needs a little more, not a full increase.
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Just whole unit marks- I've been eyeballing it based on the top of the plunger. We have the u40 syringes. I have been getting them from my vet, but we are under 30 count in our current box. I have the conversion chart for the u100, but not sure if I would remember that day to day or I'd switch. When I stress I forget the little things.

I was a bit iffy today because she was lower at +8 yesterday than she was at +6.
 
If you decide to get the u100s, HIDE the u40s. In a completely different room. In the back of a closet somewhere. That way, you don't have the option of using the wrong syringes. And I would print out the conversion chart and keep it with the syringes as a reminder.

You can get the u40s with half unit marks. Your vet may be able to help with that or maybe you can order from ADW or someplace.
 
Bad day? That PM cycle was likely a 50% drop, which is a decent cycle. And bouncing can last as many as six cycles in some cats, so you may need to be patient for a couple of days after those greens. Jaxa isn't used to those numbers right now. They are good healthy numbers, but it takes them a little time to adjust to it. Things are getting better. When I first got on the board, there was someone here who used to say that this is a dance, and only the kitty can hear the music. We just have to follow along the best we can.

You and Jaxa are both doing just fine. Hang in there. :bighug:
 
Djamila said:
Bad day? That PM cycle was likely a 50% drop, which is a decent cycle. And bouncing can last as many as six cycles in some cats, so you may need to be patient for a couple of days after those greens. Jaxa isn't used to those numbers right now. They are good healthy numbers, but it takes them a little time to adjust to it. Things are getting better. When I first got on the board, there was someone here who used to say that this is a dance, and only the kitty can hear the music. We just have to follow along the best we can.

You and Jaxa are both doing just fine. Hang in there. :bighug:
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The bad days are mostly just bad for me because I get stressed.

Tonight we are low again- 176. I stalled for 30 without feeding and tested and it was exactly 176 again, so feeding and giving reduced shot. Will just have to get a couple tests in tonight and see how tomorrow's AMPS goes.
 
This is where I am getting frustrated; she is low again tonight at 156 mg/dl. I test before I even get the shot ready now because I never know if I can give the full dose or if I have to adjust it, and while we wait she is getting upset because she is hungry and it is food time on her schedule. So right now I am waiting- if we stall for 20 that mean another 10 minute wait. And then if she doesn't move- like she didn't last night in over 30 minutes of stalling, I have to guess if I should give her half a dose, 3u again even though she is a little lower than yesterday, ugh. Poor Jaxa, I'm just a control freak.

*Adding- stalled 20 min, tested again on other ear and got 121 mg/dl. Tested first ear again and it was 142 mg/dl. Ugh. Should I skip shot or give 2u?
 
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Glassgoblin said:
This is where I am getting frustrated; she is low again tonight at 156 mg/dl. I test before I even get the shot ready now because I never know if I can give the full dose or if I have to adjust it, and while we wait she is getting upset because she is hungry and it is food time on her schedule. So right now I am waiting- if we stall for 20 that mean another 10 minute wait. And then if she doesn't move- like she didn't last night in over 30 minutes of stalling, I have to guess if I should give her half a dose, 3u again even though she is a little lower than yesterday, ugh. Poor Jaxa, I'm just a control freak.

*Adding- stalled 20 min, tested again on other ear and got 121 mg/dl. Tested first ear again and it was 142 mg/dl. Ugh. Should I skip shot or give 2u?
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This is one of those "learn by taking a chance" situations. Guess at what reduced dose is likely to be safe and try it. There's no crystal ball to help unfortunately. Go by SS data and what your gut says. She was OK yesterday when you gave 3 u on a 176. The 156 is basically the same.
 
Kris & Teasel said:
This is one of those "learn by taking a chance" situations. Guess at what reduced dose is likely to be safe and try it. There's no crystal ball to help unfortunately. Go by SS data and what your gut says. She was OK yesterday when you gave 3 u on a 176. The 156 is basically the same.
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I gave 2u; the 121 kinds scares me. But will watch and test. She has eaten a little bit twice now post test. She is not eating much during the day now that it is nice and hot or humid most days, so I wonder if I should reduce the morning shot and then do pm shots differently, if her pm numbers are more regular.
 
Glassgoblin said:
I gave 2u; the 121 kinds scares me. But will watch and test. She has eaten a little bit twice now post test. She is not eating much during the day now that it is nice and hot or humid most days, so I wonder if I should reduce the morning shot and then do pm shots differently, if her pm numbers are more regular.
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Hard decision to make without quite a bit of daytime data.
 
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